Abnormal intracellular kinetics of cell-cycle-dependent proteins in lymphocytes from patients infected with human immunodeficiency virus: a novel biologic link between immune activation, accelerated T-cell turnover, and high levels of apoptosis

Human immunodeficiency virus (HIV)-infection is characterized by loss of CD4+ T cells associated with high levels of immune activation, T-cell proliferation, and lymphocyte apoptosis. To investigate the role of intrinsic perturbations of cell-cycle control in the immunopathogenesis of acquired immunodeficiency syndrome (AIDS), we studied the expression of cell-cycle-dependent proteins in lymphocytes from HIV-infected patients. Cyclin B1 expression, Nucleolar Organizer Regions (NORs) number, and NORs area of distribution were all consistently increased in HIV-infected patients, but returned to normal after effective antiretroviral therapy, suggesting that viral replication is directly implicated in the genesis of the observed changes. Analysis of cyclin B1 intracellular turnover showed that the increased cyclin B1 expression is (1) caused by defective degradation in the presence of normal rates of synthesis, and (2) is temporally associated with decreased levels of ubiquitination. After in vitro activation of lymphocytes from healthy individuals, cyclin B1 and cdc25 expression and ubiquitination, p34 cdc2 activity, NORs morphology, and C23/nucleolin localization showed a 72- to 96-hour cyclic pattern that led to a biologic state similar to baseline. On the contrary, complex but consistent changes of the same indices followed activation of T lymphocytes from HIV-infected patients, resulting in a 5-fold increase in apoptosis. Overall, our data indicate that a profound dysregulation of cell-cycle control is present in lymphocytes from HIV-infected patients. This finding may provide a novel biologic link between immune activation, accelerated lymphocyte turnover, and increased apoptosis during HIV infection.

Unscheduled cyclin B expression and p34 cdc2 activation in T lymphocytes from HIV-infected patients

OBJECTIVE

To study the role of cell cycle regulation during HIV infection by investigating in vivo and in vitro cyclin B and p34 cdc kinase expression.

METHODS

Cyclin B expression was analysed by Western blot in CD4 and CD8 cells from 25 HIV-infected patients and 24 uninfected individuals. In eight patients, a sequential analysis was performed after initiation of antiretroviral therapy (ART), and correlations with CD4 cell count and HIV viremia were studied. Sequential changes in cyclin B expression and p34 cdc kinase expression and activity were also studied in lymphocytes activated in vitro with phytohaemagglutinin (PHA).

RESULTS

Lymphocytes from untreated HIV-infected patients demonstrate persistent in vivo overexpression of cyclin B in both CD4 and CD8 cell subpopulations. When cells are stimulated to proliferate in vitro, biochemical events that characterize the entrance into the cell cycle [ornithine decarboxylase (ODC) activity, interleukin 2 production, interleukin 2 alpha-chain receptor (IL-2R, CD25) expression, total protein synthesis, total DNA synthesis] show similar timing and sequence in lymphocytes from HIV-infected and uninfected individuals. However, in peripheral blood lymphocytes (PBL) from HIV-infected patients, cyclin B and p34 cdc kinase show premature expression during the cell cycle. Both in vivo cyclin B overexpression and in vitro unscheduled cyclin B expression were almost completely reversed 2-4 weeks after initiation of effective ART.

CONCLUSION

Increased and unscheduled expression of cyclin B and p34 cdc kinase is consistently observed in CD4 and CD8 cells from HIV-infected patients, both in vivo and after in vitro mitogenic stimulation. These alterations correlate with the level of viremia and may provide a link between the perturbation of lymphocyte proliferative homeostasis and the exaggerated propensity towards apoptosis.

