M-ficolin levels are associated with the occurrence of severe infections in patients with haematological cancer undergoing chemotherapy

The pattern recognition molecules H-ficolin, L-ficolin and M-ficolin bind to micro-organisms. They activate the lectin pathway of complement through mannan-binding lectin (MBL)-associated serine proteases (MASPs). Association between low MBL levels and infections in patients undergoing chemotherapy for haematological diseases has been observed previously. We now examine for MASP-2, MASP-3 and ficolin levels. We assessed the concentration of lectin pathway molecules as risk factors for infection in patients with haematological malignancy undergoing chemotherapy. Samples taken before the initiation of chemotherapy covering 117 chemotherapy cycles in 105 patients were available. MASPs and ficolins were measured by time-resolved immunoflourometric assays and the levels related to parameters of infections. End-points included febrile neutropenia, documented infections, bacteraemia or severe infections. Lower M-ficolin concentrations were found in patients who developed a severe infection: median 0·27 µg/ml compared to 0·47 µg/ml in patients who did not develop a severe infection (P = 0·01). Conversely, MASP-2 was higher in these patients: median 0·53 µg/ml compared to 0·37 µg/ml, respectively (P = 0·008). When considering M-ficolin levels below 0·36 µg/ml as deficient, the time to development of severe infection was shorter in the M-ficolin deficient group: the hazard ratio was 2·60 (95% confidence interval: 1·23-5·49). No associations were revealed between infections and H-ficolin, L-ficolin or MASP-3. Patients with low M-ficolin are more likely to develop severe infections, whereas MASP-2 showed the opposite.

Prevalence of vertebral fractures on chest radiographs of elderly African American and Caucasian women

The prevalence of vertebral fractures on routine chest radiographs of elderly Caucasian women was only 1.3 times higher than in African American (AA) women, a difference considerably smaller than reported in population studies. AAs with medical problems may have higher risk of vertebral fractures than previously suspected.

INTRODUCTION

Earlier studies noted a 1.9- to 3.7-fold higher prevalence of vertebral fractures in Caucasian (CA) compared to African American (AA) women. These studies, however, may have suffered from selection bias. We reported that among women referred for bone density testing, the prevalence of vertebral fractures in AA was the same as in CA women. Suspecting that the latter might have been due to a referral bias, we examined the racial difference in the prevalence of vertebra fractures on chest radiographs of patients seeking general medical care, not selected for osteoporosis.

METHODS

Consecutive chest radiographs (N = 1,200) of women over age 60 were evaluated using Genant's semi-quantitative method. Patients' race and the presence of diseases or medications associated with increased fracture risk were ascertained from the electronic medical records.

RESULTS

Among 1,011 women (76% AA) with usable radiographs, 11% had moderate or severe vertebral fractures. The prevalence of vertebral fractures was 10.3% in 773 AA and 13% in 238 CA women (p = 0.248 for difference between races). The lack of difference persisted after controlling for age, smoking, use of glucocorticoids, or presence of cancer, rheumatoid arthritis, organ transplantation, and end-stage renal disease. Among all subjects, CA women were more likely to be diagnosed and treated for osteoporosis (p <0.001).

CONCLUSION

Among subjects seeking medical care, the difference in the prevalence of vertebral fractures between AA and CA women is smaller than previously suspected. Greater attention to the detection of vertebral fractures and the management of osteoporosis is warranted in AA women with medical problems.

Mannan-binding lectin (MBL) and MBL-associated serine protease 2 (MASP-2) genotypes in colorectal cancer

Mannan-binding lectin (MBL) and MBL-associated serine protease 2 (MASP-2) are key factors of the lectin pathway of complement activation. Polymorphisms of the MBL2 and MASP-2 genes affect serum levels of MBL and MASP-2. In patients with colorectal cancer (CRC), the MBL and MASP-2 serum levels are increased and high MASP-2 levels are associated with recurrence and poor survival, whereas low MBL levels predict post-operative pneumonia. It is not known whether these associations are genetically based. In this study, the MBL and MASP-2 genotypes are investigated in 593 patients with CRC and 348 healthy controls. The potential association between genetic profile and infections, recurrence and survival is evaluated. Four single-nucleotide polymorphisms (SNPs) of MBL2 were analysed using TaqMan assays, with characterization of MBL2 wildtype A, variants B, C and D and alleles H/L, Y/X and P/Q. The SNP D120G for MASP-2 was determined. Serum levels of MBL and MASP-2 were measured. The MBL2 and MASP-2 genotype distribution was similar among patients with CRC and healthy controls and MBL2 genotype significantly associated with MBL concentration in serum (P<0.0001). No significant association between MBL2/MASP-2 genotype and post-operative infectious complications (P=0.33 and 0.22), recurrent cancer or survival (P=0.74 and P=0.61 respectively) was found. Thus, the increased serum levels of MBL and MASP-2 found in patients with CRC are not explained for by genetic profiles. In contrast to what has been demonstrated for serum levels of MBL and MASP-2, the genotypes do not predict disease course of the CRC patients.

