Welfare of dairy cows

This Scientific Opinion addresses a European Commission's mandate on the welfare of dairy cows as part of the Farm to Fork strategy. It includes three assessments carried out based on literature reviews and complemented by expert opinion. Assessment 1 describes the most prevalent housing systems for dairy cows in Europe: tie-stalls, cubicle housing, open-bedded systems and systems with access to an outdoor area. Per each system, the scientific opinion describes the distribution in the EU and assesses the main strengths, weaknesses and hazards potentially reducing the welfare of dairy cows. Assessment 2 addresses five welfare consequences as requested in the mandate: locomotory disorders (including lameness), mastitis, restriction of movement and resting problems, inability to perform comfort behaviour and metabolic disorders. Per each welfare consequence, a set of animal-based measures is suggested, a detailed analysis of the prevalence in different housing systems is provided, and subsequently, a comparison of the housing systems is given. Common and specific system-related hazards as well as management-related hazards and respective preventive measures are investigated. Assessment 3 includes an analysis of farm characteristics (e.g. milk yield, herd size) that could be used to classify the level of on-farm welfare. From the available scientific literature, it was not possible to derive relevant associations between available farm data and cow welfare. Therefore, an approach based on expert knowledge elicitation (EKE) was developed. The EKE resulted in the identification of five farm characteristics (more than one cow per cubicle at maximum stocking density, limited space for cows, inappropriate cubicle size, high on-farm mortality and farms with less than 2 months access to pasture). If one or more of these farm characteristics are present, it is recommended to conduct an assessment of cow welfare on the farm in question using animal-based measures for specified welfare consequences.

Immunobullous Transformation of Protracted Psoriasis: A Diagnostic Dilemma

Pemphigus vulgaris is a rare autoimmune disorder, characterised by the development of blistering lesions in the skin and mucosal surfaces throughout the body. It is often misdiagnosed or missed completely in many patients, prolonging their suffering for many years, as it has the ability to mimic an array of other skin diseases. Many studies have concluded that there is a strong association between pemphigus vulgaris and psoriasis, though the exact mechanism is not clearly understood. We present the case of a 77-year-old gentleman on long-term treatment for psoriasis with ultraviolet B phototherapy, steroids, and many other topical treatments who eventually went on to develop pemphigus vulgaris.

The influence of short-term selenitetriglycerides supplementation on blood selenium, and hepatic, renal, metabolic and hematological parameters in dairy cows

Selenium deficiency is a common nutritional disorder in dairy cattle globally. However, selenium supplementation can lead to selenium toxicity. This study evaluated a novel, low-toxicity selenium supplement, selenitetriglycerides, to determine its efficacy and safety in dairy cows. The study was conducted on 12 Holstein Friesian cows divided in two equal groups (control group without supplementation of selenium and experimental group with supplementation of selenitetriglycerides). Experimental cows (n=6) were orally administered 300 mg/cow/day of selenitetriglycerides for 14 days (days 1-14) and then monitored for a further 14 days (days 15-28). Blood from both groups of cows was sampled for determination of selenium concentrations, activity of aspartate aminotransferase, creatine kinase, lactate dehydrogenase, gamma- -glutamyl transferase, concentrations of triglycerides, cholesterol, non-esterified fatty acids, glucose, total protein, urea, creatinine and hematological parameters. Serum selenium concentrations in the experimental group increased significantly on day 2 (from 64.92±6.89 μg/L to 127.95±13.75 μg/L), peaked on day 7 (266.22±14.21 μg/L) and remained significantly above the initial baseline values (day 1) for 28 days. Serum selenium concentrations in the control group did not change significantly during the 28 day period (65.22 μg/L on 1st day and 64,35 μg/L on 28th day) and were significantly lower than those in the experimental group from day 2 to day 28. The results of clinical examinations, analyses of hematological parameters, and liver and kidney function tests showed that selenitetriglycerides had no adverse effect on the health or on the metabolic or haematological statuses of the cows. These findings indicate that selenitetriglycerides are safe and effective selenium supplements for cattle.

Phase I/II open-label trial of intravenous allogeneic mesenchymal stromal cell therapy in adults with recessive dystrophic epidermolysis bullosa

BACKGROUND

Recessive dystrophic epidermolysis bullosa (RDEB) is a hereditary blistering disorder due to a lack of type VII collagen. At present, treatment is mainly supportive.

