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Finn A, Nugent JL, Qi SS, Robertson M, Bobel MC, Brunsvold ME. Flipping the Classroom in Residency Didactics Leads to Higher American Board of Surgery in-Training Examination Scores. J Surg Educ 2024; 81:786-793. [PMID: 38658312 DOI: 10.1016/j.jsurg.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/05/2023] [Accepted: 10/02/2023] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Didactic education in General Surgery (GS) residency typically follows a nationally standardized curriculum; however, instructional format varies by institution. In recent years, GS residents at our institution expressed discontentment with weekly didactics and were not meeting their goals on the American Board of Surgery In-Training Examination (ABSITE). We sought to develop improvements in our didactic curriculum to increase resident satisfaction and ABSITE scores of GS junior residents (Jrs). DESIGN In a quality improvement project, we changed the weekly didactic curriculum format from hour-long lectures in the 2018 to 2019 academic year (AY) to a partially-flipped classroom in the 2019 to 2020 AY, involving a 30-minute faculty-led presentation followed by 30 minutes of resident-led practice questions. The outcomes measured were ABSITE scores taken in 2019 and 2020 and resident opinions via an anonymous survey. SETTING This study was conducted at the University of Minnesota (Minneapolis, MN). PARTICIPANTS The cohort for this study included all GS Jrs in our GS residency program, including postgraduate year (PGY) 1 nondesignated preliminary, PGY1 to 3 categorical GS residents, and residents in their lab time. Senior residents attended a separate didactics session. RESULTS After curriculum changes, the ABSITE percentile scores for GS Jrs rose from 52% ± 5% to 66% ± 4% (p = 0.03). No categorical GS Jr scored <30% in 2020, compared to 20% (6/30) of categorical General Surgery residents in 2019. All residents preferred the new format overall and reported greater engagement in and preparation for didactics. CONCLUSIONS After changing didactic education from hour-long lectures in the 2018 to 2019 AY to a flipped classroom model in the 2019 to 2020 AY including 30 minutes of faculty-led lecture followed by 30 minutes of resident-led practice questions, ABSITE scores and resident satisfaction at the University of Minnesota General Surgery Program improved.
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Affiliation(s)
- Andreana Finn
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, Minneapolis, MN 55455.
| | - Julia L Nugent
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, Minneapolis, MN 55455
| | - Steven S Qi
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, Minneapolis, MN 55455
| | - Matthew Robertson
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, Minneapolis, MN 55455
| | - Matthew C Bobel
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, Minneapolis, MN 55455
| | - Melissa E Brunsvold
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, Minneapolis, MN 55455
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Nugent JL, Singh A, Wirth KM, Oppler SH, Hocum Stone L, Janecek JL, Sheka AC, Kizy S, Moore MEG, Staley C, Hering BJ, Ramachandran S, Ikramuddin S, Graham ML. A nonhuman primate model of vertical sleeve gastrectomy facilitates mechanistic and translational research in human obesity. iScience 2021; 24:103421. [PMID: 34877488 PMCID: PMC8633018 DOI: 10.1016/j.isci.2021.103421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/22/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
The obesity epidemic significantly contributes to overall morbidity and mortality. Bariatric surgery is the gold standard treatment for obesity and metabolic dysfunction, yet the mechanisms by which it exerts metabolic benefit remain unclear. Here, we demonstrate a model of vertical sleeve gastrectomy (VSG) in nonhuman primates (NHP) that mimics the complexity and outcomes in humans. We also show that VSG confers weight loss and durable metabolic benefit, where equivalent caloric intake in shams resulted in significant weight gain following surgery. Furthermore, we show that VSG is associated with early, weight-independent increases in bile acids, short-chain fatty acids, and reduced visceral adipose tissue (VAT) inflammation with a polarization of VAT-resident immunocytes toward highly regulatory myeloid cells and Tregs. These data demonstrate that this strongly translational NHP model can be used to interrogate factors driving successful intervention to unravel the interplay between physiologic systems and improve therapies for obesity and metabolic syndrome.
