Self-dsDNA in the pathogenesis of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a systemic and poly-aetiological autoimmune disease characterized by the production of antibodies to autologous double-stranded DNA (dsDNA) which serve as diagnostic and prognostic markers. The defective clearance of apoptotic material, together with neutrophil extracellular traps (NETs), provides abundant chromatin or self-dsDNA to trigger the production of anti-dsDNA antibodies, although the mechanisms remain to be elucidated. In SLE patients, the immune complex (IC) of dsDNA and its autoantibodies trigger the robust type I interferon (IFN-I) production through intracellular DNA sensors, which drives the adaptive immune system to break down self-tolerance. In this review, we will discuss the potential resources of self-dsDNA, the mechanisms of self-dsDNA-mediated inflammation through various DNA sensors and its functions in SLE pathogenesis.

Cord blood NK cells engineered to express IL-15 and a CD19-targeted CAR show long-term persistence and potent antitumor activity

Chimeric antigen receptors (CARs) have been used to redirect the specificity of autologous T cells against leukemia and lymphoma with promising clinical results. Extending this approach to allogeneic T cells is problematic as they carry a significant risk of graft-versus-host disease (GVHD). Natural killer (NK) cells are highly cytotoxic effectors, killing their targets in a non-antigen-specific manner without causing GVHD. Cord blood (CB) offers an attractive, allogeneic, off-the-self source of NK cells for immunotherapy. We transduced CB-derived NK cells with a retroviral vector incorporating the genes for CAR-CD19, IL-15 and inducible caspase-9-based suicide gene (iC9), and demonstrated efficient killing of CD19-expressing cell lines and primary leukemia cells in vitro, with marked prolongation of survival in a xenograft Raji lymphoma murine model. Interleukin-15 (IL-15) production by the transduced CB-NK cells critically improved their function. Moreover, iC9/CAR.19/IL-15 CB-NK cells were readily eliminated upon pharmacologic activation of the iC9 suicide gene. In conclusion, we have developed a novel approach to immunotherapy using engineered CB-derived NK cells, which are easy to produce, exhibit striking efficacy and incorporate safety measures to limit toxicity. This approach should greatly improve the logistics of delivering this therapy to large numbers of patients, a major limitation to current CAR-T-cell therapies.

Cost-effectiveness analysis of fulvestrant versus anastrozole as first-line treatment for hormone receptor-positive advanced breast cancer

Although recent studies demonstrated that fulvestrant is superior to anastrozole as first-line treatment for hormone receptor (HR)-positive advanced breast cancer, the cost-effectiveness of fulvestrant versus anastrozole remained uncertain. Thus, the current study aimed to evaluate the cost-effectiveness of fulvestrant compared with anastrozole in the first-line setting. A Markov model consisting of three health states (stable, progressive and dead) was constructed to simulate a hypothetical cohort of patients with HR-positive advanced breast cancer. Costs were calculated from a Chinese societal perspective. Health outcomes were measured in quality-adjusted life-year (QALY). The incremental cost-effectiveness ratio (ICER) was expressed as incremental cost per QALY gained. Model results suggested that fulvestrant provides an additional effectiveness gain of 0.11 QALYs at an incremental cost of $32,654 compared with anastrozole, resulting in an ICER of $296,855/QALY exceeding the willingness-to-pay threshold of $23,700/QALY. Hence, fulvestrant is not a cost-effective strategy compared with anastrozole as first-line treatment for HR-positive advanced breast cancer.

Determination of the Biological Form of Human Cytomegalovirus DNA in the Plasma of Solid-Organ Transplant Recipients

Background

Whether cytomegalovirus (CMV) DNA exists in plasma as virion-associated or free DNA is uncertain.

Methods

An assay combining DNase I digestion and CMV quantitative polymerase chain reaction (DNase-CMV-qPCR) was developed to differentiate free naked DNA from virion DNA. One hundred three frozen and 10 fresh CMV DNA-positive plasma samples from solid-organ transplant recipients (SOTRs) were tested. Three sets of paired qPCR (P-qPCR) assays with amplicons of variable length were used to study CMV DNA fragmentation in 20 SOTR plasma samples, viral stocks (Towne, Merlin, AD169) and the first World Health Organization (WHO) international standard (IS) for CMV DNA.