Oxidative protein damage and degradation in lymphocytes from patients infected with human immunodeficiency virus

It has been proposed that oxidative stress is the common mediator of apoptotic cell death in AIDS. However, mechanistic relationships between oxidative damage and cell death are far from clear. It is reported here that the mitogenic activation of T lymphocytes from human immunodeficiency virus-positive subjects involves perturbation of redox balance, as indicated by the increase in hydroethydine intracellular oxidation and manganese superoxide dismutase adaptive induction. Principal molecular targets of oxidative injury are cellular proteins whose content in carbonyl groups increases together with a dramatic increase in degradation of newly synthesized proteins catalyzed by the ATP- and ubiquitin-dependent proteolytic system. The major consequence of this metabolic anomaly is the decrease in protein cell mass leading to cells that are smaller than normal at lethal mitosis.

Effect of beta-endorphin on cell growth and cell death in human peripheral blood lymphocytes

Beta-endorphin (beta-end) was investigated for its ability to influence sequential metabolic events that accompany the movements of T-lymphocytes into the cell cycle. When cultured lymphocytes are exposed to this endogenous opioid peptide an increase in polyamine transport across cell membrane is observed. This membrane modification is an early cell cycle event, whose enhancement leads to the intracellular polyamine accumulation. It is shown that beta-end is able to enhance spermidine transport and that the exposition of cells to this peptide is perceived as an apoptotic signal. The possible relationship between induction of apoptotic death and enhancement of polyamine uptake is discussed.

Serum interleukin-6 levels are increased in HIV-infected patients that develop autoimmune disease during long-term follow-up

BACKGROUND

Elevated IL-6 levels have been associated with both autoimmune diseases and treated HIV-seropositive (HIV⁺) subjects. However, few data on classic and trans-signaling IL-6 in autoimmune thyroid diseases and HIV⁺ subjects developing autoimmune disorders are currently available.

MATERIALS AND METHODS

A total of 102 patients were included in the study. They were subdivided into two groups. Group A consisted in 51 HIV⁺ patients, who were followed-up for a period of five years in search of possible occurrence of autoimmune diseases. Ten of them, treated with antiretroviral therapy (ART), developed an autoimmune disorder, namely Hashimoto's thyroiditis, and psoriasis. Group B consisted in 51 patients affected by Hashimoto's thyroiditis (HT). Serum levels of the free form of IL-6 were analyzed by ELISA in all patients and for HIV⁺ patients at the beginning of the follow-up, before initiation of ART.

RESULTS

Mean serum levels of IL-6 were similar in Group A and in Group B. In Group B, IL-6 levels showed a 5.8% increase compared with assay minimum detectable dose corresponding to 1% of full serum IL-6 level. However, serum levels of free IL-6 were increased in those HIV⁺ patients who developed autoimmune disorders (5.8±2.8pg/ml) and in these patients, the highest levels of free IL-6 correlated with age and CD4 cellular counts.

CONCLUSIONS

The present study indicates a correlation between serum free IL-6 levels and the occurrence of autoimmune disease in HIV⁺ population, treated with ART during a long-term follow-up. The increased levels of serum free IL-6 were observed before ART treatment was initiated, indicating that IL-6 measurement in such patients may represent an early predictor of development of autoimmune disease.

Kaposi's sarcoma in HIV-infected patients in the era of new antiretrovirals

Kaposi's Sarcoma (KS) is a multicentric angioproliferative cancer of endothelial cells (ECs) caused by Human Herpesvirus 8 (HHV8) characterized by clinical heterogeneity depending on the host immune conditions. Despite its incidence has dramatically decreased in developed countries after the introduction of Highly Active Antiretroviral Therapy (HAART), KS remains the most frequent tumor in HIV-infected patients worldwide. Clinical presentation varies from an indolent slowly progressive behavior, generally limited to the skin, to an aggressive and rapidly progressing disease. In more than 50% of cases, the skin lesions are often associated with a more or less important visceral involvement, particularly to the oral cavity and the gastrointestinal tract that are involved in 35% and 40% of cases respectively. A large number of treatments can be used both as local and as systemic therapy. Particularly, HAART represents the first treatment in patients with moderate lesions limited to skin, and it can be sufficient to reduce significantly the size of lesions and, often, the complete disappear in 35% of cases after 3-9 months of treatment. In case of a rapidly progressive disease with extensive cutaneous and/or visceral involvement systemic drugs are used such as the liposomal anthracyclines pegylated liposomal doxorubicin (PLD) and daunorubicin citrate liposome (DNX), the combined treatment adriamycin-bleomycin-vincristine (ABV) and bleomycin-vincristine (BV), Paclitaxel and Interferon-alfa. In patients with limited skin localization, the local treatment can play an important role. Local medical therapy is based on the use of alitretinoin, antineoplastic drugs vincristine, vinblastine and bleomycin and Sodium Tetradecyl Sulfate (STS). In addition to medical therapy, physical treatment, such as cryotherapy and radiotherapy, are also commonly used.

