Using chitosan microparticles to treat metritis in lactating dairy cows

The main objective of this study was to evaluate the efficacy of intrauterine administration of chitosan microparticles (CM) in curing metritis in dairy cows. A secondary objective was to evaluate the effects of metritis treatments on milk yield, survival, and reproductive performance. Cows with a fetid, watery, red-brownish vaginal discharge were diagnosed with metritis. Holstein cows (n = 826) with metritis from 3 dairies located in northern Florida were blocked by parity (primiparous or multiparous) and, within each block, randomly assigned to one of 3 treatments: CM (n = 276) = intrauterine infusion of 24 g of CM dissolved in 40 mL of sterile distilled water at the time of metritis diagnosis (d 0), 2 (d 2), and 4 (d 4) d later; ceftiofur (CEF; n = 275) = subcutaneous injection of 6.6 mg/kg ceftiofur crystalline-free acid in the base of the ear at d 0 and d 3; Control (CON; n = 275) = no treatment applied at metritis diagnosis. All groups could receive escape therapy if condition worsened. Cure was considered when vaginal discharge became mucoid and not fetid. A group of nonmetritic (NMET; n = 2,436) cows was used for comparison. Data were analyzed by generalized linear mixed and Cox's proportional hazard models. Cows in CM and CON had lesser risk of metritis cure on d 12 than cows in CEF (58.6 ± 5.0 vs. 61.9 ± 4.9% vs. 77.9 ± 3.9, respectively). The proportion of cows culled within 60 days in milk (DIM) was greater for cows in CM than for cows in CEF and CON (21.5 ± 2.7 vs. 9.7 ± 1.9 vs. 11.3 ± 2.0%, respectively). Treatment did not affect rectal temperature or plasma nonesterified fatty acids, β-hydroxybutyrate, and haptoglobin concentrations. Milk yield in the first 60 DIM differed for all treatments, and it was lowest for CM (35.8 ± 0.3 kg/d), followed by CON (36.8 ± 0.3 kg/d) and CEF (37.9 ± 0.3 kg/d). The hazard of pregnancy up to 300 DIM was lesser for CM than CEF (hazard ratio = 0.62; 95% CI: 0.50-0.76), for CM than CON (hazard ratio = 0.77; 95% CI: 0.62-0.95) and for CON than CEF (hazard ratio = 0.80; 95% CI: 0.65-0.99). Culling was greater, and milk yield and fertility were lesser for CEF than NMET. In summary, CM did not improve the cure of metritis, and was detrimental to milk yield, survival, and fertility compared with CON. In contrast, CEF increased the cure of metritis, milk yield, and fertility compared with CM and CON. Finally, the negative effects of metritis on milk yield culling and fertility could not be completely reversed by CEF.

Typical and atypical carcinoid tumors of the lung: a clinicopathological correlation of 783 cases with emphasis on histological features

We present 783 surgical resections of typical and atypical carcinoid tumors of the lung identified in the pathology files of 20 different pathology departments. All cases were critically reviewed for clinical and pathological features and further correlated with clinical outcomes. Long-term follow-up was obtained in all the patients and statistically analyzed to determine significance of the different parameters evaluated. Of the histopathological features analyzed, the presence of mitotic activity of 4 mitoses or more per 2 mm², necrosis, lymphatic invasion, and lymph node metastasis were identified as statistically significant. Tumors measuring 3 cm or more were also identified as statistically significant and correlated with clinical outcomes. Based on our analysis, we consider that the separation of low- and intermediate-grade neuroendocrine neoplasms of the lung needs to be readjusted in terms of mitotic count as the risk of overgrading these neoplasms exceeds 10% under the current criteria. We also consider that tumor size is an important feature to be considered in the assessment of these neoplasms and together with the histological grade of the tumor offers important features that can be correlated with clinical outcomes.

