Induced saturation transfer recovery steady states (iSTRESS) for proton exchange rate mapping with CEST MRI, a preliminary study

Proton exchange underpins essential mechanisms in diverse MR imaging contrasts. Omega plots have proven effective in mapping proton exchange rates (kex) in live human brains, enabling the differentiation of MS lesion activities and characterization of ischemic stroke. However, Omega plots require extended saturation durations (typically 5 to 10 s), resulting in high specific absorption rates (SAR) that can hinder clinical feasibility. In this study, we introduce a novel kex mapping approach, named induced Saturation Transfer Recovery Steady-States (iSTRESS). iSTRESS integrates an excitation flip angle pulse prior to chemical exchange saturation transfer (CEST) saturation, effectively aligning the magnetization with its steady-state value. This innovation reduces saturation times and mitigates SAR concerns. The formula for iSTRESS-based kex quantification was derived theoretically, involving two measurements with distinct excitation flip angles and saturation B1 values. Bloch-McConnell simulations confirmed that iSTRESS-based kex values closely matched input values (R2 > 0.99). An iSTRESS MRI sequence was implemented on a 9.4 T preclinical MRI, imaging protein phantoms with pH values ranging from 6.2 to 7.4 (n = 4). Z-spectra were acquired using excitation flip angles of 30° and 60°, followed by CEST saturation at powers of 30 and 120 Hz respectively, with a total saturation time of <1 s, resulting in two iSTRESS states for kex mapping. kex maps derived from the phantom study exhibited a linear correlation (R2 > 0.99) with Omega plot results. The developed iSTRESS method allows for kex quantification with significantly reduced saturation times, effectively minimizing SAR concerns.

Analytical solution of the Bloch-McConnell equations for steady-state CEST Z-spectra

PURPOSE

To derive an analytic expression for the steady-state Chemical Exchange Saturation Transfer (CEST) Z-spectra of a two-pool proton-exchanging system, facilitating simulations and expedited fitting of steady-state Z-spectra.

METHOD

The analytical expression is derived by directly solving the set of Bloch-McConnell differential equations in matrix form for a two-pool exchanging system, determining water magnetization under steady-state saturation across the entire Z-spectrum. The analytic solution is compared and validated against the numerical solution of Bloch-McConnell equations under prolonged saturation. The study also explores the line shape of a CEST peak, interpolating under-sampled Z-spectra, and Z-spectral fitting in the presence of noise.

RESULTS

The derived analytic solution accurately reproduces spectra obtained through numerical solutions. Direct fitting of simulated CEST spectra with the analytical solution yields the physical parameters of the exchanging system. The study shows that the analytical solution enables the reproduction of fully sampled spectra from sparsely sampled Z-spectra. Additionally, it confirms the approximation of the CEST spectrum of a single exchanging proton species with a Lorentzian function. Monte Carlo simulations reveal that the accuracy and precision of Z-spectral fittings for physical parameters are significantly influenced by data noise. The study also derives and discusses the analytical solution for three-pool Z-spectra.

CONCLUSION

The derived analytic solution for steady state Z-spectra can be utilized for simulations and Z-spectrum fitting, significantly reducing fitting times compared to numerical methods employed for fitting CEST Z-spectra.

Combining in vivo proton exchange rate (k ex) MRI with quantitative susceptibility mapping to further stratify the gadolinium-negative multiple sclerosis lesions

Background

Conventional gadolinium (Gd)-enhanced MRI is currently used for stratifying the lesion activity of multiple sclerosis (MS) despite limited correlation with disability and disease activity. The stratification of MS lesion activity needs further improvement to better support clinics.

Purpose

To investigate if the novel proton exchange rate (k _ex ) MRI combined with quantitative susceptibility mapping (QSM) may help to further stratify non-enhanced (Gd-negative) MS lesions.

