MicroRNA-375 sensitizes tumour necrosis factor-alpha (TNF-α)-induced apoptosis in head and neck squamous cell carcinoma in vitro

We investigated the effect of microRNA-375 (miR-375) on tumour necrosis factor-alpha (TNF-α)-induced cell death in head and neck squamous cell carcinoma, and further explored the potential molecular mechanism underlying this phenomenon. Cal27 cells were transfected with miR-375 mimic and subsequently treated with or without TNF-α (10 ng/ml). An additional group of cells were treated with TNF-α alone. The resulting morphological changes were observed, and the percentage of sub-G1 cells was measured. The protein expression and cleavage of caspase 3, caspase 8, and poly(ADP ribose) polymerase (PARP) were determined through Western blotting. The results showed a significant increase in cell death in the combination group, but not in the groups treated with miR-375 mimic, TNF-α alone, or control. The data obtained from sub-G1 cells supported the notion that miR-375 increases the accumulation of sub-G1. In the combination group, the degradation of caspase 3, caspase 8, and PARP was observed and the cleavage of these enzymes was detected. The pan-caspase inhibitor, Z-VAD, inhibited the apoptosis of Cal27 cells treated with a combination of miR-375 mimic and TNF-α. In addition, the apoptosis inhibitory proteins, cFLIP-L and cIAP1, were down-regulated in a time-dependent manner. Taken together, these data suggest that miR-375 sensitizes TNF-α-induced apoptosis, and the reduction in the expression of the apoptosis inhibitory proteins cFLIP-L and cIAP2 plays an important role in this sensitization.

Quercetin and daidzein β-apo-14'-carotenoic acid esters as membrane antioxidants

Esterification by β-apo-14'-carotenoic acid was found to have opposite effects on antioxidant activity of quercetin (at B4', B3' hydroxyl) as of daidzein (at A7 hydroxyl) in phosphatidylcholine liposomes. The daidzein ester had increased activity, while quercetin had a significant decreased activity. Quantum mechanical calculations using density function theory (DFT) indicate a modest decrease in bond dissociation enthalpy, BDE, for (weakest) hydrogen-oxygen phenolic bond in daidzein from 368.4 kJ · mol(- 1) to 367.7 kJ · mol(- 1) compared to a significant increase in quercetin from 329.5 kJ · mol(- 1) to 356.6 kJ · mol(- 1) upon derivatization. These opposite changes in tendency for hydrogen atom transfer from phenolic groups to lipid radicals combined with an increase in A-to-B dihedral angle from 0.0° to 36.4° and in dipole moment from 0.40 D to 6.01 D for quercetin upon derivatization, while less significant for daidzein (36.4°-36.7° and 3.26 D-7.87 D, respectively), together provide a rationale for the opposite effect of esterification on antioxidation.

Molecular signatures of peripheral blood mononuclear cells during chronic interferon-α treatment: relationship with depression and fatigue

BACKGROUND

Interferon-alpha (IFN-α) treatment for infectious disease and cancer causes high rates of depression and fatigue, and has been used to investigate the impact of inflammatory cytokines on brain and behavior. However, little is known about the transcriptional impact of chronic IFN-α on immune cells in vivo and its relationship to IFN-α-induced behavioral changes.

METHOD

Genome-wide transcriptional profiling was performed on peripheral blood mononuclear cells (PBMCs) from 21 patients with chronic hepatitis C virus (HCV) either awaiting IFN-α therapy (n=10) or at 12 weeks of IFN-α treatment (n=11).

RESULTS

Significance analysis of microarray data identified 252 up-regulated and 116 down-regulated gene transcripts. Of the up-regulated genes, 2'-5'-oligoadenylate synthetase 2 (OAS2), a gene linked to chronic fatigue syndrome (CFS), was the only gene that was differentially expressed in patients with IFN-α-induced depression/fatigue, and correlated with depression and fatigue scores at 12 weeks (r=0.80, p=0.003 and r=0.70, p=0.017 respectively). Promoter-based bioinformatic analyses linked IFN-α-related transcriptional alterations to transcription factors involved in myeloid differentiation, IFN-α signaling, activator protein-1 (AP1) and cAMP responsive element binding protein/activation transcription factor (CREB/ATF) pathways, which were derived primarily from monocytes and plasmacytoid dendritic cells. IFN-α-treated patients with high depression/fatigue scores demonstrated up-regulation of genes bearing promoter motifs for transcription factors involved in myeloid differentiation, IFN-α and AP1 signaling, and reduced prevalence of motifs for CREB/ATF, which has been implicated in major depression.

