Fetal hemoglobin regulating genetic variants identified in homozygous (HbSS) and heterozygous (HbSA) subjects from South Mexico

Hemoglobin S is caused by a nucleotide change in HBB gene (HBB:c.20A>T, p.Glu6Val), is presented in diverse forms: simple carriers (HbSA), homozygotes (HbSS) also known as sickle cell anemia, and compound heterozygotes with other β-hemoglobinopathies. It is worldwide distributed, in Mexico, is frequently observed in the southern states Guerrero, Oaxaca and Chiapas. Elevated fetal hemoglobin (HbF) is associated with mild phenotype; single-nucleotide variants (SNVs) in modifier genes, such as BCL11A, HBG2, HBBP1 pseudogene and HBS1L-MYB intergenic region, upregulate HbF synthesis. The aim of this study was to identify HbF regulating genetic variants in HbSS and HbSA Mexican subjects. We studied 39 individuals (HbSS = 24, 61%, HbSA = 15, 39%) from Chiapas (67%) and Guerrero (33%), peripheral blood was collected in ethylenediamine tetraacetic acid (EDTA) for molecular and hematological studies, DNA was isolated by salting-out technic and genotyping was performed through allelic discrimination by real time polymerase chain reaction (RT-PCR) using Taqman® probes for 15 SNV (in BCL11A: rs6706648, rs7557939, rs4671393, rs11886868, rs766432, rs7599488, rs1427407; HBS1L-MYB: rs28384513, rs7776054, rs9399137, rs4895441, rs9402686, rs1320963; HBG2: rs7482144; and HBBP1: rs10128556). The obtained data were analyzed using IMB SPSS v.22.0 software. All minor alleles were observed in frequencies over 0.05, the most frequent was rs9402686 (0.82), while the less frequent was rs101028556 (0.08). In HbSS group, the mean fetal hemoglobin was 11.9 ± 5.9% and was significantly elevated in BCL11A rs11886868 wildtype homozygotes and in carriers of HBS1L-MYB intergenic region rs7776054 (p = 0.04 and p = 0.03, respectively). In conclusion, in HbSS Mexican patients, two SNVs were observed related to increased HbF; BCL11A rs11886868 and HBS1L-MYB rs7776054.

Unsafe abortion in Brazil: a systematic review

Background

In Brazil, abortion is legally allowed in cases of risk to the woman's life, pregnancy resulting from rape and cases of fetal anencephaly. Despite the restrictive legislation, studies estimated that around 1 million abortions took place in the country in 2005. Abortions occurred regardless of womeńs socioeconomic position, race, age and religion, but unsafe practices were more common among young women, with low educational levels, single, students or domestic workers. This study sought to update knowledge on unsafe abortion in Brazil.

Methods

We carried out a systematic review with study search on Medline and LILACS, with no language restriction, from 2008 to 2018. We evaluated article quality using the Joanna Briggs Institute instruments. We evaluated 50 articles.

Results

There was a decrease in the ratio of induced abortions by 1,000 women of reproductive age reaching 16 per 1,000 in 2013. However, direct estimates do not indicate a decrease in the prevalence of induced abortion, estimated to be 13% in 2016. Higher prevalences were observed in more socially vulnerable populations. Half of all women reported using medications for terminating pregnancies and the number of hospital admissions due to complications from abortion decreased from 1992 to 2009. Maternal morbimortality from abortion had a reduced frequency but it is likely that maternal deaths from abortion are under-reported.

Conclusions

Abortion is frequently used in Brazil, especially in less-developed regions and by more socially-vulnerable women. Access to safer methods probably contributed to the reduction of complications, hospitalizations and morbimortality from abortion. However, half of all women still used other unsafe methods and the number of admissions due to complications from abortion is still high. The small scientific production and lack of methodological adequacy led to the development of a special issue on Abortion in Brazil in the jornal Reports in Public Health.

Key messages

Restrictive legislation does not prevent abortion, but limits access to safe abortion and makes it diffiult to prevent morbidity and mortaliity from abortion. Restrictive legislation and the stigma associated with abortion make studies difficult to estimate the rates, complications and factors associated with abortion.

