A synthetic thiol molecule releasing N-acetyl-l-cysteine and cysteamine drives early up-regulation of immunoproteasome subunits in the lymph nodes of mice infected with LP-BM5 leukemia retrovirus

Thiol molecules have been recently re-considered as drug candidates in viral infections because of their ability to induce redox changes which interfere with virus life cycle and modulate the host immune response. Little is known about the molecular mechanisms of their immunomodulatory properties. Here we show that I-152, a thiol molecule metabolized to release N-acetyl-l-cysteine and cysteamine and acting as a pro-glutathione agent, causes early up-regulation of immunoproteasome subunits in the lymph nodes of murine leukemia virus infected mice. This evidence suggests that the immunoproteasome may be modulated by thiol-based compounds with important implications in understanding redox-controlled immunoregulation.

The influence of redox modulation on hypoxic endothelial cell metabolic and proteomic profiles through a small thiol-based compound tuning glutathione and thioredoxin systems

Reduction in oxygen levels is a key feature in the physiology of the bone marrow (BM) niche where hematopoiesis occurs. The BM niche is a highly vascularized tissue and endothelial cells (ECs) support and regulate blood cell formation from hematopoietic stem cells (HSCs). While in vivo studies are limited, ECs when cultured in vitro at low O2 (<5%), fail to support functional HSC maintenance due to oxidative environment. Therefore, changes in EC redox status induced by antioxidant molecules may lead to alterations in the cellular response to hypoxia likely favoring HSC self-renewal. To evaluate the impact of redox regulation, HUVEC, exposed for 1, 6, and 24 h to 3% O2 were treated with N-(N-acetyl-l-cysteinyl)-S-acetylcysteamine (I-152). Metabolomic analyses revealed that I-152 increased glutathione levels and influenced the metabolic profiles interconnected with the glutathione system and the redox couples NAD(P)+/NAD(P)H. mRNA analysis showed a lowered gene expression of HIF-1α and VEGF following I-152 treatment whereas TRX1 and 2 were stimulated. Accordingly, the proteomic study revealed the redox-dependent upregulation of thioredoxin and peroxiredoxins that, together with the glutathione system, are the main regulators of intracellular ROS. Indeed, a time-dependent ROS production under hypoxia and a quenching effect of the molecule were evidenced. At the secretome level, the molecule downregulated IL-6, MCP-1, and PDGF-bb. These results suggest that redox modulation by I-152 reduces oxidative stress and ROS level in hypoxic ECs and may be a strategy to fine-tune the environment of an in vitro BM niche able to support functional HSC maintenance.

Targeting SARS-CoV-2 by synthetic dual-acting thiol compounds that inhibit Spike/ACE2 interaction and viral protein production

The SARS-CoV-2 life cycle is strictly dependent on the environmental redox state that influences both virus entry and replication. A reducing environment impairs the binding of the spike protein (S) to the angiotensin-converting enzyme 2 receptor (ACE2), while a highly oxidizing environment is thought to favor S interaction with ACE2. Moreover, SARS-CoV-2 interferes with redox homeostasis in infected cells to promote the oxidative folding of its own proteins. Here we demonstrate that synthetic low molecular weight (LMW) monothiol and dithiol compounds induce a redox switch in the S protein receptor binding domain (RBD) toward a more reduced state. Reactive cysteine residue profiling revealed that all the disulfides present in RBD are targets of the thiol compounds. The reduction of disulfides in RBD decreases the binding to ACE2 in a cell-free system as demonstrated by enzyme-linked immunosorbent and surface plasmon resonance (SPR) assays. Moreover, LMW thiols interfere with protein oxidative folding and the production of newly synthesized polypeptides in HEK293 cells expressing the S1 and RBD domain, respectively. Based on these results, we hypothesize that these thiol compounds impair both the binding of S protein to its cellular receptor during the early stage of viral infection, as well as viral protein folding/maturation and thus the formation of new viral mature particles. Indeed, all the tested molecules, although at different concentrations, efficiently inhibit both SARS-CoV-2 entry and replication in Vero E6 cells. LMW thiols may represent innovative anti-SARS-CoV-2 therapeutics acting directly on viral targets and indirectly by inhibiting cellular functions mandatory for viral replication.