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Affiliation(s)
- Julia L Nugent
- Department of Surgery, University of Minnesota, MN, USA.,Preclinical Research Center, Department of Surgery, University of Minnesota, 295 Animal Science/Veterinary Medicine Building, 1988 Fitch Avenue, St. Paul, MN 55108, USA
| | - Amar Singh
- Department of Surgery, University of Minnesota, MN, USA.,Schulze Diabetes Institute, Department of Surgery, University of Minnesota, MN, USA
| | - Keith M Wirth
- Department of Surgery, University of Minnesota, MN, USA
| | - Scott Hunter Oppler
- Department of Surgery, University of Minnesota, MN, USA.,Preclinical Research Center, Department of Surgery, University of Minnesota, 295 Animal Science/Veterinary Medicine Building, 1988 Fitch Avenue, St. Paul, MN 55108, USA
| | - Laura Hocum Stone
- Department of Surgery, University of Minnesota, MN, USA.,Preclinical Research Center, Department of Surgery, University of Minnesota, 295 Animal Science/Veterinary Medicine Building, 1988 Fitch Avenue, St. Paul, MN 55108, USA
| | - Jody L Janecek
- Department of Surgery, University of Minnesota, MN, USA.,Preclinical Research Center, Department of Surgery, University of Minnesota, 295 Animal Science/Veterinary Medicine Building, 1988 Fitch Avenue, St. Paul, MN 55108, USA
| | - Adam C Sheka
- Department of Surgery, University of Minnesota, MN, USA
| | - Scott Kizy
- Department of Surgery, University of Minnesota, MN, USA
| | - Meghan E G Moore
- Department of Surgery, University of Minnesota, MN, USA.,Preclinical Research Center, Department of Surgery, University of Minnesota, 295 Animal Science/Veterinary Medicine Building, 1988 Fitch Avenue, St. Paul, MN 55108, USA
| | - Christopher Staley
- Department of Surgery, University of Minnesota, MN, USA.,BioTechnology Institute, University of Minnesota, MN, USA
| | - Bernhard J Hering
- Department of Surgery, University of Minnesota, MN, USA.,Schulze Diabetes Institute, Department of Surgery, University of Minnesota, MN, USA
| | - Sabarinathan Ramachandran
- Department of Surgery, University of Minnesota, MN, USA.,Schulze Diabetes Institute, Department of Surgery, University of Minnesota, MN, USA
| | | | - Melanie L Graham
- Department of Surgery, University of Minnesota, MN, USA.,Preclinical Research Center, Department of Surgery, University of Minnesota, 295 Animal Science/Veterinary Medicine Building, 1988 Fitch Avenue, St. Paul, MN 55108, USA
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3
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Nugent JL, Moore M, Stone LH, Singh A, Ramachandran S, Ikramuddin S, Graham ML. Laparoscopic Vertical Sleeve Gastrectomy in Nonhuman Primates Modulates Visceral Adipose Tissue Inflammation with a Decrease in CD40-expressing Cells. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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4
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Hocum Stone L, Oppler SH, Nugent JL, Gresch S, Hering BJ, Murtaugh MP, Hegstad-Davies RL, Ramachandran S, Graham ML. Serum cytokine profiles in healthy nonhuman primates are blunted by sedation and demonstrate sexual dimorphism as detected by a validated multiplex immunoassay. Sci Rep 2021; 11:2340. [PMID: 33504894 PMCID: PMC7840937 DOI: 10.1038/s41598-021-81953-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/13/2021] [Indexed: 12/11/2022] Open
Abstract
Cytokine profiling is a valuable tool for monitoring immune responses associated with disease and treatment. This study assessed the impact of sex and sedation on serum cytokines in healthy nonhuman primates (NHPs). Twenty-three cytokines were measured from serum using a bead-based multiplex assay. Assay validation for precision, sensitivity, recovery, linearity, and stability was performed. Samples from male and female cynomolgus and rhesus macaques either cooperating or sedated were compared. All cytokines except TNFα demonstrated acceptable sensitivity and precision, with variable recovery and linearity. IFNγ, IL-2, IL-5, IL-6, IL-8, IL-12/23 (p40), IL-13, IL-15, MCP-1, TGFα, VEGF met acceptance criteria; G-CSF, IL-4, IL-10, MIP1α, sCD40L were marginal. Higher cytokine levels were observed in females and cytokine levels were blunted in sedated NHPs when compared to awake cooperating NHPs. Significant differences observed in cytokines related to sex, species, or imposed by handling highlight the importance of model design on translational relevance for clinical settings.
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Affiliation(s)
- Laura Hocum Stone
- Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA
| | | | - Julia L Nugent
- Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Sarah Gresch
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN, 55108, USA.,Veterinary Diagnostic Lab, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108, USA
| | - Bernhard J Hering
- Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Michael P Murtaugh
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN, 55108, USA
| | | | | | - Melanie L Graham
- Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA. .,Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN, 55108, USA.