Materials and methods

From December 2017 to December 2020, clinically diagnosed relapsing-remitting MS patients who underwent MRI were consecutively enrolled in this IRB-approved retrospective study. The customized MRI protocol covered conventional T₂-weighted, T₂-fluid-attenuated-inversion-recovery, pre- and post-contrast T₁-weighted imaging, and quantitative sequences, including k _ex MRI based on direct-saturation removed omega plots and QSM. Each MS lesion was evaluated based on its Gd-enhancement as well as its susceptibility and k _ex elevation compared to the normal appearing white matter. The difference and correlation concerning lesion characteristics and imaging contrasts were analyzed using the Mann-Whitney U test or Kruskal-Wallis test, and Spearman rank analysis with p < 0.05 considered significant.

Results

A total of 322 MS lesions from 30 patients were identified with 153 Gd-enhanced and 169 non-enhanced lesions. We found that the k _ex elevation of all lesions significantly correlated with their susceptibility elevation (r = 0.30, p < 0.001). Within the 153 MS lesions with Gd-enhancement, ring-enhanced lesions showed higher k _ex elevation than the nodular-enhanced ones' (p < 0.001). Similarly, lesions with ring-hyperintensity in QSM also had higher k _ex elevation than the lesions with nodular-QSM-hyperintensity (p < 0.001). Of the 169 Gd-negative lesions, three radiological patterns were recognized according to lesion manifestations on the k _ex map and QSM images: Pattern I (k _ex ⁺ and QSM⁺, n = 114, 67.5%), Pattern II (only k _ex ⁺ or QSM⁺, n = 47, 27.8%) and Pattern III (k _ex ^- and QSM^-, n = 8, 4.7%). Compared to Pattern II and III, Pattern I had higher k _ex (p < 0.001) and susceptibility (p < 0.05) elevation. The percentage of Pattern I of each subject was negatively correlated with the disease duration (r = -0.45, p = 0.015).

Conclusion

As a potential imaging biomarker for inflammation due to oxidative stress, in vivo k _ex MRI combined with QSM is promising in extending the clinical classification of MS lesions beyond conventional Gd-enhanced MRI.

Proton exchange rate of chemical exchange saturation transfer MRI constructed from direct saturation-removed omega plots to improve the assessment of patients with ischemic stroke

Background

Proton exchange rate (k_ex) magnetic resonance imaging (MRI) has recently been developed, with preliminary results demonstrating its potential for evaluating reactive oxygen species. This prospective cohort study investigated the k_ex in different stroke stages and its correlation with stroke severity and prognosis.

Methods

In all, 96 ischemic stroke patients were included in the study. Patients were divided into 3 groups based on stroke phase (acute, subacute, and chronic). A spin echo-echo planar imaging sequence with presaturation powers of 1.5, 2.5, and 3.5 µT was implemented to obtain Z-spectra, and k_ex maps were constructed from direct saturation-removed omega plots. Relative k_ex (rk_ex) and the relative apparent diffusion coefficient (rADC) were calculated as the ratio of k_ex or ADC in the infarcts to values in contralateral tissue, respectively. Correlations between both k_ex and rk_ex and National Institute of Health Stroke Scale (NIHSS) scores were evaluated. Receiver operating characteristic (ROC) analysis was used to evaluate the performance of k_ex, rk_ex, rADC, and lesion volume for predicting acute stroke outcome.

Results

The k_ex was significantly higher in ischemic lesions than in contralateral tissue at all stages. In addition, the k_ex of acute lesions was higher than that of subacute and chronic lesions [mean (± SD) 935.1±81.5 vs. 881.4±55.7 and 866.9±76.7 s^–1, respectively; P<0.05 and P<0.01, respectively]. The difference in k_ex between subacute and chronic lesions was not significant. In acute stroke, there was a limited correlation between a lesion’s k_ex and NIHSS score (R²=0.16; P=0.01) and between rk_ex and NIHSS score (R²=0.28; P=0.001). Acute stroke patients with poor prognosis had significantly higher lesion k_ex and rk_ex than did those with good prognosis (k_ex: 991.1±78.2 vs. 893.1±55.1 s^–1, P<0.001; rk_ex: 1.28±0.09 vs. 1.15±0.06, P<0.001). In ROC analyses, k_ex and rk_ex showed favorable predictive performance for acute stroke outcome, with areas under the curve (AUC) of 0.837 and 0.880, respectively, which were slightly but not significantly higher than the AUCs for lesion volume (0.730) and rADC (0.673).