Dynamical response and confinement of the electrons at the LaAlO3/SrTiO3 interface

With infrared ellipsometry and transport measurements we investigated the electrons at the interface between LaAlO3 and SrTiO3. We obtained a sheet carrier concentration of N(s) approximately = 5-9x10(13) cm(-2), an effective mass of m*=3.2+/-0.4m(e), and a strongly frequency dependent mobility. The latter are similar as in bulk SrTi(1-x)Nb(x)O3 and therefore suggestive of polaronic correlations. We also determined the vertical concentration profile which has a strongly asymmetric shape with a rapid initial decay over the first 2 nm and a pronounced tail that extends to about 11 nm.

Profiling the interface electron gas of LaAlO3/SrTiO3 heterostructures with hard x-ray photoelectron spectroscopy

The conducting interface of LaAlO3/SrTiO3 heterostructures has been studied by hard x-ray photoelectron spectroscopy. From the Ti 2p signal and its angle dependence we derive that the thickness of the electron gas is much smaller than the probing depth of 4 nm and that the carrier densities vary with increasing number of LaAlO3 overlayers. Our results point to an electronic reconstruction in the LaAlO3 overlayer as the driving mechanism for the conducting interface and corroborate the recent interpretation of the superconducting ground state as being of the Berezinskii-Kosterlitz-Thouless type.

Orbital reconstruction and the two-dimensional electron gas at the LaAlO3/SrTiO3 interface

In 2004, Ohtomo and Hwang discovered that an electron gas is created at the interface between insulating LaAlO3 and SrTiO3 compounds. Here we show that the generation of a conducting electron gas is related to an orbital reconstruction occurring at the LaAlO3/SrTiO3 interface. Our results are based on extensive investigations of the electronic properties and of the orbital structure of the interface using x-ray absorption spectroscopy. In particular, we find that the degeneracy of the Ti 3d states is fully removed and that the Ti 3d xy levels become the first available states for conducting electrons.

Electron scattering at dislocations in LaAlO3/SrTiO3 interfaces

We report experimental investigations of the effects of microstructural defects and of disorder on the properties of 2D electron gases at oxide interfaces. The cross section for scattering of electrons at dislocations in LaAlO(3)/SrTiO(3) interfaces has been measured and found to equal approximately 5 nm. Our experiments reveal that the transport properties of these electron gases are strongly influenced by scattering at dislocation cores.

Studies on the Influence of a Mutation of MASP-2 on the Binding to MBL and Ficolins

The complement system is an important part of the innate immune system. The activation of complement proceeds through three different pathways that converge in the generation of C3‐activating enzyme complexes. Complement activation via the lectin pathway is initiated when recognition molecules, mannan‐binding lectin (MBL) or ficolin, bind to carbohydrate structures characteristic for microbial surfaces. In the circulation, MBL and ficolins are found in association with three structurally related MBL‐associated serine proteases (MASP)‐1, ‐2 and ‐3 and a small, nonenzymatic component, MAp19. MASP‐2 has been shown to elicit complement activation through the sequential proteolytic cleavage of C4 and C2 upon binding of MBL/MASP‐2 complexes to microbial surfaces. We have recently uncovered a polymorphism in the MASP‐2/MAp19 gene in a patient shown to be deficient in the lectin pathway of complement activation. The polymorphism results in a single amino acid substitution in the N‐terminal part of the MASP‐2 protein. Recombinant wildtype MASP‐2 and MASP‐2 containing the amino acid substitution in question was produced, and the ability to activate complement was studied. The mutation had a profound impact on MASP‐2 function, resulting in the lack of complement activation through the lectin pathway. ELISA‐based experiments showed that the mutation leads to the impairment of complement activation through influencing the binding of MASP‐2 to MBL or ficolins. Deficiencies in the lectin pathway of complement activation have so far been accounted for only by lack of functional MBL. The mutation described above is the first defect described affecting both activation through MBL and the ficolins.