Concordance between child’s and parents’- reported Health-related quality of life and overweight

Background

Health-related quality of life (HRQoL) of children is an important health outcome which has frequently been investigated regarding children's chronicle illnesses using parents proxy-reported HRQoL. Obesity is an increasingly frequent condition in children, for which the evidence about perceived quality of life is lacking. The aim of our study is to examine the concordance between child's and parents'- reported HRQoL according to children's weight status.

Methods

A cross-sectional study was conducted in 2019 among 128 children, aged 6-10, recruited in a primary school of Imola (Italy). Children were divided in Group1 (G1: normal-underweight) and Group2 (G2: overweight-obese) using the International Obesity Task Force cut points. HRQoL was assessed using the Italian version 4.0 of Paediatric Quality of Life (PedsQL) questionnaire. We obtained self-reported children's HRQoL total score and the parents' perceived children's HRQoL total score. Each score had two subscales: one for physical health and one for emotional, social and school functioning.

Results

In G1 there were 86 children and in G2 42. The correlation between the children's and parents' HRQoL scores is low in G1 (physical health: 0.24; emotional, social and school functioning: 0.15). Children in G2 and their and parents' perception of physical health are poorly correlated (r=-0.09) and those of emotional, social and school functioning are well correlated (r = 0.43).We observed that in case of discordant HRQoL results, parents usually overestimate their children's HRQoL.

Conclusions

Correlation between the children's and parents' HRQoL scores is low in G1. In G2 children's and parents' perception are concordant for emotional, social and school functioning and unrelated for physical health. It would be useful to investigate whether these results depend from lack of communication between parents and children or lack of parents' awareness of health-related problems with obesity.

Key messages

Parents and children have a discordant perception of physical health quality of life. Further studies should investigate the reasons why these results are discordant.

Analytical Performance of Ca 19.9, Ca 125 and Ca 15.3 Assays as Observed through an External Quality Assessment Program

Immunoassays of the tumor markers CA 19.9, CA125 and CA 15.3 are generally acknowledged to be a useful tool in the management of cancer patients. As a consequence, many methods developed by different companies are now commercially available. However, discrepancies have been described in the results of marker determinations even when the same monoclonal antibody was used. An external quality assessment (EQA) was carried out; starting from 1989 about 110 laboratories participated; since December 1991 the program was linked with the interlaboratory program Oncocheck organized by the Service de Radiopharmacie et Radioanalyse, University of Lyon. At present more than 200 laboratories of many European countries are involved: cumulatively 47 quality control samples have been prepared and sent to the participants. This manuscript is a report on data collected for CA 19.9, CA 125, and CA 15.3.

Comparison between 24-h proteinuria, urinary protein/creatinine ratio and dipstick test in patients with nephropathy: patterns of proteinuria in dipstick-negative patients

OBJECTIVE

Three main tests are commonly employed for the measurement of proteinuria: the dipstick test, the urinary protein/creatinine ratio (P/C) and the 24-h urine collection. The aim of this study was to evaluate the correlation between these methods, comparing linear regression and ROC curve data.

MATERIAL AND METHODS

A total of 297 consecutive outpatients with different renal diseases were included in the study. Twenty-four-hour proteinuria was considered the reference test.

RESULTS

A high degree of correlation was observed between all the tests (p<0.0001), the highest regression coefficient being between 24-h proteinuria and P/C (R=0.82), and the lowest between P/C and the dipstick test (R=0.72). The dipstick test failed to detect pathological proteinuria in 94 patients (31.6%). Therefore, in these subjects, the patterns of proteinuria were assessed by immunofixation and sodium dodecyl sulphate (SDS) electrophoresis.

CONCLUSIONS

Our data strongly support the use of urinary P/C for the detection of proteinuria, at least in nephrology units, where the prevalence of proteinuria is likely to be high.