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Martinu T, Gowdy KM, Nugent JL, Sun J, Kinnier CV, Nelson ME, Lyes MA, Kelly FL, Foster WM, Gunn MD, Palmer SM. Role of C-C motif ligand 2 and C-C motif receptor 2 in murine pulmonary graft-versus-host disease after lipopolysaccharide inhalations. Am J Respir Cell Mol Biol 2015; 51:810-21. [PMID: 24921973 DOI: 10.1165/rcmb.2013-0451oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Environmental exposures are a potential trigger of chronic pulmonary graft-versus-host disease (pGVHD) after successful recovery from hematopoietic cell transplant (HCT). We hypothesized that inhalations of LPS, a prototypic environmental stimulus, trigger pGVHD via increased pulmonary recruitment of donor-derived antigen-presenting cells (APCs) through the C-C motif ligand 2 (CCL2)-C-C motif receptor 2 (CCR2) chemokine axis. B10.BR(H2(k)) and C57BL/6(H2(b)) mice underwent allogeneic (Allo) or syngeneic (Syn) HCT with wild-type (WT) C57BL/6, CCL2(-/-), or CCR2(-/-) donors. After 4 weeks, recipient mice received daily inhaled LPS for 5 days and were killed at multiple time points. Allo mice exposed to repeated inhaled LPS developed prominent lymphocytic bronchiolitis, similar to human pGVHD. The increase in pulmonary T cells in Allo mice after LPS exposures was accompanied by increased CCL2, CCR2, and Type-1 T-helper cytokines as well as by monocytes and monocyte-derived dendritic cells (moDCs) compared with Syn and nontransplanted controls. Using CCL2(-/-) donors leads to a significant decrease in lung DCs but to only mildly reduced CD4 T cells. Using CCR2(-/-) donors significantly reduces lung DCs and moDCs but does not change T cells. CCL2 or CCR2 deficiency does not alter pGVHD pathology but increases airway hyperreactivity and IL-5 or IL-13 cytokines. Our results show that hematopoietic donor-derived CCL2 and CCR2 regulate recruitment of APCs to the Allo lung after LPS exposure. Although they do not alter pathologic pGVHD, their absence is associated with increased airway hyperreactivity and IL-5 and IL-13 cytokines. These results suggest that the APC changes that result from CCL2-CCR2 blockade may have unexpected effects on T cell differentiation and physiologic outcomes in HCT.
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Kelly FL, Sun J, Fischer BM, Voynow JA, Kummarapurugu AB, Zhang HL, Nugent JL, Beasley RF, Martinu T, Gwinn WM, Morgan DL, Palmer SM. Diacetyl induces amphiregulin shedding in pulmonary epithelial cells and in experimental bronchiolitis obliterans. Am J Respir Cell Mol Biol 2014; 51:568-74. [PMID: 24816162 DOI: 10.1165/rcmb.2013-0339oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Diacetyl (DA), a component of artificial butter flavoring, has been linked to the development of bronchiolitis obliterans (BO), a disease of airway epithelial injury and airway fibrosis. The epidermal growth factor receptor ligand, amphiregulin (AREG), has been implicated in other types of epithelial injury and lung fibrosis. We investigated the effects of DA directly on the pulmonary epithelium, and we hypothesized that DA exposure would result in epithelial cell shedding of AREG. Consistent with this hypothesis, we demonstrate that DA increases AREG by the pulmonary epithelial cell line NCI-H292 and by multiple independent primary human airway epithelial donors grown under physiologically relevant conditions at the air-liquid interface. Furthermore, we demonstrate that AREG shedding occurs through a TNF-α-converting enzyme (TACE)-dependent mechanism via inhibition of TACE activity in epithelial cells using the small molecule inhibitor, TNF-α protease inhibitor-1, as well as TACE-specific small inhibitor RNA. Finally, we demonstrate supportive in vivo results showing increased AREG transcript and protein levels in the lungs of rodents with DA-induced BO. In summary, our novel in vitro and in vivo observations suggest that further study of AREG is warranted in the pathogenesis of DA-induced BO.
