Influence of gestational diabetes on fetal autonomic nervous system: a study using phase-rectified signal-averaging analysis

OBJECTIVES

Maternal gestational diabetes mellitus (GDM) is known to influence fetal physiology. Phase-rectified signal averaging (PRSA) is an innovative signal-processing technique that can be used to investigate fetal heart signals. The PRSA-calculated variables average acceleration capacity (AAC) and average deceleration capacity (ADC) are established indices of autonomic nervous system (ANS) function. The aim of this study was to evaluate the influence of GDM on the fetal cardiovascular and ANS function in human pregnancy using PRSA.

METHODS

This was a prospective clinical case-control study of 58 mothers with diagnosed GDM and 58 gestational-age matched healthy controls in the third trimester of pregnancy. Fetal cardiotocography (CTG) recordings were performed in all cases at entry to the study, and a follow-up recording was performed in 19 GDM cases close to delivery. The AAC and ADC indices were calculated by the PRSA method and fetal heart rate short-term variation (STV) by CTG software according to Dawes-Redman criteria.

RESULTS

Mean gestational age of both groups at study entry was 35.7 weeks. There was a significant difference in mean AAC (1.97 ± 0.33 bpm vs 2.42 ± 0.57 bpm; P < 0.001) and ADC (1.94 ± 0.32 bpm vs 2.28 ± 0.46 bpm; P < 0.001) between controls and fetuses of diabetic mothers. This difference could not be demonstrated using standard computerized fetal CTG analysis of STV (controls, 10.8 ± 3.0 ms vs GDM group, 11.3 ± 2.5 ms; P = 0.32). Longitudinal fetal heart rate measurements in a subgroup of women with diabetes were not significantly different from those at study entry.

CONCLUSIONS

Our findings show increased ANS activity in fetuses of diabetic mothers in late gestation. Analysis of human fetal cardiovascular and ANS function by PRSA may offer improved surveillance over conventional techniques linking GDM pregnancy to future cardiovascular dysfunction in the offspring. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

In situ detection of PR3-ANCA+ B cells and alterations in the variable region of immunoglobulin genes support a role of inflamed tissue in the emergence of auto-reactivity in granulomatosis with polyangiitis

Circulating anti-neutrophilic cytoplasmic autoantibodies targeting proteinase 3 (PR3-ANCA) are a diagnostic and pathogenic hallmark of granulomatosis with polyangiitis (GPA). It is, however, incompletely understood if inflamed tissue supports presence or emergence of PR3-ANCA⁺ B cells. In search of such cells in inflamed tissue of GPA, immunofluorescence staining for IgG and a common PR3-ANCA idiotype (5/7 Id) was undertaken. Few 5/7 Id⁺/IgG⁺ B cells were detected in respiratory and kidney tissue of GPA. To gain more insight into surrogate markers possibly indicative of an anti-PR3-response, a meta-analysis comprising IGVH and IGVL genes derived from respiratory tract tissue of GPA (231 clones) was performed. Next generation sequencing-based IGHV genes derived from peripheral blood of healthy donors (244.353 clones) and previously published IGLV genes (148 clones) served as controls. Additionally, Ig genes of three murine and five known human monoclonal anti-PR3 antibodies were analyzed. Primary and probably secondary rearrangements led to altered VDJ usage and an extended complementarity determining region 3 (CDR3) of IGHV clones from GPA tissue. Selection against amino acid exchanges was prominent in the framework region of IGHV clones from GPA tissue. The comparison of V(D)J rearrangements and deduced amino acid sequences of the CDR3 yielded no identities and few similarities between clones derived from respiratory tissue of GPA and anti-PR3 antibodies, arguing against a presence of B cells that carry PR3-ANCA-prone Ig genes among the clones. In line with the scarcity of 5/7 Id⁺ B lymphocytes in GPA tissue, the results suggest that with respect to a local anti-PR3 response, methods detecting rare clones are required.