CONCLUSIONS

Depression and fatigue during chronic IFN-α administration were associated with alterations in the expression (OAS2) and transcriptional control (CREB/ATF) of genes linked to behavioral disorders including CFS and major depression, further supporting an immune contribution to these diseases.

Perindopril attenuates renal tubulointerstitium injury by inhibiting scavenger receptor A over-expression in diabetic rats

Scavenger receptor A (SR-A) is the main receptor through which oxidized LDL (oxLDL) and advanced glycation end products get into the cells. The aim of the present study was to investigate the effect of an ACE inhibitor, perindopril, on the expression of SR-A in renal tubulointerstitium of diabetic rats. Diabetes was induced in male Sprague-Dawley rats by injection with streptozotocin. The rats were then randomly divided into 3 groups: normal control group; untreated diabetes mellitus group; and diabetes mellitus group treated with the ACE inhibitor, perindopril. After a 24-week treatment, tubulointerstitial injury index was assessed on Masson's trichrome sections. The number of macrophages and the expression of SR-A protein in renal tubulointerstitium were detected by immunohistochemistry and the expression of SR-A mRNA was detected by RT-PCR. The tubulointerstitial injury index, the number of macrophages and the expression of SR-A mRNA were significantly higher in the diabetes group than the normal control group. Perindopril treatment not only attenuated the tubulointerstitial injury and the macrophages infiltration but also reduced the overexpression of SR-A mRNA in diabetic rats. The expression of SR-A protein was most obvious in renal tubulointerstitium in diabetic rats, which was attenuated by perindopril treatment. The findings of the present study indicate that perindopril may have renoprotective effects of diabetic nephropathy via inhibiting the expression of SR-A in renal tubulointerstitium.

Arctigenin, a natural compound, activates AMP-activated protein kinase via inhibition of mitochondria complex I and ameliorates metabolic disorders in ob/ob mice

AIMS/HYPOTHESIS

Arctigenin is a natural compound that had never been previously demonstrated to have a glucose-lowering effect. Here it was found to activate AMP-activated protein kinase (AMPK), and the mechanism by which this occurred, as well as the effects on glucose and lipid metabolism were investigated.

METHODS

2-Deoxyglucose uptake and AMPK phosphorylation were examined in L6 myotubes and isolated skeletal muscle. Gluconeogenesis and lipid synthesis were evaluated in rat primary hepatocytes. The acute and chronic effects of arctigenin on metabolic abnormalities were observed in C57BL/6J and ob/ob mice. Changes in mitochondrial membrane potential were measured using the J-aggregate-forming dye, JC-1. Analysis of respiration of L6 myotubes or isolated mitochondria was conducted in a channel oxygen system.

RESULTS

Arctigenin increased AMPK phosphorylation and stimulated glucose uptake in L6 myotubes and isolated skeletal muscles. In primary hepatocytes, it decreased gluconeogenesis and lipid synthesis. The enhancement of glucose uptake and suppression of hepatic gluconeogenesis and lipid synthesis by arctigenin were prevented by blockade of AMPK activation. The respiration of L6 myotubes or isolated mitochondria was inhibited by arctigenin with a specific effect on respiratory complex I. A single oral dose of arctigenin reduced gluconeogenesis in C57BL/6J mice. Chronic oral administration of arctigenin lowered blood glucose and improved lipid metabolism in ob/ob mice.

CONCLUSIONS/INTERPRETATION

This study demonstrates a new role for arctigenin as a potent indirect activator of AMPK via inhibition of respiratory complex I, with beneficial effects on metabolic disorders in ob/ob mice. This highlights the potential value of arctigenin as a possible treatment of type 2 diabetes.

