Biomarkers predicting a need for intensive treatment in patients with early arthritis

The heterogeneous nature of rheumatoid arthritis (RA) complicates early recognition and treatment. In recent years, a growing body of evidence has demonstrated that intervention during the window of opportunity can improve the response to treatment and slow—or even stop—irreversible structural changes. Advances in therapy, such as biologic agents, and changing approaches to the disease, such as the treat to target and tight control strategies, have led to better outcomes resulting from personalized treatment to patients with different prognostic markers. The various biomarkers identified either facilitate early diagnosis or make it possible to adjust management to disease activity or poor outcomes. However, no single biomarker can bridge the gap between disease onset and prescription of the first DMARD, and traditional biomarkers do not identify all patients requiring early aggressive treatment. Furthermore, the outcomes of early arthritis cohorts are largely biased by the treatment prescribed to patients; therefore, new challenges arise in the search for prognostic biomarkers. Herein, we discuss the value of traditional and new biomarkers and suggest the need for intensive treatment as a new surrogate marker of poor prognosis that can guide therapeutic decisions in the early stages of RA.

Cigarette smoke condensate inhibits collagen gel contraction and prostaglandin E2 production in human gingival fibroblasts

BACKGROUND

Granulation tissue remodeling and myofibroblastic differentiation are critically important events during wound healing. Tobacco smoking has a detrimental effect in gingival tissue repair. However, studies evaluating the effects of cigarette smoke on these events are lacking.

MATERIAL AND METHODS

We used gingival fibroblasts cultured within free-floating and restrained collagen gels to simulate the initial and final steps of the granulation tissue phase during tissue repair. Collagen gel contraction was stimulated with serum or transforming growth factor-β1. Cigarette smoke condensate (CSC) was used to evaluate the effects of tobacco smoke on gel contraction. Protein levels of alpha-smooth muscle actin, β1 integrin, matrix metalloproteinase-3 and connective tissue growth factor were evaluated through Western blot. Prostaglandin E(2) (PGE(2)) levels were determined through ELISA. Actin organization was evaluated through confocal microscopy.

RESULTS

CSC reduced collagen gel contraction induced by serum and transforming growth factor-β1 in restrained collagen gels. CSC also altered the development of actin stress fibers in fibroblasts cultured within restrained collagen gels. PGE(2) levels were strongly diminished by CSC in three-dimensional cell cultures. However, other proteins involved in granulation tissue remodeling and myofibroblastic differentiation such as alpha-smooth muscle actin, β1 integrin, matrix metalloproteinase-3 and connective tissue growth factor, were unmodified by CSC.

CONCLUSIONS

CSC may alter the capacity of gingival fibroblasts to remodel and contract a collagen matrix. Inhibition of PGE(2) production and alterations of actin stress fibers in these cells may impair proper tissue maturation during wound healing in smokers.

An atypical IgM class platelet cold agglutinin induces GPVI-dependent aggregation of human platelets

Platelet cold agglutinins (PCA) cause pseudothrombocytopenia, spurious thrombocytopenia due to ex vivo platelet clumping, complicating clinical diagnosis, but mechanisms and consequences of PCA are not well defined. Here, we characterised an atypical immunoglobulin (Ig)M PCA in a 37-year-old woman with lifelong bleeding and chronic moderate thrombocytopenia, that induces activation and aggregation of autologous or allogeneic platelets via interaction with platelet glycoprotein (GP)VI. Patient temperature-dependent pseudothrombocytopenia was EDTA-independent, but was prevented by integrin αIIbβ3 blockade. Unstimulated patient platelets revealed elevated levels of bound IgM, increased expression of activation markers (P-selectin and CD63), low GPVI levels and abnormally high thromboxane (TX)A2 production. Patient serum induced temperature- and αIIbβ3-dependent decrease of platelet count in allogeneic donor citrated platelet-rich plasma (PRP), but not in PRP from Glanzmann's thrombasthenia or afibrinogenaemia patients. In allogeneic platelets, patient plasma induced shape change, P-selectin and CD63 expression, (14)C-serotonin release, and TXA2 production. Activation was not inhibited by aspirin, cangrelor or blocking anti-Fc receptor (FcγRIIA) antibody, but was abrogated by inhibitors of Src and Syk, and by a soluble GPVI-Fc fusion protein. GPVI-deficient platelets were not activated by patient plasma. These data provide the first evidence for an IgM PCA causing platelet activation/aggregation via GPVI. The PCA activity persisted over a five-year follow-up period, supporting a causative role in patient chronic thrombocytopenia and bleeding.