TLR4 abrogates Th1 immune response against L. infantum infection through IRF1 and IFN-β-dependent mechanism preventing immunopathology

Toll-like receptors (TLRs) are thought to be among the most ancient pathogen recognition systems, and these receptors directly interact with Leishmania species during the initial sensing of these parasites and mount the subsequent adaptive immune response. Herein, we aimed to evaluate the role of TLR4 during visceral leishmaniasis (VL) induced by Leishmania infantum. Initially, we observed that tlr4 messenger RNA (mRNA) expression was detected only the later stage of infection in target organs of VL, suggesting that TLR4 contributes significantly during the chronic phases of the disease. We have shown that Tlr4-deficient mice harbor fewer parasites in the spleen and liver than wild-type mice. TLR4 deficiency enhanced the Th1 immune response against the parasite, correlating with the increased activation of dendritic cells (DCs). Transcription analysis demonstrated that IRF1 and IFN-β are downstream of TLR4 after infection. Accordingly, IRF1- and IFNAR-genetically deficient mice harbored fewer parasites in the target organs than wild-type mice due to the increased Th1 response. The absence of TLR4 or IFNAR increases the serum transaminase level of infected mice. In addition, IFN-β acts directly on Th1 cells to limit IFN-γ production, without affecting the cell proliferation. Importantly, TLR4 and type I IFN (IFN-I) were positively modulated in asymptomatic subjects compared to VL patients. Thus, the TLR4-IRF1 pathway culminates in IFN-β production as a mechanism for dampening the chronic inflammatory process and preventing immunopathology development.

Expanding the genetic spectrum of ANOS1 mutations in patients with congenital hypogonadotropic hypogonadism

STUDY QUESTION

What is the prevalence and functional consequence of ANOS1 (KAL1) mutations in a group of men with congenital hypogonadotropic hypogonadism (CHH)?

SUMMARY ANSWER

Three of forty-two (7.1%) patients presented ANOS1 mutations, including a novel splice site mutation leading to exon skipping and a novel contiguous gene deletion associated with ichthyosis.

WHAT IS KNOWN ALREADY

CHH is characterized by lack of pubertal development and infertility, due to deficient production, secretion or action of GnRH, and can be associated with anosmia/hyposmia (Kallmann syndrome, KS) or with a normal sense of smell (normosmic CHH). Mutations in the anosmin-1 (ANOS1) gene are responsible for the X-linked recessive form of KS.

STUDY DESIGN, SIZE, DURATION

This cross-sectional study included 42 unrelated men with CHH (20 with KS and 22 with normosmic CHH).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Patients were screened for mutations in the ANOS1 gene by DNA sequencing. Identified mutations were further investigated by RT-PCR analysis and multiplex ligation-dependent probe amplification (MLPA) analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Hemizygous mutations were identified in three (7.1%) KS cases: a novel splice acceptor site mutation (c.542-1G>C), leading to skipping of exon 5 in the ANOS1 transcript in a patient with self-reported normosmia (but hyposmic upon testing); a recurrent nonsense mutation (c.571C>T, p.Arg191*); and a novel 4.8 Mb deletion involving ANOS1 and eight other genes (VCX3B, VCX2, PNPLA4, VCX, STS, HDHD1, VCX3A and NLGN4X) in KS associated with ichthyosis.

LIMITATIONS, REASONS FOR CAUTION

Objective olfactory testing was not performed in all cases of self-reported normosmia and this may have underestimated the olfactory deficits.

WIDER IMPLICATIONS OF THE FINDINGS

This study further expands the spectrum of known genetic defects associated with CHH and suggests that patients with self-reported normal olfactory function should not be excluded from ANOS1 genetic testing.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Portuguese Foundation for Science and Technology. The authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Predictive Value of Matrix Metalloproteinases and Their Inhibitors for Mortality in Septic Patients: A Cohort Study

Purpose:

Over 170 biomarkers are being investigated regarding their prognostic and diagnostic accuracy in sepsis in order to find new tools to reduce morbidity and mortality. Matrix metalloproteinases (MMPs) and their inhibitors have been recently studied as promising new prognostic biomarkers in patients with sepsis. This study is aimed at determining the utility of several cutoff points of these biomarkers to predict mortality in patients with sepsis.