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Affiliation(s)
- Francine L Kelly
- Divisions of 1 Pulmonary, Allergy, and Critical Care Medicine, and
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7
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Nugent JL, McCoy AN, Addamo CJ, Jia W, Sandler RS, Keku TO. Altered tissue metabolites correlate with microbial dysbiosis in colorectal adenomas. J Proteome Res 2014; 13:1921-9. [PMID: 24601673 PMCID: PMC3993967 DOI: 10.1021/pr4009783] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
![]()
Several
studies have linked bacterial dysbiosis with elevated risk
of colorectal adenomas and cancer. However, the functional implications
of gut dysbiosis remain unclear. Gut bacteria contribute to nutrient
metabolism and produce small molecules termed the “metabolome”,
which may contribute to the development of neoplasia in the large
bowel. We assessed the metabolome in normal rectal mucosal biopsies
of 15 subjects with colorectal adenomas and 15 nonadenoma controls
by liquid chromatography and gas chromatography time-of-flight mass
spectrometry. Quantitative real-time PCR was used to measure abundances
of specific bacterial taxa. We identified a total of 274 metabolites.
Discriminant analysis suggested a separation of metabolomic profiles
between adenoma cases and nonadenoma controls. Twenty-three metabolites
contributed to the separation, notably an increase in adenoma cases
of the inflammatory metabolite prostaglandin E2 and a decrease in
antioxidant-related metabolites 5-oxoproline and diketogulonic acid.
Pathway analysis suggested that differential metabolites were significantly
related to cancer, inflammatory response, carbohydrate metabolism,
and GI disease pathways. Abundances of six bacterial taxa assayed
were increased in cases. The 23 differential metabolites demonstrated
correlations with bacteria that were different between cases and controls.
These findings suggest that metabolic products of bacteria may be
responsible for the development of colorectal adenomas and CRC.
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Affiliation(s)
- Julia L Nugent
- School of Medicine, University of North Carolina at Chapel Hill , 321 South Columbia Street, Chapel Hill, North Carolina 27599, United States
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8
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Nugent JL, Wareing M, Palin V, Sibley CP, Baker PN, Ray DW, Farrow SN, Jones RL. Chronic glucocorticoid exposure potentiates placental chorionic plate artery constriction: implications for aberrant fetoplacental vascular resistance in fetal growth restriction. Endocrinology 2013; 154:876-87. [PMID: 23295737 DOI: 10.1210/en.2012-1927] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Fetal growth restriction (FGR) is a serious pregnancy complication, resulting in significant perinatal morbidity and mortality. Increased vascular resistance in the fetoplacental circulation is a hallmark of FGR and is associated with enhanced vasoconstriction of the resistance arteries in the placenta, the chorionic plate arteries (CPAs). Although the cause is unknown, FGR is associated with excess exposure to glucocorticoids (GCs), key mediators of vascular resistance in the systemic circulation. We hypothesized that GCs alter CPA reactivity, thereby contributing to the altered blood flow dynamics seen in FGR. We aimed to examine the acute and chronic effects of GCs on CPA reactivity and the operational mechanisms. Glucocorticoid receptors were highly expressed by CPA. 11β-Hydroxysteroid isoenzyme type 2 was detected within the endothelium, whereas 11β-hydroxysteroid isoenzyme type 1 was absent. Acute GC treatment significantly attenuated U46619-induced constriction. This effect was reversed by cotreatment with mifepristone or an endothelial NOS inhibitor. In contrast, chronic GC treatment potentiated U46619 constriction in a dose-dependent manner, which was partially abolished by mifepristone cotreatment. Similar effects were observed using a novel nonsteroidal glucocorticoid receptor-specific agonist. Chronic treatment with GCs altered the expression of several vasoactive factors, including thromboxane and bradykinin receptors, prokineticin-1, cyclooxygenase-2, and endothelial NOS. In summary, acute and chronic GC treatment exerts contrasting effects on CPA vasoreactivity. These opposing effects are consistent with temporal actions in other vascular beds and reflect activation of distinct nongenomic and genomic pathways. Chronic exposure to elevated GCs may contribute to the raised vascular resistance observed in the fetoplacental circulation in FGR.