Conclusions

This study indicates that k_ex MRI is promising for the diagnosis and management of ischemic stroke because it can reflect the oxidative stress of lesions and predict prognosis.

Toward In Vivo MRI of the Tissue Proton Exchange Rate in Humans

Quantification of proton exchange rate (kex) is a challenge in MR studies. Current techniques either have low resolutions or are dependent on the estimation of parameters that are not measurable. The Omega plot method, on the other hand, provides a direct way for determining kex independent of the agent concentration. However, it cannot be used for in vivo studies without some modification due to the contributions from the water signal. In vivo tissue proton exchange rate (kex) MRI, based on the direct saturation (DS) removed Omega plot, quantifies the weighted average of kex of the endogenous tissue metabolites. This technique has been successfully employed for imaging the variation in the kex of ex vivo phantoms, as well as in vivo human brains in healthy subjects, and stroke or multiple sclerosis (MS) patients. In this paper, we present a brief review of the methods used for kex imaging with a focus on the development of in vivo kex MRI technique based on the DS-removed Omega plot. We then review the recent clinical studies utilizing this technique for better characterizing brain lesions. We also outline technical challenges for the presented technique and discuss its prospects for detecting tissue microenvironmental changes under oxidative stress.

Predicting cancer malignancy and proliferation in glioma patients: intra-subject inter-metabolite correlation analyses using MRI and MRSI contrast scans

Background

The non-invasive characterization of glioma metabolites would greatly assist the management of glioma patients in the clinical setting. This study investigated the applicability of intra-subject inter-metabolite correlation analyses for differentiating glioma malignancy and proliferation.

Methods

A total of 17 negative controls (NCs), 39 low-grade gliomas (LGGs) patients, and 25 high-grade gliomas (HGGs) subjects were included in this retrospective study. Amide proton transfer (APT) and magnetization transfer contrast (MTC) imaging contrasts, as well as total choline/total creatine (tCho/tCr) and total N-acetylaspartate/total creatine (tNAA/tCr) ratios quantified from magnetic resonance spectroscopic imaging (MRSI) were co-registered voxel-wise and used to produce three intra-subject inter-metabolite correlation coefficients (IMCCs), namely, R_{APT vs . MTC}, R_{APT vs . tCho/tCr}, and R_{MTC vs . tNAA/tCr}. The correlation between the IMCCs and tumor grade and Ki-67 labeling index (LI) for tumor proliferation were explored. The differences in the IMCCs between the three groups were compared with one-way analysis of variance (ANOVA). Finally, regression analysis was used to build a combined model with multiple IMCCs to improve the diagnostic performance for tumor grades based on receiver operator characteristic curves.

Results

Compared with the NCs, gliomas showed stronger inter-metabolic correlations. R_{APT vs . MTC} was significantly different among the three groups (NC vs. LGGs vs. HGGs: -0.18±0.38 vs. -0.40±0.34 vs. -0.70±0.29, P<0.0001). No significant differences were detected in R_{MTC vs . tNAA/tCr} among the three groups. R_{APT vs . MTC} and R_{APT vs . tCho/tCr} correlated significantly with tumor grade (R=-0.41, P=0.001 and R=0.448, P<0.001, respectively). However, only R_{APT vs . MTC} was mildly correlated with Ki-67 (R=-0.33, P=0.02). R_{APT vs . MTC} and R_{APT vs . tCho/tCr} achieved areas under the curve (AUCs) of 0.754 and 0.71, respectively, for differentiating NCs from gliomas; and 0.77 and 0.78, respectively, for differentiating LGGs from HGGs. The combined multi-IMCCs model improved the correlation with the Ki-67 LI (R=0.46, P=0.0008) and the tumor-grade stratification with AUC increased to 0.85 (sensitivity: 80.0%, specificity: 79.5%).