Bartonella vinsonii subsp. berkhoffii and B. henselae in dogs

This study aimed to molecularly survey Bartonella in dogs from Chile. Quantitative real-time PCR (qPCR) for Bartonella spp. based on nuoG gene was performed in 139 blood samples taken from dogs belonging to rural localities of the Valdivia Province, Los Ríos region, southern Chile. nuoG qPCR-positive samples were submitted to conventional PCR assays for ftsZ, gltA, rpoB and nuoG genes and sequencing for speciation and phylogenetic analysis. Based upon qPCR results, Bartonella spp. occurrence in dogs was 4.3% (6/139). Out of six nuoG qPCR-positive samples, six, three, two and none showed positive results in cPCR assays based on gltA, ftsZ, rpoB and nuoG genes, respectively. Consistent sequencing results were obtained only for the ftsZ gene from sample #1532 (GeneBank accession number: MG252491), and gltA gene from samples #1535 (MG252490) and #1532 (148 bp fragment that was not deposited in GenBank). Phylogenetic analysis of ftsZ and gltA genes allowed speciation of two nuoG-positive samples, one as Bartonella vinsonii subsp. berkhoffii and the other as B. henselae. Bartonella vinsonii subsp. berkhoffii and B. henselae are detected for the first time in dogs from Chile, highlighting the importance of the canine population as a source of zoonotic agents and potential infection risk to humans.

Influence of Membranes on Generation of β2 M and Release of Leukocyte Lysosomal Enzymes

Normal leukocyte functional capacity was investigated by evaluation of phagocytosis of opsonised yeast cells in a radiometric test system. After incubation with dialysis membranes (different cellulosic membranes, polysulfon membrane (PS), polymethylmetacrylate membrane (PMMN), the phagocytosis index, expressed as percent decrease with respect to initial values without membrane, decreased by 10%–25%. The most pronounced effect was observed with PS, cuprophane, modified cellulose and PMMA. The results are not related to differences in the viability of PMN during the test procedure; dead PMN amounted to about 4–6.5%. A significant increase in β-NAG and β-Gluc activities was released in the supernatants of the phagocytosis suspensions. This increase activity can be explained by the phagocytosis of PMN but it was not influenced by membrane contact. There was no influence of membrane contact or phagocytosis activity of PMN on the β2M concentration in the supernatant demonstrating that no in vitro generation during incubation with either membrane exists.

Pathogenetic and Clinical Aspects of Anti-Neutrophil Cytoplasmic Autoantibody-Associated Vasculitides

Anti-neutrophil cytoplasmic autoantibodies (ANCA) targeting proteinase 3 (PR3) and myeloperoxidase expressed by innate immune cells (neutrophils and monocytes) are salient diagnostic and pathogenic features of small vessel vasculitis, comprising granulomatosis with polyangiitis (GPA), microscopic polyangiitis, and eosinophilic GPA. Genetic studies suggest that ANCA-associated vasculitides (AAV) constitute separate diseases, which share common immunological and pathological features, but are otherwise heterogeneous. The successful therapeutic use of anti-CD20 antibodies emphasizes the prominent role of ANCA and possibly other autoantibodies in the pathogenesis of AAV. However, to elucidate causal effects in AAV, a better understanding of the complex interplay leading to the emergence of B lymphocytes that produce pathogenic ANCA remains a challenge. Different scenarios seem possible; e.g., the break of tolerance induced by a shift from non-pathogenic toward pathogenic autoantigen epitopes in inflamed tissue. This review gives a brief overview on current knowledge about genetic and epigenetic factors, barrier dysfunction and chronic non-resolving inflammation, necro-inflammatory auto-amplification of cellular death and inflammation, altered autoantigen presentation, alternative complement pathway activation, alterations within peripheral and inflamed tissue-residing T- and B-cell populations, ectopic lymphoid tissue neoformation, the characterization of PR3-specific T-cells, properties of ANCA, links between autoimmune disease and infection-triggered pathology, and animal models in AAV.

Near-K-Edge Double and Triple Detachment of the F^{-} Negative Ion: Observation of Direct Two-Electron Ejection by a Single Photon

Double and triple detachment of the F^{-}(1s^{2}2s^{2}2p^{6}) negative ion by a single photon have been investigated in the photon energy range 660 to 1000 eV. The experimental data provide unambiguous evidence for the dominant role of direct photodouble detachment with a subsequent single-Auger process in the reaction channel leading to F^{2+} product ions. Absolute cross sections were determined for the direct removal of a (1s+2p) pair of electrons from F^{-} by the absorption of a single photon.

