Insulin-like growth factor 1 inversely relates to monocyte/macrophage activation markers in HIV

Effects of Zhuang medicine compound Xiancao Granule on diabetic kidney disease: A multi-omics analysis

ETHNOPHARMACOLOGICAL RELEVANCE

Diabetic kidney disease (DKD) poses a severe threat to human health. Compound Xiancao Granule (CXCG), a classic Zhuang medicinal formula, is reported as highly effective in treating DKD. However, the mechanisms underlying the action of CXCG in DKD remain unclear.

AIM OF THE STUDY

This study aimed to investigate the mechanisms of action of CXCG against DKD using multi-omics analysis, including 16s rRNA sequencing, metabolomics, and transcriptomics.

MATERIALS AND METHODS

The chemical compounds of CXCG were identified using ultra-high- performance liquid chromatography quadrupole/electrostatic field orbital trap high-resolution mass spectrometry analysis. A rat model of DKD was established by combining nephrectomy of the left kidney, high-fat diet, and streptozotocin. The therapeutic effects of CXCG on DKD were assessed based on body weight, blood glucose level, renal function, inflammatory cytokine levels, and histological staining. Subsequently, 16s rRNA sequencing, liquid chromatography-tandem mass spectrometry untargeted metabolomic profiling, and RNA sequencing analysis were used to investigate the mechanisms of action of CXCG in DKD. Spearman's correlation analysis was performed to elucidate the correlations between efficacy indicators, gut microbiota, metabolites, and inflammation-related genes.

RESULTS

A total of 118 compounds were identified in CXCG. CXCG significantly ameliorated glucose metabolism disorders, improved renal function, attenuated inflammation, and delayed renal pathological changes in DKD rats. CXCG modulated gut microbiota dysbiosis, including Alloprevotella, Oscillibacter, Anaeroplasma, Anaerotruncus, and Faecalibacterium. In addition, metabolic disruption in DKD rats was regulated by CXCG, which is involved in the metabolism of carbohydrates and amino acids. Transcriptome analysis showed that CXCG affected DKD mainly by regulating inflammation-related genes and pathways, such as the PI3K/Akt and MAPK signaling pathways. Furthermore, there were significant correlations between efficacy indicators, gut microbiota, metabolites, and genes.

CONCLUSION

This multi-omics association study provides novel insights into the effects of CXCG on DKD by remodeling the gut microbiota structure and restoring the metabolic homeostasis through the regulation of carbohydrate metabolism, amino acid metabolism, and inflammation-related pathways, highlighting a potential therapeutic strategy for DKD.

Identification of immune infiltration and immune-related biomarkers of periprosthetic joint infection

Background

The immune response associated with periprosthetic joint infection (PJI) is an emerging but relatively unexplored topic. The aim of this study was to investigate immune cell infiltration in periprosthetic tissues and identify potential immune-related biomarkers.

Methods

The GSE7103 dataset from the GEO database was selected as the data source. Differentially expressed genes (DEGs) and significant modular genes in weighted correlation network analysis (WGCNA) were identified. Functional enrichment analysis and transcription factor prediction were performed on the overlapping genes. Next, immune-related genes from the ImmPort database were matched. The protein-protein interaction (PPI) analysis was performed to identify hub genes. CIBERSORTx was used to evaluate the immune cell infiltration pattern. Spearman correlation analysis was used to evaluate the relationship between hub genes and immune cells.

Results

A total of 667 DEGs were identified between PJI and control samples, and 1847 PJI-related module genes were obtained in WGCNA. Enrichment analysis revealed that the common genes were mainly enriched in immune and host defense-related terms. TFEC, SPI1, and TWIST2 were the top three transcription factors. Three hub genes, SDC1, MMP9, and IGF1, were identified in the immune-related PPI network. Higher levels of plasma cells, CD4+ memory resting T cells, follicular helper T cells, resting mast cells, and neutrophils were found in the PJI group, while levels of M0 macrophages were lower. Notably, the expression of all three hub genes correlated with the infiltration levels of seven types of immune cells.

Conclusion

The present study revealed immune infiltration signatures in the periprosthetic tissues of PJI patients. SDC1, MMP9, and IGF1 were potential immune-related biomarkers for PJI.