Polimorfismos de los genes CAPN1, CAST, DES, PRKAG3 Y RYR1 asociados a la capacidad de retención de agua en crudo y cocinado en carne de bovino en cruces Bos indicus y Bos taurus en Colombia

La capacidad de retención de agua (CRA) es uno de los parámetros de calidad de la carne más importante, dado que posee asociación con la percepción de jugosidad y la pérdida de peso de la pieza cárnica durante procedimientos como la maduración, la cocción y otro tipo de procesamiento tecnológico. La CRA en crudo y cocinado (CRAr y CRAc respectivamente) fue evaluada en 164 machos castrados cruzados, en los cuales se realizó la genotipificación de 23 regiones genómicas de los genes CAPN1, CAST, DES, PRKAG3 y RYR1. El marcador CAST2959 presentó asociación con el parámetro CRAr en el músculo Longissimus dorsi (LD) siendo el genotipo AA el de mejor comportamiento. El marcador RYR1-11195 se encontró asociado con el parámetro CRAc en LD, siendo la carne de animales con los genotipos GG y GA, la de mayor pérdida de peso, si son comparados con carne proveniente de animales con genotipo AA. Lo anterior permite establecer estos marcadores como posibles polimorfismos de importancia en procesos de selección y mejoramiento animal de este parámetro de calidad cárnica (CRAr y CRAc) en bovinos, posterior a un proceso de validación.

Gingival wound healing: an essential response disturbed by aging?

Gingival wound healing comprises a series of sequential responses that allow the closure of breaches in the masticatory mucosa. This process is of critical importance to prevent the invasion of microbes or other agents into tissues, avoiding the establishment of a chronic infection. Wound healing may also play an important role during cell and tissue reaction to long-term injury, as it may occur during inflammatory responses and cancer. Recent experimental data have shown that gingival wound healing is severely affected by the aging process. These defects may alter distinct phases of the wound-healing process, including epithelial migration, granulation tissue formation, and tissue remodeling. The cellular and molecular defects that may explain these deficiencies include several biological responses such as an increased inflammatory response, altered integrin signaling, reduced growth factor activity, decreased cell proliferation, diminished angiogenesis, reduced collagen synthesis, augmented collagen remodeling, and deterioration of the proliferative and differentiation potential of stem cells. In this review, we explore the cellular and molecular basis of these defects and their possible clinical implications.

MicroRNAs in hemostasis

Epidemiologic studies have revealed that modification of the levels of individual components of the hemostatic system may have effects on the development of thrombosis or hemorrhage. To maintain the necessary equilibrium, the hemostatic system is finely regulated. It is known that acquired factors and/or alterations in genes (single-nucleotide polymorphisms or mutations) may be the cause of interindividual differences or exacerbated levels of hemostatic proteins in plasma, but there are still many non-characterized factors that provoke such variations. The search for new elements, such as microRNAs (miRNAs), a family of small non-coding RNAs that are novel regulators of protein expression, may reveal an additional layer at which to investigate the causes of hemostatic diseases. In this review, we discuss the latest developments in research into the role of miRNAs in the regulation of several hemostatic factors, and the potential use of miRNAs as prognostic or diagnostic tools in hemostasis and thrombosis.

Allogeneic hematopoietic SCT in multiple myeloma: long-term results from a single institution

The role of allogeneic hematopoietic SCT (allo-HCT) in multiple myeloma (MM) remains controversial. A total of 58 patients received an allo-HCT (25 of them with myeloablative conditioning-allo-MAC-and 33 with reduced-intensity conditioning-allo-RIC) at our institution over a 28-year period. The CR rate for allo-MAC was 36%. The incidence of grade III-IV acute GVHD (aGVHD) and chronic GVHD (cGVHD) was 28% and 39%, respectively The TRM at any time was 60% and the main causes of death were aGVHD or infectious complications not directly related to GVHD. The estimated PFS and OS at 15 years were 8% and 15%, respectively. The CR rate with allo-RIC was 45%. The incidence of grade III-IV aGVHD and cGVHD were 24% and 41%, respectively. The TRM at any time was 33% and was mainly related to aGVHD. The estimated PFS and OS at 5 years were 22% and 38%, respectively. Despite its high TRM, a proportion of patients with high-risk myeloma (early relapse and newly diagnosed ultrahigh risk) may obtain long-term disease control with allo-HCT. New approaches aimed at decreasing the incidence of aGVHD, and consequently to decrease the TRM, are needed.