Autoantibodies in Serum of Systemic Scleroderma Patients: Peptide-Based Epitope Mapping Indicates Increased Binding to Cytoplasmic Domains of CXCR3

Systemic sclerosis (SSc) is a severe chronic autoimmune disease with high morbidity and mortality. Sera of patients with SSc contain a large variety of autoantibody (aab) reactivities. Among these are functionally active aab that bind to G protein-coupled receptors (GPCR) such as C-X-C motif chemokine receptor 3 (CXCR3) and 4 (CXCR4). Aab binding to the N-terminal portion of these two GPCRs have been shown to be associated with slower disease progression in SSc, especially deterioration of lung function. Aabs binding to GPCRs exhibit functional activities by stimulating or inhibiting GPCR signaling. The specific functional activity of aabs crucially depends on the epitopes they bind to. To identify the location of important epitopes on CXCR3 recognized by aabs from SSc patients, we applied an array of 36 overlapping 18-20mer peptides covering the entire CXCR3 sequence, comparing epitope specificity of SSc patient sera (N = 32, with positive reactivity with CXCR3) to healthy controls (N = 30). Binding of SSc patient and control sera to these peptides was determined by ELISA. Using a Bayesian model approach, we found increased binding of SSc patient sera to peptides corresponding to intracellular epitopes within CXCR3, while the binding signal to extracellular portions of CXCR3 was found to be reduced. Experimentally determined epitopes showed a good correspondence to those predicted by the ABCpred tool. To verify these results and to translate them into a novel diagnostic ELISA, we combined the peptides that represent SSc-associated epitopes into a single ELISA and evaluated its potential to discriminate SSc patients (N = 31) from normal healthy controls (N = 47). This ELISA had a sensitivity of 0.61 and a specificity of 0.85. Our data reveals that SSc sera preferentially bind intracellular epitopes of CXCR3, while an extracellular epitope in the N-terminal domain that appears to be target of aabs in healthy individuals is not bound by SSc sera. Based upon our results, we could devise a novel ELISA concept that may be helpful for monitoring of SSc patients.

Circulating CD4+CD8+ double-positive T-cells display features of innate and adaptive immune function in granulomatosis with polyangiitis

OBJECTIVES

To examine functional features of CD4+CD8+ double-positive T-cells in patients with granulomatosis with polyangiitis (GPA) using phenotypic and transcriptomic analysis.

METHODS

Staining of cellular surface marker was performed using freshly collected whole blood. For intracellular cytokine staining freshly collected whole blood was stimulated with phorbol myristate acetate and ionomycin. Multicolor flow cytometric analysis was performed on a FACSCanto II cytometer using FACSDiva software. Lymphocytes were gated on CD3, CD4, and CD8 staining. FACS-sorted CD4+CD8+ double-positive T-cells of GPA-patients and HC (n=3 each) were subjected to transcriptional profiling using an Affymetrix Human Genome 2.0 microarray. Differently expressed genes were analysed using biological databases.

RESULTS

Frequency of CD4+CD8+ double-positive T-cells was increased within the total CD3+ T-cell population in GPA, but no difference was detected between patients with active disease and remission. Percentages of interferon γ (Th1-type), interleukin 17 and interleukin 22 (Th17-type) producing CD4+CD8+ double-positive T-cells exceeded the percentage of interleukin 4 (Th2-type) producing cells. There were no significant differences in the percentages of the respective cytokine-positive CD4+CD8+ double-positive T-cells between GPA and HC. Up-regulated genes of CD4+CD8+ double-positive T-cells in GPA were enriched within Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways related to nuclear factor kappa-lightchain-enhancer of activated B cells signalling, toll-like receptor signalling, nucleotide-binding oligomerisation domain-like receptor signalling as well as major histocompatibility complex class-II antigen presentation.

CONCLUSIONS

Employing a combined phenotypic and transcriptomic approach we disclosed a Th1/Th17 phenotype as well as innate and adaptive functions of CD4+CD8+ double-positive T-cells in GPA.