Measles outbreak from February to August 2017 in Messina, Italy

Introduction

Measles continues to be a major public health issue worldwide, with high morbidity and mortality rates. The disease remains endemic in 14 European countries, including Italy where, from 2013 to 2016, over 5,000 cases have been reported. In 2017, many Italian regions, including Sicily, have reported many cases of measles. In this study, we described the latest measles outbreak in the city of Messina, from 1^st February to 31^st August 2017.

Methods

We considered all reported measles cases that came to the "Public Health, Epidemiology and Preventive Medicine" Operative Unit of the Messina Provincial Health Agency Prevention Department, which receives all reported cases of measles in the Messina province.

Results

From 1^st February to 31^st August 2017, a total of 59 measles cases were reported, of which 44 were confirmed, nine were classified as possible, four were probable and two cases were discarded. Of the 57 possible, probable and confirmed cases, 31 (54%) were males and 26 (46%) were females. Moreover, 54 (95%) had not been previously vaccinated while the remaining cases had documented evidence of one (two cases) or two doses (one case). Genotype B3 was identified in 39/44 cases (88,6%) by the regional reference laboratory in Palermo.

Conclusions

Despite the development of an effective vaccination, unfortunately measles continues to threaten the lives of millions of children worldwide each year. The suboptimal immunization level in Italy has led to an increase in the transmission of measles with detrimental effects on both public health and ongoing measles elimination efforts.

Hepatitis C-related hepatocellular carcinoma: diagnostic and therapeutic management in HIV-patients

The efficacy of the current HIV therapy has led to increased survival and prolongation of the average life expectancy of people living with HIV (PLWH), as well as the emergence of comorbidities and non-AIDS related cancer. Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Current evidence suggests that HCC is an important cause of morbidity and mortality in HIV infected patients. In fact, HCC prevalence rate is indeed higher with respect to the general population average. In this paper, we review the diagnostic and therapeutic management of Hepatitis C-related hepatocellular carcinoma in HCV-HIV co-infected patients. Several therapeutic options are available depending on several factors as HCC stage, liver functions, comorbidities and they have been divided into three groups: potentially curative, proven effective but not curative, and unproven or ineffective therapy. In HIV-infected patients, surgical options are preferred compared to non-surgical therapies. Further studies, especially multicenter ones, are needed in order to define the most appropriate, evidence-based therapeutic approach to PLWH suffering from HCC. It also appears necessary to develop appropriate care guidelines for PLWH.

Health conditions of migrants landed in north-eastern Sicily and perception of health risks of the resident population

OBJECTIVES

In Italy, a recent irregular movement of people raised concerns among the host population on possible introduction of diseases that have long been controlled in the host countries. This study evaluates the health conditions of illegal immigrants landed on the north-eastern Sicilian territory, to provide information on the clinical and epidemiologic burden of infectious diseases among migrants and how the local population feel about these landings.

STUDY DESIGN

The study design is a cross-sectional study.

METHODS

The study considered all migrants landed illegally in the city of Messina, Sicily, between January 2014 and July 2018. Analysing the data of hospital admissions and disease notifications, we calculated the frequency of infectious diseases among migrant population. Furthermore, through a survey conducted by a well-known online newspaper, we analysed the perception that the local population has about the health risk represented by migrants.

