Dimethyl fumarate and 4-octyl itaconate are anticoagulants that suppress Tissue Factor in macrophages via inhibition of Type I Interferon

Excessive inflammation-associated coagulation is a feature of infectious diseases, occurring in such conditions as bacterial sepsis and COVID-19. It can lead to disseminated intravascular coagulation, one of the leading causes of mortality worldwide. Recently, type I interferon (IFN) signaling has been shown to be required for tissue factor (TF; gene name F3) release from macrophages, a critical initiator of coagulation, providing an important mechanistic link between innate immunity and coagulation. The mechanism of release involves type I IFN-induced caspase-11 which promotes macrophage pyroptosis. Here we find that F3 is a type I IFN-stimulated gene. Furthermore, F3 induction by lipopolysaccharide (LPS) is inhibited by the anti-inflammatory agents dimethyl fumarate (DMF) and 4-octyl itaconate (4-OI). Mechanistically, inhibition of F3 by DMF and 4-OI involves suppression of Ifnb1 expression. Additionally, they block type I IFN- and caspase-11-mediated macrophage pyroptosis, and subsequent TF release. Thereby, DMF and 4-OI inhibit TF-dependent thrombin generation. In vivo, DMF and 4-OI suppress TF-dependent thrombin generation, pulmonary thromboinflammation, and lethality induced by LPS, E. coli, and S. aureus, with 4-OI additionally attenuating inflammation-associated coagulation in a model of SARS-CoV-2 infection. Our results identify the clinically approved drug DMF and the pre-clinical tool compound 4-OI as anticoagulants that inhibit TF-mediated coagulopathy via inhibition of the macrophage type I IFN-TF axis.

Sex-specific differences in plasma levels of FXII, HK, and FXIIa-C1-esterase inhibitor complexes in community acquired pneumonia

Sex-dependent differences in immunity and coagulation play an active role in the outcome of community-acquired pneumonia (CAP). Contact phase proteins act at the crossroads between inflammation and coagulation thus representing a point of convergence in host defense against infection. Here, we measured the levels of factor XII (FXII), FXIIa-C1 esterase inhibitor (C1INH) complexes, and high molecular weight kininogen (HK) in plasma of CAP patients and correlated them to clinical disease severity. Levels of FXIIa-C1INH/albumin ratio were elevated, irrespective of sex, in plasma of CAP patients (n=139) as compared to age-matched donors (n=58). No simultaneous decrease in FXII levels, indicating its consumption, was observed. Stratification by sex revealed augmented FXII levels in plasma of CAP women as compared to sex-matched donors yet no apparent differences in men. This sex-specific effect was, however, attributable to lower FXII levels in female donors relative to men donors. Plasma estradiol levels mirrored those for FXII. Levels of HK/albumin ratio were decreased in CAP plasma as compared to donors, however, after stratification by sex, this difference was only observed in women and was related to higher HK/albumin values in female donors as opposed to male donors. Finally, strong negative correlation between plasma levels of HK/albumin ratio and CAP severity, as assessed by CRB65 score, in males and females was observed. Our study identifies sex-dependent differences in plasma levels of the contact phase proteins in elderly subjects that may contribute to specific clinical outcomes in CAP between men and women.

[Beta-hydroxybutyrate measurements with the GlucoMen®LX Plus in the diagnosis of diabetic ketoacidosis in dogs and cats]

OBJECTIVE

The measurement of beta-hydroxybutyrate (BOHB) carries high significance for the diagnosis, prognosis as well as treatment decisions in canine and feline diabetic ketoacidosis. The aim of this study was to establish clinically usable cut-off values for BHOB measurements in dogs and cats using the glucometer GlucoMen^®LX Plus.

MATERIAL AND METHODS

We measured BOHB with the GlucoMen^®LX Plus in 4 patient groups (diabetic ketoacidosis, diabetic non-ketoacidic, catabolic non-diabetic status, control). These were classified based upon medical history and laboratory findings (pH, glucose-, HCO₃ ^- concentrations, anion gap). The data was analyzed in a ROC-curve-analysis in order to create cut-off values.

RESULTS

A total of 47 dogs and 55 cats were included into the study. In the differentiation between the two diabetic groups, cut-off values for dogs and cats amounted to 2.55 mmol/l and 4.05 mmol/l, respectively. Here, good sensitivity (100 %) and specificity (82 % and 100 %, respectively) were attained. In the comparison of the catabolic non-diabetic status group and the individuals with diabetic ketosis, the analysis resulted in a cut-off value of 0.25 mmol/l in dogs and 0.25 mmol/l in cats, carrying poor sensitivity (58 % and 59 %, respectively) and specificity (90 %).