Surfactant protein D inhibits lipopolysaccharide-induced monocyte chemoattractant protein-1 expression in human renal tubular epithelial cells: implication for tubulointerstitial fibrosis

Surfactant protein D (SP-D), a member of the C-type lectin (collectin) protein family, plays a critical role in innate host defence against various microbial pathogens and in the modulation of inflammatory responses in the lung. However, little is known about its expression and biological function in the kidney. In this work, we studied SP-D expression in human kidney and cultured human renal proximal tubular epithelial cells (HK-2), and examined the effect of SP-D on proinflammatory cytokine production after lipopolysaccharide (LPS) stimulus. We observed the expression of both SP-D mRNA and protein in human kidney and in-vitro HK-2 cells by immunohistochemistry, Western blot analysis, reverse transcription-polymerase chain reaction (RT-PCR) and real-time PCR. To explore the potential role of SP-D in the pathogenesis of tubulointerstitial fibrosis in kidney infection, we examined the production of monocyte chemoattractant protein-1 (MCP-1) in HK-2 cells after LPS treatment. Results showed that the level of MCP-1 in the conditioned medium increased significantly when HK-2 cells were cultured with LPS (>0·1 µg/ml) for 8 h. Of interest, LPS treatment inhibited SP-D expression in HK-2 cells. Furthermore, over-expression of SP-D reduced significantly the LPS-induced expression of MCP-1 in transfected cells. These findings suggest that SP-D in the kidney functions as an anti-inflammatory factor in renal tubular epithelial cells and may modulate tubulointerstitial fibrosis in kidney.

Pentoxifylline as a rescue treatment for DMD: a randomized double-blind clinical trial

OBJECTIVE

To determine whether pentoxifylline (PTX) slows the decline of muscle strength and function in ambulatory boys with Duchenne muscular dystrophy (DMD).

METHODS

This was a multicenter, randomized, double-blinded, controlled trial comparing 12 months of daily treatment with PTX or placebo in corticosteroid-treated boys with DMD using a slow-release PTX formulation (~20 mg/kg/day). The primary outcome was the change in mean total quantitative muscle testing (QMT) score. Secondary outcomes included changes in QMT subscales, manual muscle strength, pulmonary function, and timed function tests. Outcomes were compared using Student t tests and a linear mixed-effects model. Adverse events (AEs) were compared using the Fisher exact test.

RESULTS

A total of 64 boys with DMD with a mean age of 9.9 ± 2.9 years were randomly assigned to PTX or placebo in 11 participating Cooperative International Neuromuscular Research Group centers. There was no significant difference between PTX and the placebo group in total QMT scores (p = 0.14) or in most of the secondary outcomes after a 12-month treatment. The use of PTX was associated with mild to moderate gastrointestinal or hematologic AEs.

CONCLUSION

The addition of PTX to corticosteroid-treated boys with DMD at a moderate to late ambulatory stage of disease did not improve or halt the deterioration of muscle strength and function over a 12-month study period.

CLASSIFICATION OF EVIDENCE

This study provides Class I evidence that treatment with PTX does not prevent deterioration in muscle function or strength in corticosteroid-treated boys with DMD.

Randomized, blinded trial of weekend vs daily prednisone in Duchenne muscular dystrophy

OBJECTIVE

To perform a double-blind, randomized study comparing efficacy and safety of daily and weekend prednisone in boys with Duchenne muscular dystrophy (DMD).

METHODS

A total of 64 boys with DMD who were between 4 and 10 years of age were randomized at 1 of 12 centers of the Cooperative International Neuromuscular Research Group. Efficacy and safety of 2 prednisone schedules (daily 0.75 mg/kg/day and weekend 10 mg/kg/wk) were evaluated over 12 months.

RESULTS

Equivalence was met for weekend and daily dosing of prednisone for the primary outcomes of quantitative muscle testing (QMT) arm score and QMT leg score. Secondary strength scores for QMT elbow flexors also showed equivalence between the 2 treatment groups. Overall side effect profiles of height and weight, bone density, cataract formation, blood pressure, and behavior, analyzed at 12 months, did not differ between weekend and daily dosing of prednisone.

CONCLUSIONS

Weekend dosing of prednisone is equally beneficial to the standard daily dosing of prednisone. Analysis of side effect profiles demonstrated overall tolerability of both dosing regimens.

CLASSIFICATION OF EVIDENCE

This study provides Class I evidence that weekend prednisone dosing is as safe and effective as daily prednisone in preserving muscle strength and preventing body mass index increases in boys with DMD over a 12-month period.

H63D polymorphism in the hemochromatosis gene is associated with sporadic amyotrophic lateral sclerosis in China

BACKGROUND AND PURPOSE

The H63D polymorphism in the hemochromatosis (HFE) gene has been reported as a risk factor for amyotrophic lateral sclerosis (ALS) in Europe and America, but no data have been reported for Asia. Here, we investigated the possible association between H63D and sporadic ALS (sALS) in a Chinese Han population.

