Inhibition of glycogen synthase kinase 3β promotes autophagy to protect mice from acute liver failure mediated by peroxisome proliferator-activated receptor α

Our previous studies have demonstrated that inhibition of glycogen synthase kinase 3β (GSK3β) activity protects mice from acute liver failure (ALF), whereas its protective and regulatory mechanism remains elusive. Autophagy is a recently recognized rudimentary cellular response to inflammation and injury. The aim of the present study was to test the hypothesis that inhibition of GSK3β mediates autophagy to inhibit liver inflammation and protect against ALF. In ALF mice model induced by D-galactosamine (D-GalN) and lipopolysaccharide (LPS), autophagy was repressed compared with normal control, and D-GalN/LPS can directly induce autophagic flux in the progression of ALF mice. Autophagy activation by rapamycin protected against liver injury and its inhibition by 3-methyladenine (3-MA) or autophagy gene 7 (Atg7) small interfering RNA (siRNA) exacerbated liver injury. The protective effect of GSK3β inhibition on ALF mice model depending on the induction of autophagy, because that inhibition of GSK3β promoted autophagy in vitro and in vivo, and inhibition of autophagy reversed liver protection and inflammation of GSK3β inhibition. Furthermore, inhibition of GSK3β increased the expression of peroxisome proliferator-activated receptor α (PPARα), and the downregulated PPARα by siRNA decreased autophagy induced by GSK3β inhibition. More importantly, the expressions of autophagy-related gene and PPARα are significantly downregulated and the activity of GSK3β is significantly upregulated in liver of ALF patients with hepatitis B virus. Thus, we have demonstrated the new pathological mechanism of ALF that the increased GSK3β activity suppresses autophagy to promote the occurrence and development of ALF by inhibiting PPARα pathway.

[Epidemiology of intussusception related hospitalizations in children aged <2 years in Suzhou, 2007-2013]

OBJECTIVE

To understand the epidemiological and clinical characteristics of <2 years old children hospitalized due to intussusceptions.

METHODS

Clinical and demographic data of <2 years old children hospitalized due to intussusception between January 2007 and August 2013 were retrospectively collected in Affiliated Children' s Hospital of Soochow University in Suzhou. The incidence data, age distribution, seasonality and clinical characteristics of hospitalized intussusceptions cases were analyzed.

RESULTS

A total of 594 intussusception-related hospitalizations were identified during this period in children aged <2 years, no death occurred. The crude incidence of hospitalized intussusception was 57.3 per 100,000 in children aged <2 years (95%CI: 52.8-62.1), and 100.6 per 100,000 in children aged <1 year (95%CI: 92.1-109.8). The male to female ratio was 1.90:1. Up to 85.4% (507/594) of the cases were aged <1 year, and 66.2% (393/594) of the cases were aged 3-8 months. The incidence peaked in age group 5-8 months. The median age of the cases was 6.8 months (QR=4.4), and increased from 6.3 months (QR=4.2) in 2007 to 7.3 months (QR=4.0) in 2013. No obvious seasonality was observed. Main symptoms or signs included vomiting (83.2%, 494/594), abdominal mass (81.1%, 482/594), and bloody stool (64.5%, 383/594). Abdominal ultrasonic testing was the most frequently used diagnostic approach (98.7%, 586/594). Up to 86.2% (512/594) of patients were successfully treated by surgical intervention. The main sites for acute intussusception in children aged <2 years were ileocolic (34.5%, 183/530), ileo-ileo (30.8%, 163/530) or ileo-ileo-colic (27.9%, 148/530).

CONCLUSION

The incidence of hospitalized intussusception in children aged <2 years was high in Suzhou. It is necessary to establish an active surveillance system to provide baseline data for the evaluation of rotavirus vaccine safety.

Cirrhosis is under-recognised in patients subsequently diagnosed with hepatocellular cancer

BACKGROUND

Most clinical practice guidelines recommend screening for HCC in patients with cirrhosis. However, patients with compensated cirrhosis are often asymptomatic and may remain unrecognised for years.

AIMS

To determine the extent to which cirrhosis is unrecognised in a US Veteran population with HCC, and to evaluate the association between lack of cirrhosis recognition and stage of HCC at diagnosis.