Conclusions

This study demonstrated that glioma patients showed stronger inter-metabolite correlations than control subjects, and the IMCCs were significantly correlated with glioma grade and proliferation. The multi-IMCCs combined model further improved the performance of clinical diagnosis.

Effect of glucocorticoid therapy on the prognosis of patients with severe and critical COVID-19: a single-center retrospective cohort study

OBJECTIVE

Coronavirus disease 2019 (COVID-19) has elevated mortality in severe and critical patients globally. This study examined the effect of glucocorticoids (GCS) on the time of virus clearance and absorption of lung lesions in severe and critical COVID-19 patients.

PATIENTS AND METHODS

Severe and critical COVID-19 cases diagnosed in Wuhan Pulmonary Hospital from January 7 to February 10, 2020 were analyzed. The generalized linear model was utilized to assess the effects of GCS therapy on the times of nucleic acid test turning negative and improved pulmonary imaging, respectively.

RESULTS

Of 66 patients, 51 (77.3%) and 15 (22.7%) were severe and critical cases, respectively, and aged 62 ± 11 years. A total of 58 patients (87.9%) tested negative, and 56 (84.8%) showed improved lung imaging. Age, thrombocytopenia, CD8 + T cell count, course of GCS therapy, and total dose were correlated with the time of nucleic acid test turning negative (p < 0.05), and sex was correlated with the time of initial pulmonary imaging improvement (p < 0.05). The time of nucleic acid test turning negative in individuals with GCS therapy course ≤ 10 days was shorter than that of the GCS therapy course > 10 days group (p=0.001). No statistical difference was found in the dose, course of GCS, and initial time of improved lung imaging.

CONCLUSIONS

Increasing the dose of GCS and prolonging the course of treatment do not shorten the time of nucleic acid test turning negative or improved absorption of pulmonary lesions. Thus, the rational use of GCS is particularly important.

Neurite Orientation Dispersion and Density Imaging of Rat Brain Microstructural Changes due to Middle Cerebral Artery Occlusion at a 3T MRI

The purpose of this work was to demonstrate the feasibility of neurite orientation dispersion and density imaging (NODDI) in characterizing the brain tissue microstructural changes of middle cerebral artery occlusion (MCAO) in rats at 3T MRI, and to validate NODDI metrics with histology. A multi-shell diffusion MRI protocol was performed on 11 MCAO rats and 10 control rats at different post-operation time points of 0.5, 2, 6, 12, 24 and 72 h. NODDI orientation dispersion index (ODI) and intracellular volume fraction (V_ic) metrics were compared between MCAO group and control group. The evolution of NODDI metrics was characterized and validated by histology. Infarction was consistent with significantly increased ODI and V_ic in comparison to control tissues at all time points (P<0.001). Lesion ODI increased gradually from 0.5 to 72 h, while its V_ic showed a more complicated and fluctuated evolution. ODI and V_ic were significantly different between hyperacute and acute stroke periods (P<0.001). The NODDI metrics were found to be consistent with the histological findings. In conclusion, NODDI can reflect microstructural changes of brain tissues in MCAO rats at 3T MRI and the metrics are consistent with histology. This study helps to prepare NODDI for the diagnosis and management of ischemic stroke in translational research and clinical practice.

Characterization of microenvironmental changes in the intervertebral discs of patients with chronic low back pain using multiparametric MRI contrasts extracted from Z-spectrum

PURPOSE

Z-spectral MRI data were analyzed to produce multiparametric metabolic and microenvironmental contrasts for identifying intervertebral discs with/without pain symptom and sore pain.