Thyroid hormones homeostasis in pediatric patients during and after cardiopulmonary bypass

The concentrations of thyroid hormones were measured in 14 pediatric patients before, during, and after cardiopulmonary bypass. The ages of the patients ranged between 18 months and 14 years. Patients were kept normothermic, or moderate or deep hypothermia was induced depending on the specific pathologic condition involved. A marked reduction in the levels of total triiodothyronine, total thyroxine, free triiodothyronine, and thyroid-stimulating hormone, and in the ratio of free triiodothyronine to free thyroxine was detected during the time frame of the study. The minimum levels of each hormone were reached between 12 and 48 hours after cardiopulmonary bypass, indicating that changes in thyroid function and in the conversion of thyroxine to triiodothyronine are triggered by cardiopulmonary bypass and represent specific phenomena, and that these changes are progressively exacerbated during the post-operative period. The thyroid-stimulating hormone level was markedly reduced versus its baseline values (24% +/- 0.13%), despite low levels of both total (40% +/- 18%) and free (39% +/- 20%) triiodothyronine: it returned to its preoperative level by the third postoperative day, but both the total (75% +/- 10%) and free (74% +/- 3%) triiodothyronine levels remained below their baseline values for 7 days postoperatively. Neither hemodilution nor hypothermia was responsible for the alteration observed. We conclude that pediatric patients undergoing cardiopulmonary bypass manifest changes in hormone metabolism similar to those seen in adult patients. These changes increase progressively during the postoperative period, and are still present 7 days postoperatively. The exact mechanism responsible for causing these changes is not thoroughly understood. Whether triiodothyronine replacement therapy is beneficial or deleterious remains controversial.

Systematic differences between commercial immunoassays for free thyroxine and free triiodothyronine in an external quality assessment program

Data collected in a national external quality assessment program for free thyroxine (fT4) and free triiodothyronine (fT3) were analyzed to evaluate the performance of 10 method/kits with 26 control samples distributed to approximately 170 laboratories. The control materials were normal serum pools, pooled sera supplemented with thyroid hormones, a pregnancy serum pool, serum pooled from patients with familial dysalbuminemic hyperthyroxinemia (FDH), and a normal serum pool progressively diluted. The between-laboratory variability (CV) was approximately constant in normal and supplemented pools for fT4 (15.3%) and fT3 (24.0%) but markedly increased in diluted, pregnancy, and FDH pools (21.9-35.2% for fT4 and 28.6-66.5% for fT3) because of increases in systematic between-kit differences in control samples with altered binding-protein capacity. Moreover, free hormone concentrations measured in progressively diluted sera averaged lower than in undiluted samples. This decrease of concentration was less for back-titration or labeled-antibody techniques and greater for labeled-analog methods; only the method involving adsorption to cross-linked dextran (Sephadex) was unaffected by dilution. Evaluation of the reproducibility of the method/kits showed between-assay, between-laboratory precision ranging from 7.8% to 17.0% for fT4 and from 9.8% to 20.3% for fT3.

Systematic differences between commercial immunoassays for free thyroxine and free triiodothyronine in an external quality assessment program

Data collected in a national external quality assessment program for free thyroxine (fT4) and free triiodothyronine (fT3) were analyzed to evaluate the performance of 10 method/kits with 26 control samples distributed to approximately 170 laboratories. The control materials were normal serum pools, pooled sera supplemented with thyroid hormones, a pregnancy serum pool, serum pooled from patients with familial dysalbuminemic hyperthyroxinemia (FDH), and a normal serum pool progressively diluted. The between-laboratory variability (CV) was approximately constant in normal and supplemented pools for fT4 (15.3%) and fT3 (24.0%) but markedly increased in diluted, pregnancy, and FDH pools (21.9-35.2% for fT4 and 28.6-66.5% for fT3) because of increases in systematic between-kit differences in control samples with altered binding-protein capacity. Moreover, free hormone concentrations measured in progressively diluted sera averaged lower than in undiluted samples. This decrease of concentration was less for back-titration or labeled-antibody techniques and greater for labeled-analog methods; only the method involving adsorption to cross-linked dextran (Sephadex) was unaffected by dilution. Evaluation of the reproducibility of the method/kits showed between-assay, between-laboratory precision ranging from 7.8% to 17.0% for fT4 and from 9.8% to 20.3% for fT3.