"Candidatus Neoehrlichia chilensis" sp. nov.: Molecular detection and characterization of a novel Anaplasmataceae in wild rodents from Valdivia, southern Chile

This study aimed to screen wild rodents from southern Chile, for the presence of Anaplasmatacea. Spleen samples from 33 wild rodents trapped in Valdivia Province were screened by conventional PCR (cPCR), targeting the Anaplasmataceae 16S rRNA gene (16S). Positive samples were further evaluated, targeting a larger 16S fragment, groEL operon, and gltA gene, followed by sequencing and phylogenetic analysis. Anaplasmataceae DNA was detected in 15% (five of 33) of the tested rodents (Abrothrix sp. [four of five] and Mus musculus [one of five]). Analysis of sequenced products based on the 16S gene revealed high similarity with "Ca. Neoehrlichia mikurensis," "Ca. Neoehrlichia lotoris" and "Ca. Neoehrlichia arcana" (97.8%-98.6%). A lower similarity was observed with Candidatus Neoehrlichia groEL (89.7%-92%) and gltA (79.5%-79.9%) loci. According to the 16SrRNA, groEL and gltA phylogenetic analyses, two closely related genotypes of "Candidatus Neoehrlichia" spp. from Chile were observed, which clustered together in a separate clade from other species in this genus. This study suggests the presence of two genotypes of a novel species of "Candidatus Neoehrlichia," proposed as "Candidatus Neoehrlichia chilensis," circulating in rodents from Chile. This is the first report of "Ca. Neoehrlichia" species in rodents from America.

Saisonale und überregionale Unterschiede der Selenversorgung bei Pferden

Gegenstand und Ziel: Überprüfung der Selenversorgung von Pferden in verschiedenen Ländern Europas. Material und Methoden: In Serumproben von 137152 Pferden aus Europa, die im Zeitraum vom 1.1.2006 bis 31.12.2011 von Tierärzten in das IDEXX Vet Med Labor nach Ludwigsburg eingesandt wurden, erfolgte eine routinemäßige Bestimmung der Selenkonzentration mittels ICP-Analytik. Ergebnisse: Die Selengehalte im Boden scheinen für die Selenversorgung zentrale Bedeutung zu besitzen. In Ländern, die in Ozeannähe liegen, besteht durch den Seleneintrag eine bessere Selenversorgung der Pferdepopulation als in zentraleuropäischen Ländern. Dänemark und die Niederlande stehen in der Selenversorgung an erster Stelle. Die schlechteste Selenversorgung in Europa zeigen die Länder Österreich und Luxemburg. In fast allen Ländern lassen sich große regionale Unterschiede nachweisen. Besonders in Deutschland besteht vor allem ein West-Ost-Gefälle in der Selenversorgung. Das Nord-Süd-Gefälle ist weniger ausgeprägt, wie die Selengehalte im Boden zeigen. Eine sehr schlechte Selenversorgung findet sich in den Zentralgebieten Österreichs mit einer Unterversorgung von über 50%. Schlussfolgerung und klinische Relevanz: Die individuelle Pferdehaltung und -versorgung spielt für die Selenversorgung eine große Rolle. Da die Selenkonzentration in der Grundfutterration sehr stark schwankt und Spurenelementanalysen des Grundfutters meist nicht durchgeführt werden, gestaltet sich die Anpassung der Mineralfuttergabe für Selen oft sehr schwierig. Daher wird eine jährliche Kontrolle des Selengehalts im Serum empfohlen. Bei Pferden mit niedrigen Selenwerten kann die Unterversorgung durch Gaben von selenhaltigem Zusatz-/Mineralfutter behoben werden.

