Whole transcriptome-based skin virome profiling in typical epidermodysplasia verruciformis reveals α-, β-, and γ-HPV infections

HPVs are DNA viruses include approximately 450 types that are classified into 5 genera (α-, β-, γ-, μ-, and ν-HPV). The γ- and β-HPVs are present in low copy numbers in healthy individuals; however, in patients with an inborn error of immunity, certain species of β-HPVs can cause epidermodysplasia verruciformis (EV), manifesting as recalcitrant cutaneous warts and skin cancer. EV presents as either typical or atypical. Manifestations of typical EV are limited to the skin and are caused by abnormal keratinocyte-intrinsic immunity to β-HPVs due to pathogenic sequence variants in TMC6, TMC8, or CIB1. We applied a transcriptome-based computational pipeline, VirPy, to RNA extracted from normal-appearing skin and wart samples of patients with typical EV to explore the viral and human genetic determinants. In 26 patients, 9 distinct biallelic mutations were detected in TMC6, TMC8, and CIB1, 7 of which are previously unreported to our knowledge. Additionally, 20 different HPV species, including 3 α-HPVs, 16 β-HPVs, and 1 γ-HPV, were detected, 8 of which are reported here for the first time to our knowledge in patients with EV (β-HPV-37, -47, -80, -151, and -159; α-HPV-2 and -57; and γ-HPV-128). This study expands the TMC6, TMC8, and CIB1 sequence variant spectrum and implicates new HPV subtypes in the pathogenesis of typical EV.

Ichthyosis follicularis syndromes in patients with germline mutations in GJB2

Ichthyosis follicularis (IF) manifests as generalized spiny follicular projections found in syndromic diseases secondary to SREBF1 and MBTPS2 mutations. We sought the genetic cause of IF in two distinct families from a cohort of 180 ichthyosis patients. In Family 1, the proband presented with IF, bilateral sensorineural hearing loss (SNHL) and punctate palmoplantar keratoderma, and compound heterozygous GJB2 mutations were discovered in DNA from peripheral blood lymphocytes: GJB2:c.526A>G and c.35delG. In Family 2, the proband presented with a previously unreported IF phenotype in the context of KID syndrome, and whole-exome sequencing found a de novo heterozygous GJB2:c.148G>A mutation. Histopathology was consistent with porokeratotic eccrine ostial and dermal duct nevus (PEODDN) and IF in Probands 1 and 2, respectively. Our findings add to the clinical and histopathological spectrum of IF and emphasize the association of PEODDN-like entities with GJB2 variants.

Whole-transcriptome sequencing-based concomitant detection of viral and human genetic determinants of cutaneous lesions

Severe viral infections of the skin can occur in patients with inborn errors of immunity (IEI). We report an all-in-one whole-transcriptome sequencing–based method by RNA-Seq on a single skin biopsy for concomitantly identifying the cutaneous virome and the underlying IEI. Skin biopsies were obtained from healthy and lesional skin from patients with cutaneous infections suspected to be of viral origin. RNA-Seq was utilized as the first-tier strategy for unbiased human genome-wide rare variant detection. Reads unaligned to the human genome were utilized for the exploration of 926 viruses in a viral genome catalog. In 9 families studied, the patients carried pathogenic variants in 6 human IEI genes, including IL2RG, WAS, CIB1, STK4, GATA2, and DOCK8. Gene expression profiling also confirmed pathogenicity of the human variants and permitted genome-wide homozygosity mapping, which assisted in identification of candidate genes in consanguineous families. This automated, online, all-in-one computational pipeline, called VirPy, enables simultaneous detection of the viral triggers and the human genetic variants underlying skin lesions in patients with suspected IEI and viral dermatosis.

