Biallelic variants in PPP1R13L cause paediatric dilated cardiomyopathy

Childhood dilated cardiomyopathy (DCM) is a leading cause of heart failure requiring cardiac transplantation and approximately 5% of cases result in sudden death. Knowledge of the underlying genetic cause can aid prognostication and clinical management and enables accurate recurrence risk counselling for the family. Here we used genomic sequencing to identify the causative genetic variant(s) in families with children affected by severe DCM. In an international collaborative effort facilitated by GeneMatcher, biallelic variants in PPP1R13L were identified in seven children with severe DCM from five unrelated families following exome or genome sequencing and inheritance-based variant filtering. PPP1R13L encodes inhibitor of apoptosis-stimulating protein of p53 protein (iASPP). In addition to roles in apoptosis, iASPP acts as a regulator of desmosomes and has been implicated in inflammatory pathways. DCM presented early (mean: 2 years 10 months; range: 3 months-9 years) and was progressive, resulting in death (n = 3) or transplant (n = 3), with one child currently awaiting transplant. Genomic sequencing technologies are valuable for the identification of novel and emerging candidate genes. Biallelic variants in PPP1R13L were previously reported in a single consanguineous family with paediatric DCM. The identification here of a further five families now provides sufficient evidence to support a robust gene-disease association between PPP1R13L and severe paediatric DCM. The PPP1R13L gene should be included in panel-based genetic testing for paediatric DCM.

Prostate cancer cell-intrinsic interferon signaling regulates dormancy and metastatic outgrowth in bone

The latency associated with bone metastasis emergence in castrate-resistant prostate cancer is attributed to dormancy, a state in which cancer cells persist prior to overt lesion formation. Using single-cell transcriptomics and ex vivo profiling, we have uncovered the critical role of tumor-intrinsic immune signaling in the retention of cancer cell dormancy. We demonstrate that loss of tumor-intrinsic type I IFN occurs in proliferating prostate cancer cells in bone. This loss suppresses tumor immunogenicity and therapeutic response and promotes bone cell activation to drive cancer progression. Restoration of tumor-intrinsic IFN signaling by HDAC inhibition increased tumor cell visibility, promoted long-term antitumor immunity, and blocked cancer growth in bone. Key findings were validated in patients, including loss of tumor-intrinsic IFN signaling and immunogenicity in bone metastases compared to primary tumors. Data herein provide a rationale as to why current immunotherapeutics fail in bone-metastatic prostate cancer, and provide a new therapeutic strategy to overcome the inefficacy of immune-based therapies in solid cancers.

Mapping the gas thermodynamic properties of the massive cluster merger MOO J1142+1527 at z = 1.2

We present the results of the analysis of the very massive cluster MOO J1142+1527 at a redshift z = 1.2 based on high angular resolution NIKA2 Sunyaev-Zel’dovich (SZ) andChandraX-ray data. This multi-wavelength analysis enables us to estimate the shape of the temperature profile with unprecedented precision at this redshift and to obtain a map of the gas entropy distribution averaged along the line of sight. The comparison between the cluster morphological properties observed in the NIKA2 andChandramaps together with the analysis of the entropy map allows us to conclude that MOOJ1142+1527 is an on-going merger hosting a cool-core at the position of the X-ray peak. This work demonstrates how the addition of spatially-resolved SZ observations to low signal-to-noise X-ray data can bring valuable insights on the intracluster medium thermodynamic properties atz>1.