Preoperative Mannan-Binding Lectin Pathway and Prognosis in Colorectal Cancer

Background:  Deficiency of the mannan‐binding lectin (MBL) pathway of innate immunity leads to increased susceptibility to infections. In patients with colorectal cancer, postoperative infection is associated with poor prognosis. The aim of the present study was to evaluate (1) the relation between the MBL pathway and postoperative infectious complications and survival of patients resected for colorectal cancer and (2) the role of MBL as acute phase reactant compared to CRP.

Methods:  Preoperative MBL concentration, MBL/MBL‐associated serine protease (MASP) activity and CRP were determined in serum from 611 patients and 150 healthy controls. The patients were observed for 8 years. Postoperative infections, recurrence and survival were recorded.

Results:  The MBL pathway components were increased in the patients (P < 0.0001) compared to healthy controls. Low MBL levels were predictive of pneumonia (P = 0.01), and pneumonia (n = 87) was associated with poor survival (P = 0.003, HR = 1.5, 95% CI 1.1–1.9). MBL and MBL/MASP activity could not predict postoperative overall infections. MBL showed no correlation (spearman's ρ = 0.02, 95% CI −0.06–0.10) with CRP.

Conclusions:  Low preoperative MBL levels are predictive of pneumonia, which is associated with poorer survival. MBL concentration and MBL/MASP activity was not predictive of other postoperative infections or long‐term prognosis. MBL apparently is not a surrogate measure of CRP.

Mannan-Binding Lectin, L-Ficolin and H-Ficolin Selectively Binds to Different Bacteria

Mannan‐binding lectin (MBL), L‐ficolin and H‐ficolin are pattern recognition molecules of the innate immune system. We investigated the ability of these molecules to bind to different serotypes and noncapsulated variants of Streptococcus pneumonia and Staphylococcus aureus. We found that MBL binds to noncapsulated S. aureus strain (Wood) but not any of the examined S. pneumoniae serotypes. L‐ficolin binds to some capsulated S. pneumoniae serotypes (11A, 11D and 11F) as well as some capsulated S. aureus serotypes (Type‐1, ‐8, ‐9, ‐11 and ‐12). H‐ficolin does not bind to any of the examined S. pneumoniae and S. aureus serotypes included in this study but did bind to a strain of Aerococcus viridans. When bound to bacteria, MBL and H‐ficolin initiated activation of complement factor C4, whereas L‐ficolin did not. During this study, quantitative assays for the three proteins were developed and the concentration in 97 plasma samples were determined and the median values were estimated at 0.8 μg of MBL/ml, 3.3 μg of L‐ficolin/ml and 18.4 μg of H‐ficolin/ml, respectively.

Association between Mannose-Binding Lectin and Vascular Complications in Type 1 Diabetes

Complement activation and inflammation have been suggested in the pathogenesis of diabetic vascular lesions. We investigated serum mannose‐binding lectin (MBL) levels and polymorphisms in the MBL gene in type 1 diabetic (T1DM) patients with and without diabetic nephropathy and associated macrovascular complications. Polymorphisms in the MBL gene and serum MBL levels were determined in 199 T1DM patients with overt nephropathy and 192 T1DM patients with persistent normoalbuminuria matched for age, sex and duration of diabetes as well as in 100 healthy control subjects. The frequencies of high and low expression MBL genotypes were similar in patients with T1DM and healthy controls. High MBL genotypes were significantly more frequent in diabetic patients with nephropathy than in the normoalbuminuric group, and the risk of having nephropathy, given a high MBL genotype, assessed by odds ratio was 1.52 (1.02–2.27), P = 0.04. Median serum MBL concentrations were significantly higher in patients with nephropathy than in patients with normoalbuminuria [2306 µg/l (IQR 753–4867 µg/l) versus 1491 µg/l (IQR 577–2944), P = 0.0003], and even when comparing patients with identical genotypes, serum MBL levels were higher in the nephropathy group than in the normoalbuminuric group. Patients with a history of cardiovascular disease had significantly elevated MBL levels independently of nephropathy status [3178 µg/l (IQR 636–5231 µg/l) versus 1741 µg/l (IQR 656–3149 µg/l), P = 0.02]. The differences in MBL levels between patients with and without vascular complications were driven primarily by pronounced differences among carriers of high MBL genotypes (P < 0.0001). Our findings suggest that MBL may be involved in the pathogenesis of microvascular and macrovascular complications in type 1 diabetes and that determination of MBL status might be used to identify patients at increased risk of developing these complications.