RESULTS

In the considered five-year period, 108 landings, for a total of 38,608 migrants occurred at the Messina port. The percentage of hospitalisation was rather low (3.5%), and it concerned mainly pregnant women. The notifications of infectious diseases were contained, with exception of scabies and tuberculosis. Finally, from the online survey, resulted that there is a large part of local population that considers migrants a potential danger to community health.

CONCLUSIONS

Our data show that the presence of migrants should not have to date any impact on the health conditions of the resident population. However, monitoring over time the health of migrants and screening for infectious diseases as soon as possible after landing are advantageous for both migrants and host country.

Increased transglutaminase activity was associated with IL-6 release in cultured human gingival fibroblasts exposed to dental cast alloys

Molecular mechanisms underlying gingival and periodontal inflammation caused by dental alloys are still poorly understood. Recently, it has been demonstrated that tissue transglutaminase can be involved in inflammatory cell response. The aim of this study was to evaluate effects of exposure to orthodontic materials on transglutaminase in cultured human gingival fibroblasts. The incubation with Ni-Ti heat-activated (T3) or Ni-Ti super-elastic (T4), and with Ni-Cr-Co (T2) alloys produced respectively 2.5-fold and 8-fold increases in IL-6 release compared with control cultures. Transglutaminase activity was significantly increased in cells exposed to T3 and T4 alloys (about 170% of control; p < 0.05), where it was mainly localized close to inner part of cell membrane. The exposure to T3 and T4 specimens significantly up-regulated also tTG expression compared with control cultures. These data first show an association between IL-6 release and tissue transglutaminase increases, suggesting that TGase-mediated reactions may play a major role in periodontal inflammation.

The frequency of Mycoplasma pneumoniae antibodies in a Calabrian population

The epidemiological survey was carried out in a Calabrian population in order to ascertain the incidence of antibodies to Mycoplasma pneumoniae. In the past it has been felt that this infection does not occur in Southern Italy. We have found an incidence in our survey equal to that of the other countries. It was impossible to tell when these infections had occurred and the possibility of a continuing survey is discussed.

Seroprevalence study on the diffusion of the West Nile virus among blood donors, healthcare workers, jockeys, grooms and fowlers, veterinary surgeons and hunters in Messina (Italy)

INTRODUCTION

West Nile virus (WNV) is a mosquito-transmitted flavivirus widely distributed in Africa, Middle East, Asia, Southern Europe and in 1999 was first identified in the United States as a cause of disease in New York City. It mainly circulates among birds, but can infect many species of mammals. Epidemics can occur in rural as well as urban areas.

METHODS

1,280 sera were collected during 2006 from 80 stable workers, as jockey and grooms, 100 fowlers, 500 blood donors, 600 healthcare workers, 100 veterinary surgeons and 100 hunters in the Messina province to evaluate the prevalence of the WNV infection, by ELISA test, in relation to risk exposure or not.

RESULTS

None of the 1280 subjects examined has shown positive for antibodies anti WN virus.

CONCLUSION

Among the strategies of control and surveillance, finally, in our opinion, are and will be indispensable the programs of continuous antibody survey in all the risk categories and in the general population in order to succeed to preview which effects could have the presence of infections from WNV, also imported from other zones where the virus is constantly present, in future and which it could be the impact of geographic factors on the epidemic spread of the disease.

Epidemiological HIV infection surveillance among subjects with risk behaviours in the city of Messina (Sicily) from 1992 to 2015

INTRODUCTION

Epidemiological studies are a key element in determining the evolution and spread of HIV infection among the world population. Knowledge of the epidemiological dynamics improves strategies for prevention and monitoring.

METHODS

We examined 2,272 subjects who voluntarily underwent HIV testing from January 1992 to December 2015. For each subject, an anonymous form was completed to obtain information on personal data, sexual habits and exposure to risk factors.

RESULTS

The number of subjects undergoing the screening test has increased over the years and the average age of the tested subjects has decreased over time. The main motivation for undergoing HIV testing is unprotected sex. Although heterosexual subjects taking the test were more numerous than homosexuals in this study, an increase in the latter over time should be highlighted.