METHODS

A total of 195 individuals with sALS from three centers in China and 405 unrelated healthy controls were recruited. All subjects were genotyped by restriction fragment length polymorphism (RFLP) analysis.

RESULTS

Sporadic ALS was significantly related to the H63D polymorphism in heterozygous carriers (odds ratio 3.10, 95%CI: 1.49-6.47, P=0.002).

CONCLUSIONS

The HFE H63D polymorphism may contribute to the development of sALS in Chinese.

Mapping quantitative trait loci for cytokines in the pig

Increased disease resistance through improved general immune capacity would be beneficial for the welfare and productivity of farm animals. Cytokines are essential diagnostic parameters in veterinary practice. To identify quantitative trait loci (QTL) for cytokine levels in serum in the pig, Interferon-gamma (IFN-γ) and Interleukin 10 (IL-10) levels and the ratio of IFN-γ to IL-10 were measured in a composite pig population, before and after challenge with modified live CSF (classical swine fever) vaccine. Through interval mapping using the variance component approach and the permutation test, 11 QTL (five for IFN-γ, two for IL-10 and four for the ratio of IFN-γ to IL-10) with significance levels of P < 0.10 were identified, of which five were significant at the P < 0.05 level. The most significant QTL (P < 0.01) was found on chromosome 16, with effect on the ratio of IFN-γ to IL-10. Within these QTL regions, a number of known genes were revealed and their potential relationships to the studied traits were discussed. Some of these genes may serve as candidate genes for these traits in swine.

Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: A meta-regression approach

109

Background: The standard of chemotherapy regimens for patients with advanced or metastatic gastric cancer vary and the clinical outcome were heterogeneous in Asian vs. non-Asian countries.

Methods: Treatment group-based meta-analysis and meta-regression were performed to analyze results of randomized trials published since 2005 for advanced or metastatic gastric cancer patients who received systemic chemotherapy as first-line treatment. Data were extracted and synthesized according to the Cochrane guidelines.

Results: Among the 24 trials (totally 6,502 patients) eligible for meta-analysis, Asian trials reported lower percentage of gastroesophageal junctional carcinoma, higher percentage of diffuse-type histology, and more frequent use of second-line chemotherapy. Meta- regression analyses indicate that, after controlling other patient or treatment factors, Asian trials are associated with 22.7% (95% CI: 19.5-26.0%, p<0.0001) lower incidence of grade 3-4 neutropenia and 3.5% (95% CI: 2.1-4.9%, p<0.0001) lower incidence of grade 3-4 diarrhea, which were the most commonly reported toxicity. The use of high-dose infusional 5-fluorouracil, compared with other fuoropyrimidine regimens, reported 16.6% lower incidence of neutropenia (95% CI: 13.3-19.9%, p<0.0001). Higher percentage of patients with gastroesophageal junction carcinoma and patients with 2 or more organs involved predicted poor progression-free survival. The use of second-line chemotherapy predicts better 1-year overall survival, which will increase by 9% (95% CI: 8-10%) for every 10 percent increase in patients who received second-line chemotherapy.

Conclusions: Geographic region (Asian vs. non-Asian) plays an important role in the heterogeneity of gastric cancer clinical trials and is an independent predictor of safety in systemic therapy for gastric cancer.

No significant financial relationships to disclose.

Next-generation small RNA sequencing for microRNAs profiling in the honey bee Apis mellifera

MicroRNAs (miRNAs) are key regulators in various physiological and pathological processes via post-transcriptional regulation of gene expression. The honey bee (Apis mellifera) is a key model for highly social species, and its complex social behaviour can be interpreted theoretically as changes in gene regulation, in which miRNAs are thought to be involved. We used the SOLiD sequencing system to identify the repertoire of miRNAs in the honey bee by sequencing a mixed small RNA library from different developmental stages. We obtained a total of 36,796,459 raw sequences; of which 5,491,100 short sequences were fragments of mRNA and other noncoding RNAs (ncRNA), and 1,759,346 reads mapped to the known miRNAs. We predicted 267 novel honey bee miRNAs representing 380,182 short reads, including eight miRNAs of other insects in 14,107,583 genome-mapped sequences. We verified 50 of them using stem-loop reverse-transcription PCR (RT-PCR), in which 35 yielded PCR products. Cross-species analyses showed 81 novel miRNAs with homologues in other insects, suggesting that they were authentic miRNAs and have similar functions. The results of this study provide a basis for studies of the miRNA-modulating networks in development and some intriguing phenomena such as caste differentiation in A. mellifera.