METHODS

Z-spectra data were collected from the lumbar discs of 26 patients with non-specific chronic low bck pain (CLBP) and 21 asymptomatic controls (AC) with a chemical exchange saturation transfer (CEST). Data were fitted to quantify the CEST effects from glycosaminoglycan, amide proton transfer (APT), nuclear Overhauser enhancement (NOE), semi-solid magnetization transfer contrast effects, and the direct saturation of water. Multiparametric maps were computed from the fitted peak amplitudes, and the average values were calculated from all five lumber discs. Those parameters were compared between the CLBP and AC groups and between the subgroups with and without (Nsore) sore pain.

RESULTS

The discs in symptomatic patients have lower water content, collagen-bound water and collagen than the discs in AC (P < 0.05). Additionally, Z-sepctral MRI indicated that the discs in the sore subgroup had less water, collagen-bound water and collagen, and likely lower pH compared to the Nsore subgroup (P < 0.05). Lower pH as measured with reduced APT and NOE effects may be an important pathological factor causing sore pain of the back.

CONCLUSION

Z-spectral MRI with its multiparametric metabolic and microenvironmental contrasts has been demonstrated to identify discs with and without pain symptom or sore pain, providing more important information of CLBP.

In Vivo Proton Exchange Rate (kex ) MRI for the Characterization of Multiple Sclerosis Lesions in Patients

BACKGROUND

Currently available radiological methods do not completely capture the diversity of multiple sclerosis (MS) lesion subtypes. This lack of information hampers the understanding of disease progression and potential treatment stratification. For example, inflammation persists in some lesions after gadolinium (Gd) enhancement resolves. Novel metabolic and molecular imaging methods may improve the current assessments of MS pathophysiology.

PURPOSE

To compare the in vivo proton exchange rate (k_ex ) MRI with Gd-enhanced MRI for characterizing MS lesions.

STUDY TYPE

Retrospective.

SUBJECTS

Sixteen consecutively diagnosed relapsing-remitting multiple sclerosis (RRMS) patients.

FIELD STRENGTH/SEQUENCE

3.0T MRI with T₂ -weighted imaging, postcontrast T₁ -weighted imaging, and single-slice chemical exchange saturation transfer imaging.

ASSESSMENT

MS lesions in white matter were assessed for Gd enhancement and k_ex elevation compared to normal-appearing white matter (NAWM).

STATISTICAL TESTS

Student's t-test was used for analyzing the difference of k_ex values between lesions and NAWM, with statistical significance set at 0.05.

RESULTS

Of all 153 MS lesions, 78 (51%) lesions were Gd-enhancing and 75 (49%) were Gd-negative. Without exception, all 78 Gd-enhancing lesions showed significantly elevated k_ex values compared to NAWM (924 ± 130 s^-1 vs. 735 ± 61 s^-1 , P < 0.05). Of 75 Gd-negative lesions, 18 lesions (24%) showed no k_ex elevation (762 ± 29 s^-1 vs. 755 ± 28 s^-1 , P = 0.47) and 57 (76%) showed significant k_ex elevation (950 ± 124 s^-1 vs. 759 ± 48 s^-1 , P < 0.05) compared to NAWM. MS lesions with k_ex elevation appeared nodular (118, 87.4%), ring-like (15, 11.1%), or irregular-shaped (2, 1.5%).

DATA CONCLUSION

For Gd-enhancing lesions, k_ex MRI is highly consistent with Gd-enhanced images by showing 100% of elevated k_ex . For all Gd-negative lesions, the discrepancy on k_ex MRI may further differentiate active slowly expanding lesions or chronic inactive lesions, supporting k_ex as an imaging biomarker for tissue oxidative stress and inflammation. Level of Evidence 2 Technical Efficacy Stage 3 J. MAGN. RESON. IMAGING 2021;53:408-415.