CONCLUSIONS

Although the number of tests performed has increased over the years, the persistence of unprotected sex shows an inadequate perception of risk. Therefore, it is necessary to implement programmes to increase the general awareness of HIV infection. It is also essential to undertake constant monitoring of behaviour, risk perception and the application of the screening test via surveillance systems in order to implement effective and efficient prevention.

[Isolation of Listeria spp., Aeromonas spp., and Vibrio spp. from seafood products]

Forty-one strains of Listeria, Aeromonas and Vibrio have been isolated in 71 samples of seafood, both raw and ready to eat and frozen. L. monocytogenes, detected by PCR also, is found in the smoked salmon only. Aeromonas spp. and Vibrio spp. are isolated in the raw products (shrimps and shellfish). No relationship is found between the presence of such microrganisms and the common indicator bacteria. Finally, the health hazard related to strong contamination and the need to diversify the food safety assurance programmes, for the various products, are underlined.

Effect of growth conditions on extracellular products (ECPs) of Aeromonas hydrophila

Owing to the significant role in gastrointestinal illness of A. hydrophila, frequently detected in various raw and ready-to eat foods, its pathogenetic mechanisms are particularly studied. In this paper we report the results obtained studying in vitro the effect of O2 tension and inoculum age on the extra cellular products (ECPs) of seven strains food-borne isolated and cultured at 37 degrees. The considered factors influenced markedly bacterial growth as well as ECPs production and the more notable differences were detected among 15 hours old strains let grown slowly shaking (15SH), that showed the highest bacterial yield, and 24 h old strains cultured statically (24ST), whose haemolysin and cytotoxin production was favoured. Wilcoxon test shows as, in these latter conditions, the strains needed short time to adapt the haemolysin and cytotoxin production. The oxygen tension reduction, extending the replication time, induces the bacterial metabolism toward secondary products, as verified by Spearman test applied to ECPs indexes. The increased production per cell of virulence-associated factors could be responsible of gastrointestinal disorders caused by food-borne A. hydrophila strains, even without a massive gut colonization, especially when immunocompromised individuals ingest contaminated foods.

Virulence factors in Vibrios and Aeromonads isolated from seafood

Thirty-one isolates from seafood, identified as Aeromonas hydrophila (7), Aeromonas caviae (11), Vibrio parahaemolyticus (3), Vibrio fluvialis (5), Vibrio alginolytictus (3), Vibrio metschnikovii (1) and Vibrio damsela (1), were tested for possible virulence factors including extracellular hydrolytic enzymes, haemolysins, cytotoxins (VERO and HEp-2 cells) and adherence ability (HEp-2 cells). All the A. hydrophila strains were beta-haemolytic and produced cytotoxins as well as one strain of V. fluvialis. A. hydrophila and A. caviae strains, frequently adhesive, showed both aggregative and diffusive patterns, while five Vibrio strains only (three V. fluvialis, one V. parahaemolyticus and one V. alginolyticus) were adhesive with an aggregative pattern.

Is diabetes mellitus a risk factor for HCV infection?

The aim of this study was to investigate whether or not the diabetes mellitus may be considered a risk factor for the HCV infection. The HCV seroprevalence was evaluated in 254 diabetic subjects, whose anamnestic data and risk factors are known, in comparison to 223 first-time blood donors, carefully age- and gender-matched. The statistical analysis showed that the studied groups belonged to the same population (Mann-Whitney U test) and that there were no significant differences between cases and controls as regards HCV prevalence (Yates corrected chi 2 test). The obtained data underline the importance of the control group selection, especially in the studies considering age-related pathologies. The authors disprove type 2 diabetes as a risk factor for the HCV infection and consider that this is a valid hypothesis only when the hepatitis C was unknown and not adequate prevention was used.

Adherence of Aeromonas hydrophila strains to human enterocyte-like cells pre-infected with rotavirus

INTRODUCTION

The interest grown in these years about emerging pathogens in the onset of intestinal disease showed that the pathogenic mechanism is a multifactorial event. Our objective was to evaluate the role of co-infection with rotavirus in the expression of Aeromonas spp adhesiveness.