The molecular characteristics of cefepime-susceptible Escherichia coli and Klebsiella spp. isolates with a positive β-lactamase screening test result but negative confirmation

A negative extended-spectrum β-lactamase (ESBL) phenotypic confirmation test result obtained after a positive ESBL screening test result but which was cefepime-susceptible (NCPSCS) using the Clinical and Laboratory Standards Institute (CLSI) methods has been observed among isolates of Escherichia coli and Klebsiella spp. in the antimicrobial surveillance program in Shanghai, China. Among isolates collected from Huashan Hospital in 2005, NCPSCS strains were observed in 2.5% of 433 E. coli isolates and in 1.2% of 562 Klebsiella spp. isolates. We then selected 11 E. coli isolates and seven Klebsiella spp. NCPSCS isolates. Transmission electron microscopy (TEM), SHV, plasmid-borne AmpC, and CTX-M type ESBL genes were detected by the polymerase chain reaction (PCR) method. We found that all except two K. pneumoniae strains of NCPSCS isolates producing ESBL and AmpC harbored a plasmid-borne CMY-2 or DHA-1 type AmpC enzyme. The majority of NCPSCS E. coli and K. pneumoniae strains from Shanghai harbor plasmid-borne AmpC enzyme, and we recommend that, when NCPSCS strains are identified, further work such as the PCR detection of ESBL genes is necessary to determine whether they will produce ESBLs. The ESBL-positive strains should be reported as resistant to cefepime according to the CLSI guidelines.

Effect of hyperoxic resuscitation on propensity of germinal matrix haemorrhage and cerebral injury

AIMS

Intraventricular haemorrhage (IVH) and cerebral injury are major neurological disorders of premature infants. The effect of hyperoxic resuscitation on the occurrence of IVH and cerebral injury is elusive. Therefore, we asked whether hyperoxia during neonatal resuscitation increased the incidence and severity of IVH and cerebral injury in premature newborns.

METHODS

Premature rabbit pups, delivered by C-section, were sequentially assigned to receive 100%, 40% or 21% oxygen for 15 or 60 min at birth. The pups were treated with intraperitoneal glycerol at 24-h postnatal age to determine the incidence and severity of glycerol-induced IVH. Vascular endothelial growth factor and angiopoietin-2 genes and protein expression, endothelial proliferation as well as free radical levels and antioxidants were assessed in the germinal matrix, white matter and cortex of pups exposed to 100% oxygen and to 21% oxygen.

RESULTS

Exposure with 100% oxygen for 1 h did not adversely exacerbate the incidence of glycerol-induced IVH in premature rabbit pups. Compared with room air, 100% oxygen enhanced mRNA expression of both vascular endothelial growth factor and angiopoietin-2 as well as reactive oxygen species levels in the germinal matrix. Hyperoxia did not affect endothelial proliferation, apoptosis or neuronal degeneration in the forebrain.

CONCLUSION

Our data suggest that 100% oxygen exposure for 1 h does not increase the risk of IVH or cerebral injury in premature rabbit pups. Although extrapolating rabbit neural developmental data into humans has obvious limitations, we speculate that hyperoxia of short duration at birth in premature infants may not result in major neurological adverse effects.

Quality of life in advanced non-small cell lung cancer patients receiving first-line gefitinib monotherapy

9614

Background: Gefitinib is a potential first-line treatment option for patients with advanced non-small cell lung cancer (NSCLC), especially for patients with activating mutations in the EGFR gene. However, little is known about patient-reported health-related quality of life (HRQOL) in this patient population. The aims of this study were to explore the prognostic values of baseline HRQOL for time-to-treatment failure (TTF), as well as the predictors of repeatedly measured posttreatment HRQOL, in advanced NSCLC patients receiving first-line gefitinib. Methods: A total of 106 chemonaive patients with advanced NSCLC were enrolled in a phase II trial. Gefitinib was given at a dose of 250 mg/d. HRQOL was assessed monthly with the EuroQoL instrument (EQ-5D) and the Lung Cancer Symptom Scale (LCSS) questionnaire. Baseline HRQOL and clinical/molecular predictors of TTF were jointly examined by multiple Cox's proportional hazards model. The associations between the clinical/molecular factors and repeatedly measured posttreatment HRQOL were analyzed by fitting marginal linear regression model using the generalized estimating equations (GEE) method. Results: In this prospective study, HRQOL data were obtained from 94 patients. Baseline EQ-5D index (estimated hazard ratio = 0.286, 95% C.I.: 0.135–0.603, p = 0.001) and the presence of L858R EGFR mutation in adenocarcinoma (estimated hazard ratio = 0.520, 95% C.I.: 0.307–0.880, p = 0.015) were retained as independent prognostic factors in the final multiple Cox's proportional hazards model for TTF. According to preliminary GEE analysis of repeatedly measured posttreatment HRQOL, the patients with wild-type EGFR consistently had worse HRQOL in EQ-5D index (p < 0.0001), EQ-5D VAS score (p = 0.0002), and LCSS global score (p < 0.0001), respectively. Conclusions: In advanced NSCLC patients receiving first-line gefitinib, better baseline EQ-5D index and L858R EGFR mutation in adenocarcinoma predict longer TTF. In addition, patients with wild-type EGFR had worse posttreatment HRQOL.