4 Sperm, but not seminal plasma, elicit changes in the bovine endometrial transcriptome after natural mating

Studies in mice and pigs have shown that seminal plasma (SP) can modulate the uterine environment, leading to an increase in embryo survival and implantation. However, in cattle, conflicting evidence has resulted from studies in which SP was infused into the uterus. In contrast to mice and pigs, it is questionable whether any SP reaches the bovine uterus during natural mating. However, sperm could act as vehicle for SP proteins that bind to their plasma membrane at ejaculation. Thus, the aim of this study was to analyse the effect of exposure to SP, in the presence or absence of sperm, on the endometrial transcriptome. Beef heifers were oestrus synchronized and mated after being seen in standing oestrus with intact bulls (which ejaculate sperm and SP, n=7) or vasectomized bulls (VX, which only ejaculate SP, n=8) or left unmated (control, n=7). To reduce a potential bull effect, 3 vasectomized and 2 intact Holstein bulls were used. Each heifer was mounted once to one intact or VX bull. Heifers were slaughtered 24h (±6h) after mating, and their reproductive tracts were recovered. Endometrial tissue from the base of the uterine horn ipsilateral to the ovulatory follicle was processed for RNA sequencing. Surprisingly, mating with a VX bull resulted in no differentially expressed genes (DEG) in the endometrium compared with unmated controls. In contrast, mating with intact bulls resulted in 22 DEG (10 down regulated and 12 upregulated) compared with unmated controls and 24 DEG (6 downregulated and 18 upregulated) compared with VX samples. The upregulated genes in intact versus VX samples included several that may have a potential role in implantation: CX3CL1, C4BPA, VCAM1-like, and IL17F. Gene CX3CL1 promotes trophoblast migration in women and has been described as a potential bovine embryokine. In addition, decreased levels of C4BPA have been correlated with implantation failure and unexplained recurrent abortions in women. Further, VCAM1 is involved in bovine conceptus implantation and is downregulated in women with unexplained infertility. In mice, SP regulates inflammation of IL17F in the uterus through the γδT/IL-17 pathway. On the other hand, the immune-related genes PRSS2 and CEBPD were downregulated in intact versus control samples, and BOLA-DQB was downregulated in intact versus VX samples. Gene PRSS2, involved in tissue remodelling, is upregulated in the endometrium of repeated breeder cows. Gene CEBPD, is a transcription factor that enhances IL6 expression, whereas BOLA-DQB is involved in antigen presentation. Interestingly, the gene coding for the α-chain of this protein is also downregulated in high fertility cows. In conclusion, these results do not support a direct effect of SP in regulating pregnancy success in cattle. However, sperm can elicit modest endometrial transcriptomic changes related to implantation and immune system regulation. Further research is needed to elucidate the role of intrinsic sperm proteins, or SP proteins transported by these cells, in the modulation of the uterine environment. This work was supported by EU Horizon 2020 Marie Sklodowska-Curie (No. 792212).

Specificity and Durability of Changes in Auditory Processing Efficiency After Targeted Cognitive Training in Individuals With Recent-Onset Psychosis

BACKGROUND

We previously demonstrated that the high heterogeneity of response to computerized Auditory Training (AT) in psychosis can be ascribed to individual differences in sensory processing efficiency and neural plasticity. In particular, we showed that Auditory Processing Speed (APS) serves as a behavioral measure of target engagement, with faster speed predicting greater transfer effects to untrained cognitive domains. Here, we investigate whether the ability of APS to function as a proxy for target engagement is unique to AT, or if it applies to other training interventions, such as Executive Functioning Training (EFT). Additionally, we examine whether changes in APS are durable after these two forms of training.

METHODS

One hundred and twenty-five participants with Recent Onset Psychosis (ROP) were randomized to AT (n = 66) and EFT (n = 59), respectively. APS was captured at baseline, after treatment, and at 6-month follow-up. Mixed models repeated measures analysis with restricted maximum likelihood was used to examine whether training condition differentiated APS trajectories. Within-group correlational analyses were used to study the relationship between APS and performance improvements in each of the training exercises.

RESULTS

The two groups were matched for age, gender, education, and baseline APS. Participants showed high inter-individual variability in APS at each time point. The mixed model showed a significant effect of time (F = 5.99, p = .003) but not a significant group-by-time effect (F = .73, p = .48). This was driven by significant APS improvements AT patients after treatment (d = .75) that were maintained after 6 months (d = .63). Conversely, in EFT patients, APS improvements did not reach statistical significance after treatment (p = .33) or after 6 months (p = .24). In AT patients, baseline APS (but not APS change) highly predicted peak performance for each training exercise (all r's >.42).

CONCLUSIONS

Participant-specific speed in processing basic auditory stimuli greatly varies in ROP, and strongly influences the magnitude of response to auditory but not executive functioning training. Importantly, enhanced auditory processing efficiency persists 6 months after AT, suggesting the durability of neuroplasticity processes induced by this form of training. Future studies should aim to identify markers of target engagement and durability for cognitive training interventions that target sensory modalities beyond the auditory domain.

Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19

Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants' physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.