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Affiliation(s)
- J L Nugent
- Maternal and Fetal Health Research Centre, University of Manchester, St Mary's Hospital, Research Fifth Floor, Oxford Road, Manchester M13 9WL, United Kingdom
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Gowdy KM, Cardona DM, Nugent JL, Giamberardino C, Thomas JM, Mukherjee S, Mukherjee S, Martinu T, Foster WM, Plevy SE, Pastva AM, Wright JR, Palmer SM. Novel role for surfactant protein A in gastrointestinal graft-versus-host disease. J Immunol 2012; 188:4897-905. [PMID: 22508928 DOI: 10.4049/jimmunol.1103558] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Graft-versus-host disease (GVHD) is a severe and frequent complication of allogeneic bone marrow transplantation (BMT) that involves the gastrointestinal (GI) tract and lungs. The pathobiology of GVHD is complex and involves immune cell recognition of host Ags as foreign. We hypothesize a central role for the collectin surfactant protein A (SP-A) in regulating the development of GVHD after allogeneic BMT. C57BL/6 (H2b; WT) and SP-A-deficient mice on a C57BL/6 background (H2b; SP-A(-/-)) mice underwent allogeneic or syngeneic BMT with cells from either C3HeB/FeJ (H2k; SP-A-deficient recipient mice that have undergone an allogeneic BMT [SP-A(-/-)alloBMT] or SP-A-sufficient recipient mice that have undergone an allogeneic BMT) or C57BL/6 (H2b; SP-A-deficient recipient mice that have undergone a syngeneic BMT or SP-A-sufficient recipient mice that have undergone a syngeneic BMT) mice. Five weeks post-BMT, mice were necropsied, and lung and GI tissue were analyzed. SP-A(-/-) alloBMT or SP-A-sufficient recipient mice that have undergone an allogeneic BMT had no significant differences in lung pathology; however, SP-A(-/-)alloBMT mice developed marked features of GI GVHD, including decreased body weight, increased tissue inflammation, and lymphocytic infiltration. SP-A(-/-)alloBMT mice also had increased colon expression of IL-1β, IL-6, TNF-α, and IFN-γ and as well as increased Th17 cells and diminished regulatory T cells. Our results demonstrate the first evidence, to our knowledge, of a critical role for SP-A in modulating GI GVHD. In these studies, we demonstrate that mice deficient in SP-A that have undergone an allogeneic BMT have a greater incidence of GI GVHD that is associated with increased Th17 cells and decreased regulatory T cells. The results of these studies demonstrate that SP-A protects against the development of GI GVHD and establishes a role for SP-A in regulating the immune response in the GI tract.
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Affiliation(s)
- Kymberly M Gowdy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Gowdy KM, Nugent JL, Martinu T, Potts E, Snyder LD, Foster WM, Palmer SM. Protective role of T-bet and Th1 cytokines in pulmonary graft-versus-host disease and peribronchiolar fibrosis. Am J Respir Cell Mol Biol 2011; 46:249-56. [PMID: 21960548 PMCID: PMC3297167 DOI: 10.1165/rcmb.2011-0131oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
T-box expressed in T cells (T-bet) is a critical transcription factor for T helper (Th) 1 responses. Although Th1 cells are thought to contribute to certain alloimmune responses, their role in pulmonary graft-versus-host disease (GVHD) is uncertain. We have established a murine model of acute pulmonary GVHD after hematopoietic cell transplant (HCT) and inhaled LPS exposure. We tested the hypothesis that pulmonary GVHD can occur independent of Th1 cells using T-bet-deficient donors. B10.BR(H2(k)) mice underwent allogeneic (Allo) or syngeneic (Syn) HCT with cells from either C57Bl/6J(H2(b)) mice (Allo wild-type [WT] or SynWT) or C57Bl/6J mice lacking T-bet (AlloTbet(-/-) or SynTbet(-/-)). After HCT, mice were exposed daily to aerosolized LPS and subsequently bronchoalveolar lavage and lung tissue were analyzed for cytokines, lymphocytic inflammation, pathology, and fibrosis. Independent of LPS exposure, AlloTbet(-/-) mice developed pulmonary GVHD manifested by lymphocytic inflammation. Furthermore, AlloTbet(-/-) mice developed features of chronic pulmonary GVHD, including increased peribronchiolar fibrosis and collagen content. LPS exposure increased neutrophil recruitment and decreased static compliance in AlloTbet(-/-) mice as compared with LPS-exposed AlloWT mice or LPS-exposed SynTbet(-/-) mice. In addition, LPS-exposed AlloTbet(-/-) mice had increased pulmonary IL-17, IL-13, and Th17 cells, and diminished regulatory T cells compared with the other groups. Our results demonstrate that Th1 cytokines are dispensable in pulmonary GVHD. In the absence of T-bet, there is increased production of Th17 and Th2 cytokines that is associated with peribronchiolar fibrosis and is further enhanced by LPS. These results suggest that the interplay between local innate immunity and non-Th1 T cell subsets contribute to chronic pulmonary GVHD.