CONCLUSION

Measurements with the GlucoMen^®LX Plus are suitable for a reliable differentiation between ketoacidosis and ketosis in dogs and cats. Here, the determined cut-off values carried high sensitivity and specificity. A distinction between non-diabetic catabolic individuals and patients with diabetic catabolic states, however, cannot be achieved with adequate consistency.

CLINICAL RELEVANCE

The established cut-off values aid in the treatment decision-making process as well as the assessment of prognosis and treatment success in diabetic ketoacidosis. In representing a point of care technique, the method allows for direct owner communication of the results and immediate adjustment of the treatment regime. Concerning the initial diagnosis or a differentiation between non-diabetic and diabetic catabolic states, however, the presented method alone is not sufficient, therefore additional diagnostic procedures are warranted in order to ascertain a correct diagnosis.

[Comparative measurement using the GlucoMen®LX PLUS and a reference method to quantify β-hydroxybutyrate in dogs and cats]

OBJECTIVES

The detection of ketone bodies in urinary samples often underestimates the degree of ketonuria and may lead to false negative results due to the lack of detection of β-hydroxybutyrate. In human medicine, the standard method used to quantify and monitor ketonemia is the measurement of β-hydroxybutyrate in whole blood samples which is associated with a higher sensitivity. For this, only few devices have to date been evaluated in veterinary medicine. These have shown limitations in areas of high β-hydroxybutyrate concentrations. The aim of the study was to compare the portable ketone meter GlucoMen^®LX PLUS with a reference method for measurement of β-hydroxybutyrate in canine and feline venous blood samples.

MATERIAL AND METHODS

In this prosepctive study, a total of 47 dogs and 55 cats were enrolled. These cases comprised patients with diabetic ketoacidosis, diabetes mellitus and catabolic metabolism as well as healthy individuals. Comparison between the GlucoMen^®LX PLUS ketone meter and an enzymatic reaction method by an automated chemistry analyzer was performed. Measurement results of dogs and cats were evaluated separately.

RESULTS

There was a high correlation between measurement values of the GlucoMen^®LX PLUS and the enzymatic reaction laboratory method in dogs (R = 0.99, p < 0.001) and cats (R = 0.98, p < 0.001). Mean difference was 0.01 mmol/l (SD ± 0.20) in dogs and 0.05 mmol/l (SD ± 0.29) in cats. In 44 % of all dogs and cats the GlucoMen^®LX PLUS measured lower values in comparison to the reference method. Greater differences between the 2 measurement methods were apparent in both high and low β-hydroxybutyrate concentration ranges (dogs, R = -0.762 and cats, R = -0.86). In high concentration areas, the GlucoMen^®LX PLUS led to slightly lower results, whereas in low concentration areas slightly higher values were measured.

CONCLUSION

The GlucoMen^®LX PLUS shows a strong correlation with the standard reference method and is useful for measurement of β-hydroxybutyrate in canine and feline venous blood samples. Limitations can be seen in high concentration ranges of β-hydroxybutyrate in which the GlucoMen^®LX PLUS resulted in slightly lower measurement values.

CLINICAL RELEVANCE

The GlucoMen^®LX PLUS is a cost-effective portable device representing a viable alternative to urinary ketone body measurement.

Emergence and dissemination of a linezolid-resistant Staphylococcus capitis clone in Europe

Objectives

We investigated the epidemiological, clinical, microbiological and genetic characteristics of linezolid-resistant (LZR) Staphylococcus capitis isolates from French ICUs, and compared them with LZR S. capitis isolates from other European countries.

Methods

All LZR isolates were subjected to antimicrobial susceptibility testing (AST) and the presence of cfr and optrA genes as well as mutations in the 23S rRNA and ribosomal proteins were investigated using specific PCR with sequencing. The genetic relationship between isolates was investigated using PFGE and WGS. Epidemiological data concerning LZR S. capitis were collected retrospectively in French microbiology laboratories.

Results

Twenty-one LZR isolates were studied: 9 from France, 11 from Greece and 1 from Finland. All were resistant to methicillin and aminoglycosides. In addition, this unusual AST profile was identified in S. capitis isolates from seven French hospitals, and represented up to 12% of the S. capitis isolates in one centre. A G2576T mutation in 23S rRNA was identified in all isolates; cfr and optrA genes were absent. All isolates belonged to the same clone on the basis of their PFGE profiles, whatever their geographical origin. WGS found at most 212 SNPs between core genomes of the LZR isolates.

Conclusions

We identified and characterized an LZR S. capitis clone disseminated in three European countries, harbouring the same multiple resistance and a G2576T mutation in the 23S rRNA. The possible unrecognized wider distribution of this clone, belonging to a species classically regarded as a low-virulence skin colonizer, is of major concern not least because of the increasing use of oxazolidinones.