OBJECTIVES

To determine whether intravenous allogeneic bone marrow-derived mesenchymal stromal/stem cells (BM-MSCs) are safe in RDEB adults and if the cells improve wound healing and quality of life.

METHODS

We conducted a prospective, phase I/II, open-label study recruiting 10 RDEB adults to receive 2 intravenous infusions of BM-MSCs (on day 0 and day 14; each dose 2-4 × 10⁶ cells/kg).

RESULTS

BM-MSCs were well tolerated with no serious adverse events to 12 months. Regarding efficacy, there was a transient reduction in disease activity scores (8/10 subjects) and a significant reduction in itch. One individual showed a transient increase in type VII collagen.

LIMITATIONS

Open-label trial with no placebo.

CONCLUSIONS

MSC infusion is safe in RDEB adults and can have clinical benefits for at least 2 months.

Lichen Planus Pemphigoides Mimicking Toxic Epidermal Necrolysis

Lichen planus pemphigoides (LPP) is an immunobullous disorder characterized by a combination of lesions resembling bullous pemphigoid and lichen planus (LP). Immunofluorescence studies typically show linear deposition of IgG and C3 along the basement membrane zone and circulating antibodies to the hemidesmosome protein BP180 also known as type XVII collagen. It is now recognized that drug-induced linear IgA disease may present with lesions mimicking toxic epidermal necrolysis (TEN). However, to date, there have been no reported cases of LPP presenting with TEN-like lesions. This report describes a 70-year-old woman with LPP who presented with extensive erosions mimicking TEN. This case also highlights the need to consider important etiologies such as drug-induced and paraneoplastic LPP.

The optimal oral biopsy site for diagnosis of mucous membrane pemphigoid and pemphigus vulgaris

BACKGROUND

Accepted 'standard practice' for the diagnosis of immunobullous disease is a perilesional sample for direct immunofluorescence (DIF).

OBJECTIVES

To compare diagnostic outcomes of a normal buccal punch biopsy (NBPB) with a perilesional biopsy (PLB) for mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV).

METHODS

A retrospective analysis of 251 DIF-positive patients with MMP and 77 DIF-positive patients with PV was undertaken. Parameters analysed included the intraoral sites of involvement and histopathological, DIF and indirect immunofluorescence (IIF) findings.

RESULTS

For MMP, PLB was positive in 134 of 143 (93·7%) samples, compared with 129 of 144 (89·6%) by NBPB. The diagnostic sensitivities for PLB (81%, 39 of 48) and NBPB (77%, 37 of 48) among 48 patients who underwent both techniques were not significantly different (P = 0·62). In gingival-only MMP, PLB was positive in 63 of 69 (91%) and NBPB was positive in 63 of 75 (84%). For multisite MMP, PLB was positive in 71 of 74 (96%) and NBPB was positive in 66 of 69 (96%). In gingival-only MMP, biopsies from reflected alveolar mucosa in 17 consecutive patients were positive in 17 of 17 cases (100%). For PV, PLB was positive in 42 of 43 (98%), compared with 42 of 42 (100%) by NBPB. Histopathology was diagnostic in 93 of 134 (69·4%) cases of MMP and 38 of 41 (93%) cases of PV. IIF was positive in 126 of 197 (64·0%) MMP and 68 of 74 (92%) PV patient sera.

CONCLUSIONS

In the largest series of combined oral DIF results in patients with MMP and PV, we have shown that NBPB is equivalent to PLB for the diagnosis of PV and multisite MMP, and is more sensitive than both histology and IIF. What's already known about this topic? The variation in sensitivity of oral biopsy sites for direct immunofluorescence (DIF) in the diagnosis of oral MMP and PV has not been studied in detail in large series of patients. Biopsy can be challenging due to difficult access and fragility of the oral mucosa. The diagnostic biopsy technique is therefore critical. What does this study add? We have shown that a normal buccal punch biopsy (NBPB) from uninvolved oral mucosa is as sensitive as a perilesional biopsy (PLB) for diagnosis of oral PV, and superior to serology and histology. For multisite MMP, NBPB is equivalent to PLB and is more sensitive than serology and histology. The oral punch biopsy technique on uninvolved buccal mucosa tissue is a simple and safe practical method for diagnosing oral PV and MMP.