Kindler epidermolysis bullosa-like skin phenotype and downregulated basement membrane zone gene expression in poikiloderma with neutropenia and a homozygous USB1 mutation

Epidermolysis bullosa (EB) is a genotypically heterogeneous group of disorders characterized by cutaneous blistering and erosions with a tremendous spectrum of severity. One of the distinct forms of EB, Kindler EB (KEB), manifests with blistering and poikiloderma; this subtype of EB is caused by mutations in the FERMT1 gene encoding kindlin-1. In this study, we investigated a patient clinically diagnosed as KEB with reduced FERMT1 gene expression and intensity of immunostaining for kindlin-1. Transmission electron microscopy showed lamina densa reduplication, frequently observed in KEB. However, no mutations were identified in FERMT1 in this patient with consanguineous parents, and this gene resided outside of genomic regions of homozygosity (ROH). Instead, whole-exome sequencing and homozygosity mapping identified a homozygous sequence variant at the +4 position of intron 2 in the USB1 gene, encoding an exoribonuclease required for processing of U6 snRNA, a critical component of spliceosomes. Examination of the patient's RNA by RNA-Seq confirmed the pathogenicity of this variant, causing aberrant splicing predicted to result in loss of function of USB1. Mutations in this gene have been reported in patients with poikiloderma and neutropenia, with a few reported cases in association with skin fragility, a condition distinct from the KEB phenotype. Transcriptome analysis revealed that several genes, expressed in the cutaneous basement membrane zone and previously associated with different subtypes of EB, were differentially downregulated at the mRNA level. EB-associated mRNA downregulation was confirmed at protein levels by skin immunofluorescence. These observations provide a novel mechanism for blistering and erosions in the skin as a result reduced presence of adhesion complexes critical for stable association of epidermis and dermis at the level of cutaneous basement membrane zone.

Keratitis-ichthyosis-deafness syndrome: Phenotypic heterogeneity and treatment perspective of patients with p.Asp50Asn GJB2 mutation

Keratitis-ichthyosis-deafness (KID) syndrome is caused by mutations in the GJB2 gene encoding connexin 26, a component of transmembrane hemichannels which form gap junction channels, critical for cell-cell communication. Here, we report two patients from two distinct families with KID syndrome with the same GJB2 mutation (p.Asp50Asn); in both cases the mutation was de novo, as the parents depicted the wild-type allele only. The patients' cutaneous manifestations were strikingly different illustrating the wide spectrum of phenotype of these patients, even with the same GJB2 mutation. One of the patients was treated with acitretin with dramatic improvement in his skin findings, illustrating the role of oral acitretin in treatment of patients with KID syndrome. Collectively, these patients attest to the phenotypic spectrum of KID syndrome, with therapeutic perspective.

0063 Age Related Changes in Central Autonomic Couplings During Sleep

Introduction

Studies show coupling between central nervous system (CNS) and autonomic nervous system (ANS) activity during sleep. We reported on a novel central/autonomic coupling event (ACE) during non-rapid eye movement (NREM) sleep, in which bursts in heart rate (HRBs) coincide with increased slow-wave activity (SWA) 5 seconds prior to the HRB, followed by a surge in vagal high-frequency activity in the RR signal (HFRR) 5 seconds after the HRB. ACEs predicted sleep-related explicit memory improvement. Aging is characterized with impaired sleep and autonomic loss. We, therefore, investigated ACE activity in older adults.

Methods

We compared ACEs during a daytime nap between youngers (18-25yrs, N=49) and olders (60-75yrs, N=32). Subjects took an EEG-monitored, 90-minute nap. We measured SWA and HFRR in a 20-sec window around the HRB peak separately for Stage 2 and slow-wave sleep (SWS). EEG were binned into 5-sec intervals around the HRB: -10, -5, +5, +10 bins. For Stage 2 and SWS, repeated-measure ANOVAs with two factors (age and windows) were performed on SWA and HFRR. Corrections used Greenhouse-Geisser and Bonferroni methods.

Results

For SWA, we found an interaction between age and windows during Stage 2 (p<.001), and SWS (p=.001). SWA during the -5bin was greater in youngers than olders during both Stage 2 and SWS (ps < .001). The ACE profile in youngers showed highest SWA in the -5bin in Stage 2 and SWS (ps < .001) and highest HFRR in the +5bin in Stage 2 (ps < .001) The ACE profile in olders, however, showed no clear pattern for SWA in either sleep stage. Olders showed greater HFRR during the +5bin compared to the -10bin (p=.041) during Stage 2 but no HFRR modulations were found during SWS.