Insulin-like growth factor 1 associated with altered immune responses in preterm infants and pigs

BACKGROUND

Preterm infants show low blood levels of insulin-like growth factor 1 (IGF-1), known to be negatively correlated with Interleukin-6 (IL-6). We hypothesized that circulating IGF-1 is associated with systemic immune-markers following preterm birth and that exogenous IGF-1 supplementation modulates immune development in preterm pigs, used as model for preterm infants.

METHODS

Plasma levels of IGF-1 and 29 inflammatory markers were measured in very preterm infants (n = 221). In preterm pigs, systemic immune development, assessed by in vitro challenge, was compared between IGF-1 treated (2.25 mg/kg/day) and control animals.

RESULTS

Preterm infants with lowest gestational age and birth weight showed the lowest IGF-1 levels, which were correlated not only with IL-6, but a range of immune-markers. IGF-1 supplementation to preterm pigs reduced plasma IL-10 and Interferon-γ (IFN-γ), IL-2 responses to challenge and reduced expression of genes related to Th1 polarization. In vitro addition of IGF-1 (100 ng/mL) further reduced the IL-2 and IFN-γ responses but increased IL-10 response.

CONCLUSIONS

In preterm infants, plasma IGF-1 correlated with several immune markers, while supplementing IGF-1 to preterm pigs tended to reduce Th1 immune responses. Future studies should document whether IGF-1 supplementation to preterm infants affects immune development and sensitivity to infection.

IMPACT

Supplementation of insulin-like growth factor 1 (IGF-1) to preterm infants has been proposed to promote postnatal growth, but its impact on the developing immune system is largely unknown. In a cohort of very preterm infants, low gestational age and birth weight were the primary predictors of low plasma levels of IGF-1, which in turn were associated with plasma immune markers. Meanwhile, in immature preterm pigs, experimental supplementation of IGF-1 reduced Th1-related immune responses in early life. Supplementation of IGF-1 to preterm infants may affect the developing immune system, which needs consideration when evaluating overall impact on neonatal health.

The delicate balance between neurotoxicity and neuroprotection in the context of HIV-1 infection

Human immunodeficiency virus type-1 (HIV-1) causes a spectrum of neurological impairments, termed HIV-associated neurocognitive disorder (HAND), following the infiltration of infected cells into the brain. Even though the implementation of antiretroviral therapy reduced the systemic viral load, the prevalence of HAND remains unchanged and infected patients develop persisting neurological disturbances affecting their quality of life. As a result, HAND have gained importance in basic and clinical researches, warranting the need of developing new adjunctive treatments. Nonetheless, a better understanding of the molecular and cellular mechanisms remains necessary. Several studies consolidated their efforts into elucidating the neurotoxic signaling leading to HAND including the deleterious actions of HIV-1 viral proteins and inflammatory mediators. However, the scope of these studies is not sufficient to address all the complexity related to HAND development. Fewer studies focused on an altered neuroprotective capacity of the brain to respond to HIV-1 infection. Neurotrophic factors are endogenous polyproteins involved in neuronal survival, synaptic plasticity, and neurogenesis. Any defects in the processing or production of these crucial factors might compose a risk factor rendering the brain more vulnerable to neuronal damages. Due to their essential roles, they have been investigated for their diverse interplays with HIV-1 infection. In this review, we present a complete description of the neurotrophic factors involved in HAND. We discuss emerging concepts for their therapeutic applications and summarize the complex mechanisms that down-regulate their production in favor of a neurotoxic environment. For certain factors, we finally address opposing roles that rather lead to increased inflammation.

[Comparison of the effectiveness of oblique lumbar interbody fusion and posterior lumbar interbody fusion for treatment of Cage dislodgement after lumbar surgery]

OBJECTIVE

To compare the clinical and radiological effectiveness of oblique lumbar interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) in the treatment of Cage dislodgement after lumbar surgery.