Immunoassay of CEA, CA 19-9, CA 125, and CA 15-3 on the automated systems ES 300 and ES 600: methodological evaluation from a multicentre collaborative study

The analytical performance of the automated Enzymun Test System ES 300 and ES 600 (developed by Boehringer Mannheim) for the assay of the tumour markers CEA, CA 19-9, CA 125, and CA 15-3, was assessed from data collected in a multicentre collaborative study in which eleven laboratories were involved. Results of the 1990 cycle of the external quality assessment (EQA) scheme for tumour markers, supported by the Italian National Research Council (CNR), were also used in this evaluation. The within-assay and between-assay precision was found to be 2.0 and 4.3 CV% for CEA, 2.9 and 6.8 CV% for CA 19-9, 3.6 and 9.4 CV% for CA 125, 2.9 and 6.0 CV% for CA 15-3. The between-lab variability of the four tumour markers on ES 300 and ES 600 systems was 9.4, 10.6, 11.9, 9.2 CV% for CEA, CA 19-9, CA 125 and CA 15-3 respectively. These values were comparable to or better than those obtained with the most precise manual kits used by laboratories participating in the 1990 EQA cycle. The agreement between the results from the Enzymun Test and those obtained using other method/kits was evaluated by assaying control samples previously circulated either in the CNR EQA or in the German EQA. The regression analysis indicates that for CEA, CA 125 and CA 15-3 assays the results produced by ES 300 and ES 600 are in good agreement with the consensus means of the EQAs; CA 19-9 results exhibit a worse correlation and are generally lower than the consensus mean. The linearity of the assays for the four tumour markers was checked by dilution tests performed by participants in the collaborative study; in all cases the dilution of the sample did not affect the values obtained.

External Quality Assurance of the Carcinoembryonic Antigen (CEA) Assay: Main Findings in Six Years' Experience

In 1984 we initiated a national external quality assessmnent (EQA) program (supported by the Italian National Research Council, CNR) for the CEA assay; at present, about 200 Italian laboratories are participating in the program. The laboratories assayed the quality control (QC) samples according to their routine procedures and returned the results together with the name of the method/kit they used. The collecterd results were computer-processed and reports were sent back to the participants. A significant reduction of the CVt (mean between-laboratory agreement) of the CEA assay was observed throughout the EQA survey (from 35% in 1985 to 20-25% in the last cycles). In order to better clarify the differences in variability observed in the first QC cycles against the last ones, we used the ANOVA technique to evaluate the components of variability. The improvement in between-laboratory agreement was mainly due to the reduction of the between-kit component (from 30.5% to 15.2%), rather than to the smaller decrease observed for the within-kit variability (from 18.4% to 14.0%). The results reported for QC samples from different materials showed differences in the between-lab variability and substantial changes of the kit biases, thus suggesting a different specificity of the antibodies used in the various method/kits against different families of CEA molecules.

Considerable uncertainty was also encountered in the clinical classification of low pathological samples, which seems mainly due to the variability in cut-off values used by the laboratories for the clinical assessment of the same analytical results. Our data indicate a progressive increase in the reliability of CEA determination during our study and confirm that EQA has improved the reliability of analysis carried out by the participating laboratories, thus stimulating the kit manufacturers to provide more reliable products.

Increased circulating concentrations of interleukin 2 receptor during rejection episodes in heart- or kidney-transplant recipients