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Affiliation(s)
- Kymberly M Gowdy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA.
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Abstract
We report the synthesis of S-nitrosothiol-modified silica particles capable of nitric oxide (NO) release. The thiol precursor modification to form S-nitrosothiol NO donors was introduced into the silica network via co-condensation of mercaptosilane and alkoxysilane precursors. Both the concentrations of reactants (i.e., water, ammonia, and silane) and the silane feed rate into the reaction proved important in the yield of monodisperse, spherical particles with tunable diameters ranging from 241-718 nm. Subsequent nitrosation resulted in NO storage approaching ~4.40 μmol NO mg(-1), as determined by total NO release. Behaving similar to low molecular weight S-nitrosothiol NO donors, the NO release from the macromolecular silica vehicles was influenced by light, temperature, and metal ions.
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Affiliation(s)
- Daniel A. Riccio
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Julia L. Nugent
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mark H. Schoenfisch
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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12
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Palmer SM, Flake GP, Kelly FL, Zhang HL, Nugent JL, Kirby PJ, Foley JF, Gwinn WM, Morgan DL. Severe airway epithelial injury, aberrant repair and bronchiolitis obliterans develops after diacetyl instillation in rats. PLoS One 2011; 6:e17644. [PMID: 21464978 PMCID: PMC3064568 DOI: 10.1371/journal.pone.0017644] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 02/09/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchiolitis obliterans (BO) is a fibrotic lung disease that occurs in a variety of clinical settings, including toxin exposures, autoimmunity and lung or bone marrow transplant. Despite its increasing clinical importance, little is known regarding the underlying disease mechanisms due to a lack of adequate small animal BO models. Recent epidemiological studies have implicated exposure to diacetyl (DA), a volatile component of artificial butter flavoring, as a cause of BO in otherwise healthy factory workers. Our overall hypothesis is that DA induces severe epithelial injury and aberrant repair that leads to the development of BO. Therefore, the objectives of this study were 1) to determine if DA, delivered by intratracheal instillation (ITI), would lead to the development of BO in rats and 2) to characterize epithelial regeneration and matrix repair after ITI of DA. METHODS AND MAIN RESULTS Male Sprague-Dawley rats were treated with a single dose of DA (125 mg/kg) or sterile water (vehicle control) by ITI. Instilled DA resulted in airway specific injury, followed by rapid epithelial regeneration, and extensive intraluminal airway fibrosis characteristic of BO. Increased airway resistance and lung fluid neutrophilia occurred with the development of BO, similar to human disease. Despite rapid epithelial regeneration after DA treatment, expression of the normal phenotypic markers, Clara cell secretory protein and acetylated tubulin, were diminished. In contrast, expression of the matrix component Tenascin C was significantly increased, particularly evident within the BO lesions. CONCLUSIONS We have established that ITI of DA results in BO, creating a novel chemical-induced animal model that replicates histological, biological and physiological features of the human disease. Furthermore, we demonstrate that dysregulated epithelial repair and excessive matrix Tenacin C deposition occur in BO, providing new insights into potential disease mechanisms and therapeutic targets.
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Affiliation(s)
- Scott M Palmer
- Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.