Conclusion

Our results replicated the ACE profile in daytime naps first reported by Naji et al (2018). In youngers, heart rate bursts were coupled with increased SWA and vagal activity. In contrast, olders demonstrated a lack of boost in SWA and HFRR, which provides implications in cognitive aging. Future research is needed to further understand the impact of decreased coupling between ANS/CNS activity on cognitive decline.

Support

 

Comparative Plaque Removal Efficacy of Three Manual Toothbrushes

OBJECTIVES

The purpose of this study was to determine the safety and plaque-reducing effectiveness of a newly designed manual toothbrush compared to that of a leading marketed toothbrush and a reference standard manual toothbrush control.

METHODS

This examiner-blind, randomized, single-use study used a cross-over design. Sixty-eight qualifying male and female subjects were randomly assigned either an Arm & Hammer™ Truly Radiant™ Deep Clean manual toothbrush (TR), a Colgate® Extra Clean manual toothbrush (C), or an ADA reference standard manual toothbrush (SM) according to one of three computer-generated sequences. Following instruction in the use of their assigned brush, subjects brushed at home with a standard fluoride toothpaste twice daily for two minutes during a one-week familiarization period. At the end of this period, the subjects returned to the study site after refraining from oral hygiene for 12-16 hours and from eating and drinking for four hours. Plaque was disclosed and scored using the Rustogi Modification of the Navy Plaque Index (RMNPI). Subjects brushed under supervision with their assigned toothbrush for two minutes in a room without mirrors and apart from the dental examiner, after which plaque was disclosed and rescored. They were then given one of the alternate toothbrushes according to their assigned sequence, and the familiarization routine and evaluations were repeated until each of the subjects used each of the three brushes. Within-treatment and between-treatment whole mouth RMNPI scores and scores at each of twelve subsets of sites were analyzed using paired t-tests and appropriate ANCOVA models, respectively.

RESULTS

Within-group analyses showed that all three toothbrushes produced statistically significant reductions from the pre-brushing baseline in whole mouth RMNPI scores (p < 0.0001), with respective reductions of 68.2%, 58.3%, and 48.5% for TR, C, and SM. Between-group analyses showed that TR was significantly more effective (p < 0.0001) than C and SM with 16.4% and 40.3% greater reductions in whole mouth scores, respectively. TR also produced statistically significant greater reductions (p < 0.0001) than the other two manual brushes at each of the twelve subsets of sites examined, with the greatest differences at the lingual and gingival sites, especially sites presenting difficulty in access, such as those in the posterior lingual gingival region.

CONCLUSIONS

While all three manual toothbrushes produced significant supragingival plaque reductions with a single use, the Truly Radiant Deep Clean brush was significantly more effective than the Colgate Extra Clean and ADA manual brushes in reducing wholemouth plaque, as well as plaque at all subsets of sites analyzed including difficult-to-reach areas.

Joint Raman spectroscopic and quantum chemical analysis of the vibrational features of Cs2RuO4

The Raman spectroscopic characterization of the orthorhombic phase of Cs₂RuO₄ was carried out by means of group theory and quantum chemical analysis. Multiple models based on ruthenate (VI+) tetrahedra were tested, and characterization of all the active Raman modes was achieved. A comparison of Raman spectra of Cs₂RuO₄, Cs₂MoO₄, and Cs₂WO₄ was also performed. Raman laser heating induced a phase transition from an ordered to a disordered structure. The temperature-phase transition was calculated from the anti-Stokes/Stokes ratio and compared with the ones measured at macroscopic scale. The phase transition is connected with tilting and/or rotations of RuO₄ tetrahedra, which lead to a disorder at the RuO₄ sites. © 2015 The Authors. Journal of Raman Spectroscopy published by John Wiley & Sons Ltd.