METHODS

We reviewed the electronic medical records of a random sample of HCC cases diagnosed in the national Veterans Affairs system between 2005 and 2011. We conducted multivariable analyses adjusting for patients' demographics, comorbidity, aetiology of underlying disease and healthcare utilisation including HCC surveillance.

RESULTS

Of 1201 patients with HCC and cirrhosis, 24.6% had unrecognised cirrhosis prior to HCC diagnosis. Older patients [>65 years, odds ratio (OR) 2.32], African Americans (OR 1.93), patients with alcoholic or NAFLD liver disease (OR 1.69 and 4.77 respectively), HIV (OR 3.02), and fewer comorbidities (Deyo 0 vs. 3, OR 2.42) had significantly higher odds of having unrecognised cirrhosis than comparison groups. Furthermore, patients with unrecognised cirrhosis were 6.5 times more likely to have advanced stage HCC at diagnosis. The effect of cirrhosis recognition on HCC stage remained significant after adjusting for pre-specified covariates (OR 3.37).

CONCLUSIONS

In one quarter of patients, cirrhosis was unrecognised prior to HCC diagnosis, and this group was significantly more likely to have advanced stage HCC. These findings emphasise the importance of timely evaluation for cirrhosis in at-risk populations as a critical step to improving outcomes for patients with HCC.

The dysregulation of endoplasmic reticulum stress response in acute-on-chronic liver failure patients caused by acute exacerbation of chronic hepatitis B

Although endoplasmic reticulum (ER) stress is critical in various liver diseases, its role in acute-on-chronic liver failure (AoCLF) caused by acute exacerbation of chronic hepatitis B (CHB) is still elusive. This study aimed to analyse ER stress responses in the progression of HBV-related AoCLF. Normal liver tissues (n = 10), liver tissues of CHB (n = 12) and HBV-related patients with AoCLF (n = 19) were used. Electron microscopy of the ultrastructure of the ER was carried out on liver specimens. The gene and protein expression levels of ER stress-related genes were measured. We further analysed the correlation between the expression levels of ER stress-related molecules and liver injury. Electron microscopy identified typical features of the ER microstructure in AoCLF subjects. Among the three pathways of unfolded protein responses, the PKR-like ER kinase and inositol-requiring enzyme 1 signalling pathway were activated in CHB subjects and inactivated in AoCLF subjects, while the activating transcription factor 6 signalling pathway was sustained in the activated form during the progression of AoCLF; the expression of glucose-regulated protein (Grp)78 and Grp94 was gradually decreased in AoCLF subjects compared to healthy individuals and CHB subjects, showing a negative correlation with serum ALT, AST and TBIL; moreover, the ER stress-related apoptosis molecules were activated in the progression of acute exacerbation of CHB. The dysregulated ER stress response may play a complicated role in the pathogenesis of AoCLF, and a severe ER stress response may predict the occurrence of AoCLF caused by acute exacerbation of CHB.

Rotavirus-specific and Overall Diarrhea Mortality in Chinese Children Younger than 5 Years: 2003 to 2012

BACKGROUND

During the past decade, substantial declines in overall childhood mortality from diarrhea have been documented among Chinese children, but the last detailed assessment of rotavirus-specific mortality in China was conducted in 2002. To provide policy makers with up-to-date information, we examined rotavirus-related mortality in children <5 years of age in China during 2003-2012.

METHODS

We obtained mortality rates for children <5 years of age from the Chinese Health Statistic Yearbook; these figures were multiplied by the proportion of deaths in this age group attributable to diarrhea from the Chinese Maternal and Child Mortality Surveillance to obtain estimates of diarrhea deaths in children <5 years of age. To estimate rotavirus deaths, diarrhea death estimates were multiplied by the detection rate of rotavirus in children hospitalized with diarrhea from the Viral Diarrhea Surveillance System in China and from peer-reviewed literature.