No significant financial relationships to disclose.

A phase I trial of intratumoral administration of recombinant oncolytic adenovirus overexpressing HSP70 in advanced solid tumor patients

Our pre-clinical studies demonstrated that intratumoral vaccination with a recombinant oncolytic type 2 adenovirus overexpressing the heat shock protein (HSP)70 protein, designated as H103, can inhibit primary and metastatic tumors through enhanced oncolytic activity and HSP-mediated immune responses against shared and mutated tumor antigens. In the pre-clinical studies of local H103 administration, no significant toxicity was observed in the animal trials with mice, cavy or rhesus monkeys. A phase I clinical trial of intratumoral injection of H103 was conducted in the patients with advanced solid tumors. A total of 27 patients were injected intratumorally with H103 in a dose-escalation study from a dose of 2.5 x 10(7) to 3.0 x 10(12) viral particles (VPs). The maximum tolerated dose of H103 was not defined. Two patients developed dose-limiting toxicities of grade III fever at the dose of 1.5 x 10(12) VP and transient grade IV thrombocytopenia at the dose of 3.0 x 10(12) VP. The common adverse events were mainly mild to moderate (grade I/II) in nature, including fever, mild injection-site reaction, leucopenia, lymphopenia, thrombocytopenia and hypochromia. The objective response (complete response+partial response) to H103-injected tumors was 11.1% (3/27), and the clinical benefit rate (complete response+partial response+minor response+stable disease) was 48.1%. Interestingly, transient and partial regression of distant, uninjected tumors was observed in three patients. The numbers of immune cells (CD4(+) and CD8(+) T cells, and natural killer cells) were elevated after H103 administration, but without statistical significance. This phase I trial demonstrates that intratumoral administration of H103 can be safely applied to cancer patients and shows promising clinical antitumor activity, warranting a further clinical investigation.

NOD2-expressing bone marrow-derived cells appear to regulate epithelial innate immunity of the transplanted human small intestine

BACKGROUND

Intestinal allograft rejection resembles Crohn's disease clinically and pathologically. An understanding of its mechanism could impact this life-saving procedure, as well as provide insight into the pathophysiology of inflammatory bowel disease. The NOD2 protein has been implicated as a key player in intestinal immune health, as a consequence of the discovery of three polymorphisms linked with Crohn's disease. An investigation was carried out to determine whether epithelial immune function and graft survival were influenced by NOD2 mutations in an intestinal transplant population.

METHODS

The NOD2 genotypes of 34 transplants performed consecutively over the past 3 years were determined. The NOD2 genotypes were related to clinical outcomes and the expression of certain intestinal antimicrobial peptides (AMPs) believed to protect the epithelium.

RESULTS

An unexpectedly high percentage of recipients, 35%, possessed NOD2 polymorphisms, while 8.6% of donors had comparable mutations. The likelihood of allograft failure was about 100-fold higher in recipients with mutant NOD2 alleles compared with recipients with wild-type NOD2 loci. Rejection in NOD2 mutant recipients was characterised by decreased expression of certain Paneth cell and enterocyte AMPs, prior to the onset of epithelial injury and inflammation.

CONCLUSIONS

Crohn's disease-associated polymorphisms in the NOD2 gene in the recipient represent a critical immunological risk factor for intestinal allograft rejection. Compromised epithelial defences precede visible epithelial injury and inflammatory infiltration. The association of impaired epithelial immunity with the recipient's genotype suggests that certain NOD2-expressing cells of haematopoietic origin play a role in the process, perhaps by regulating expression of certain epithelial AMPs within the allograft.