Materials and Methods:

A multicenter, prospective, analytic cohort study was performed in the metropolitan area of Bucaramanga, Colombia. A total of 289 patients with sepsis and septic shock were included. MMP-9, MMP-2, tissue inhibitor of metalloproteinase 1 (TIMP-1), TIMP-2, TIMP-1/MMP-9 ratio, and TIMP-2/MMP-2 ratio were determined in blood samples. Value ranges were correlated with mortality to estimate sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiving operating characteristic curve.

Results:

Sensitivity ranged from 33.3% (MMP-9/TIMP-1 ratio) to 60.6% (TIMP-1) and specificity varied from 38.8% (MMP-2/TIMP-2 ratio) to 58.5% (TIMP-1). As for predictive values, positive predictive value range was from 17.5% (MMP-9/TIMP-1 ratio) to 70.4% (MMP-2/TIMP-2 ratio), whereas negative predictive values were between 23.2% (MMP-2/TIMP-2 ratio) and 80.9% (TIMP-1). Finally, area under the curve scores ranged from 0.31 (MMP-9/TIMP-1 ratio) to 0.623 (TIMP-1).

Conclusion:

Although TIMP-1 showed higher sensitivity, specificity, and negative predictive value, with a representative population sample, we conclude that none of the evaluated biomarkers had significant predictive value for mortality.

TIMP1 and MMP9 are predictors of mortality in septic patients in the emergency department and intensive care unit unlike MMP9/TIMP1 ratio: Multivariate model

INTRODUCTION

Matrix metalloproteinases and tissue inhibitors of metalloproteinases could be promising biomarkers for establishing prognosis during the development of sepsis. It is necessary to clarify the relationship between matrix metalloproteinases and their tissue inhibitors. We conducted a cohort study with 563 septic patients, in order to elucidate the biological role and significance of these inflammatory biomarkers and their relationship to the severity and mortality of patients with sepsis.

MATERIALS AND METHODS

A multicentric prospective cohort was performed. The sample was composed of patients who had sepsis as defined by the International Conference 2001. Serum procalcitonin, creatinine, urea nitrogen, C-Reactive protein, TIMP1, TIMP2, MMP2 and MMP9 were quantified; each patient was followed until death or up to 30 days. A descriptive analysis was performed by calculating the mean and the 95% confidence interval for continuous variables and proportions for categorical variables. A multivariate logistic regression model was constructed by the method of intentional selection of covariates with mortality at 30 days as dependent variable and all the other variables as predictors.

RESULTS

Of the 563 patients, 68 patients (12.1%) died within the first 30 days of hospitalization in the ICU. The mean values for TIMP1, TIMP2 and MMP2 were lower in survivors, MMP9 was higher in survivors. Multivariate logistic regression showed that age, SOFA and Charlson scores, along with TIMP1 concentration, were statistically associated with mortality at 30 days of septic patients; serum MMP9 was not statistically associated with mortality of patients, but was a confounder of the TIMP1 variable.

CONCLUSION

It could be argued that plasma levels of TIMP1 should be considered as a promising prognostic biomarker in the setting of sepsis. Additionally, this study, like other studies with large numbers of septic patients does not support the predictive value of TIMP1 / MMP9.

Acute Hypotensive Response to Continuous and Accumulated Isocaloric Aerobic Bouts

Evidence indicates that chronic reductions in blood pressure (BP) due to aerobic exercise depend on the ability to induce post-exercise hypotension (PEH) after each training bout. The purpose of this study was to investigate PEH after isocaloric bouts of continuous and accumulated running. 10 healthy pre-hypertensive men (aged 27.6±3.5 years) performed the following bouts of exercise: a) A continuous bout (CONT) expending a total of 400 kcal; and b) An accumulated bout split into 2×200 kcal (INTER1 and INTER2) to total 400 kcal at 75% of oxygen uptake reserve. BP, mean arterial pressure (MAP) and heart rate variability were monitored 10 min before and 60 min after control and all exercise conditions. The decrease in MAP over time after continuous (400 kcal) and accumulated (2×200 kcal) bouts of exercise was more pronounced than during control (mean diff between 1.6 and 5.4 mmHg, P≤0.01), although the magnitude of change was similar between continuous and accumulated bouts (mean diff=0.1 mmHg, P=0.79). Concomitant to the PEH, sympathovagal balance was inversely related to changes in MAP after isocaloric bouts performed continuously and cumulatively (r=- 0.72 and-0.85, P=0.019 and 0.002, respectively). In conclusion, BP decreased to similar levels after continuous and accumulated acute aerobic exercise matched for total energy expenditure. Our findings also indicate that the recovery pattern of cardiac autonomic activity may have an important role in eliciting PEH.