RESULTS

From 2003 to 2012, a total of 127,539 deaths from diarrhea were reported among Chinese children <5 years of age, of which an estimated 53,559 (42%) had illness attributable to rotavirus. Comparing 2003 to 2012, the annual number of deaths from rotavirus diarrhea decreased by 74% (from 10,531 to 2,791, respectively) and the mortality rate fell 74% (from 0.66 to 0.17 deaths per 1000 live births, respectively). Ninety-three percent of all rotavirus deaths occurred in rural areas, where mortality rates (0.33 deaths per 1000 live births in 2012) were 11 times greater than in urban areas (0.03 deaths per 1000 live births in 2012).

CONCLUSIONS

Rotavirus diarrhea mortality has substantially declined in the past decade in Chinese children. The vast majority of rotavirus deaths occurred in rural areas. There is potential value in using rotavirus vaccine interventions in rural areas to further reduce mortality from this disease.

[Inactivation of EV71 by Exposure to Heat and Ultraviolet Light]

Enterovirus 71 (EV71) is a major agent of hand, foot and mouth disease that can cause a severe burden of disease to children. To identify an effective method for the control and prevention of EV71, we studied the effect of exposure to heat and ultraviolet (UV) light upon EV71 inactivation. We found that exposure to 50 degrees C could not inactivate the infectivity of EV71. However, exposure to 60 degrees C and 70 degrees C could inactivate EV71 effectively. EV71 could be inactivated after exposure to UV light at a distance between the sample and a lamp of 30 cm for 30 min or 60 min because viral genomic RNA was destroyed. However, fetal bovine serum (FBS) could attenuate the inactivation proffered by heat and UV light. Attenuation effects of FBS were correlated positively with FBS concentration. Hence, EV71 can be inactivated by exposure to heat and UV light, and our results could provide guidance on prevention of the spread of EV71.

Failure recovery of circulating NKG2D+CD56dimNK cells in HBV-associated hepatocellular carcinoma after hepatectomy predicts early recurrence

Dysfunction of natural killer (NK) cells has been implicated in the failure of antitumor immune responses in hepatocellular carcinoma (HCC) patients. However, the changes of NK profile in peripheral blood after surgery and tumor tissues of HCC patients, as well as the underlying reason and the significance are vague. Here, we observed that the frequencies of circulating NKG2D⁺CD56^dimNK cells decreased significantly in HBV-related HCC and were negatively correlated with the levels of serum TGF-β and soluble MICA (sMICA). In vitro experiments confirmed that the TGF-β and sMICA in tumor tissue homogenates, as well as sMICA in HCC cells culture supernatants could reduce the frequency of NKG2D⁺CD56^dimNK cells. In addition, in HCC patients the lower frequency of circulating NKG2D⁺CD56^dimNK cells was associated with larger tumor size and/or higher serum GGT. Noticeably, the frequency of NKG2D⁺CD56^dimNK cells at one month after surgery usually failed to restore in early recurrent patients, and that frequency was negatively associated with early recurrence and shorter overall survival. These results suggest that declined frequency of NKG2D⁺CD56^dimNK cells in HCC was associated with higher TGF-β and sMICA production, and low frequency of circulating NKG2D⁺CD56^dimNK cells at one month after surgery may predict poor prognosis of HBV-related HCC patients accepting hepatectomy.

[Advances in Correlation between Rotaivrus and Histo-blood Group Antigens]

Group A rotaviruses (RVs) are major pathogens associated with acute gastroenteritis in young children and animals worldwide. VP4 is responsible for interaction with the host and viral attachment. Recent study showed that the distal portion of rotavirus (RV) VP4 spike protein (VP8*) is implicated in binding to human histo-blood group antigens (HBGAs), which is new cellular receptors on rotavirus, Published in Nature and Journal of Virology in 2012. The paper describes advances in correlation between rotaivrus and HBGAs, summarizes the main achievements has gotten, Clarify the significance of study on Rotaivrus and HBGAs.