High IP-10 levels decrease T cell function in HIV-1-infected individuals on ART

HIV-1-infected subjects, despite control of viral replication with ART, have an altered immune cytokine/chemokine milieu. Changes in systemic cytokines and chemokines can alter immune responses. IP-10, in particular, has been associated with pathogenesis in a number of conditions, and we found that IP-10 is increased in serum in subjects who are HIV-1 infected and on stable ART compared with HIV-1-uninfected individuals. In a series of in vitro studies, we found that PBMCs exposed to IP-10 showed a significant decrease in the number of cells capable of secreting IFN-γ, as well as other cytokines, when stimulated with recall antigens. Furthermore, treatment with IP-10 led to decreased antigen-specific calcium signaling and MAPK38 phosphorylation. Importantly, the cytokines, as well as proliferative responses, could be enhanced with an IP-10 Nab. Our findings suggest that IP-10-modulating drugs may potentially enhance T cell responses to vaccination and HIV-1 in HIV+ subjects on ART.

[An uncommon cutaneous presentation of cat scratch disease]

BACKGROUND

Herein we report a case of cat scratch disease on account of its atypical presentation.

PATIENTS AND METHODS

A 21-year-old woman presented erythema nodosum associated with painful bilateral inguinal adenopathy, odynophagia, joint pain and evening urticaria in a setting of impaired general condition. Initial serological testing for Bartonella henselae was negative. PCR for Bartonella henselae performed on an adenectomy fragment was positive. A favourable outcome was achieved with azithromycin.

COMMENTS

This case shows an atypical and severe presentation of cat scratch disease and raises the problem of sensitivity of serotyping.

A comparison of the performance of ⁶⁸Ga-DOTATATE PET/CT and ¹²³I-MIBG SPECT in the diagnosis and follow-up of phaeochromocytoma and paraganglioma

PURPOSE

To compare the sensitivity of (123)I-metaiodobenzylguanidine (MIBG) SPECT and (68)Ga-DOTATATE PET/CT in detecting phaeochromocytomas (PCC) and paragangliomas (PGL) in the initial diagnosis and follow-up of patients with PCC and PGL disease.

METHODS

Retrospective analysis of 15 patients with PCC/PGL who had contemporaneous (123)I-MIBG and (68)Ga-DOTATATE imaging.

RESULTS

Of the 15 patients in the series, 8 were concordant with both modalities picking up clinically significant lesions. There were no patients in whom both modalities failed to pick up clinically significant lesions. There was discordance in seven patients: 5 had positive (68)Ga-DOTATATE and negative (123)I-MIBG, and 2 (12 and 14) had negative (68)Ga-DOTATATE and positive (123)I-MIBG. Utilizing (123)I-MIBG as the gold standard, (68)Ga-DOTATATE had a sensitivity of 80 % and a positive predictive value of 62 %. The greatest discordance was in head and neck lesions, with the lesions in 4 patients being picked up by (68)Ga-DOTATATE and missed by (123)I-MIBG. On a per-lesion analysis, cross-sectional (CT and MRI) and (68)Ga-DOTATATE was superior to (123)I-MIBG in detecting lesions in all anatomical locations, and particularly bony lesions.

CONCLUSION

First, (68)Ga-DOTATATE should be considered as a first-line investigation in patients at high risk of PGL and metastatic disease, such as in the screening of carriers for mutations associated with familial PGL syndromes. Second, if (123)I-MIBG does not detect lesions in patients with a high pretest probability of PCC or PGL, (68)Ga-DOTATATE should be considered as the next investigation. Third, (68)Ga-DOTATATE hould be considered in preference to (123)I-MIBG in patients in whom metastatic spread, particularly to the bone, is suspected.

[Coagulation factor XIII: more than just a fibrin stabilizer]

The role played by coagulation factor XIII in the scarring process is considered. Identified in 1923, the role of factor XIII or the fibrin stabilizing factor in coagulation has been accurately described. Its role in scarring was defined as long ago as 1960 but continues to be unknown to haematologists and doctors treating burn patients. The aim of this paper is to cast more light on this role, which remains a mystery still to be unfolded.