Safety and early efficacy outcomes for lentiviral fibroblast gene therapy in recessive dystrophic epidermolysis bullosa

BACKGROUNDRecessive dystrophic epidermolysis bullosa (RDEB) is a severe form of skin fragility disorder due to mutations in COL7A1 encoding basement membrane type VII collagen (C7), the main constituent of anchoring fibrils (AFs) in skin. We developed a self-inactivating lentiviral platform encoding a codon-optimized COL7A1 cDNA under the control of a human phosphoglycerate kinase promoter for phase I evaluation.METHODSIn this single-center, open-label phase I trial, 4 adults with RDEB each received 3 intradermal injections (~1 × 106 cells/cm2 of intact skin) of COL7A1-modified autologous fibroblasts and were followed up for 12 months. The primary outcome was safety, including autoimmune reactions against recombinant C7. Secondary outcomes included C7 expression, AF morphology, and presence of transgene in the injected skin.RESULTSGene-modified fibroblasts were well tolerated, without serious adverse reactions or autoimmune reactions against recombinant C7. Regarding efficacy, there was a significant (P < 0.05) 1.26-fold to 26.10-fold increase in C7 mean fluorescence intensity in the injected skin compared with noninjected skin in 3 of 4 subjects, with a sustained increase up to 12 months in 2 of 4 subjects. The presence of transgene (codon-optimized COL7A1 cDNA) was demonstrated in the injected skin at month 12 in 1 subject, but no new mature AFs were detected.CONCLUSIONTo our knowledge, this is the first human study demonstrating safety and potential efficacy of lentiviral fibroblast gene therapy with the presence of COL7A1 transgene and subsequent C7 restoration in vivo in treated skin at 1 year after gene therapy. These data provide a rationale for phase II studies for further clinical evaluation.TRIAL REGISTRATIONClincalTrials.gov NCT02493816.FUNDINGCure EB, Dystrophic Epidermolysis Bullosa Research Association (UK), UK NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, and Fondation René Touraine Short-Exchange Award.

Functional correlates of the interleukin-1 receptor antagonist gene polymorphism in the colonic mucosa in ulcerative colitis

Association studies have identified the interleukin-1 receptor antagonist gene allele 2(IL-1RN*2) as a marker of susceptibility in ulcerative colitis (UC). This study investigated the significance of the IL-1RN genotype with respect to protein and mRNA expression in the colonic mucosa. Homogenates of rectal biopsies from 99 UC and 54 controls were assayed for cytokines IL-1ra, IL-1a and IL-1b using ELISA. IL1RN, IL1A and IL1B genotypes were determined using restriction-enzyme analysis. The ability of the two IL1RN alleles to generate steady-state mRNA accumulation was assessed in the colonic mucosa of seven heterozygous patients. Stepwise linear regression demonstrated that IL-1RN genotype (P=0.001), diagnosis (P<0.0001) and treatment (P<0.03) were independent factors associated with the IL-1ra protein level whilst IL1RN genotype (P=0.005) and macroscopic inflammatory grade (P<0.0001) were associated with the IL-1ra/ total IL-1 ratio. The IL1RN*2 correlated with reduced IL-1ra and IL-1ra/IL-1 ratio with a gene dosage effect. In heterozygous UC patients the ratio of allele 1 mRNA / allele 2 steady state mRNA was always greater than 1 (range: 1.2-3.1) (P=0.018). The IL-1RN*2 is associated with reduced levels of IL-1ra protein and IL-1RN mRNA in the colonic mucosa, providing a biologically plausible explanation for the observed association of the allele with the disease.