The phosphatase and tensin homolog PTEN improves murine polymicrobial sepsis outcome by decreasing MyD88 expression. (P1344)

Sepsis is systemic inflammatory response caused by an infectious agent and may progress to multiple organ dysfunction and death. Therapeutic strategies to inhibit excessive inflammation in sepsis are needed. The lipid and protein phosphatase PTEN is a well-known tumor suppressor, but its role in host defense is poorly studied. Here, we investigated whether PTEN activation is involved in TLR activation in vivo and in vitro. PTEN expression is decreased in cells from the peritoneal cavity 24 h after cecum ligation and puncture (CLP). In vivo pretreatment with the PTEN inhibitor bpV(HOpic) 150 ug/Kg for 1 hour before cecum and ligation puncture decreases animals survival, associated with high bacterial number in the peritoneal cavity when compared to untreated mice. In vivo PTEN inhibition increases expression of the TLR adaptor MyD88 during sepsis. In vitro, LPS (TLR4) and PAM3Cys (TLR2) increase PTEN phosphorylation in thyoglicolate-elicited macrophages (MΦs). PTEN mRNA silencing further enhances MyD88 expression and TLR-2 and -4-induced IRAK and NFkB p65 phosphorylation. Transfection of MΦs with adenovirus expressing constitutively active PTEN decreases MyD88 expression. Together, our data show that PTEN is a key determinant of macrophage TLR activation by decreasing MyD88 expression, leading to reduced systemic inflammatory response and therefore improving sepsis outcome.

In vivo PPAR-gamma activation inhibits MyD88 expression to protect mice from polymicrobial sepsis. (P4425)

Sepsis is a disorder characterized by systemic inflammatory response caused by an infectious agent and may progress to multiple organ dysfunction and death. Overwhelming inflammatory response is believed to underlie tissue damage and preceding multiple organ disfunction syndrome. Thus, therapeutic strategies to inhibit excessive inflammation in sepsis is needed. The nuclear receptor peroxisossome proliferating factor (PPAR)-g exhibit anti-inflammatory properties in different immune cells. We hypothesize that prolonged PPAR-g activation decreases systemic inflammatory responses, improving sepsis outcome. We employed a model of polymicrobial sepsis (cecum and ligation puncture-CLP) to evaluate whether prolonged PPAR-g activation inhibits inflammation and improves animal survival. PPAR-g mRNA expression is increased in both peritoneal and lung cells at 6 h after CLP. Our data show that the PPAR-g agonist pioglitazone treatment for 18 h enhances bacterial clearance in the peritoneal cavity; which was associated with enhanced neutrophil migration to the infectious focus. These data correlates with lower expression of the TLR adaptor MyD88 in pioglitazone in vivo and peritoneal macrophages in vitro. Together, our findings suggest that PPAR-g activation impairs TLR responses, by inhibiting expression of MyD88 and preventing overwhelming inflammatory response.

The role of nucleotide-binding oligomerization domain 2 (Nod2) in initiation of rheumatoid arthritis. (68.7)

The etiology of several inflammatory diseases such as rheumatoid arthritis (RA) remains unknown. Some studies including data from our group, report that the receptor NOD2, a member of NLR family, is overexpressed in synovial fibroblasts of patients with RA. Since NOD2 activation might contribute to the initiation and perpetuation of chronic destructive inflammation in RA, we decided to investigate the role of this receptor in arthritis. Initially, WT and NOD2-/- mice were immunized with mBSA, and arthritis was induced by an i.a. injection of mBSA. Our data shows that knockout NOD2 mice did not develop arthritis, as evidenced by the low number of infiltrating cells into the articular cavity, and that transfer of wild type neutrophils into NOD2-/- mice did not restored the inflammatory status. Additionally, to assess if synovial fluid of RA patients could activate NOD2 in vitro, HEK293-Luciferase-NF-κB cells were transfected with a plasmid encoding the NOD2 receptor, 24 hours later these cells were stimulated with MDP or synovial fluid in different concentrations, osteoarthritis synovial fluid were used as control. Luciferase activity was measured 8 hours after stimulation. We observed that stimulation of NOD2 transfected cells with synovial fluid from RA patients leads to increased luciferase activity, suggesting the NF-κB activation dependent of NOD2 signaling in HEK293 cells. Together, these results suggest that NOD2 receptor has an important role in the pathogenesis of RA.