Characterization of organic fouling in reverse osmosis membranes by headspace solid phase microextraction and gas chromatography-mass spectrometry

Adsorption of organic substances on reverse osmosis (RO) membrane surfaces may form an organic film on the membrane, known as organic fouling, and cause flow-rate loss. This problem is mostly unavoidable as no pretreatment method exists for perfect removal of possible foulants, including organic compounds resulting from undesirable bioactivity. Understanding the characteristics of fouling layers is an essential step towards overall improvement of RO membrane operations. In this study, the organic fouling in RO membranes treating the effluent of a secondary treatment from an urban wastewater treatment plant was characterized. Headspace solid phase microextraction (HS-SPME) coupled with gas chromatography-mass spectrometry has been used for the first time, to provide valuable information of organic fouling. Different polarity SPME fibers were tested for this purpose. In addition, the characterization of the organic fouling obtained by HS-SPME was compared with the results obtained by extraction using several organic solvents. The results indicated that more compound families can be identified by HS-SPME than by organic solvent extraction. Moreover, complementary organic analyses were done for better understanding of the organic fouling in RO membranes, such as total organic carbon and loss on ignition.

Overview of indications, preferred methods and technical tips for hand fractures from around the world

This article presents techniques used by six senior surgeons from different parts of the world. Our commentaries on treating hand fractures are included, together with the methods we use. While non-operative treatment is appropriate and effective for the majority of the hand fractures (including those many practitioners currently treat surgically), we describe how we try to manage difficult cases with less invasive surgical methods. We recommend simple, efficient, non-operative or less invasive operative methods for almost all fractures, except for some open or very complex injuries.

PARP-2 sustains erythropoiesis in mice by limiting replicative stress in erythroid progenitors

Erythropoiesis is a tightly regulated process in which multipotential hematopoietic stem cells produce mature red blood cells. Here we show that deletion of poly(ADP-ribose) polymerase-2 (PARP-2) in mice leads to chronic anemia at steady state, despite increased erythropoietin plasma levels, a phenomenon not observed in mice lacking PARP-1. Loss of PARP-2 causes shortened lifespan of erythrocytes and impaired differentiation of erythroid progenitors. In erythroblasts, PARP-2 deficiency triggers replicative stress, as indicated by the presence of micronuclei, the accumulation of γ-H2AX (phospho-histone H2AX) in S-phase cells and constitutive CHK1 and replication protein A phosphorylation. Transcriptome analyses revealed the activation of the p53-dependent DNA-damage response pathways in PARP-2-deficient cells, culminating in the upregulation of cell-cycle and cell death regulators, concomitant with G2/M arrest and apoptosis. Strikingly, while loss of the proapoptotic p53 target gene Puma restored hematocrit levels in the PARP-2-deficient mice, loss of the cell-cycle regulator and CDK inhibitor p21 leads to perinatal death by exacerbating impaired fetal liver erythropoiesis in PARP-2-deficient embryos. Although the anemia displayed by PARP-2-deficient mice is compatible with life, mice die rapidly when exposed to stress-induced enhanced hemolysis. Our results pinpoint an essential role for PARP-2 in erythropoiesis by limiting replicative stress that becomes essential in the absence of p21 and in the context of enhanced hemolysis, highlighting the potential effect that might arise from the design and use of PARP inhibitors that specifically inactivate PARP proteins.

Efecto del tipo genético y la maduración sobre la retención de agua en carne de toros castrados

La capacidad de retención de agua en crudo (CRAr) y en cocinado (CRAc) fue determinada en carne madurada a 7, 14 y 21 días post mórtem. Los músculos Longissimus dorsi (LD) y Semitendi-nosus (ST) de 164 machos castrados provenientes del cruce de machos de las razas Simmental, Normanda, Blanco Orejinegro, Braunvieh, Guzerat, Brahman Blanco, Brahman Rojo, Limousin y Romosinuano con hembras Brahman blanco. Para el parámetro CRAr en LD se presentó significancia de los factores tipo genético y maduración y en ST del factor maduración. Para el parámetro de CRAc en LD fue significativo el factor tipo genético y para ST ninguno de los dos factores fue significativo. No existieron interacciones significativas de los dos factores evaluados. Lo ideal es someter a tiempos cortos de maduración ambos músculos y tener en cuenta el tipo genético al cual pertenece el individuo con el fin de minimizar las pérdidas de exudado.