In vivo quantification of proton exchange rate in healthy human brains with omega plot

Background

To implement omega plot method for in vivo mapping of proton exchange rates in human brain by taking into account the water direct saturation (DS) effect and multiple saturation transfer exchanging species in vivo.

Methods

Four Z-spectra were collected with chemical exchange saturation transfer (CEST) saturation power =1, 2, 3 & 4 µT. Water DS was estimated by fitting the Z-spectrum to a linear combination of multiple Lorentzian components and its contribution to the signal was subsequently removed. Exchange rate maps were derived by the omega plot, consisting of fitting the inverse of the signal intensity, M_z /(M ₀-M_z ), as a function of 1/(γB₁)².

Results

The exchange rate values quantified with the DS removed omega plot were significantly higher in the GM region than in the WM region (616±29 vs. 575±20 s^-1, P<0.001). Phantom studies confirmed that the exchange rates from DS-removed plots varied linearly with pH (R²=0.998) for the pH range of 6.2 to 7.4, whereas exchange rates from conventional omega plots failed to show such linearity in the entire physiological pH range.

Conclusions

The calculated exchange rate with DS-corrected omega plot is a weighted average for all saturation transfer exchanging proton species which contribute to Z-spectral signal. The healthy brain exchange rate map provided by DS-removed omega plots may serve as a baseline for detecting any pathological changes.

The Phase Behavior and Organization of Sphingomyelin/Cholesterol Membranes: A Deuterium NMR Study

We have studied the dependence of the phase and domain characteristics of sphingomyelin (SM)/cholesterol model membranes on sterol content and temperature using deuterium nuclear magnetic resonance. NMR spectra of N-palmitoyl(D31)-D-erythro-sphingosylphosphorylcholine (PSM-d31) were taken for temperatures from 25 to 70°C and cholesterol concentrations of 0-40%. Analogous experiments were performed using 1-palmitoyl,2-palmitoyl(D31)-sn-glycero-3-phosphocholine (DPPC-d31)/cholesterol membranes to carefully compare the data obtained using palmitoyl chains that have similar "kinked" conformations. The constructed phase diagrams exhibit both solid-ordered (so) + liquid-ordered (lo) and liquid-disordered (ld) + lo phase-coexistence regions with a clear three-phase line. Macroscopic (micron-sized) coexistence of ld and lo phases was not observed; instead, line-broadening in the ld+lo region was characterized by intermediate exchange of lipids between the two types of domains. The length scales associated with the domains were estimated to be 75-150 nm for PSM-d31/cholesterol and DPPC-d31/cholesterol model membranes.

Circulating Helper T-Cell Subsets and Regulatory T Cells in Patients With Common Variable Immunodeficiency Without Known Monogenic Disease

BACKGROUND

Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency (PID). It is characterized by heterogeneous clinical manifestations and defects in B cells and T cells. In the present study, we investigated helper T (TH) cell subsets and regulatory T (Treg) cells and their related cytokines and transcription factors in CVID patients with no definitive genetic diagnosis.

METHODS

The study population comprised 13 CVID patients and 13 healthy controls. Mutation analysis was performed using whole exome sequencing in CVID patients to rule out monogenic PIDs. TH subsets and Treg were analyzed using flow cytometry. The expression of determinant cytokines (IFN-γ, IL-17, IL-22, and IL-10) and cell subset specific transcription factors was evaluated before and after stimulation.

RESULTS

The main clinical presentations of these patients were infections only and lymphoproliferative phenotypes. No autoimmune or allergy phenotypes were recorded. The frequencies of CD4+ T cells, TH17, and Treg cells were significantly reduced in CVID patients; however, TH1, TH1-like TH17, and TH22 subsets were normal. After stimulation, expression of retinoic-acid-orphan-receptor-C (RORC), runtrelated transcription factor 1 (RUNX1), IL17, and IL10 was significantly lower in CVID patients than in the healthy controls. Moreover, the concentration of IL-17 and IL-10 in the cell culture supernatants of stimulated CD4+ T cells was lower in CVID patients than in healthy controls.

