TC-PTP regulates the IL-7 transcriptional response during murine early T cell development

Cytokines play a critical role in directing the discrete and gradual transcriptional changes that define T cell development. The interleukin-7 receptor (IL-7R), via its activation of the JAK-STAT pathway, promotes gene programs that change dynamically as cells progress through T cell differentiation. The molecular mechanism(s) directing differential gene expression downstream of the IL-7R are not fully elucidated. Here, we have identified T cell protein tyrosine phosphatase (TC-PTP), also known as PTPN2, as a negative regulator of IL-7R-STAT signaling in T cell progenitors, contributing to both the quantitative and qualitative nature of STAT-gene targeting. Novel genetic strategies used to modulate TC-PTP expression demonstrate that depletion of TC-PTP expression heightens the phosphorylation of STAT family members, causing aberrant expression of an interferon-response gene profile. Such molecular re-programming results in deregulation of early development checkpoints culminating in inefficient differentiation of CD4⁺CD8⁺ double positive cells. TC-PTP is therefore shown to be required to safeguard the dynamic transcriptome necessary for efficient T cell differentiation.

Establishment of cell line with NK/NKT phenotype from myeloid NK cell acute leukemia

Acute Myeloid Leukemia (AML) is the most common malignancy in adults with a 5-year survival rate of 27% of the total affected population. For effective treatment and new drug discovery, cell lines are considered as a very important tool. Here we report an establishment of a continuous human cell line AML-004 with a hypo-diploid chromosome 44 and presence of both NK/NKT phenotypes. The cell line was isolated from the blood sample of myeloid NK cell acute leukemia patients and extensively characterized by flow cytometery, morphology, and cytogentic analysis. Cytotoxicity by standard chemotherapeutic drugs was also examined. As characterized by Giemsa staining, the predominant cell type in the culture had high nuclear/cytoplasmic ratio. Cytogenetic analysis revealed high chromosome instability and structural abnormalities confirming the source of cell line from a patient with AML. The karyotype of the isolated cells did not alter up to around 40 passages. These AML-004 cells lacked specific markers for B and T lymphoid cells, but expressed surface receptors for lymphoid/NK cells. Cells also lacked the presence of early progenitors. The proliferation of the isolated cells was inversely proportional to the IL-2 concentration confirming presence of NK phenotype. AML-004 was resistant against standard chemotherapeutic drugs excluding cisplatin. Thus, AML-004 cells provide a continuous source of human cells for designing novel therapies for patients with T-lymphoblastic leukemia/lymphoma.

Concomitant transfemoral transcatheter aortic and mitral valve-in-valve replacement

The valve-in-valve (viv) procedure has been shown to be effective in treating patients with a degenerated bioprosthesis who are also considered high risk or inoperable for a reoperation. We describe a case of concomitant transfemoral transcatheter viv aortic and mitral valve replacements.

Abstract 182: Heart Transplantation Patients in the Medicare Population: Outcomes, Costs and Readmission Rates

Objective: The average age of heart transplant recipients in the United States has been increasing over the past decade. The effect of age on outcomes following heart transplantation, including cost and readmission has yet to be thoroughly evaluated.

Methods: All Medicare fee-for-service patients undergoing heart transplantation between 2008 and 2013 were included in the study. Denominator files were used to collect patient demographics and mortality. Kaplan-Meier survival estimates and Cox Proportional Hazards models were used for overall survival analysis.

Results: A total of 4431 heart transplant patients were included in this study. Patients were broken down into categories of age <60, 60-69, and >70. Patients >70 were more likely to be male, white and have CAD and ischemic cardiomyopathy than patients <60. Multivariable cox survival model showed ECMO (HR 9.5, 95% CI 7.7 - 11.6, p < 0.01) and liver disease (HR 1.6 95% CI 1.2 - 2.2, p < 0.01) were associated with increased long-term mortality (p<0.01 and p=0.02, respectively). There was a significant difference in ECMO usage between patient groups with 6% of patents > 70, 4% of patients 60-69, and 3% of patients < 60 requiring ECMO (p=0.05). There was no significance was seen in 30 day mortality rates among between patients > 70 (5%) and patients < 70 years of age (5% ), p=0.83. Additionally, there was no difference between ICU lengths of stay, 30- and 90-day readmission rates (p=1.0 and p=0.72 respectively), and hospital length of stay (p=0.35) (Table 1).