METHODS

The clinical data of 40 patients who underwent revision surgery due to Cage dislodgement after lumbar surgery betweem April 2013 and March 2017 were retrospectively analyzed. Among them, 18 patients underwent OLIF (OLIF group) and 22 patients underwent PLIF (PLIF group) for revision. There was no significant difference between the two groups in age, gender, body mass index, intervals between primary surgery and revision surgery, number of primary fused levels, disc spaces of Cage dislodgement, and visual analogue scale (VAS) scores of low back pain and leg pain, Oswestry disability index (ODI), the segmental lordosis (SL) and disc height (DH) of the disc space of Cage dislodgement, and the lumbar lordosis (LL) before revision ( P>0.05). The operation time, intraoperative blood loss, hospital stay, and complications of the two groups were recorded and compared. The VAS scores of low back pain and leg pain were evaluated at 3 days, 3, 6, and 12 months after operation, and the ODI scores were evaluated at 3, 6, and 12 months after operation. The SL and DH of the disc space of Cage dislodgement and LL were measured at 12 months after operation and compared with those before operation. CT examination was performed at 12 months after operation, and the fusion of the disc space implanted with new Cage was judged by Bridwell grading standard.

RESULTS

The intraoperative blood loss in the OLIF group was significantly less than that in the PLIF group ( t=-12.425, P=0.000); there was no significant difference between the two groups in the operation time and hospital stay ( P>0.05). Both groups were followed up 12-30 months, with an average of 18 months. In the OLIF group, 2 patients (11.1%) had thigh numbness and 1 patient (5.6%) had hip flexor weakness after operation; 2 patients (9.1%) in the PLIF group had intraoperative dural sac tear. The other patients' incisions healed by first intention without early postoperative complications. There was no significant difference in the incidence of complications between the two groups ( χ 2=0.519, P=0.642). The VAS scores of low back pain and leg pain, and the ODI score of the two groups at each time point after operation were significantly improved when compared with those before operation ( P<0.05); there was no significant difference between the two groups at each time point after operation ( P>0.05). At 12 months after operation, SL, LL, and DH in the two groups were significantly increased when compared with preoperative ones ( P<0.05); SL and DH in the OLIF group were significantly improved when compared with those in the PLIF group ( P<0.05), and there was no significant difference in LL between the two groups ( P>0.05). CT examination at 12 months after operation showed that all the operated disc spaces achieved bony fusion. According to the Bridwell grading standard, 12 cases were grade Ⅰ and 6 cases were grade Ⅱ in the OLIF group, and 13 cases were grade Ⅰ and 9 cases were grade Ⅱ in the PLIF group; there was no significant difference between the two groups ( Z=-0.486, P=0.627). During follow-up, neither re-displacement or sinking of Cage, nor loosening or fracture of internal fixation occurred.

CONCLUSION

OLIF and PLIF can achieve similar effectiveness in the treatment of Cage dislodgement after lumbar surgery. OLIF can further reduce intraoperative blood loss and restore the SL and DH of the disc space of Cage dislodgement better.

[Comparative study of microendoscope-assisted and conventional minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar diseases]

OBJECTIVE

To analyze the medium and long-term effectiveness of microendoscope-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases in comparison with conventional tubular retractor-assisted MIS-TLIF.

METHODS

Between November 2008 and March 2013, 53 patients with single segment lumbar degenerative diseases were enrolled. According to the different working channel performed, 28 patients were treated by microendoscope-assisted MIS-TLIF (observation group), while the remaining cases received conventional tubular retractor-assisted MIS-TLIF via Wiltse approach (control group). Preoperative baseline data, including age, gender, body mass index, disease etiology, operated level, the ration for requiring bilateral canal decompression, and preoperative visual analogue scale (VAS) socre of low back pain and leg pain, Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI) score, showed no significant difference between the two groups ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy time, postoperative analgesic drug dose, postoperation in-bed time, and perioperative complication incidence were recorded respectively and compared between the two groups. Radiographic evaluation of interbody fusion was performed based on Bridwell grading system at 2 years after operation. VAS scores of low back pain and leg pain, JOA score, and ODI score were assessed before operation, at 2 years after operation, and at last follow-up respectively. Surgical outcome satisfaction was assessed by modified MacNab criteria at last follow-up.