Elektronischer Mutter(Eltern)-Kind Pass – Möglichkeiten, Zielsetzungen und internationale Erfahrungen

Vor dem Hintergrund einer Neugestaltung des Eltern-Kind-Vorsorgeprogramms in Österreich, welche auch eine elektronische statt papierbasierte Umsetzung beinhalten könnte, soll ein Überblick internationaler Pilotierungen elektronischer Eltern-Kind-Vorsorge Initiativen (eEKVI) gegeben, und für die Umsetzung relevanten Grenzen, Möglichkeiten und Zielsetzungen dieser Projekte aufgezeigt werden.

Datenbankrecherche sowie Handsuche nach internationalen (Pilot-) Projekten.

Von 30 ausgewählten eEKVI können 9 als elektronische Eltern- bzw. Kinder-Gesundheitsakten angesehen werden, welche entweder im Kontext einer umfassenden elektronischen Gesundheitsakte, als elektronische Umsetzung eines papierbasierten Dokuments oder als an eine Einrichtung gebundene IT-Lösung realisiert wurden. eEKVI sind bislang international noch kaum flächendeckend implementiert, einige wenige bedienen neben klassischen Kern-Zielen (Abwicklung und Administration der Versorgung usw.) auch planerische Zielsetzungen und ermöglichen dadurch ein systemisches Lernen aufgrund von Feedback und Evaluationszyklen.

Basierend auf Erfahrungen internationaler eEKVI sollten Kernaspekte einer erfolgreichen Planung und Umsetzung, wie beispielsweise die Definition von erwarteten Nutzen-Zielen und deren Monitoring oder die Bildung eines für Planung und Konzeption verantwortlichen Teams unter früher Einbeziehung von Endnutzern und Akteuren, berücksichtigt werden, um vermeidbare Fehler zu minimieren. Eine konsequente Technikfolgenabschätzung – auch von IT-basierten Interventionen im Gesundheitswesen – ist jedenfalls zu fordern, um ein reflektiertes Vorgehen zu ermöglichen.

[Study of hepatitis C virus leukotropism by characterization of viral quasispecies in the liver transplantation setting]

Besides hepatocytes, representing the main replication site of hepatitis C virus, peripheral blood mononuclear cells also represent a crucial target for viral infection. Hepatitis C virus compartmentalization (i.e., non-random distribution) of viral variants between plasma and peripheral blood mononuclear cells, more frequently observed in liver transplant patients compared to non-transplanted patients, makes liver transplantation an interesting model for the analysis of hepatitis C leukotropism. This article aims to present, firstly, in clinical and biological features arguing favour of hepatitis C virus infection leukotropism and, secondly, to review current knowledge about compartmentalization between plasma and peripheral blood mononuclear cells, especially in the liver transplantation setting.

Histamine mediates osteoclastic resorption only during the acute phase of bone loss in ovariectomized rats

Short-term studies have shown that histamine is involved, via its H2 receptors (H2R), in the mediator network regulating trabecular bone loss in long bones of ovariectomized (OVX) rats. It is not known whether this effect of histamine persists over time or involves other skeletal sites. In this study, rats were maintained for 6 months postOVX and treated daily with saline or famotidine (10 mg kg(-1)), an H2R antagonist. At the end of the experimental period, femur trabecular bone mass was markedly decreased in OVX rats, whether or not they were treated with famotidine. In contrast, in the fourth lumbar vertebra, where bone loss starts later than in the femur, famotidine treatment attenuated the decline in trabecular bone volume, protected the trabecular architecture, maintained the thickness of the cortices and reduced the numbers of osteoclasts and tartrate-resistant acid phosphatase-positive preosteoclasts, whereas it had no influence on bone formation parameters. In vertebral bone marrow of OVX rats, the numbers of mast cells (MCs) and non-MC histamine-producing cells increased, while famotidine treatment significantly diminished both cell populations. These data show that H2R antagonism does not protect trabecular bone mass in the long term, and that short-term protection involves all bones. Histamine is involved during the early phase of strong osteoclastic resorption but not during the late phase of slower resorption, suggesting that different mediator networks control the two phases of destruction. Histamine would be part of the network mediating the early phase.

Rechtliche Möglichkeiten und Grenzen der Integrierten Versorgung in der Kardiologie

Regulations of Integrated Health Care are capable of overriding the barriers of separated outpatient and inpatient health care. These regulations create a situation of competition among health care providers, but not among payers. Since the laws exclude common regulations of competition laws, antitrust laws and public procurement laws from Integrated Health Care, insurance companies gain a relatively strong position in the competition for contracts. This is even enforced by the fact that no health care provider is entitled to request a contract with a specific insurance company. The main result is that insurance companies can determine the contracts deliberately.