Mobility Improvements are Found in Older Veterans After 6-Months of Gerofit Regardless of BMI Classification

Veterans represent a unique population of older adults as they are more likely to self-report disability and be overweight or obese compared to the general population. We sought to compare changes in mobility function across the obesity spectrum in older Veterans participating in six-months of Gerofit, a clinical exercise program. 270 Veterans completed baseline, three, and six-month functional assessment and were divided post-hoc into groups: normal weight, overweight, and obese. Physical function assessment included: ten-meter walk time, six-minute walk distance, 30-second chair stands, and eight-foot up-and-go time. No significant weight x time interactions were found for any measure. However, significant (P<0.02) improvements were found for all mobility measures from baseline to three-months and maintained at six-months. Six-months of participation in Gerofit, if enacted nationwide, appears to be one way to improve mobility and function in older Veterans at high risk for disability regardless of weight status.

A hundred heart failure deaths: lessons learnt from the Dr Foster heart failure hospital mortality alert

Background

Despite advances in evidence-based pharmacotherapy, the latest National Heart Failure Audit (NHFA) has shown that in-hospital mortality of heart failure (HF) remains high with large interhospital variations. University Hospitals Coventry & Warwickshire, a tertiary cardiac centre, received a mortality alert of excess HF deaths based on a high Dr Foster hospital standardised mortality ratio (HSMR). This conflicted with our local NHFA data which showed lower than national average mortality rates.

Objective

To review various systemic and individual processes of care in patients admitted with HF and examine the validity of HSMR in HF.

Design, setting, patients

A retrospective case note analysis was performed on a random sample of 100 HF deaths identified by Dr Foster from 2010 to 2016.

Measures

Case record reviews were performed on the following aspects of care: admission to appropriate wards, resuscitation status, palliative care input and National Confidential Enquiry into Patient Outcome and Death classification. Primary diagnosis coding, diagnostic accuracy and actual causes of death were examined to assess limitations of HSMR.

Results

Despite evidence of lower mortality on cardiology wards, only 28% of patients with acute HF were admitted to a cardiology-ward. Sixty four per cent were considered palliative but only 4.6% were referred to palliative care. The Do Not Attempt Resuscitation order was appropriate in 91% patients but only 74% had this in place. The primary diagnosis of HF was incorrectly coded in 34% while three cases were misdiagnosed.

Conclusion

HF may be coded as a cause of death in some cases where the cause is uncertain and misdiagnosed. Although HSMR has many limitations, it is a smoke alarm that should not be ignored.

43 Effect of early life nutrition on endometrial gland development and endometrial gene expression in heifers

In cattle, uterine gland development (adenogenesis) occurs postnatally, beginning immediately after birth, and is normally complete by approximately 2 months of age. Normal development of uterine glands is essential for subsequent fertility. Early life plane of nutrition can impact age at puberty, but the impact of early postnatal nutrition on adenogenesis is unclear. The aim of this study was to examine the effect of enhanced nutrition during the first 21 weeks of life on heifer reproductive organ growth, endometrial gland development, and endometrial gene expression. To this end, Angus×Holstein-Friesian heifer calves with a mean (±s.d.) age and body weight of 19 (±5) days and 51.2 (±7.8) kg, respectively, were assigned to either a high (HIGH; n=16; targeted average daily gain, ADG, 1.2 kg/d) or a moderate plane of nutrition (MOD; n=16; targeted ADG 0.5 kg/d). Calves were slaughtered at five months of age, and their reproductive tracts were collected and dissected for analysis. To assess endometrial gland number, a cross-section of the midpoint of one horn (n=8 per group) was fixed in 10% neutral buffered formalin, embedded, and processed for histology. Slides were stained with haematoxylin-eosin. Five pictures were randomly taken on each slide using a stereomicroscope at 40× magnification and the number of glands was counted using ImageJ (https://imagej.nih.gov/ij/) software. In addition, endometrial tissue samples were collected and snap frozen for subsequent quantitative RT-PCR analysis. At the time of slaughter, calves on the HIGH and MOD diets presented a body weight of 189.6 and 110.2kg, respectively (P&lt;0.001), indicating an ADG of 1.18 kg/d for the HIGH group and 0.50 kg/d for the MOD group (P&lt;0.001). Calves in the HIGH group had a greater (P&lt;0.001) total reproductive tract (mean±s.d.; 114.01±35.56g v. 52.67±14.29g), isolated cervix (33.17±9.35g v. 16.14±5.27g), uterus (59.35±25.78g v. 27.46±10.61g), and ovarian (14.80±11.38g v. 5.40±1.94g) tissue weights compared with those in the MOD group. This difference was also present when organ weight was expressed on a per unit of body weight basis (P&lt;0.05). However, no differences were found in the number of endometrial glands between groups (HIGH: 453.50±94.18v. MOD: 482.38±124.69). In accordance with this result, transcript abundance of six paracrine mediators of gland development (ESR1, IGF1, IGFBP1, WNT5A, WNT7A, and FGF10) was not affected by diet. In conclusion, enhanced early-life plane of nutrition increased the size of the reproductive tract in heifer calves but did not affect endometrial gland development. Future studies will compare the global endometrial transcriptome between groups to explore other putative effects of diet on uterine development. Research was supported by EU, Horizon 2020 Marie Sklodowska-Curie, REPBIOTECH 675526, Science Foundation Ireland 13/IA/1983, and São Paulo Research Foundation (FAPESP) 2017/21415-5.