RESULTS

When compared with those in control group, both intraoperative blood loss and postoperative analgesic drug dose were significantly decreased in observation group ( P<0.05); similarly, the operation time and intraoperative fluoroscopy time were also significantly increased in observation group ( P<0.05). There was no significant difference of postoperative in-bed time between the two groups ( t=-0.812, P=0.420). Both groups were followed up 6-10.3 years, with an average of 7.9 years. Regarding perioperative complication, its incidence was 14.3% and 20.0% in observation group and control group, respectively, showing no significant difference between both groups ( χ 2=0.306, P=0.580). Specifically, there were intraspinal hematoma formation in 1 case, incision infection in 1 case, urinary infection in 1 case, transient delirium in 1 case in observation group. By contrast, there were dural tear and cerebrospinal fluid leakage in 1 case, urinary infection in 1 case, pneumonia in 1 case, transient delirium in 2 cases in control group. Bridwell criterion was used to judge the intervertebral fusion at 2 years after operation, the fusion rates of observation group and control group were 92.9% and 92.0%, respectively, showing no significant difference ( χ 2=0.162, P=0.687). At both 2-year postoperatively and last follow-up, the VAS scores of low back pain and leg pain, JOA score, and ODI score were significantly improved when compared with those before operation ( P<0.01), whereas no significant difference between the two groups at either time point was found ( P>0.05). At last follow-up, the results of patients' satisfaction with surgery evaluated by modified MacNab criteria, and the excellent and good rates of the observation group and the control group were 96.4% and 92.0%, respectively, showing no significant difference ( χ 2=0.485, P=0.486).

CONCLUSION

The medium and long-term effectiveness of microendoscope-assisted MIS-TLIF are similar to those of conventional tubular retractor-assisted MIS-TLIF for lumbar degenerative diseases. The former operation has the additional advantages in terms of more clear surgical site visually, less intraoperative blood loss, and reduced postoperative analgesic dose, all of which seem more feasible to clinical teaching.

[Application of modified direction-changeable lumbar Cage in transforaminal lumbar interbody fusion]

OBJECTIVE

To investigate the effectiveness of modified direction-changeable lumbar Cage in transforaminal lumbar interbody fusion (TLIF).

METHODS

A retrospective analysis was made of 161 patients with single segment L 4 or L 5 isthmic spondylolisthesis treated between January 2013 and December 2015. According to the implantation of Cage, they were divided into trial group (85 cases, modified direction-changeable lumbar Cage implanted in TLIF) and control group (76 cases, traditional nondirection-changeable Cage implanted in TLIF). There was no significant difference in the general data of gender, age, disease duration, slippage segment, and slippage grade between the two groups ( P>0.05). The intraoperative implantation time of Cage, Cage position adjustments times, fluoroscopy times during implantation of Cage, fluoroscopy exposure time, and total operation time were recorded and compared between the two groups. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate the effectiveness of the patients before operation, and at 3, 6, and 12 months after operation, and the incidence of complications was recorded and analyzed. CT examinations were performed at 6 and 12 months after operation, and lumbar fusion was evaluated by Bridwell criteria.

RESULTS

The intraoperative implantation time of Cage, Cage position adjustments times, fluoroscopy times during implantation of Cage, fluoroscopy exposure time, and total operation time in trial group were significant less than those in control group ( P<0.05). All the 161 patients were followed up 12-18 months (mean, 14.3 months). There was 1 case of dural sac tear in the trial group and 1 case of superficial infection in the control group; no complication such as dural tear and infection occurred in other patients. The fusion rate was 76.5% (64/85) in the trial group and 57.9% (44/76) in the control group at 6 months after operation, showing significant difference ( χ 2=6.44, P=0.02); at 12 months after operation, the fusion rate was 96.5% (82/85) in the trial group and 90.8% (69/76) in the control group (including 3 cases of Cage displacement and 4 cases of screw breakage), showing no significant difference in the fusion rate between the two groups ( χ 2=1.54, P=0.26). The VAS and ODI scores of the two groups decreased gradually at 3, 6, and 12 months after operation, and improved significantly when compared with those before operation ( P<0.05). There was no significant difference in VAS and ODI scores between the two groups before and after operation ( P>0.05).

CONCLUSION

Both Cages can obtain the similar effectiveness. The modified direction-changeable lumbar Cage can significantly reduce the fluoroscopy times and radiation dose during TLIF, shorten the operation time, and effectively reduce the radiation exposure of patients and medical staff.

[Effectiveness of nano-hydroxyapatite/polyamide-66 Cage in interbody fusion for degenerative lumbar scoliosis]

Objective

To explore the effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) Cage in interbody fusion for degenerative lumbar scoliosis.