Caveolin isoform expression during differentiation of C6 glioma cells

Caveolae, a specialized form of lipid rafts, are cholesterol- and sphingolipid-rich membrane microdomains implicated in potocytosis, endocytosis, transcytosis, and as platforms for signal transduction. One of the major constituents of caveolae are three highly homologous caveolin isoforms (caveolin-1, caveolin-2, and caveolin-3). The present study expands the analysis of caveolin isoform expression in C6 glioma cells. Three complementary approaches were used to assess their differential expression during the dibutyryl-cyclic AMP-induced differentiation of C6 cells into an astrocyte-like phenotype. Immunoblotting, conventional RT-PCR, and real-time RT-PCR analysis established the expression of the caveolin-3 isoform in C6 cells, in addition to caveolin-1 and caveolin-2. Similar to the other isoforms, caveolin-3 was associated with light-density, detergent-insoluble caveolae membrane fractions obtained using sucrose-density gradient centrifugation. The three caveolin isoforms display different temporal patterns of mRNA/protein expression during the differentiation of C6 cells. Western blot and real-time RT-PCR analysis demonstrate that caveolin-1 and caveolin-2 are up-regulated during the late stages of the differentiation of C6 cells. Meanwhile, caveolin-3 is gradually down-regulated during the differentiation process. Indirect immunofluorescence analysis via laser-scanning confocal microscopy reveals that the three caveolin isoforms display similar subcellular distribution patterns. In addition, co-localization of caveolin-1/caveolin-2 and caveolin-1/caveolin-3 was detected in both C6 glioma phenotypes. The findings reveal a differential temporal pattern of caveolin gene expression during phenotypic differentiation of C6 glioma cells, with potential implications to developmental and degenerative events in the brain.

Characterization of the antitumor activity of a polyantigenic immunomodulator (PAI): II--Involvement of NK cells and adoptive immunotherapy

Natural killer (NK) cell activity and adoptive immunotherapy were used to characterize the anticancerous effect of a polyantigenic immunomodulator (PAI). PAI consists of a mixture of inactivated bacteria and influenza virus in a peanut oil-arlacel A-aluminum monoesterate emulsion, shown previously to have antitumoral activity in mice implanted with Ehrlich's ascites tumor. The administration of PAI, its bacterial or viral component strongly increased the in vitro activity of NK cells of splenocyte populations obtained from Swiss-Webster (allogeneic) and C57BL/6J (syngeneic) mice, specially during the early post-induction period. On the other hand, PAI-sensitized, allogeneic or syngeneic lymphocytes were transferred successfully to tumor-bearing mice implanted with Ehrlich's ascites tumor, reducing tumor growth and increasing survival. The results confirm our previous suggestions that PAI acts probably at the level of cellular immunity. Therefore complex polyantigenic substances such as PAI could be used directly alone, in combination with other immunoadjuvants or to sensitize in a global manner immunocompetent cells to be employed in adoptive immunotherapy.

Deep venous thrombosis in high-risk hemiplegic patients: detection by impedance plethysmography

Clinically significant thromboembolic disease originating from the paralyzed leg of hemiplegic patients can occur unexpectedly and may affect morbidity and mortality in the rehabilitation setting. Impedance plethysmography (IPG), a simple, noninvasive technique, can accurately reveal deep vein thrombosis (DVT) in the large veins of the thigh. IPG studies were performed on the lower extremities of 20 hemiplegic patients considered at high risk for DVT. Each patient had one or several of the following potential risk factors: mild swelling, vague leg discomfort, loss of sensation, poor or absent muscle power at the ankle, at least one week of complete bedrest, repeated minor trauma. None of the patients had major signs or symptoms of DVT at the time of testing (ie, severe pain and tenderness, increased temperature or redness, a palpable venous cord, or positive Homans' sign). Seven patients had an abnormal IPG in the paralyzed lower limb and DVT was confirmed in each case by venography. After appropriate anticoagulation therapy, the seven patients resumed their rehabilitation programs. It was concluded that IPG can be successfully used in the early detection of DVT in high-risk hemiplegic patients, thus leading to prompt medical management, reduced morbidity and mortality, and improved rehabilitation outcome.