Crossover from the Ultracold to the Quasiclassical Regime in State-Selected Photodissociation

Processes that break molecular bonds are typically observed with molecules occupying a mixture of quantum states and successfully described with quasiclassical models, while a few studies have explored the distinctly quantum mechanical low-energy regime. Here, we use photodissociation of diatomic strontium molecules to demonstrate the crossover from the ultracold, quantum regime where photofragment angular distributions strongly depend on the kinetic energy to the quasiclassical regime. Using time-of-flight imaging for photodissociation channels with millikelvin reaction barriers, we explore photofragment energies in the 0.1-300 mK range experimentally and up to 3 K theoretically, and discuss the energy scale at which the crossover occurs. We find that the effects of quantum statistics can persist to high photodissociation energies.

The Onus for Altruism in Kidney Transplantation

Ideally, all programs performing living donor kidney transplantation should educate patients on all contemporary exchange options. They should be strongly encouraged to participate in multicenter exchange, or at least refer those with a willing yet incompatible donor to a center that does, and to preferentially allocate altruistic donor kidneys towards chain initiation.

Should Structured Exercise Be Promoted As a Model of Care? Dissemination of the Department of Veterans Affairs Gerofit Program

Exercise provides a wide range of health-promoting benefits, but support is limited for clinical programs that use exercise as a means of health promotion. This stands in contrast to restorative or rehabilitative exercise, which is considered an essential medical service. We propose that there is a place for ongoing, structured wellness and health promotion programs, with exercise as the primary therapeutic focus. Such programs have long-lasting health benefits, are easily implementable, and are associated with high levels of participant satisfaction. We describe the dissemination and implementation of a long-standing exercise and health promotion program, Gerofit, for which significant gains in physical function that have been maintained over 5 years of follow-up, improvements in well-being, and a 10-year 25% survival benefit among program adherents have been documented. The program has been replicated at 6 Veterans Affairs Medical Centers. The pooled characteristics of enrolled participants (n = 691) demonstrate substantial baseline functional impairment (usual gait speed 1.05 ± 0.3 m/s, 8-foot up and go 8.7 ± 6.7 seconds, 30-second chair stands 10.7 ± 5.1, 6-minute walk distance 404.31 ± 141.9 m), highlighting the need for such programs. Change scores over baseline for 3, 6, and 12 months of follow-up are clinically and statistically significant (P < .05 all measures) and replicate findings from the parent program. Patient satisfaction ratings of high ranged from 88% to 94%. We describe the implementation process and present 1-year outcomes. We suggest that such programs be considered essential elements of healthcare systems.

Control of Ultracold Photodissociation with Magnetic Fields

Photodissociation of a molecule produces a spatial distribution of photofragments determined by the molecular structure and the characteristics of the dissociating light. Performing this basic reaction at ultracold temperatures allows its quantum mechanical features to dominate. In this regime, weak applied fields can be used to control the reaction. Here, we photodissociate ultracold diatomic strontium in magnetic fields below 10 G and observe striking changes in photofragment angular distributions. The observations are in excellent agreement with a multichannel quantum chemistry model that includes nonadiabatic effects and predicts strong mixing of partial waves in the photofragment energy continuum. The experiment is enabled by precise quantum-state control of the molecules.