CONCLUSIONS

Our findings demonstrate that the imbalance of TH17 and Tregs could be associated with infection and the lymphoproliferative phenotype in CVID patients without monogenic disorders.

Constrained Versus Free Cholesterol in DPPC Membranes: A Comparison of Chain Ordering Ability Using Deuterium NMR

We report here the first exploration of the nature of the hydrophobic region of bilayer membranes formed from sterol-modified phospholipids [Huang, Z.; Szoka, F. C., Sterol-Modified Phospholipids: Cholesterol and Phospholipid Chimeras with Improved Biomembrane Properties. J. Am. Chem. Soc. 2008, 130 (46), 15702-15712] & [Ding, J.; Starling, A. P.; East, J. M.; Lee, A. G., Binding Sites for Cholesterol on Ca(2+)-ATPase Studied by Using a Cholesterol-Containing Phospholipid. Biochemistry 1994, 33 (16), 4974-4979]. Using ²H NMR spectroscopy, we present our results for the phase behavior and acyl chain ordering of multilamellar vesicles (MLVs) of a sterol-modified phospholipid, 1-cholesterylhemisuccinoyl-2-palmitoyl(d₃₁)-sn-glycero-3-phosphocholine (hereafter referred to as CholPPC-d₃₁). We compared our results with the conformational order induced by cholesterol at various concentrations in 1-palmitoyl,2-palmitoyl(d₃₁)-sn-glycero-3-phosphocholine (DPPC-d₃₁)/cholesterol membranes. On the basis of the existing literature [Foglia, F.; Barlow, D. J.; Szoka, F. C.; Huang, Z.; Rogers, S. E.; Lawrence, M. J., Structural Studies of the Monolayers and Bilayers Formed by a Novel Cholesterol-Phospholipid Chimera. Langmuir 2011, 27 (13), 8275-8281], we expected to find that the deuterated palmitoyl chain in CholPPC-d₃₁ membranes had an order parameter profile similar to the deuterated palmitoyl chain of sn-2 labeled DPPC-d₃₁ in MLVs of a mixture of DPPC-d₃₁ with 40 mol % unconstrained cholesterol. Our data indicate that the ordering ability of cholesterol in CholPPC is significantly reduced compared to free cholesterol in DPPC. This result emphasizes that cholesterol molecules must be free to move in the bilayers to reach their maximum ordering ability. In other words, when compared to unconstrained cholesterol, the constrained cholesterol moiety in CholPPC causes nonoptimal chain packing.

Epidemiology and pathophysiology of malignancy in common variable immunodeficiency?

Common variable immunodeficiency (CVID) is a diagnostic category of primary immunodeficiency (PID) which may present with heterogeneous disorders including recurrent infections, autoimmunity, granulomatous diseases, lymphoid and other types of malignancies. Generally, the incidence of malignancy in CVID patients is around 1.5-20.7% and usually occurs during the 4th-6th decade of life. Non-Hodgkin lymphoma is the most frequent malignancy, followed by epithelial tumours of stomach, breast, bladder and cervix. The exact pathological mechanisms for cancer development in CVID are not fully determined; however, several mechanisms including impaired genetic stability, genetic predisposition, immune dysregulation, impaired clearance of oncogenic viruses and bacterial infections, and iatrogenic causes have been proposed to contribute to the high susceptibility of these patients to malignancies.