Role of p14ARF-HDM2-p53 axis in SOX6-mediated tumor suppression

Sex-determining region Y box 6 (SOX6) has been described as a tumor-suppressor gene in several cancers. Our previous work has suggested that SOX6 upregulated p21^Waf1/Cip1(p21) expression in a p53-dependent manner; however, the underlying mechanism has remained elusive. In this study, we confirmed that SOX6 can suppress cell proliferation in vitro and in vivo by stabilizing p53 protein and subsequently upregulating p21. Co-immunoprecipitation and immunocytofluorescence assays demonstrated that SOX6 can promote formation of the p14ARF-HDM2-p53 ternary complex by promoting translocation of p14ARF (p14 alternate reading frame tumor suppressor) to the nucleoplasm, thereby inhibiting HDM2-mediated p53 nuclear export and degradation. Chromatin immunoprecipitation combined with PCR assay proved that SOX6 can bind to a potential binding site in the regulatory region of the c-Myc gene. Furthermore, we confirmed that SOX6 can downregulate the expression of c-Myc, as well as its direct target gene nucleophosmin 1 (NPM1), and that the SOX6-induced downregulation of NPM1 is linked to translocation of p14ARF to the nucleoplasm. Finally, we showed that the highly conserved high-mobility group (HMG) domain of SOX6 is required for SOX6-mediated p53 stabilization and tumor inhibitory activity. Collectively, these results reveal a new mechanism of SOX6-mediated tumor suppression involving p21 upregulation via the p14ARF-HDM2-p53 axis in an HMG domain-dependent manner.

Evaluation and significance of C-reactive protein in the clinical diagnosis of severe pneumonia

Severe pneumonia is a major cause of mortality in children. The present study evaluated the diagnostic value of serum C-reactive protein (CRP) levels for cases of severe pneumonia. A total of 862 children, hospitalized for acute respiratory tract infections, were evaluated between September 2008 and February 2011; the serum levels of CRP were measured in all the children. Bacterial identification was performed, while polymerase chain reaction was used to detect the 12 respiratory viruses. Multivariate logistic regression analysis was performed with independent [CRP, proportion of neutrophils (NEUT), body temperature, sputum production, age and dyspnea] and dependent (severe and mild pneumonia) variables for clinical diagnosis, which produced three new variables that represented an individual's predictive value: Pre-1, Pre-2 and Pre-3. A receiver operating characteristic (ROC) curve was generated using the new variables to assess their predictive value for severe pneumonia. Of the 862 patients, 108 individuals were diagnosed with severe pneumonia and 754 individuals had mild pneumonia. Increased levels of CRP were associated with severe pneumonia and bacterial infection (P<0.05). Multivariate logistic regression analysis found that severe pneumonia was associated with the levels of CRP, body temperature, expectoration, age, NEUT and dyspnea (P<0.05). The ROC curve of the regression diagnostics model sequentially presented CRP, CRP and the other five correlative variables (NEUT + body temperature + sputum production + age + dyspnea) and the other five correlative variables used to diagnose severe pneumonia. The area under curve values were determined as 0.550 for Pre-1 [95% confidence interval (CI), 0.490-0.609], 0.897 for Pre-2 (95% CI, 0.861-0.932) and 0.893 for Pre-3 (95% CI, 0.855-0.931). The results revealed that the six correlative variables had improved accuracy in the diagnosis of severe pneumonia. The serum levels of CRP were strongly associated with bacterial infection and severe pneumonia. Therefore, the CRP level, along with other parameters, may be used as early indicators of severe pneumonia development. However, the efficiency of the CRP level alone to diagnose severe pneumonia was found to be limited.

[Genotype of Rotavirus Vaccine Strain LLR in China is G10P[15]]

Rotavirus is the leading causal agent of severe acute gastroenteritis in children aged <5 years. A specific pharmacologic agent for the treatment of rotavirus-infected children is lacking. In China, only the Luo Tewei oral vaccine (Lanzhou Institute of Biological Products, Shanghai, China), which is produced from Lanzhou lamb rotavirus vaccine (LLR), is available. Studies have hypothesized that the genotype of LLR is G10P[12], To identify the genotype of LLR by reverse transcription-polymerase chain reaction, we showed that the VP7 and VP4 genotypes of LLR were G10 and P[15], respectively, based on sequencing, alignment and phylogenetic analyses. In conclusion, we identified the genotype of rotavirus strain LLR to be G10P[15].