Results

In all plasma samples, 98.8%-100% of CMV DNA was free DNA; this was the only form in 93 of 103 (90.3%) frozen and all 10 fresh samples tested using DNase-CMV-qPCR. Low levels of virion CMV DNA were found in 10 of 103 (9.7%) samples with higher total DNA load. Cytomegalovirus DNA results were highly reproducible for 3 CMV virus stocks and WHO IS (P > .80), tested by three sets of paired q-PCR. However, for the 20 SOTR plasma samples, the smaller amplicon assay result was 2.6-fold, 3.4-fold, and 6.5-fold higher than the longer amplicion result (P < .001).

Conclusions

Cytomegalovirus DNA in SOTR plasma is almost exclusively free DNA, highly fragmented, and not virion associated.

A Review of Guselkumab, an IL-23 Inhibitor, for Moderate-to-Severe Plaque Psoriasis

Psoriasis is a chronic inflammatory skin disorder that affects 2% of the population. Evidence suggests that interleukin (IL)-23 plays a pivotal role in the pathogenesis of psoriasis. Guselkumab is a subcutaneously administered, humanized anti-IL23 monoclonal antibody indicated for the treatment of moderate-to-severe plaque psoriasis. Data from Phase I-III trials in this patient population reveal that guselkumab has proven to be superior to placebo or adalimumab based on achieving a Psoriasis Area and Severity Index (PASI) 90% reduction, or a static Physician Global Assessment (sPGA) score of 0 or 1 from baseline. This article reviews the current status of guselkumab as a therapy for moderate-to-severe plaque psoriasis.

Comparison of chemical profiles and effectiveness between Erxian decoction and mixtures of decoctions of its individual herbs: a novel approach for identification of the standard chemicals

Background

Identification of bioactive standard chemicals is a major challenge in the study of the Chinese medicinal formula. In particular, the chemical components may interact differently depending on the preparative methods, therefore affecting the amounts of bioactive components and their pharmacological properties in the medicinal formula. With the use of Erxian decoction (EXD) as a study model—a  well-known Chinese medicinal formula for treating menopausal symptoms, a novel and rapid approach in seeking standard chemicals has been established by differentially comparing the HPLC profiles and the menopause-related biochemical parameters of combined decoction of EXD (EXD-C) and mixtures of the decoctions of its individual herbs (EXD-S).

Methods

The levels of six chemicals, which exerted actions on the HPO axis, have been measured in EXD-C and EXD-S by HPLC. Twelve-month-old female Sprague-Dawley rats were employed and treated with EXD-C and EXD-S. Their endocrine functions after treatment were evaluated by determining the ovarian mRNA levels of aromatase, a key enzyme for estradiol biosynthesis. The effect of the antioxidant regimen was determined by the hepatic superoxide dismutase-1 (SOD), catalase (CAT) and glutathione peroxidase (GPx-1) mRNA levels.

Results

The amounts of mangiferine, ferulic acid, jatrorrhizine and palmatine in EXD-S were twofold higher than those in EXD-C. EXD-S was more effective in stimulating ovarian aromatase and the expression of the antioxidant enzymes compared with EXD-C.

Conclusion

Mangiferine, ferulic acid, jatrorrhizine and palmatine are suitable for use as standard chemicals for quality evaluation of EXD according to our approach. EXD-S could be more effective than EXD-C.

A Review of Brodalumab, an IL-17 Receptor Antagonist, for Moderate-to-Severe Plaque Psoriasis

Psoriasis is a chronic immune-mediated inflammatory disease with epidermal hyperplasia that affects 2-3% of the population. Interleukin (IL)-17 signaling has a central role in its pathogenesis. Brodalumab is a monoclonal antibody that neutralizes IL-17 receptor type A. Brodalumab is highly effective in the reversal of psoriatic phenotype and gene expression patterns.

A new class of hybrid super-supertetrahedral cluster and its assembly into a five-fold interpenetrating network

The first hybrid super-supertetrahedron, formed by five [Ga₁₀S₁₆L₄]²⁻ supertetrahedral clusters, is presented.

