Substrate mechanical properties bias MSC paracrine activity and therapeutic potential

Mesenchymal stromal cells (MSCs) have significant therapeutic potential due to their ability to differentiate into musculoskeletal lineages suitable for tissue-engineering, as well as the immunomodulatory and pro-regenerative effects of the paracrine factors that these cells secrete. Cues from the extracellular environment, including physical stimuli such as substrate stiffness, are strong drivers of MSC differentiation, but their effects upon MSC paracrine activity are not well understood. This study, therefore sought to determine the impact of substrate stiffness on the paracrine activity of MSCs, analysing both effects on MSC fate and their effect on T-cell and macrophage activity and angiogenesis. The data show that conditioned medium (CM) from MSCs cultured on 0.2 kPa (soft) and 100 kPa (stiff) polyacrylamide hydrogels have differing effects on MSC proliferation and differentiation, with stiff CM promoting proliferation whilst soft CM promoted differentiation. There were also differences in the effects upon macrophage phagocytosis and angiogenesis, with the most beneficial effects from soft CM. Analysis of the media composition identified differences in the levels of proteins including IL-6, OPG, and TIMP-2. Using recombinant proteins and blocking antibodies, we confirmed a role for OPG in modulating MSC proliferation with a complex combination of factors involved in the regulation of MSC differentiation. Together the data confirm that the physical microenvironment has an important influence on the MSC secretome and that this can alter the differentiation and regenerative potential of the cells. These findings can be used to tailor the culture environment for manufacturing potent MSCs for specific clinical applications or to inform the design of biomaterials that enable the retention of MSC activity after delivery into the body. STATEMENT OF SIGNIFICANCE: • MSCs cultured on 100 kPa matrices produce a secretome that boosts MSC proliferation • MSCs cultured on 0.2 kPa matrices produce a secretome that promotes MSC osteogenesis and adipogenesis, as well as angiogenesis and macrophage phagocytosis • IL-6 secretion is elevated in MSCs on 0.2 kPa substrates • OPG, TIMP-2, MCP-1, and sTNFR1 secretion are elevated in MSCs on 100 kPa substrates.

Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update

BACKGROUND

Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.

METHODS

SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey.

RESULTS

The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

Melatonin suppresses nitric oxide production in glial cultures by pro-inflammatory cytokines through p38 MAPK inhibition

Melatonin has been shown to down-regulate inflammatory responses and provide neuroprotection. However, the mechanisms underlying the anti-inflammatory properties of melatonin are poorly understood. In the present work, we studied the modulatory effect of melatonin against pro-inflammatory cytokines in glial cell cultures. Treatment with pro-inflammatory cytokines mainly tumor necrosis factor-alpha, interleukin 1-beta, and interferon-gamma induces an increase in inducible nitric oxide synthase (iNOS) expression and nitric oxide (NO) production. Pre-treatment with melatonin produced an inhibitory effect on iNOS expression and NO production. The biochemical studies revealed that cytokine treatment favors the activation of several pathways, such as mitogen-activated protein kinases (MAPKs), STAT1, and STAT3; however, the anti-inflammatory effect of melatonin was accompanied only by a decrease in p38 MAPK activity. Likewise, SB203580 a p38 kinase inhibitor inhibits NO production. These data indicate that the anti-inflammatory action of melatonin in glial cells after stimulation with pro-inflammatory cytokines may be in part, attributable to p38 inhibition which down-regulates iNOS expression and NO production.

The SHARON process in the treatment of landfill leachate

The purpose of this paper was to study the partial nitrification of the nitrogen present in a landfill leachate applying the SHARON process in order to obtain a suitable effluent to the ANAMMOX process. As a first step, the SHARON reactor was fed anaerobically pre-treated leachate at an ammonium concentration of 2,000 mg N/L (1.1 kg N/m(3) d). In such conditions, the average ammonium and nitrite concentrations in the effluent were 775 mg N/L and 1,225 mg N/L, respectively. During this period the COD removal was very low since most of the biodegradable organic matter was removed in the anaerobic pre-treatment. Afterwards, the SHARON reactor was fed leachate without a previous treatment and the efficiency of the partial nitritation diminished. As well, the COD removal increased, achieving a percentage around 28%.