Insemination factors affecting the conception rate in seasonal calving Holstein-Friesian cows

Differences in conception rate to first service between artificial inseminations (AI) carried out by commercial AI operators (CAI) or do-it-yourself operators (DIY), between natural service (NAT) and AI, between different AI sires, and between fresh and frozen-thawed semen, on Irish commercial dairy farms, were studied using logistic regression. The study comprised 12,933 potential first inseminations from 77 spring-calving dairy herds. The data were recorded during 1999 and 2000. Amongst the total, 4,394 cows had repeated records across the two years. Adjustment variables included: herd, year, parity, calving period, calving to service interval, herd size, proportion of North American Holstein-Friesian genes, peak milk yield, semen fresh or frozen-thawed status, AI sire and a cow history variable to account for the correlation structure that may exist between performance records of cows present in both years of the study. Interactions of interest were tested but were non-significant. No significant association was observed between the category of AI operator and the likelihood of conception rate to first service (PREG1). The variation in PREG1 observed within the category of operator (CAI and DIY) was investigated using the Levene test for homogeneity of variance. There was no difference between the level of variation observed within CAI and DIY operators. There were significant differences in the likelihood of PREG1 between different AI sires. Amongst the 40 most commonly used AI sires, 3 sires had a lower likelihood of PREG1 (P < 0.05) when compared to the reference AI sire (sire with PREG1 similar to the mean of the group). There was a tendency for a reduced likelihood of PREG1 with the use of fresh semen compared to frozen-thawed semen (OR = 0.80, P = 0.067). Amongst the adjustment variables in the model, those significantly associated with the likelihood of PREG1 included the herd, calving period, calving to first service interval and peak milk yield. No significant difference in the likelihood of PREG1 was observed between AI and NAT.

Association of the interleukin 1 receptor antagonist gene with ulcerative colitis in Northern European Caucasians

BACKGROUND AND AIMS

An association between the allele 2 of the interleukin 1 receptor antagonist gene variable number tandem repeats polymorphism in intron 2 and ulcerative colitis was first reported in 1994. Subsequent studies in Caucasian Northern European patients have not confirmed this, although trends towards an association were observed. The lack of statistical significance could reflect inadequate power. In this study the association was reassessed in a large independent set of well characterised Caucasian patients and a meta-analysis of reported patient series was performed.

PATIENTS AND METHODS

A total of 320 patients with endoscopically and histologically confirmed ulcerative colitis (124 pancolitis, 196 left sided and distal disease) and 827 ethnically matched controls were genotyped at polymorphic sites in the interleukin 1 receptor antagonist gene. Carriage rates were compared using chi(2) statistics. A meta-analysis of this and seven previous studies in North European Caucasian patients was performed using the Mantel-Haenszel chi(2) test.

RESULTS

Patients had a significantly increased carriage rate of allele 2 compared with controls (52% v 45%; odds ratio 1.3 (95% confidence interval (CI) 1.01-1.7); p=0.04). The allele 2 carriage rate was highest in extensive colitis (carriage rate 56%; odds ratio 1.5 (95% CI 1.1-2.3) p=0.02) and in individuals who had undergone colectomy (carriage rate 55%; odds ratio 1.5 (95% CI 0.95-2.4); p=0.08). Meta-analysis of all eight studies showed a significant association between carriage of allele 2 and ulcerative colitis (odds ratio 1.23 (95% CI 1.04-1.45); p=0.01).

CONCLUSIONS

The association of the interleukin 1 receptor antagonist gene polymorphism with ulcerative colitis is confirmed. The association is minor and confers only a small risk to an individual but will contribute a high attributable risk in a population due to the high allelic frequency. Accurate phenotypic characterisation defines more homogeneous subsets of patients, such as those with extensive disease, in whom the association is greater.

Effects of 8-Gy radiation on the microcirculation of muscle flaps in the rat

Combination of radical excision and radiation has been used as a treatment modality for cancer patients. As a result, in reconstructive surgery there is often a need to harvest flaps in the vicinity of previously irradiated tissues. Radiation has been shown to cause progressive injury to the macrocirculation and microcirculation, often jeopardizing flap survival. The purpose of this study was to examine whether radiation significantly affects the sequence of leukocyte-endothelial interactions or the hemodynamics of the muscle flap in both acute and chronic situations. Male Sprague-Dawley rats (n = 42) were divided into seven groups of six rats each. Rats in group I were not irradiated. Groups II through VII received 8-Gy radiation to the right groin and scrotum. Groups II, III, and IV were examined at 4, 24 and 72 hours, respectively, and groups V, VI, and VII were examined at 1, 2 and 12 weeks. For intravital microscopy, the cremaster muscle was dissected on its neurovascular pedicle. Vessel diameters and red blood cell velocities were measured in the central cremasteric branches and branch arterioles. Capillary perfusion was evaluated in 27 visual fields of each flap. Leukocyte-endothelial interactions were evaluated by numbers of rolling, adhering, and transmigrating leukocytes in post-capillary venules. In the same postcapillary venule, we measured the endothelial edema index (constriction index). The hemodynamics of irradiated flaps did not differ significantly from those of controls. Diameter and red blood cell velocity were increased in the first- and second-order arterioles and were highest at 72 hours and 1 week. After irradiation, third-order arterioles were constricted. Radiation reduced capillary perfusion by 4.3, percent. None of the differences were statistically significant. Neither leukocyte behavior nor the constriction indices differed among the groups. In conclusion, low-dose radiation of 8 Gy does not affect hemodynamics or leukocyte-endothelial interactions of muscle flaps in the rat. Muscle tissue with intact microvasculature can be harvested for reconstructive procedures after low-dose radiation.