[Analyses of Binding Profiles of the GII. 12 Norovirus with Human Histo-blood Group Antigens]

Interactions between noroviruses (NoVs) and the receptors of histo-blood group antigens (HB-GAs) affect the infectivity and host susceptibility of NoVs. We elucidated the binding profile of a GII. 12 NoV to HBGAs. First, we synthesized the P domain sequence of the GII. 12 NoV strain Pune (GenBank accession number EU921353). Protein of the P domain was expressed in a prokaryotic system. Formation of the P particle was monitored by gel-filtration chromatography. Antiserum was prepared by immunization of mice with GII. 12 P particles. The binding profile of the GII. 12 NoV Pune strain was determined by binding of the P particle with a panel of saliva samples with various known HBGAs phenotypes. The GII. 12 NoV was bound strongly to saliva samples of subjects with B and AB types and weakly to A, O secretor, and non-secretor saliva samples, suggesting higher affinity with B antigen by GII. 12 NoV. These results were consistent with those determined by a previous crystallography study of GII. 12 NoV. These data suggested that individuals with B and AB blood types may be more susceptible to infection by GII. 12 NoV compared with those with other blood types. Our findings may provide a basis for the prevention and control of an epidemic of GII. 12 NoV.

[MicroRNA and Viral Infection]

MicroRNA (miRNA) are small non-coding molecules of ribonucleic acid. They are about 22 nucleotides in length, single-stranded, and mediate post-translational regulation by the repression or degradation of messenger RNA(mRNA). miRNA play a key part in the proliferation, differentiation and death of cells. Viral infection is one of the most common causes of human disease. Some studies have found that miRNA has a very close relationship with viral infection, which has an effect on viral replication, the immune response and antiviral immunity. Use of miRNA may become the cornerstone of new methods for the diagnosis and treatment of viral infection. This article summarizes the progress of research into miRNA and viral infection.

Strain-specific interaction of a GII.10 Norovirus with HBGAs

Noroviruses (NoVs), an important cause of gastroenteritis in humans, recognize human histo-blood group antigens (HBGAs) as receptors. The crystal structures of the protruding (P) domain of a GII.10 NoV (Vietnam 026) in complex with various HBGA oligosaccharides were elucidated. However, the HBGA binding profile of this virus remains unknown. In this study, we determined the saliva and oligosaccharide binding profiles of this virus and the roles of amino acids that are involved in HBGA binding. Our data showed that Vietnam 026 bound to all ABO secretor and non-secretor saliva with clear signals detected by monoclonal antibodies against H3, H1, Le(y), Le(a) and sialyl Le(a). Mutagenesis study confirmed the binding site determined by the crystallography study, in which single mutations wiped out the binding function. We also identified amino acids surrounding the central binding pocket that may participate in the binding by affecting the HBGA binding specificity of the GII.10 NoV.

[Discovery of human bocavirus 4 in children with acute gastroenteritis in Lanzhou, China]

We studied the epidemiological characteristics of human bocavirus 4 (HBoV4) in children with a- cute gastroenteritis in Lanzhou (China). A total of 331 stool specimens were collected from children aged < 5 years with acute diarrhea at the First Hospital of Lanzhou University between July 2012 and June 2013. Specimens of HBoV were identified by nested polymerase chain reaction assays. Compared with related sequences in GenBank, the HBoV-positive strain isolated in the present study was,quite surprisingly, a rare genotype named HBoV4. This strain was a typical HBoV4,with high levels of nucleotide and amino acid homology to the Thailand strain, JQ267789 (98.9% and 98.7%, respectively), and the USA strain, GQ506568 (97.6% and 97.4%, respectively). This is the first report of HBoV4 as the causative agent for acute gastroenteritis in pediatric patients in China. This strain is one of two genotypes of HBoV that are currently circulating.

[A preliminary assessment of the clinical utility of measuring hepatitis C virus antibody to evaluate infection status]

OBJECTIVE

To investigate the potential of hepatitis C virus (HCV) antibody measurement as a clinical approach to determine the infection status and potential for spontaneous-resolution among patients with HCV mono-infection and HCV/human immunodeficiency virus (HIV) co-infection.

METHODS

A total of 340 individuals who tested positive for serum anti-HCV antibodies and/or serum anti-HW antibodies were enrolled for study in 2009 from a single village in central China. Markers of liver function (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)) and infection (anti-HCV antibodies, CD4⁺ T cell counts, HCV genotype, and HCV viral load) were measured at baseline and follow-up (in July 2012). At follow-up,the subjects were grouped according to ongoing HCV mono-infection (n=129), ongoing HCV/HIV co-infection (n=98), spontaneously resolved (SR)-HCV in mono-infection (n=65), and SR-HCV in HCV/HIV co-infection (n=48) for statistical analysis.