METHODS

The rate of co-infection involves contact of Caco-2 cells with the virus, followed by adsorption for 1 and 2 hours. Aliquots of bacterial suspensions were added to tissue-culture plates. After infection, cell monolayers were lysed; serially diluted lysates were plated to determine the number of bound bacteria by performing colony forming units (CFU) counts.

RESULTS

Non-adhesive strains were not subject to variations resulting from co-infection, while those who had medium or high adhesiveness gave rise to an increase of the same.

DISCUSSION

Infection with rotavirus promotes the Aeromonas ability to adhere to Caco-2 cells and this effect depends on the duration of infection and on the starting adhesiveness of bacteria strain.

[Chlamydia pneumoniae and Helicobacter pylori infections in acute myocardial infarction]

BACKGROUND

Increasing evidence suggests an acute or chronic linkage between infection and acute coronary syndromes. The aim of this study was to assess the frequency of Chlamydia pneumoniae (CP) and Helicobacter pylori (HP) antibodies in patients with angiographically defined acute myocardial infarction and in population controls. Case patients and controls were drawn from the same geographic area (city of Messina and its province).

METHODS

Blood samples were collected in 206 incident cases of acute myocardial infarction presenting to the Coronary Care Unit (196 men, 10 women, mean age 58+/-7 years) in the period from March 1997 to June 1999. Case patients were selected if they were non-smokers, non-diabetic and if they had no history of hypertension. The control group consisted of 142 healthy subjects, without a known history of smoking, diabetes, and hypertension. Controls were matched to acute myocardial infarction patients for age, sex and socio-economic status. Commercial ELISA assay was used to measure IgG antibody to HP (positive titer > 8 IU/ml) and indirect immunofluorescence method was used to assess IgG antibody anti-CP (IgG titer > 1:64 was considered a marker of chronic infection).

RESULTS

No significant difference was observed in the frequency of HP antibodies in acute myocardial infarction patients and in the control group (43.3 vs 41.5%, p = NS, odds ratio-OR 1, 95% confidence interval-CI 0.7-1.6). On the contrary, CP titers were increased in 83% of acute myocardial infarction patients, and in 57% of control subjects (p < 0.001, OR 3.6, 95% CI 2.2-5.7). In acute myocardial infarction patients seropositivity for CP was associated with increased basal fibrinogen levels (539 vs 445 mg/dl). No correlation was found between seropositivity to CP and C-reactive protein, and with total or fractionated cholesterol and triglyceride concentrations.

CONCLUSIONS

The present data indicate that, in our sample, acute myocardial infarction was associated with an increased frequency of CP seropositivity. The presence of CP antibodies was not associated with elevated levels of C-reactive protein. Our data support the need for controlled studies to investigate the role of these infective agents as a trigger of acute coronary syndromes.

Detection of human papillomavirus E6/E7 mRNA in women with high-risk HPV types 16, 18, 31, 33 and 45 which are associated with the development of human cervical cancer

PURPOSE OF INVESTIGATION

The aim of our study was to increase the clinical meaningfulness of the virological data through mRNA E6/E7 oncoprotein identification, and to find a correlation between codon 72 polymorphism of the p53 gene and integration of HPV in host cell genomes.

METHODS

We analyzed 80 cervical samples from women with HPV DNA types 16, 18, 31, 33 and 45. Transcripts of HPV were detected by the NucliSense EasyQ HPV assay and genotyping of the TP53 polymorphism was conducted using a TaqMan assay.

RESULTS

Twenty percent of 80 tested samples were positive for mRNA Papillomavirus. The frequency of Arg/Pro heterozygotes in controls was over-represented compared with mRNA positive samples while there were no significant differences in the distribution of Pro/Pro and Arg/Arg alleles.

CONCLUSION

The introduction of HPV mRNA testing in clinical analysis improved diagnostic accuracy of HPV infections. Our data suggest that a structural difference at codon 72 of the p53 gene may not be a sufficient risk factor for cervical carcinogenesis.