The radial artery as a bypass graft

The radial artery is being reintroduced into clinical practice to increase the number of arterial grafts for patients undergoing coronary artery bypass surgery. The radial artery is readily available from one or both forearms and removal is safe in patients who have a normal collateral circulation to the hand. Harvesting the radial artery with the adjacent veins using a minimal touch technique and vasodilators will prevent vasospasm and possibly early occlusion. A concern is that subclinical atheroma is present in many patients. The radial artery can be used as a single graft, anastomosed in a "Y" fashion with the internal mammary artery, or used as a sequential graft. The early mortality and complications are low. There are potential cost savings because the need for an incision in the leg is avoided, so that patients may be discharged early. The early results of radial artery grafting are encouraging. Further follow-up is required to determine the late patency and effects on survival of using the radial artery graft.

Measles pneumonia: lung puncture findings in 56 cases related to chest X-ray changes and clinical features

Fifty-six African children with pneumonia following measles were investigated. Lung puncture identified bacteria by culture or countercurrent immune electrophoresis in 38% and blood culture with blood countercurrent immune electrophoresis (CIE) identified a further 17%, a bacterial diagnosis being made in a total 55%. Pneumococcus was the most common organism found, occurring in 30% of all measles pneumonias. More severe changes on chest X-ray at presentation were associated with higher rates of bacterial identification and worse outcome at 2 weeks. Chest X-ray changes were worse and bacterial identification was more common in poorly nourished children. Pneumothoraces occurred following lung puncture in 21% and surgical drainage was needed in 11%.

Immunity to measles in malnourished children

This work tests the hypothesis that the increased severity of measles in malnourished children is related to the immune response of the host to the virus. Peripheral blood mononuclear cells (PBM) from well-nourished and malnourished children who had not had measles were infected in vitro with measles virus. The yield of virus from the cells of malnourished children was significantly greater than the yield from well nourished children. This was not due to lack of interferon as both types of cells produced similar amounts on challenge with measles virus. Antibody-independent and antibody-dependent cellular cytotoxicity to Hela cells persistently infected with measles virus was measured on average 1 week after the onset of the measles rash. Mononuclear cells from malnourished children killed infected Hela cells as well as cells from well-nourished children in both types of assay. There was also no significant difference in the ability of serum from the two groups of children to lyse PMB which were infected with measles virus. However, plasma from malnourished children was found to depress proliferation of lymphocytes in the presence of PHA or Candida antigen to a greater degree than plasma from well-nourished children. We conclude that the severity of measles in the malnourished may well be related to the immune response for if their cells are abnormally susceptible to infection and if this infection is followed by a normal cellular and humoral immune response severe and extensive allergic damage would result. The reaction in turn may generate immunosuppressive factors in the patient's plasma thus making the child susceptible to secondary infections.

Circulating immune complexes and complement levels in relation to the clinical presentation of Nigerian children with acute poststreptococcal glomerulonephritis

Circulating immune complexes have been detected in the sera of 24 Nigerian children with acute poststreptococcal glomerulonephritis using two methods. There was a significant correlation between levels of soluble complexes, detected in samples taken from patients in the oliguric phase of acute nephritis, and severity of disease, as judged by blood urea levels. Serial estimation of immune complexes was more useful than serial C3 estimation in predicting the onset of anuria in two patients admitted with mild disease who subsequently deteriorated. With one exception, C4 values were normal. Factor B levels were low in 90% of cases, in keeping with activation of the alternate complement pathway.