Evaluation of immune response in dorsal root ganglion of mice infected with Herpes Simplex Virus type 1 (HSV-1) (76.8)

Herpes Zoster (HZ) is a disease caused by reactivation of latent herpesvirus Varicella Zoster in the sensory ganglion, characterized by dermal rash and severe pain. A model of mice infected with HSV-1 on the skin of the hind paw has been used to study the pathophysiology of HZ, since they develop HZ-like skin lesions and pain-related responses. There are no data available about the immune response in dorsal root ganglion (DRG) of these mice. Thus, the aim of this study was to evaluate cells and inflammatory mediators present in DRGs and its relationship with hypernociception during HSV-1 cutaneous infection. Mice developed hypernociception from day 3 to 7 post inoculation in the ipsilateral (Ips) paws, but not in the contralateral (Cl) paws. A higher viral load, measured by qPCR, was detected in DRGs L3, L4 and L5 of infected mice, when compared to control mice or naïve mice. By flow citometry analysis, we observed an inflammatory infiltrate composed by CD4+, CD8+, CD11b and Gr1+ cells in DRGs L3, L4 and L5, but not in spinal cord, that correlated with virus presence previously found. A higher expression of COX-2, IFN-γ, GFAP and IL-22 was detected in the same DRGs of Ips paws from infected mice, when compared to the same ganglion of Cl paws or ganglion from naïve mice. Our results show the presence of an inflammatory infiltrate in DRGs of infected mice and the expression of inflammatory mediators which might contribute for the development of hypernociception.

Th17/Th1 axis polarization is mediated by IL-1 receptor in type 1 diabetes murine model (123.13)

Introduction: Autoimmune diseases including type 1 diabetes (T1D) are thought to have a Th1/Th17 bias, but the underlying mechanisms driving the differentiation and activation of these pathogenic T cells has been investigated. Recently, the IL-1beta has been shown to regulate Th17 cell differentiation through of the expression of the transcription factor RORγt. Objective: For this reason, we addressed the respective IL-1 receptor (IL-1R) role in the TD1. Methods: IL-1R deficient mice and their wild-type (C57BL/6) were inoculated intraperitoneally with 40mg/Kg of streptozotocin for 5 consecutive days. Blood glucose levels and body weight were monitored weekly. The pancreatic lymph nodes (PLN) were removed to assess the Th17 and Th1 frequency by flow cytometry. Results: Diabetic IL-1R deficient mice developed lower hyperglycemia with only 50% of mice becoming diabetic. In agreement, mice lacking IL-1R have reduced inflammatory infiltrate (insulitis) and augmented insulin content into pancreatic islets by second week. In addition, the IL-1R deficiency caused a decrease in IL-17 and IFN-γ-producing CD4+ T cell population in pancreatic lymph nodes (PLN). The IL-17, IL-6, TNF-α, IFN-γ levels were not altered, but IL-10 and IL-4 levels were higher in pancreatic tissue of diabetic IL-1R deficient mice. Conclusion: These results suggest that IL-1receptor promotes the Th17/Th1 skewing in the PLN and possibly contributes to pancreatic islet damage during the T1D onset.