Methods

A retrospective analysis was designed and conducted for 43 patients, who underwent posterior decompression and n-HA/PA66 Cage interbody fusion with correction of deformity between January 2013 and June 2016. Eighteen cases were single-level fusion (single-level group) and 25 cases were double-level fusion (double-level group). There was no significant difference in gender, age, body mass index, direction of convex, degree of apical rotation, fusion level, the number of osteoporotic patients, pre-operative intervertebral height of fusion segments, coronal Cobb angle, visual analogue score (VAS), and modified Oswestry Disability Index (ODI) between 2 groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospital stay, and complications of the operation were recorded. Modified ODI, VAS score, and MacNab criteria were adopted to assess clinical outcomes. Radiographic indexes, including intervertebral height of fusion segments, coronal Cobb angle, disc insertion depth, and the bone graft fusion rate, were also evaluated.

Results

There was no significant difference in operation time, intraoperative blood loss, postoperative drainage, and hospital stay between 2 groups ( P>0.05). All patients were followed up 18-62 months (mean, 30.9 months). Wound complications, postoperative delirium, and Cage retropulsion occurred in 4 cases (2 cases in single-level group, 2 cases in double-level group), 1 case of single-level group, and 1 case of double-level group, respectively. The intervertebral height of fusion segments after operation significantly improved compared with preoperative ones in both groups ( P<0.05). At last follow-up, the intervertebral height in double-level group was superior to which in single-level group ( P<0.05). The coronal Cobb angles after operation significantly improved compared with preoperative ones ( P<0.05), and no significant difference was found between 2 groups at each time point ( P>0.05). The disc insertion depth showed no significant difference between different time points after operation in 2 groups ( P>0.05) and between 2 groups at each time point after operation ( P>0.05). Bony fusion was obtained in all patients at last follow-up. The VAS score and modified ODI after operation in both groups were superior to those before operation ( P<0.05). The VAS score in double-level group was higher than that in single-level group ( P<0.05) at last follow-up, and no significant difference was found in VAS score and modified ODI between 2 groups at other time points ( P>0.05). According to the MacNab criteria, the excellent and good rates at last follow-up were 94.4% and 84.0% in single-level group and double-level group, respectively.

Conclusion

The n-HA/PA66 Cage can effectively restore and maintain the disc height of fusion segment, normal sequence, and biomechanical stability of the spine, and gain favorable effectivenss for degenerative lumbar scoliosis. And double-level fusion is superior to single-level fusion in maintaining disc height of fusion segment.

Caspase-1-associated immune activation in an accelerated SIV-infected rhesus macaque model

In the antiretroviral therapy (ART) era, chronic HIV infection is primarily associated with chronic inflammation driving comorbidities such as cardiovascular disease and neurocognitive impairment. Caspase-1 activation in leukocytes has been documented in HIV infection; however, whether caspase-1 activation and the downstream pro-inflammatory cytokines interleukin-1beta (IL-1β) and interleukin-18 (IL-18) contribute to chronic inflammation in HIV comorbidities remains undetermined. The relationship between the caspase-1 cascade and persistent inflammation in HIV has not been investigated. Here, we used an accelerated simian immunodeficiency virus (SIV)-infected rhesus macaque model with or without ART to investigate the dynamics of caspase-1 and immune cell activation before infection, 21 days post infection (dpi), and necropsy. Caspase-1, IL-18, IL-1β, and immune markers were measured both in the circulation and lymphoid tissues. We found a significant increase in caspase-1 and IL-18 in SIV infection that positively correlated with inflammatory monocytes and negatively correlated with CD4⁺ T cell counts. ART attenuated these effects at necropsy in the circulation. Further, lymph nodes from SIV+ or SIV+ART animals had increased activation of caspase-1 and potential upstream priming of the NF-κB pathway, indicating that tissue-specific immune activation persists with ART. Together, these results shed light on the interconnectedness of the caspase-1 pathway and peripheral immune activation and further indicate that ART is not sufficient for suppressing inflammation. The caspase-1 pathway may provide novel therapeutic targets to improve HIV-associated comorbidities and health outcomes in the context of viral suppression.