Conclusions: Among Medicare patients undergoing heart transplantation, those over the age of 70 had no difference in terms of survival and cost utilization compared to younger patients. Heart transplantation programs are doing a good job of selecting older patients in order to maintain these outcomes. Age was associated with increased use of ECMO, and ECMO adversely affected long-term survival.

Transcatheter aortic valve replacement for bicuspid aortic stenosis 13years post heart transplant

Despite the widespread use of transcatheter aortic valve replacement (TAVR) for moderate and high-risk patients with severe aortic stenosis, it is utilized less frequently in patients with bicuspid aortic valves (BAV). Orthotopic heart transplant (OHT) donors tend to be younger and may have undiagnosed BAV. We present a case of successful TAVR in a patient with BAV thirteen years after OHT.

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Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality

Type A acute aortic dissection (TAAD) is a disease that has a catastrophic impact on a patient's life and emergent surgery represents a key goal of early treatment. Despite continuous improvements in imaging techniques, medical therapy and surgical management, early mortality in patients undergoing TAAD repair still remains high, ranging from 17% to 26%. In this setting, the International Registry of Acute Aortic Dissection (IRAD), the largest worldwide registry for acute aortic dissection, was established to assess clinical characteristics, management and outcomes of TAAD patients. The present review aimed to evaluate and comment on outcomes of TAAD surgery as reported from IRAD series.

One-Year Clinical Outcomes With SAPIEN 3 Transcatheter Aortic Valve Replacement in High-Risk and Inoperable Patients With Severe Aortic Stenosis

Background:

In the initial PARTNER trial (Placement of Aortic Transcatheter Valves) of transcatheter aortic valve replacement for high-risk (HR) and inoperable patients, mortality at 1 year was 24% in HR and 31% in inoperable patients. A recent report of the 30-day outcomes with the low-profile SAPIEN 3 transcatheter aortic valve replacement system demonstrated very low rates of adverse events, but little is known about the longer-term outcomes with this device.

Methods:

Between October 2013 and September 2014, 583 HR (65%) or inoperable (35%) patients were treated via the transfemoral (84%) or transapical/transaortic (16%) access route at 29 US sites. Major clinical events at 1 year were adjudicated by an independent clinical events committee, and echocardiographic results were analyzed by a core laboratory.

Results:

Baseline characteristics included age of 83 years, 42% female, and median Society of Thoracic Surgeons score of 8.4%. At the 1-year follow-up, survival (all-cause) was 85.6% for all patients, 87.3% in the HR subgroup, and 82.3% in the inoperable subgroup. Survival free of all-cause and cardiovascular mortality in the transfemoral patients from the HR cohort was 87.7% and 93.3%, respectively. There was no severe paravalvular leak. Moderate paravalvular leak (2.7%) was associated with an increase in mortality at 1 year, whereas mild paravalvular leak had no significant association with mortality. Symptomatic improvement as assessed by the percentage of patients in New York Heart Association class III and IV (90.1% to 7.7% at 1 year; P <0.0001) and by Kansas City Cardiomyopathy Questionnaire overall summary score (improved from 46.9 to 72.4; P <0.0001) was marked. Multivariable predictors of 1-year mortality included alternative access, Society of Thoracic Surgeons score, and disabling stroke.

Conclusions:

In this large, adjudicated registry of SAPIEN 3 HR and inoperable patients, the very low rates of important complications resulted in a strikingly low mortality rate at 1 year. Between 30 and 365 days, the incidence of moderate paravalvular aortic regurgitation did not increase, and no association between mild paravalvular leak and 1-year mortality was observed, although a small increase in disabling stroke occurred. These results, which likely reflect device iteration and procedural evolution, support the use of transcatheter aortic valve replacement as the preferred therapy in HR and inoperable patients with aortic stenosis.

Clinical Trial Registration

: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01314313.

New Ventricular Septal Defects Following Balloon-Expandable Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) has been commercially approved in the United States for the treatment of high-risk and inoperable patients with severe symptomatic aortic stenosis. While TAVR has proven benefits with regard to survival and quality of life in studied populations, the procedure is also associated with several well-described complications including stroke, vascular injury, and paravalvular regurgitation. More infrequent complications are less well described. Here, we report the development of new ventricular septal defects after TAVR in 4 patients with left ventricular outflow tract calcification. We discuss imaging and post-TAVR management of these patients.