Effect of phenol on the biological treatment of wastewaters from a resin producing industry

The effect of phenol on the biological treatment of wastewaters from a resin producing industry was analyzed in a pre-denitrification system. First, the effect of phenol overloads on the removal of organic matter and nitrogen compounds was studied. During the overloads (from 250 to 4000 mg/L), phenol was detected in the effluent of the anoxic reactor but the system recovered fast after stopping the overloads. The total organic carbon (TOC) removal remained unchanged during phenol addition (91.9% at 0.20 kg TOC/m3 d), except for the highest overload. With regard to total Kjeldahl nitrogen (TKN), its mean removal (87.9% at 0.08 kg TKN/m3 d) was not affected by the phenol overloads. Afterwards, the effect of different phenol concentrations on the biological treatment of these wastewaters was analyzed. Phenol concentrations from 250 to 4000 mg/L were added to the feed. Phenol was completely removed despite the presence of other carbon sources in the wastewater. In spite of the presence of phenol, a TOC removal around 91.3% was achieved at an average organic loading rate of 0.11 kg TOC/m3 d. The mean applied nitrogen loading rates were 0.05 and 0.08 kg TKN/m3 d, obtaining TKN removals around 85.8% and 87.1%, respectively. Therefore, the biological treatment of wastewaters from a resin producing industry in a pre-denitrification system was not affected by the presence of phenol.

Formaldehyde biodegradation and its effect on the denitrification process

Simultaneous formaldehyde biodegradation and denitrification in batch assays and in a continuous lab-scale reactor were studied. In batch assays, initial biodegradation rates between 0.7 and 3.3 g CKH2O g VSS(-1) d(-1) were obtained at formaldehyde concentrations between 300 and 2150 mg l(-1). The denitrification process was affected by the presence of formaldehyde. The nitrite accumulation increased with the initial formaldehyde concentration. In the continuous reactor, removal efficiencies above 98.5% were obtained at formaldehyde loading rates between 0.37 and 2.96 kg COD m(-3) d(-1) (625-5000 mg CH2O l(-1)). Formaldehyde removal led to the appearance of methanol and formic acid in the medium. Denitrification process was almost complete (around 99.7%) at nitrogen loading rates up to 0.44 kg N-NO3- m(-3) d(-1). Nitrite occasionally appeared in the effluent at concentrations less than 2.9 mg l(-1). The composition of the biogas indicated that denitrification and methanogenesis occurred simultaneously in the same unit.

Partial nitrification of wastewater from an aminoplastic resin producing factory

Nitrification via nitrite was studied in two aerobic reactors treating wastewater from an aminoplastic resin producing factory at HRT varying between 1.37-1.89 and 2.45-3.63 days. Both eactors were fed with concentrations of 366, 450, 1099 and 1899 mg N-NH4+/L. In general in the reactor operated at a lower HRT, the nitritation percentage decreased from 87.2 to 21.6%, while the nitratation percentage remained always lower than 2.5% (except in the last period) when the ammonium concentration was increased. This behaviour could be due to the inhibition of the ammonium and nitrite oxidation produced by high free ammonia concentrations up to 179.3 mg N-NH3/L. In the reactor operated at a higher HRT, the nitritation percentage decreased and the nitratation percentage increased from 88.6 to 39.6% and from 0.65 to 35.7%, respectively, due to an increase of the dissolved oxygen concentration from 0.76 to 1.02 mg O2/L. However, when ammonium was fed at a concentration of 1898.7 mg N-NH4+/L, the nitritation increased and the nitratation decreased, probably as a result of the accumulation of free ammonia up to 2.04 mg N-NH3/L, meaning that nitrite oxidizers were inhibited. Nitrite build-up was observed after each modification of ammonium concentration in the feed.

Biodegradation and effect of formaldehyde and phenol on the denitrification process

Formaldehyde and phenol biodegradation during the denitrification process was studied at lab-scale, first in anoxic batch assays and then in a continuous anoxic reactor. The biodegradation of formaldehyde (260 mgl(-1)) as single carbon source and at phenol concentrations ranging from 30 to 580 mgl(-1) was investigated in batch assays, obtaining an initial biodegradation rate around 0.5g CH(2)OgVSS(-1)d(-1). With regard to phenol, its complete biodegradation was only observed at initial concentrations of 30 and 180 mgl(-1). The denitrification process was inhibited at phenol concentrations higher than 360 mgl(-1). Studies were also done using a continuous anoxic upflow sludge blanket reactor in which formaldehyde removal efficiencies above 99.5% were obtained at all the applied formaldehyde loading rates, between 0.89 and 0.14g COD (CH(2)O)l(-1)d(-1). The phenol loading rate was increased from 0.03 to 1.3g COD (C(6)H(6)O)l(-1)d(-1). Phenol removal efficiencies above 90.6% were obtained at phenol concentrations in the influent between 27 and 755 mgl(-1). However, when the phenol concentration was increased to 1010 mgl(-1), its removal efficiency decreased. Denitrification percentages around 98.4% were obtained with phenol concentrations in the influent up to 755 mgl(-1). After increasing phenol concentration to 1010 mgl(-1), the denitrification percentage decreased because of the inhibition caused by phenol.