Endocrine tumors: the evolving role of positron emission tomography in diagnosis and management

Endocrine tumors comprise a range of benign and malignant conditions that produce a spectrum of clinical symptoms and signs depending on the specific hormones they produce. The symptoms and presentations of these tumors are often independent of their size and location. Because of their expression of cell membrane receptors or production of specific types of hormones or peptides, endocrine tumors can be identified with functional radionuclide imaging much more readily compared to standard cross-sectional imaging. In recent years, 18F-fluoro-deoxy- D-glucose positron emission tomography (18F-FDG-PET) has emerged as a useful tool for diagnosing and assessing many tumors. In this review we describe how PET, using 18F-FDG and other radiopharmaceuticals can be useful in the diagnosis and management of a wide range of endocrine tumors.

[Systemic endothelial dysfunction in patients with pseudoexfoliation syndrome]

BACKGROUND

Recent studies have shown that pseudoexfoliation syndrome (PEX) is not limited to the anterior segment of the eye, but also affects different structures, such as blood vessels, heart, liver and lungs. Vascular endothelial dysfunction is associated with an increased cardiovascular risk. The purpose of our study was to evaluate endothelial function of the brachial artery in patients with PEX.

PATIENTS/MATERIALS AND METHODS

We prospectively examined 21 patients with PEX and 21 age- and sex-matched individuals in a control group. Brachial artery endothelial function was assessed by the response to flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) using high resolution ultrasound. Dilation was expressed as the percent change in diameter relative to the baseline diameter.

RESULTS

Patients with PEX had significantly lower FMD (1.9-2.8 versus 4.1-3.3 in the control group, p = 0.02). NMD in PEX patients was lower than in the control group (10.1-5.1 versus 10.8-5.8 in the control group, p < 0.69), but the difference was not statistically significant.

CONCLUSIONS

Our study showed a statistically significant association between PEX and systemic vascular endothelial dysfunction. Larger clinical studies are needed to prove the higher cardiovascular risk in PEX patients.

[Predictive factors of successful selective laser trabeculoplasty in open-angle glaucoma]

BACKGROUND

The aim of this study was to determine factors that predict successful selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG).

PATIENTS AND METHODS

In 122 eyes suffering from OAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 66, 72, 78 and 84 months thereafter. Success was defined as an IOP reduction exceeding 20 % of the pretreatment IOP. Correlations between successful SLT and baseline IOP, age, sex, hypertension, diabetes mellitus, family history of glaucoma, previous anterior segment surgery, the grade of trabecular meshwork pigmentation, laser energy used, and local antiglaucoma therapy were determined.

RESULTS

The mean follow-up time was 43.4 months (SD: 25.6). The mean pretreatment IOP was 22.5 mmHg (SD: 2.8). The success rate after 12 months determined from the Kaplan-Meier survival analysis was 88 %, after 24 months 79 %, after 36 months 67 %, after 48 months 58 %, after 60 months 49 % and after 84 months 48 %. We found statistically significant negative correlation betweens successful SLT and the grade of trabecular meshwork pigmentation (r = -0.234; p = 0.01), diabetes mellitus (r = -0.223; p = 0.014). We found no statistically significant correlations between successful SLT and baseline IOP, age, sex, hypertension, family history of glaucoma, previous anterior segment surgery, laser energy used, local antiglaucoma therapy.

CONCLUSION

SLT success in OAG with a mean follow-up time of 43.4 months was significantly predicted by the lower grade of trabecular meshwork pigmentation and the absence of diabetes mellitus.

Adenoviral mediated uteroglobin gene transfer to the adventitia reduces arterial intimal hyperplasia

PURPOSE

The aim of this study was to investigate the feasibility of gene transfer of uteroglobin, a potent anti-inflammatory and immunomodulatory agent, via adenoviral mediated gene transfer to the adventitia in the mouse carotid ligation injury model and also to investigate the efficacy of uteroglobin in reducing neointimal hyperplasia.