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13
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Kinnier CV, Martinu T, Gowdy KM, Nugent JL, Kelly FL, Palmer SM. Innate immune activation by the viral PAMP poly I:C potentiates pulmonary graft-versus-host disease after allogeneic hematopoietic cell transplant. Transpl Immunol 2010; 24:83-93. [PMID: 21070856 DOI: 10.1016/j.trim.2010.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 11/04/2010] [Indexed: 12/18/2022]
Abstract
Respiratory viral infections cause significant morbidity and increase the risk for chronic pulmonary graft-versus-host disease (GVHD) after hematopoietic cell transplantation (HCT). Our overall hypothesis is that local innate immune activation potentiates adaptive alloimmunity. In this study, we hypothesized that a viral pathogen-associated molecular pattern (PAMP) alone can potentiate pulmonary GVHD after allogeneic HCT. We, therefore, examined the effect of pulmonary exposure to polyinosinic:polycytidylic acid (poly I:C), a viral mimetic that activates innate immunity, in an established murine HCT model. Poly I:C-induced a marked pulmonary T cell response in allogeneic HCT mice as compared to syngeneic HCT, with increased CD4+ cells in the lung fluid and tissue. This lymphocytic inflammation persisted at 2 weeks post poly I:C exposure in allogeneic mice and was associated with CD3+ cell infiltration into the bronchiolar epithelium and features of epithelial injury. In vitro, poly I:C enhanced allospecific proliferation in a mixed lymphocyte reaction. In vivo, poly I:C exposure was associated with an early increase in pulmonary monocyte recruitment and activation as well as a decrease in CD4+FOXP3+ regulatory T cells in allogeneic mice as compared to syngeneic. In contrast, intrapulmonary poly I:C did not alter the extent of systemic GVHD in either syngeneic or allogeneic mice. Collectively, our results suggest that local activation of pulmonary innate immunity by a viral molecular pattern represents a novel pathway that contributes to pulmonary GVHD after allogeneic HCT, through a mechanism that includes increased recruitment and maturation of intrapulmonary monocytes.
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Affiliation(s)
- Christine V Kinnier
- Department of Medicine, Duke University Medical Center, 106 Research Drive, Building MSRB2 Room 2100B, Durham, NC 27710, USA
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Nugent JL, Bunn PA, Matthews MJ, Ihde DC, Cohen MH, Gazdar A, Minna JD. CNS metastases in small cell bronchogenic carcinoma: increasing frequency and changing pattern with lengthening survival. Cancer 1979; 44:1885-93. [PMID: 227582 DOI: 10.1002/1097-0142(197911)44:5<1885::aid-cncr2820440550>3.0.co;2-f] [Citation(s) in RCA: 317] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bunn PA, Cohen MI, Widerlite L, Nugent JL, Matthews MJ, Minna JD. Simultaneous gastric and plasma immunoreactive plasma carcinoembryonic antigen in 108 patients undergoing gastroscopy. Gastroenterology 1979; 76:734-41. [PMID: 422001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Simultaneous measurement of plasma and gastric immunoreactive carcinoembryonic antigen (CEA) was performed in 108 patients undergoing upper gastrointestinal endoscopy. Gastric immunoreactive CEA was more sensitive than plasma CEA (92% vs. 65% positive) in patients with gastric cancer. In cancer patients gastric CEA was significantly higher than in all other patient groups. The extent of disease, the histologic type of adenocarcinoma, and the macroscopic appearance of the tumor had no influence on gastric CEA results. Gastric CEA was elevated in 44% of patients with gastritis and 26% of patients with benign gastric ulcers, but was never elevated in patients with no gastric pathology. In patients with benign disorders, elevated gastric CEA was significantly correlated with atrophic gastritis especially of moderate or severe degrees. Elevated levels persisted in patients with pernicious anemia and severe atrophic gastritis but returned to normal with healing of benign gastric ulcers. Simultaneous measurement of gastric total protein or potassium content was necessary to correct for variations in sample collection. We conclude that gastric CEA was not useful for distinguishing between benign and malignant lesions but should be studied further for screening high risk patients, for identifying and following patients with "premalignant" conditions, and for following cancer patients before and after surgery and/or chemotherapy.
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Bunn PA, Nugent JL, Matthews MJ. Central nervous system metastases in small cell bronchogenic carcinoma. Semin Oncol 1978; 5:314-22. [PMID: 211643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bunn PA, Nugent JL, Ihde DC, Cohen MH, Eddy JL, Minna JD. 5-fluorouracil, methyl-CCNU, adriamycin, and mitomycin C in the treatment of advanced gastric cancer. Cancer Treat Rep 1978; 62:1287-93. [PMID: 356983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Eighteen previously untreated patients with advanced nonresectable adenocarcinoma of the stomach were treated with a four-drug regimen consisting of 5-fluorouracil, methyl-CCNU, adriamycin, and mitomycin C. Objective responses occurred in only two patients (11%); the majority of patients had stable disease for greater than or equal to 8 weeks (61%). The median survival of 27 weeks was similar to that reported in other combination chemotherapy trials. Numerous staging and restaging procedures and strict response criteria were utilized and each was evaluated for its effectiveness in following responses. None of these parameters was useful for evaluating response of intra-abdominal tumor. We conclude that this four-drug combination is no better than previously described two-drug regimens.
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