RESULTS

Almost all of the subjects in the ongoing HCV mono-infection group showed high levels of HCV antibodies (S/CO more than or equal to 10), but the majority of the subjects in the SR-HCV in mono-infection group and in the ongoing HCV/HIV co-infection group. The SR-HCV mono-infection group showed a remarkable decrease in HCV antibodies from 2009 (HIV:7.75 ± 3.8; HIV+:7.61 ± 3.47) to 2012 (HIV:5.51 ± 3.67; HIW:4.93 ± 3.35) (HIV:t =10.67, P less than 0.01; HIV+:t =9.52, P less than 0.01). The ongoing HCV/HIV co-infection group showed a positive correlation between HCV antibodies S/CO ratio and CD4⁺ T cell count (r=028, P=0.008). In the ongoing HCV mono-infection group,the levels of HCV antibodies were significantly higher in individuals infected with HCV-1b than in those with HCV-2a (14.74 ± 1.68 vs.14.08 ± 1.44, t=2.20, P=0.03). In the ongoing HCV/HIV co-infection group, the numbers of subjects with elevated (more than 40 U/L) liver function markers were significantly different according to the HCV genotype infection:HCV-1b:ALT, 25/42 vs.16/56 (x²=9.45, P=0.002); HCV2a:AST, 28/42 vs.18/56 (x²=11.49, P=0.001). The HCV RNA positive rate was significantly higher in subjects with high HCV antibody cutoff values (S/CO more than or equal to 10) than in those with low HCV antibody (S/CO less than 10) (HIV:128/151 vs.1/43, x²=102.11, P less than 0.01; HIV+:88/98 vs.10/48, x²=69.44, P less than 0.01), regardless of HIV co-infection. Significantly more subjects in the ongoing HCV mono-infection group had elevated (more than 40 U/L) ALT or AST than the subjects in the SR-HCV mono-infection group with high levels of HCV antibody (S/CO more than or equal to 10) (ALT:57/128 vs.2/23, x²=10.52, P=0.001; AST:57/128 vs.0/23, x²=16.45, P less than 0.01).

CONCLUSION

Serum HCV antibody levels, in combination with other clinical information such as liver function and HIV infection status, may aid in the preliminarily evaluation of an individual's HCV infection status and likelihood for spontaneous resolution. Low levels of HCV antibody (S/CO less than 10) may indicate a better chance of SR-HCV, after ruling out the possibility of suffering from immunosuppressive diseases such as HIV infection.

Effectiveness of HCV core antigen and RNA quantification in HCV-infected and HCV/HIV-1-coinfected patients

Background

The measurement of hepatitis C virus core antigen (HCV-coreAg) has been shown to be an indicator of active HCV infection. The aim of the present study was 1) to investigate the stability and effectiveness of HCV-coreAg and HCV-RNA quantification in HCV infection with or without HIV-1 coinfection, 2) to explore the association between the HCV-coreAg/HCV-RNA (Ag/RNA) ratio and the immune status in chronic HCV/HIV-1-coinfected patients.

Methods

A longitudinal investigation comprised of 227 HCV-monoinfected (n = 129) and HCV/HIV-1-coinfected (n = 98) patients was initiated in August 2009, and 139 (73 with HCV monoinfection and 66 with HCV/HIV-1 coinfection) were followed up in August 2012. Both HCV core antigen and HCV RNA quantification were determined on this cryopreserved plasma. HCV core antigen and HCV RNA quantification were performed subsequently. In addition, an in vitro experiment investigating the possibility of degradation of HCV components (core antigen and RNA) were conducted.