Infectious and Noninfectious Pulmonary Complications in Patients With Primary Immunodeficiency Disorders

Primary immunodeficiency disorders (PIDs) are caused by 1 or more defects of the immune system. Patients are more likely to experience recurrent and/or severe infections and tend to develop a wide range of complications. Respiratory diseases are the main and initial manifestation in most cases and the most common complication. Pulmonary complications cause significant morbidity and mortality in patients with PIDs. Early diagnosis and appropriate treatment can prevent or at least slow the development of respiratory complications. Since the spectrum of pulmonary complications in PIDs is broad, we divided pulmonary complications into upper respiratory complications (eg, sinusitis, otitis media, and laryngeal angioedema) and lower respiratory complications (eg, pneumonia, bronchitis, bronchiectasis, interstitial lung diseases, organizing pneumonia, pulmonary adenopathies and malignancies, hyperreactive airway diseases, pulmonary dysgenesis, and adverse reactions to treatment). This review covers the main respiratory manifestations in patients with PIDs.

Effect of Sterol Structure on the Physical Properties of 1-Palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine Membranes Determined Using (2)H Nuclear Magnetic Resonance

The effect of a series of phytosterols on lipid chain ordering in 1-palmitoyl((2)H31)-2-oleoyl-sn-glycero-3-phosphocholine (POPC-d31) multibilayer vesicles was examined by (2)H NMR spectroscopy at 25 °C. These results, along with existing data for other sterols, indicate that the ordering power of sterols in POPC-d31 depends on subtle aspects of sterol structure. Cholesterol, 7-dehydrocholesterol (7-DHC), campesterol, β-sitosterol, ergosterol, brassicasterol, and stigmasterol all increase the lipid chain order as sterol concentration is increased. However, saturation of the ordering occurs at different sterol concentrations for ergosterol (as previously reported), brassicasterol, β-sitosterol, and stigmasterol. Here our interest lies in finding which part of the sterol structure is responsible for the observed saturation of the palmitoyl chain order as a function of sterol concentration. In particular, we propose that the saturation of the ordering of POPC-d31/brassicasterol and POPC-d31/stigmasterol membranes at quite low sterol concentrations is due to the presence of a double bond at C22. We also discuss how the structural differences between the sterols affect their ability to intercalate between the POPC acyl chains. Furthermore, the effective solubility of sterols in POPC is discussed in relation to the dependence of maximum POPC-d31 chain order vs sterol concentration.

Frequency and expression of inhibitory markers of CD4(+) CD25(+) FOXP3(+) regulatory T cells in patients with common variable immunodeficiency

Common variable immunodeficiency (CVID) is the most symptomatic primary antibody deficiency associated with recurrent infections and chronic inflammatory diseases as well as autoimmunity. CD4(+) CD25(+) FOXP3(+) regulatory T cells (Tregs) are critical T cell subsets for maintaining self-tolerance and regulation of immune response to antigens thus play a pivotal role in preventing autoimmunity. Thirty-seven CVID patients and 18 age-/sex-matched controls were enrolled. Peripheral blood mononuclear cells (PBMCs) were obtained from both groups, and the percentage of Tregs was calculated using flow cytometry method. The mRNA expression of Tregs' surface markers cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) and glucocorticoid-induced tumour necrosis factor receptor (GITR), which are associated with Tregs' inhibitory function, was compared between patients and controls by quantitative real-time PCR TaqMan method. The results revealed that the frequency of Tregs was significantly lower in CVID patients than normal individuals (P < 0.001). In addition, CVID patients with autoimmunity were found to have markedly reduced proportion of Tregs compared to those cases without autoimmune diseases (P = 0.023). A significant difference was seen in factor forkhead box P3 (FOXP3) expression between CVID patients and controls (P < 0.001). The mRNAs of CTLA-4 and GITR genes were expressed at lower levels in CVID patients compared to control group (P = 0.005 and <0.001, respectively). Our findings showed reduced proportion of Tregs in CVID patients together with downregulation of FOXP3 protein and diminished expression of inhibitory Tregs' markers. It could be concluded that all of these changes may be responsible for cellular immune dysregulation observed in these patients especially those with autoimmune manifestation.