Concentrations of interleukin 2 receptor (sIL-2R) have been suggested as a marker of rejection episodes after organ transplantation. To evaluate the analytical performance of a "sandwich-type" enzyme immunoassay method for sIL-2R and to verify whether increased concentrations of sIL-2R might be a useful marker of allograft rejection, we quantified sIL-2R in serum samples from heart- or kidney-transplant patients. The mean (+/- SD) pre-transplant value of sIL-2R (592 +/- 209 kilo-units/L) in heart-transplant patients was significantly higher (P less than 0.01) than that observed in controls (350 +/- 101 kilo-units/L). After heart transplantation, the concentrations of sIL-2R slowly decreased to baseline in successfully treated patients but increased significantly (1129 +/- 215 kilo-units/L; P less than 0.01) during acute rejection crisis. However, severe infections were also associated with a significant increase of sIL-2R, so the sIL-2R test is not specific for allograft rejection. The mean pre-transplant concentration of sIL-2R was also increased (1943 +/- 878 kilo-units/L) in 26 renal-transplant patients; after transplantation, this value returned to normal, as did that for creatinine, but persisted steadily high in five patients who experienced acute tubular necrosis. In this group of patients, the sIL-2R concentration increased by 1.5- to fourfold, both during acute rejection episodes and in clinically evident infection; thus measurement of creatinine and sIL-2R concentrations can help to distinguish between rejection, infection, and cyclosporine toxicity. In two episodes of mild cyclosporine-induced nephrotoxicity, we observed slight increases in serum creatinine (which returned to baseline when the cyclosporine dose was decreased) not associated with an increase in sIL-2R. We conclude that systematic monitoring of sIL-2R together with other biochemical and clinical markers may be useful in the management of kidney-transplant patients.

Increased circulating concentrations of interleukin 2 receptor during rejection episodes in heart- or kidney-transplant recipients

Concentrations of interleukin 2 receptor (sIL-2R) have been suggested as a marker of rejection episodes after organ transplantation. To evaluate the analytical performance of a "sandwich-type" enzyme immunoassay method for sIL-2R and to verify whether increased concentrations of sIL-2R might be a useful marker of allograft rejection, we quantified sIL-2R in serum samples from heart- or kidney-transplant patients. The mean (+/- SD) pre-transplant value of sIL-2R (592 +/- 209 kilo-units/L) in heart-transplant patients was significantly higher (P less than 0.01) than that observed in controls (350 +/- 101 kilo-units/L). After heart transplantation, the concentrations of sIL-2R slowly decreased to baseline in successfully treated patients but increased significantly (1129 +/- 215 kilo-units/L; P less than 0.01) during acute rejection crisis. However, severe infections were also associated with a significant increase of sIL-2R, so the sIL-2R test is not specific for allograft rejection. The mean pre-transplant concentration of sIL-2R was also increased (1943 +/- 878 kilo-units/L) in 26 renal-transplant patients; after transplantation, this value returned to normal, as did that for creatinine, but persisted steadily high in five patients who experienced acute tubular necrosis. In this group of patients, the sIL-2R concentration increased by 1.5- to fourfold, both during acute rejection episodes and in clinically evident infection; thus measurement of creatinine and sIL-2R concentrations can help to distinguish between rejection, infection, and cyclosporine toxicity. In two episodes of mild cyclosporine-induced nephrotoxicity, we observed slight increases in serum creatinine (which returned to baseline when the cyclosporine dose was decreased) not associated with an increase in sIL-2R. We conclude that systematic monitoring of sIL-2R together with other biochemical and clinical markers may be useful in the management of kidney-transplant patients.

A new chemiluminescence immunoassay for triiodothyronine and thyroxine: evaluation using quality control sera assayed in an interlaboratory survey

A recently developed chemiluminescence immunoassay system (LIA-mat) for triiodothyronine and thyroxine, set up by Byk-Sangtec Diagnostica (Dietzenbach, Germany), has been evaluated and compared with radioimmunoassays and with a chemiluminescence enhanced enzyme immunoassay (Amerlite), using control materials circulated in a national interlaboratory quality control, as well as patient sera. The LIA-mat assays are competitive methods which use coated monoclonal antibodies and triiodothyronine- or thyroxine-ABEI (aminobutylethylisoluminol) conjugate as tracers. The working range of LIA-mat T3 (computed from the within-assay precision profile) extended from 1.4 to 12.3 nmol/l; the between-assay precision was 8.1 - 19.3 CV%. Regression analysis of the LIA-mat T3 results (y) against the consensus means (x) of the participants in the national interlaboratory survey yielded: y = -0.14 + 1.05 x, r = 0.95. The working range of LIA-mat T4 extended from 33 to 515 nmol/l; the between-assay precision was 5.4 - 9.2 CV%. An excellent agreement was found between LIA-mat T4 results (y) and the consensus means (x) of the laboratories participating in the national interlaboratory survey (y = 3.79 + 1.02 x, r = 0.98).