Results

Significant and stable correlations (p < 0.001) were observed both in chronic HCV-monoinfected and HCV/HIV-1-coinfected patients over the 3-year observation. Coinfected patients with immunocompromised condition had a significantly higher (p < 0.05) Ag/RNA ratios than those patients with immunocompetent condition both at two time points (2009 and 2012). Moreover, the Ag/RNA ratios were negatively correlated with CD4+ T-cell counts (p < 0.001). An in vitro experiment investigated the possibility of the slower degradation of HCV particles under HIV-related immunocompromised condition was conducted and the data demonstrated that the Ag/RNA ratios were significantly higher in HIV-1-positive plasma than in healthy plasma (p = 0.005) in this study.

Conclusions

Our longitudinal study indicated that the HCV-coreAg presented comparable dynamics over time as HCV RNA in chronic HCV-infected patients. Meanwhile, the HCV-coreAg/HCV-RNA ratio was closely associated with immune status in HCV/HIV-1-coinfected patients.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-014-0577-1) contains supplementary material, which is available to authorized users.

HIV co-infection accelerates decay of humoral responses in spontaneous resolvers of HCV infection

Acute hepatitis C virus (HCV) infection is primarily followed by chronic infection, while spontaneous recovery of HCV infection (SR-HCV) occurs in a minority of those infected. Identification of SR-HCV clinically depends on two combined indicators, persistently undetectable peripheral HCV RNA and positivity for anti-HCV. However, the characteristics of dynamic variation in anti-HCV antibodies in SR-HCV, especially in those patients co-infected with HIV, are still undefined. In this study, a cohort of patients infected with HCV through commercial blood collection practices was studied. We found that the annual decreasing rate of anti-HCV presented a gradually accelerated process in HCV resolvers. However, the variation in the decline of anti-HCV presented a slowly accelerated process within the early decrease stage and a gradually decelerated process within the latter decrease stage. In addition, we deduced that it expended approximately 16 years from natural HCV recovery to undetectable peripheral anti-HCV in HCV resolvers co-infected with HIV, while this time was estimated to be 20 years in SR-HCV without HIV co-infection. Our data indicated that the decay of anti-HCV was accelerated by HIV-related impairment of immune function. The prevalence of HCV infection may be severely underestimated in this large-scale retrospective epidemiologic investigation in an HIV-infected population.

Regulation of transepithelial ion transport in the rat late distal colon by the sympathetic nervous system

The colorectum (late distal colon) is innervated by the sympathetic nervous system, and many colorectal diseases are related to disorders of the sympathetic nervous system. The sympathetic regulation of colorectal ion transport is rarely reported. The present study aims to investigate the effect of norepinephrine (NE) in the normal and catecholamine-depleted condition to clarify the regulation of the sympathetic adrenergic system in ion transport in the rat colorectum. NE-induced ion transport in the rats colorectum was measured by short-circuit current (I(sc)) recording; the expression of beta-adrenoceptors and NE transporter (NET) were quantified by real-time PCR, and western blotting. When the endogenous catecholamine was depleted by reserpine, the baseline I(sc) in the colorectum was increased significantly comparing to controls. NE evoked downward deltaI(sc) in colorectum of treated rats was 1.8-fold of controls. The expression of beta(2)-adrenoceptor protein in the colorectal mucosa was greater than the control, though the mRNA level was reduced. However, NET expression was significantly lower in catecholamine-depleted rats compared to the controls. In conclusion, the sympathetic nervous system plays an important role in regulating basal ion transport in the colorectum. Disorders of sympathetic neurotransmitters result in abnormal ion transport, beta-adrenoceptor and NET are involved in the process.

Peroxisome proliferator-activated receptor α activation attenuates the inflammatory response to protect the liver from acute failure by promoting the autophagy pathway