A Review of Ixekizumab, an Anti-Interleukin-17A Monoclonal Antibody, for Moderate-to-Severe Plaque Psoriasis

Psoriasis is a multifactorial chronic skin disease that can have significant detrimental effects on patients' physical, mental, antibodypsychosocial wellbeing. Patients often suffer from a decreased quality of life along with numerous comorbidities. Recent advances in our understanding of the innate and adaptive immune systems have led to the identification of interleukin (IL)-17 as a key pro-inflammatory mediator in psoriasis. This knowledge has in turn led to the development of newer biologic agents that have been shown to be more effective than traditional therapies. In this article, we review phase 1-3 clinical trials of the anti-IL-17 monoclonal antibody, ixekizumab, for treatment of moderate-to-severe plaque psoriasis.

Pharmacokinetic Study of a Diclofenac Sodium Capsule Filled with Enteric-coated Pellets in Healthy Chinese Volunteers by Liquid Chromatography-electrospray Ionization-tandem Mass Spectrometry

The pharmacokinetic study of a diclofenac sodium capsule filled with enteric-coated pellets (abbreviated as CAPSULE) in healthy Chinese subjects was evaluated using liquid chromatography-electrospray ionization-tandem mass spectrometry with simple sample preparation. In a cross-over study, 12 healthy male volunteers were given 50 mg CAPSULE and diclofenac sodium enteric-coated tablet (abbreviated as TABLET, used as a control dosage form) at fasting. The Cmax, AUC0-t, and Tmax of CAPSULE were 1.01±0.52 μg/mL, 1.54±0.18 μg·h/mL, and 1.50±1.31 h, respectively. When compared with TABLET, the pharmacokinetic study showed that although this CAPSULE exhibited similar AUC (only 10% lower), it presented lower maximum plasma concentration, faster absorption and shorter time to reach maximum concentration. When compared with the previous study in Germany, obvious variations on Tmax were found in Chinese subjects taking CAPSULE, but not TABLET. The results indicated that individual difference should be paid attention when prescribing CAPSULE to Chinese patients.

Greater sensitivity of the cortical face processing system to perceptually-equated face detection

Face detection, the perceptual capacity to identify a visual stimulus as a face before probing deeper into specific attributes (such as its identity or emotion), is essential for social functioning. Despite the importance of this functional capacity, face detection and its underlying brain mechanisms are not well understood. This study evaluated the roles that the cortical face processing system, which is identified largely through studying other aspects of face perception, play in face detection. Specifically, we used functional magnetic resonance imaging (fMRI) to examine the activations of the fusifom face area (FFA), occipital face area (OFA) and superior temporal sulcus (STS) when face detection was isolated from other aspects of face perception and when face detection was perceptually-equated across individual human participants (n=20). During face detection, FFA and OFA were significantly activated, even for stimuli presented at perceptual-threshold levels, whereas STS was not. During tree detection, however, FFA and OFA were responsive only for highly salient (i.e., high contrast) stimuli. Moreover, activation of FFA during face detection predicted a significant portion of the perceptual performance levels that were determined psychophysically for each participant. This pattern of result indicates that FFA and OFA have a greater sensitivity to face detection signals and selectively support the initial process of face vs. non-face object perception.

The effects of bortezomib alone or in combination with 5-fluorouracil on proliferation and apoptosis of choriocarcinoma cells

PURPOSE

To investigate the effects of bortezomib alone and in combination with 5-fluorouracil (5-FU) on proliferation and apoptosis in the human choriocarcinoma cell line JEG-3.

MATERIALS AND METHODS

Cells were treated with bortezomib, 5-FU or with a combination. Proliferation and apoptosis were measured. NF-iB protein expression was examined using immunofluorescence.

RESULTS

Following treatment with ten nM bortezomib, rates of apoptosis were significantly higher than controls (p < 0.05) and NF-kB expression increased. 5-FU at 0.025 μg/ml or 0.25 μg/ml resulted in 60.1 ± 0.4% and 67.0 ± 0.2% growth inhibition, respectively, an increase compared to individual treatment (p < 0.05). Apoptosis in cells treated with bortezomib +5-FU was significantly higher than either treatment alone (p < 0.05). Inhibition of proliferation by the combination treatment was synergistic.

CONCLUSION

Bortezomib alone or in combination with 5-FU inhibited JEG-3 cell proliferation and induced apoptosis by increasing NF-kB expression. Combination treatment exerted synergistic effects on growth inhibition.