Methodological evaluation of a new chemiluminescence immunoassay for thyrotropin using acridinium ester-labelled antibody

A recently available immunochemiluminometric assay (ICMA) for TSH developed by Ciba Corning Corp. has been evaluated. This system (Magic Lite) uses an acridinium-ester-labelled antibody and magnetizable particle for bound-free separation. In each assay only two calibrators are carried out and used to re-scale a manufacturer-generated curve stored in the memory of the luminometer. The precision of the response (RLU) estimated by all duplicates of 14 runs was about 4% for responses greater than 12,000 RLU (corresponding to a concentration interval 0.7-113 microIU/ml) and worsened in the lower range (up to 10% CV); the sensitivity, computed from the mean within-assay precision profile, was 0.028 microIU/ml; the between-assay precision ranged from 4.6 to 13.1 CV%. Regression analysis of ICMA results (y) against consensus values of Behring IRMA (x) on 15 QC sera assayed in an inter-laboratory survey (concentration range 1-30 microIU/ml) gave y = -0.003 + 0.98x indicating a good agreement of the two techniques. Similar conclusions have been derived from the comparison of the ICMA results (y) in the low TSH concentration range (less than 1 microIU/ml) against the IRMA Boots Celltech (x) on 80 patient samples (y = 0.04 + 1.04x).

A new luminescence immunoassay for thyrotropin using coated tubes: evaluation and comparison with immunoradiometric assay

A recently available chemiluminescence immunoassay (LIA-MAT) for TSH, set up by Byk-Sangtec Diagnostica, has been evaluated and compared with IRMA methods. The system LIA-MAT uses two monoclonal antibodies: one coated on tubes and the other labelled with isoluminol. To compute the within-assay precision profile, we estimated the response error relationship from all the duplicates (420) of eleven experiments. The CV of the response was 4-5% from the maximal response until 10,000 RLU (corresponding to about 1 microIU/ml); in the lower response range the CV worsened up to 8%. The sensitivity, derived from the precision profile, was 0.052 microIU/ml similar to that found in IRMA-MAT (0.044 microIU/ml); the working range extended from 0.33 to 100 microIU/ml. Results from LIA-MAT in the concentration range 1-30 microIU/ml were compared with the consensus mean produced by users of IRMA methods (IRMA-MAT, IRMA-Behring, Maiaclone Serono) participating in an inter-laboratory survey; a good correlation with IRMA techniques was found. The distribution of TSH determinations produced by LIA-MAT on 62 low concentration sample (less than 0.3 microIU/ml) from patients unresponsive to TRH test, was found similar to that observed for the kit IRMA Boots-Celltech assumed as reference.

Minimizing between-kit variability in immunoassay for carcinoembryonic antigen by use of a common standard

Between-laboratory agreement of CEA determinations collected in a multicenter study has been substantially improved (CV decreased from 60.4 to 21.6%) by converting the results from mass concentration units (ng/mL) of local kit standards to int. units/L of the international standard first IRP 73/601. Conversion factors for the kits most used were computed, during the same survey, from results of two analytical-recovery experiments in which control samples, supplemented with the international standard, were analyzed by participating laboratories (n = 96).

Minimizing between-kit variability in immunoassay for carcinoembryonic antigen by use of a common standard

Between-laboratory agreement of CEA determinations collected in a multicenter study has been substantially improved (CV decreased from 60.4 to 21.6%) by converting the results from mass concentration units (ng/mL) of local kit standards to int. units/L of the international standard first IRP 73/601. Conversion factors for the kits most used were computed, during the same survey, from results of two analytical-recovery experiments in which control samples, supplemented with the international standard, were analyzed by participating laboratories (n = 96).