[Microepidemics of tuberculosis; apropos of 2 school outbreaks in the area 15 of the Valencia community]

Schools are settings with high concentrations of young people with little exposure to Mycobacterium tuberculosis and greater risk of developing disease when infection occurs as the result of sporadic localized outbreaks. We studied two outbreaks in two elementary schools (A and B) after two cases of bacilliferous pulmonary tuberculosis were detected in teachers in 1990 and 1994. Contacts were trace din school A by the primary care physician and in school B by the pneumologist and public health authorities. Contacts were classified as belonging to the risk group (RG) or the low risk group (LRG). The RG was composed of 187 contacts in school A and 59 in school B. Individuals in the LRG numbered 429 and 116 respectively. Mantoux positives numbered 108 in the RG and 45 in the LRG in school A (p < 0.001). In school B 50 RG individuals and 29 LRG individuals were positive (p < 0.001). The proportion of Mantoux positives was greater in the RG of school B than in the RG of school A (p < 0.01), probably owing to longer time of evolution of disease and possible laryngeal involvement in the index case. Likewise, tuberculin positives were fewer in the LRG of school A than in the LRG of school B (p < 0.001), owing to the small size of the LRG in school A. Thirteen cases of tuberculosis were seen in school A, six of which called for drug prophylaxis after contacts were traced. The nature of the index case and the conditions of exposure are both important in such outbreaks, demonstrating the need to act appropriately to trace contacts, preferably under the supervision of a pneumologists.

Endocarditis caused by Stenotrophomonas maltophilia: case report and review

Stenotrophomonas (Xanthomonas) maltophilia is a rare cause of endocarditis. The extensive resistance of this organism to several antibiotics leaves few options for antimicrobial therapy. In vitro synergism of the combination of trimethoprim-sulfamethoxazole (TMP-SMZ) and ticarcillin/clavulanic acid (TIC/CA) has been demonstrated. To our knowledge, we report the first case of ventriculoatrial cerebrospinal fluid shunt-associated endocarditis due to S. maltophilia. The patient was cured with combination therapy with TMP-SMZ and TIC/CA along with catheter removal. This is also the first report of S. maltophilia endocarditis successfully treated with this antibiotic combination. In a review of the medical literature, only 16 cases of S. maltophilia endocarditis were found. Most patients were intravenous drug users (43.8%) or had either prosthetic heart valves (50%) or an indwelling vascular catheter (18.8%). Although S. maltophilia is usually considered a nosocomial pathogen, about one-half of the cases were community-acquired. Twelve of sixteen patients had left-sided endocarditis. Therapy with a combination of two or more antibiotics was employed in most cases. Seven patients had been given TMP-SMZ therapy, but none had been treated with TIC/CA before. One-half of the patients required cardiac surgery. The overall mortality rate was 33%. Although the optimal antibiotic treatment for S. maltophilia endocarditis remains unknown, the case reported herein reinforces in vitro findings that the combination of TMP-SMZ and TIC/CA may be effective therapy.

Once-a-month administration of intravenous pentamidine to patients infected with human immunodeficiency virus as prophylaxis for Pneumocystis carinii pneumonia

We reviewed the charts of 52 patients infected with human immunodeficiency virus (HIV) who received at least three consecutive doses of intravenous pentamidine as prophylaxis for Pneumocystis carinii infections. Pentamidine isethionate was administered intravenously over 60-90 minutes once a month, at a dosage of 4 mg/kg, in 250 mL of 5% dextrose in water. During 387 months of administration of primary prophylaxis to 37 patients, no cases of P. carinii pneumonia were observed. During 200 months of administration of secondary prophylaxis to 15 patients, only one case of P. carinii pneumonia was diagnosed (6.0 cases per 100 patient-years). Side effects associated with the intravenous pentamidine were mild and did not necessitate withdrawal of the drug. Once-a-month administration of intravenous pentamidine is a valid alternative as prophylaxis for P. carinii pneumonia for patients who are intolerant of sulfonamides.

[Respiratory distress and multiple organ failure after intravesical instillation of BCG]

A case of probable hypersensitivity reaction with multi-organic failure, following bladder installation of BCG, in a male with a diagnosis of bladder carcinoma is presented. The patient developed respiratory, renal and liver failure as well as leukocytosis, thrombopenia and an increase in muscular enzymes. It was resolved with hemodynamic support. The rare complication, occasionally described in medical literature and its probable pathogenic mechanisms are discussed.