Chronic infection with Toxoplasma gondii potentiates the immune response against polymicrobial infection in an IFN-gamma and TNF - mediated pathway, which can be harmful to the host (164.18)

Introduction: The majority of studies regarding host-pathogen interactions have focused on a single pathogen. However, host organisms in a natural environment are commonly exposed to multiple pathogens, such as T. gondii infection, which induces a strong immune response by Th1 pathway, that can persists throughout the life of the host. Therefore, we hypothesized that chronic infection with T. gondii could alter the course of host response against bacterial infection. Methodology: C57BL/6 mice were orally infected with 5 cysts of ME-49 strain of T. gondii and 40 days post infection, subjected infection by cecal ligation and puncture (CLP) sepsis model. Results: Our data showed that, 12 and 24 hours after of CLP, the group of mice infected with T. gondii exhibited decreased bacterial count, increased inflammation characterized by an increase in myeloperoxidase content in lung and increase in IFN-γ and TNF cytokines levels, as compared mice subjected to the same stimulus infectious without previous T. gondii infection. Moreover, after CLP, these animals showed a significantly increase in mortality rate, which was reduced in mice TLR-2 knockout or treated with low concentrations of anti-IFN-γ or anti-TNF antibodies. Conclusion: This study demonstrates that T. gondii infection potentiates the host response against polymicrobial infection, which can be harmful to the host. The mechanism by which this happens seems to be mediated via the overproduction of IFN-γ and TNF.

Divergent role of heme oxygenase inhibition in the pathogenesis of sepsis (111.7)

The reduction of neutrophil migration to an infectious focus is associated with high mortality in severe sepsis. The present study was designed to determine the role of heme oxygenase (HO) in sepsis induced by cecal ligation and puncture (CLP) model. We demonstrated that pre-treatment, but not the combination of pre- plus post-treatment with ZnPP IX, a HO inhibitor, prevented the reduction of CXCR2 on circulating neutrophils and the failure of intraperitoneal neutrophil migration to site of infection. Consequently, bacterial dissemination, systemic inflammatory response and organ injury were prevented. In addition, pre-treatment with the HO inhibitor avoided hypotension and consequently increased survival. Moreover, in mice subjected to Severe-CLP, the pre-treatment, but not the combination of pre- plus post-treatment with ZnPP IX, prevented the increase of plasmatic free heme observed in non-treated Severe-CLP. The administration of exogenous hemin to mice subjected to moderate sepsis consistently increased the mortality rate. Furthermore, hemin resulted in a reduction of neutrophil migration both in vivo and in vitro. Altogether, our results demonstrated that pre-treatment with the HO inhibitor prevents the pathological findings in Severe-CLP. However, the combination of pre- plus post-treatment with ZnPP IX enhances sepsis severity due to an increase in circulating levels of heme, which is deleterious to the host tissues and also inhibits neutrophil migration.

15d-PGJ2 ameliorates collagen-induced arthritis by convergence of Th17 to induced-Tregs (83.1)

Regulatory T cells (Treg) are CD4+T subtype cells with a critical role in inhibiting autoimmunity. Several works reported efficacy therapeutic of 15d-PGJ2 in autoimmune models as well in vitro is able to generate the differentiation of naïve T lymphocytes to the regulatory profile. However, this prostanoid use and its interrelationship with Tregs during the arthritis rheumatoid are unknown. In view of a therapeutic perspective, we investigate the potential role of 15d-PGJ2 in a model of collagen-induced arthritis (CIA) and its interplay with Tregs-induced anti-inflammatory mechanism. CIA was elicited in DBA male mice by collagen-emulsion injection and then treated with 15-PGJ2 daily during 7 days. 15d-PGJ2 administration at the disease onset attenuated the severity of CIA, reducing clinical score, pain and edema. Furthermore, while the mRNA expression of ROR-γt was reduced, FOXP3 expression was up-regulated in draining lymph nodes cells from 15d-PGJ2-treated mice. In vitro, 15-PGJ2 increased the expression of FOXP3, GITR and CTLA-4, Tregs makers, on CD4+CD25- population, suggesting the induction of Tregs on effector cells. Coculture of Th17 cells with 15d-PGJ2-induced Treg reduced significantly the IL-17 production by collagen and α-CD3 stimuli whereas IL-10 production was enhanced. 15d-PGJ2 converge Th17 lymphocytes to regulatory profile, reducing the number of pathogenic T cells and consequently suppressing the inflammatory immune response. FAPEMIG 097/09