Peroxisome proliferator-activated receptor α (PPARα) has been reported to induce a potent anti-inflammatory response. Autophagy is a recently recognized rudimentary cellular response to inflammation and injury. The aim of the present study was to test the hypothesis that PPARα activation mediates autophagy to inhibit liver inflammation and protect against acute liver failure (ALF). PPARα expression during ALF and the impact of PPARα activation by Wy-14 643 on the hepatic immune response were studied in a D-galactosamine/lipopolysaccharide-induced mouse model. Autophagy was inhibited by 3-methyladenine or small interfering RNA (siRNA) against Atg7. In both the mouse model and human ALF subjects, PPARα was significantly downregulated in the injured liver. PPARα activation by pretreatment with Wy-14 643 protected against liver injury in mice. The protective effect of PPARα activation relied on the suppression of inflammatory mechanisms through the induction of autophagy. This hypothesis is supported by the following evidence: first, PPARα activation suppressed proinflammatory responses and inhibited phosphorylated NF-κBp65, phosphorylated JNK and phosphorylated ERK pathways in vivo. Second, protection by PPARα activation was due to the induction of autophagy because inhibition of autophagy by 3-methyladenine or Atg7 siRNA reversed liver protection and inflammation. Third, PPARα activation directly induced autophagy in primary macrophages in vitro, which protected cells from a lipopolysaccharide-induced proinflammatory response. Here, for the first time, we have demonstrated that PPARα-mediated induction of autophagy ameliorated liver injury in cases of ALF by attenuating inflammatory responses, indicating a potential therapeutic application for ALF treatment.

Genetic polymorphisms of CXCR5 and CXCL13 are associated with non-responsiveness to the hepatitis B vaccine

A cohort based study has been undertaken to investigate the possible association of genetic polymorphisms in genes functionally related to follicular T helper (TfH) cells with non-responsiveness to hepatitis B virus (HBV) vaccination. A total of 24 single nucleotide polymorphisms (SNPs) in 6 TfH related genes (CXCR5, ICOS, CXCL13, IL-21, BCL6 and CD40L) were investigated in 20 non-responders and 45 responders to HBV vaccination. Genetic association analysis revealed that three SNPs (rs497916, rs3922, rs676925) in CXCR5 and one SNP (rs355687) in CXCL13 were associated with hepatitis B vaccine efficacy. In addition, significantly unbalanced distributions of two haplotypes, defined by three SNPs (rs497916, rs3922, rs676925) within CXCR5, were also seen between non-responders and responders. Furthermore, we demonstrated that the rs3922 "GG" genotype was associated with higher levels of CXCR5 than the "AG" and "AA" genotype in a group of healthy volunteers. A dual luciferase report assay was used to confirm that the "G" allele in rs3922 may lead to higher gene expression than the "A" allele, implicating that rs3922 might be a functional SNP affecting CXCR5 expression. These results indicated that polymorphism associated changes in CXCR5 expression in TfH cells may be associated with non-responsiveness to hepatitis B vaccination.

Asymmetrical cortical vessel sign on susceptibility-weighted imaging: a novel imaging marker for early neurological deterioration and unfavorable prognosis

BACKGROUND AND PURPOSE

Susceptibility-weighted imaging (SWI) is a high spatial resolution technique that can indirectly demonstrate increased cerebral oxygen extraction. Our aim was to assess whether asymmetric cortical vessel sign (ACVS) on SWI could be associated with early neurological deterioration (END) as well as 90-day unfavorable outcome in patients with acute ischaemic stroke.

MATERIALS AND METHODS

Consecutive patients with acute middle cerebral artery (MCA) territory infarction were prospectively enrolled. ACVS was defined as more and/or larger vessels with greater signal loss than those in the opposite hemisphere on minimum intensity projection of SWI. The neurofunctional fluctuation during acute phase as well as 90-day outcomes were assessed. A National Institutes of Health Stroke Scale increment ≥2 points and ≥4 points despite standard treatment in the first 72 h after admission was defined as END2 and END4, respectively.

RESULTS

In all, 572 patients were finally enrolled. ACVS on SWI was present in 39 (6.8%) subjects. Multivariate analysis indicated that ACVS is an independent predictor for END2 [odds ratio (OR) 4.47, 95% confidence interval (CI) 1.99-10.05) and END4 (OR 4.24, 95% CI 1.94-9.23). Furthermore, ACVS also correlates with 90-day unfavorable outcome defined as a modified Rankin Scale score >1 point (OR 2.93, 95% CI 1.15-7.48). Both positive and negative predictive values of ACVS for END2, END4 and 90-day prognosis were reasonable and both could be slightly enhanced as long as patients with contralateral artery stenosis or occlusion were excluded.

CONCLUSION

In patients with MCA territory acute ischaemic stroke, especially in those without contralateral internal carotid artery/MCA stenosis or occlusion, ACVS might be considered as a neuroimaging predictor for END and unfavorable prognosis.