Saisonale und überregionale Unterschiede im Selenversorgungsstatus von Rindern

Gegenstand und Ziel: Überprüfung des Selenversorgungsstatus von Rindern in verschiedenen Ländern Europas. Material und Methode: In 35 722 Serumproben von Rindern aus Europa mit unbekannter klinischer Symptomatik, die im Zeitraum vom 1.1.2006 bis 30.06.2013 von Tierärzten in das IDEXX Vet Med Labor nach Ludwigsburg eingesandt wurden, erfolgte eine routinemäßige Bestimmung der Selenkonzentration mittels ICP-Analytik. Ergebnisse: Die Selenversorgung bei Rindern zeigt saisonale Unterschiede mit hohen Serumkonzentrationen im Winter und niedrigen Serumgehalten im Sommer sowie einen generellen Trend zur Verschlechterung der Selenversorgung über die letzten Jahre. Die Betriebsgröße, die Haltungsform, die allgemeine wirtschaftliche Lage und der Selengehalt im Boden sowie die länderspezifische Fütterung scheinen für die Selenversorgung von zentraler Bedeutung zu sein. Ungarn und die skandinavischen Länder Schweden und Dänemark sind in der Selenversorgung weit führend. Die schlechteste Versorgungslage besteht in Frankreich und Luxemburg (> 50%) der beprobten Rinder im unterversorgten Bereich). Schlussfolgerung und klinische Relevanz: Eine optimale Selenversorgung ist im Rinderbereich sehr wichtig, da durch Mangelerscheinungen gesundheitliche Probleme und Leistungsbeeinträchtigungen (Milchleistung) entstehen. Die Selenkonzentration schwankt je nach Fütterungsart und Haltungsbedingungen sehr stark, sodass eine jährliche Kontrolle der Selenversorgung in den Herden empfohlen wird.

Evaluation eines neuen elektronischen Handmess geräts zur Messung von β-Hydroxybutyrat bei Milchkühen

Gegenstand und Ziel: Die subklinische Ketose (SCK), eine weitverbreitete Stoffwechselkrankheit frischlaktierender Milchkühe, ist definiert durch das Auftreten erhöhter Mengen zirkulierender Ketonkörper bei Fehlen klinischer Symptome. Daher beschränken sich die Möglichkeiten der Diagnostik auf den Nachweis dieser Ketonkörper in verschiedenen Körperflüssigkeiten. Ziel der Studie war die Evaluation eines neuen elektronischen mobilen Messgeräts (NovaVet) zur Messung von β-Hydroxybutyrat (BHB) im Nativblut von Milchkühen. Material und Methoden: Anhand von Blutproben von 155 laktierenden Milchkühen erfolgte ein Vergleich zwischen den mit dem Gerät ermittelten und den in einem kommerziellen Labor gemessenen BHB-Konzentrationen. Zur Auswertung wurden der Rangkorrelationskoeffizient nach Spearman bestimmt, ein Wilcoxon-Test durchgeführt und die gepaarten Messwerte nach Bland und Altman graphisch dargestellt. Ferner wurden für das Gerät spezifische BHB-Grenzwerte im Vergleich zu international anerkannten Grenzwerten zur Diagnose einer SCK mithilfe einer Receiver-Operating-Characteristic(ROC)-Analyse ermittelt und die entsprechenden Testcharakteristika bestimmt. Ergebnisse: Zwischen den vom Gerät und den im Labor gemessenen BHB-Konzentrationen bestand eine hohe Korrelation (rs = 0,87; p < 0,05). Die vom Gerät (Median 1,0 mmol/l; Interquartilsabstand [IQR] 0,7–1,3 mmol/l) und im Labor (Median 0,9 mmol/l; IQR 0,7–1,1 mmol/l) gemessenen BHB-Konzentrationen differierten (Median 0,0 mmol/l; IQR –0,1 bis 0,2 mmol/l; p < 0,05). Mit dem Gerät konnte eine SCK bei einem Grenzwert von 1,2 mmol/l BHB mit einer Sensitivität von 97% und einer Spezifität von 82% diagnostiziert werden. Als Goldstandard diente der Laborwert. Schlussfolgerung und klinische Relevanz: Das BHB-Messgerät zeigte eine gute Übereinstimmung mit dem Labor und gute Testeigenschaften. Seine geringfügige Messabweichung im Vergleich zum Labor kann unter praktischen Bedingungen vernachlässigt werden, doch muss mit einer gewissen Anzahl falsch als erkrankt diagnostizierter Tiere gerechnet werden. Das Gerät kann für die Dia gnostik der SCK beim Rind empfohlen werden.