METHODS

Forty-five C57bl/6NHSD mice were anesthetized and left common carotid artery ligation was performed. Adenoviral vector encoding the uteroglobin gene (Ad.UG; 15 microl of 1.35 x 10(11) pfu/mL) was applied to the adventitia of the injured artery in 16 mice. In our control groups, 16 mice received adenoviral vector encoding the beta-galactosidase reporter gene (Ad.lacZ; 15 microl of 1.0 x 10(11) pfu/mL) and 13 mice received PBS only. Six mice from each group were sacrificed at 4 days for carotid artery protein extraction and Western blot analysis. The remainder were harvested at 30 days for histologic and morphometric analysis. The intima/media area ratios were calculated for each artery. The results were analyzed and compared using ANOVA and Bonferroni/Dunn post hoc testing.

RESULTS

Two mice from the LacZ group and one from the PBS group died before the 30-day endpoint. Uteroglobin expression was demonstrated in the Ad.UG treated arteries by Western blot analysis. Morphometric analysis demonstrated a statistically significant reduction in the intima/media area ratio of Ad.UG treated carotids compared to controls. There was a reduction of intima/media ratio with Ad. UG treatment of 68% compared to Ad.lacZ treatment (P < 0.0001) and 62% compared to PBS treatment (P = 0.0006). There was no statistical difference between the control groups.

CONCLUSION

Adenoviral mediated gene transfer via the adventitia is an effective mode of gene delivery. Adventitial uteroglobin gene transfer using an adenoviral vector induces uteroglobin protein production and significantly reduces neointimal hyperplasia in the mouse carotid ligation injury model.

Adenoviral-mediated uteroglobin gene transfer inhibits neointimal hyperplasia after balloon injury in the rat carotid artery

OBJECTIVE

Uteroglobin is a protein with potent anti-inflammatory and immunomodulatory effects. We hypothesize that induction of uteroglobin expression in the artery wall by local adenoviral gene transfer will decrease neointimal hyperplasia in the rat carotid artery after balloon injury.

METHODS

Seven male Sprague-Dawley rats underwent balloon injury of the common carotid artery. After the injury, with flow occluded, the artery was instilled with 50 microL of the adenoviral vector encoding uteroglobin gene (Ad.UG) at a concentration of 1.35 x 10(11) pfu/mL (n = 7) or 0.68 x 10(11) pfu/mL (n = 7) (n = 7). Control animals were similarly treated: either an adenovirus encoding for beta-galactosidase gene (Ad.LacZ) at 1 x 10(11) pfu/mL (n = 7) or the phosphate-buffered saline (PBS) vehicle (n = 6) was used. The solution was allowed to dwell for 20 minutes. The rats were humanely killed after 14 days by perfusion fixation, and the carotid arteries were sectioned for analysis with computerized planimetry. The intima-media area ratios were calculated for each artery and compared with analysis of variance with Bonferroni/Dunn post hoc testing. One additional rat from the PBS, Ad.LacZ, and Ad.UG (1.35 x 10(11) pfu/mL) groups was humanely killed 4 days after treatment for carotid artery protein extraction and Western blotting.

RESULTS

Uteroglobin protein production was confirmed in the Ad.UG-treated arteries with Western blotting. Morphometric analysis showed that the Ad.UG group at 1.35 x 10(11) pfu/mL had a significantly lower intima-media area ratio than both the Ad.LacZ (P =.002) and PBS (P =.004) controls. The Ad.UG group at 0.68 x 10(11) pfu/mL was also significantly different from the Ad. LacZ (P =.003) and PBS (P =.006) controls. There was no statistical difference between the two control groups or between the two Ad.UG groups.

CONCLUSION

Adenoviral gene transfer of uteroglobin, delivered intraluminally after arterial injury causes the production of uteroglobin protein and has an inhibitory effect on neointimal accumulation in the rat model.

Influence of size and gene dosage on the survival of skin allografts on rats rendered tolerant at birth

The attributes of the test grafts with which putatively tolerant rats are challenged influence their immune response. Lewis (Lew) rats inoculated at birth with Lew/BN F1 hybrid bone marrow cells accept large skin allografts more readily than small allografts, and F1 hybrid skin grafts survive better than BN transplants. The results indicate that the survivals of these major histocompatibility complex-incompatible grafts are determined by the same factors that operate when only weak histoincompatibilities prevail.