Sciatic-femoral nerve block versus unilateral spinal anesthesia for outpatient knee arthroscopy: a meta-analysis

BACKGROUND

Because of the short hospital stay involved in outpatient knee arthroscopy, anesthesiologists should provide an effective and safe anesthesia scheme. Unilateral spinal anesthesia is a conventional choice for outpatient knee arthroscopy, and combined sciatic-femoral nerve block also permits successful results. This study aimed to compare sciatic-femoral nerve block with unilateral spinal anesthesia for outpatient knee arthroscopy.

METHODS

We screened randomized controlled trials (RCTs) that compared sciatic-femoral nerve block (SFB) with unilateral spinal anesthesia (USA) from EMBASE, MEDLINE and the Cochrane Library. Ten statistic parameters, such as time-to-readiness for discharge (TRD, minutes), time to first spontaneous urination (minutes), time to perform (PT, minutes), Visual Analogue Scale (VAS) for postoperative (24 hours) pain, patients' satisfaction, and total anesthesia time (TAT, minutes) were considered in this study. RevMan 5.2 and Stata 12.0 softwares were used for data analysis.

RESULT

There were 7 RCTs including 402 total patients which met our criteria. Compared with the USA group, in the SFB group TRD (mean difference [MD]=-38.8; 95% CI [-63.7, -14.0]; P=0.002) and time to first spontaneous urination (MD=-78.2; 95% CI [-92.7, -63.7]; P<0.00001) were shorter, TAT (MD=100.2; 95% CI [30.3, 170.1]; P=0.005) and PT (MD=4.0; 95% CI [2.4, 5.6]; P<0.00001; I2=97%) were longer in the SFB group. For the two groups, no statistically significant differences were observed in patients' satisfaction (MD=3.2; 95% CI [0.3, 31.8]; P=0.33).

CONCLUSION

SFB provided faster bladder function recovery and faster discharging from hospital, hence it could be a good alternative to USA for outpatient knee arthroscopy.

Rapid genotyping of human rotavirus using SYBR green real-time reverse transcription-polymerase chain reaction with melting curve analysis

AIM: To develop a real-time reverse transcription-polymerase chain reaction (RT-PCR) assay to genotype rotavirus (G and P) in Alberta from January 2012 to June 2013.

METHODS: We developed and validated a different approach to perform rotavirus G and P genotyping using a two-step SYBR green RT-PCR (rt-gPCR) by selecting genotype-specific primers of published conventional RT nested PCR (cnRT-PCR) assay and optimizing the amplification conditions. cDNA was first synthesized from total RNA with SuperScript™ II reverse transcriptase kit followed by amplication step using monoplex SYBR green real-time PCR. After the PCR reaction, melting curve analysis was used to determine specific genotype. Sixteen samples previously genotyped using cnRT-PCR were tested using the new assay and the genotyping results were compared as sensitivity analysis. Assay specificity was evaluated by testing other gastroenteritis viruses with the new assay. The amplicon size of each available genotype was determined by gel-electrophoresis and DNA sequences were obtained using Sanger-sequencing method. After validation and optimization, the new assay was used to genotype 122 pediatric clinical stool samples previously tested positive for rotavirus using electron microscopy between January 2012 and June 2013.

RESULTS: The new rt-gPCR assay was validated and optimized. The assay detected G1 to G4, G9, G12 and P[4] and P[8] that were available as positive controls in our laboratory. A single and clear peak of melting curve was generated for each of specific G and P genotypes with a T_m ranging from 80 °C to 82 °C. The sensitivity of rt-gPCR was comparable to cnRT-PCR with 100% correlation of the 16 samples with known G and P genotypes. No cross reaction was found with other gastroenteritis viruses. Using the new rt-gPCR assay, genotypes were obtained for 121 of the 122 pediatric clinical samples tested positive for rotavirus: G1P[8] (42.6%), G2P[4] (4.9%), G3P[8] (10.7%), G9P[8] (10.7%), G9P[4] (6.6%), G12P[8] (23.0%), and unknown GP[8] (0.8%). For the first time, G12 rotavirus strains were found in Alberta and G12 was the second most common genotype during the study period. Gel electrophoresis of all the genotypes showed expected amplicon size for each genotype. The sequence data of the two G12 samples along with other genotypes were blasted in NCBI BLAST or analyzed with Rota C Genotyping tool (http://rotac.regatools.be/). All genotyping results were confirmed to be correct.

CONCLUSION: rt-gPCR is a useful tool for the genotyping and characterization of rotavirus. Monitoring of rotavirus genotypes is important for the identification of emerging strains and ongoing evaluation of rotavirus vaccination programs.

Optimal blood pressure levels in patients undergoing intravenous thrombolysis for AIS

AIM

We wished to define the most optimal blood pressure ranges in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis treatment.

METHODS

The study comprised 626 patients with AIS who underwent the treatment with recombinant tissue plasminogen activator. The patients were randomly assigned to receive either conservative blood pressure lowering regimen (N.=302, target systolic blood pressure of 151-185 mmHg) or intensive blood pressure lowering regimen (N.=324, target systolic blood pressure of 141-150 mm Hg). The outcomes were occurrence of intracranial hemorrhages and survival after 3 months post-treatment.

RESULTS

Patients who received intensive blood pressure lowering regimen showed significantly lower rates of intracranial hemorrhage and mortality. Also, these patients demonstrated a trend to better overall condition.

CONCLUSION

Intensive blood pressure lowering regimen warrants a safe and effective intravenous thrombolysis in patients with AIS, and the targeted systolic blood pressure levels should be within 141-150 mmHg.

Large-scale two-dimensional MoS₂ photodetectors by magnetron sputtering

We report on the demonstration of photodetectors based on large scale two-dimensional molybdenum disulfide (MoS2) transition metal dichalcogenides. Excellent film uniformity and precise control of the MoS2 thickness down to a monolayer (~0.75nm) were achieved by magnetron sputtering synthesis approach. In particular, the photodetectors integrated with five MoS2 monolayers exhibit a high photoresponsivity of 1.8 A/W, an external quantum efficiency exceeding 260%, and a photodetectivity of ~5 x 10(8) Jones for a wavelength of 850 nm, surpassing the performance of mechanically exfoliated based photodetectors.

Effects of p-chlorophenoxyisobutyric acid, arabinogalactan, and activated charcoal on microspore embryogenesis in kale

To improve embryogenesis in microspore cultures of kale (Brassica oleracea L. var. acephala DC.), 6-benzylaminopurine (6-BA), naphthaleneacetic acid (NAA), arabinogalactan (AG), p-chlorophenoxyisobutyric acid (PCIB), and activated charcoal (AC) were added to the medium using four varieties of kale. The results showed that the addition of AG (0.1-0.2 g/L), AC (0.1-0.2 g/L) or a combination of 6-BA (0.1-0.2 mg/L) and NAA (0.1-0.2 mg/L) promoted embryo-genesis. Adding 40 μM PCIB or a combination of 40 μM PCIB and 0.2 g/L AC to NLN-13 medium at pH 5.8 effectively enhanced embryogenesis. Treatment with a combination of 40 μM PCIB and 10 mg/L AG gave the highest rate of embryonic induction, especially in genotype "Y007," which showed a twelve-fold increase in yield.

Serum immunoglobulin E level and its impact on the pregnancy outcome associated with fetal growth restriction: a prospective cohort study

We evaluated the relationship between total serum immunoglobulin E (IgE) levels and pregnancy outcome in a prospective cohort study focusing on fetal growth restriction (FGR). Sixty women with FGR and twenty with normal singleton pregnancy were enrolled during their third trimester. Infants were followed up for 6 months. Blood samples were obtained from pregnant women during the third trimester; cord blood samples were also taken. Six months after birth, blood samples were obtained from infants. Demographic and baseline characteristics were compared between groups. Birth weight, length and head circumference of neonates in the FGR group were lower than those in the control group. Total serum IgE level was significantly increased in third-trimester pregnant women with FGR compared with normal group (P < 0.05). However, this trend was not observed in the cord blood at birth or peripheral blood of 6-month-old infants. The prevalence of atopic eczema between the 2 groups was similar. Linear regression analysis revealed that the IgE level in the third trimester was negatively correlated with birth weight (P < 0.05). Higher serum IgE level in the cord blood was significantly associated with an increased risk of being small for gestational age (P < 0.05). In conclusion, IgE levels in the third trimester of pregnancy and cord blood are strongly related to birth outcomes of FGR.