Modulation of secretory factors by lipofundin contributes to its anti‑neuroinflammatory effects

As the global population ages, the prevalence of neuroinflammatory diseases such as Alzheimer's disease, Parkinson's disease and stroke continues to increase. Therefore, it is necessary to develop preventive and therapeutic methods against neuroinflammatory diseases. Lipofundin is a lipid emulsion commonly used in clinical anesthetic solvents and nutritional supplements. Lipid emulsions have been shown to possess anti-inflammatory properties. However, the potential beneficial effect of lipofundin against neuroinflammation requires elucidation. In the present study, two cell models were used to investigate the efficacy of lipofundin against neuroinflammation. In the first model, BV2 mouse microglial cells were treated with lipopolysaccharide (LPS) to induce nitric oxide (NO) production as a model of neuroinflammation. In the second model, HMC3 human microglial were activated by LPS, and changes in the secretion of factors associated with inflammation were analyzed using Luminex xMAP® technology. Griess assay results revealed that lipofundin significantly prevented and treated LPS-induced NO production. An anti-neuroinflammatory effect was also observed in HMC3 cells, where lipofundin exhibited excellent preventive and therapeutic properties by reducing the LPS-induced expression and secretion of interleukin-1β. Notably, lipofundin also promoted the secretion of certain growth factors, suggesting a potential neuroprotective effect. These results demonstrate that, in addition to its role as a solvent for drugs and nutritional support, lipofundin may also have beneficial effects in alleviating the progression of neuroinflammation. These findings may serve as an important reference for future translational medicine applications.

Case report: Sudden onset optic neuritis shortly after SARS-CoV-2 vaccination in an allogeneic hematopoietic stem cell transplant recipient with chronic graft-vs.-host disease

Hematopoietic stem cell transplantation (HSCT) recipients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have a high mortality rate. The American Society of Transplantation and Cellular Therapy (ASTCT) and the European Society for Blood and Marrow Transplantation (EBMT) recommend vaccination for these vulnerable populations. However, emerging data suggested that vaccination might elicit immunological adverse events, including an exacerbation of graft-vs.-host disease (GVHD). Herein, we report a case of severe optic neuritis developed shortly after AstraZeneca COVID-19 vaccination in an allogeneic HSCT recipient with underlying chronic GVHD. The patient had a headache 5 days after vaccination, and the disease progressed rapidly to complete blindness 17 days after the vaccination. The diagnosis of optic neuritis was well-confirmed by the presence of an anti-myelin oligodendrocyte glycoprotein antibody and the typical features of MRI image and Ophthalmoscopy. Other differential diagnoses, such as infection or leukemia relapse in the central nervous system (CNS), were carefully excluded. A timely high-dose corticosteroid was administered, and her visual acuity improved rapidly. She returned to her baseline status 1 month later. With more than 1 year of follow-up, no optic neuritis or leukemia relapse was observed. In summary, allogeneic transplant recipients can develop severe optic neuritis after vaccination. Optic neuritis can be an exacerbation of GVHD or rarely a sporadic adverse event of vaccination. Furthermore, our experience indicates that a prompt diagnosis and early steroid treatment are vital for a good recovery.

Rapid progressive vaccine-induced immune thrombotic thrombocytopenia with cerebral venous thrombosis after ChAdOx1 nCoV-19 (AZD1222) vaccination: A case report

BACKGROUND

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare and potentially life-threatening condition after receiving coronavirus disease vaccines. It is characterized by symptom onset at 5 to 30 d postvaccination, thrombocytopenia, thrombosis, high D-dimer level, and antiplatelet factor 4 (anti-PF4) antibody positivity. VITT can progress very fast, requiring urgent management. Only few studies have described its detailed clinical course and imaging changes. We report a typical VITT case in a patient who underwent regular repeated brain imaging examinations.

CASE SUMMARY

A young woman presented with headaches at 7 d after the ChAdOx1 nCoV-19 vaccine (AZD1222) injection. She then showed progressive symptoms of left upper limb clumsiness. Brain computed tomography revealed venous infarction at the right parietal lobe with a hyperacute thrombus in the cortical vein. Two hours later, brain magnetic resonance imaging revealed hemorrhage at the same area. Magnetic resonance venography showed an irregular contour of the right transverse sinus. Laboratory examination revealed a high D-dimer level, thrombocytopenia, and a high titer for anti-PF4 antibodies. She was treated with anticoagulants, intravenous immunoglobulin, and steroids and analgesic agents were administered for pain control. She had a marked improvement on headaches and clumsiness after treatment along with radiological thrombus resolution. During follow-up at the outpatient department, her modified Rankin scale at 90 d was 1.

CONCLUSION

Clinicians should be alerted whenever patients present with persistent and progressive headaches or focal motor/sensory deficits postvaccination.

[Assessment of setup errors of IGRT combined with a six degrees of freedom bed for patients with primary rectal cancer]

Objective: To investigate the effect of six degree of freedom (6-DOF) bed combined with cone beam computed tomography (CBCT) in the on-line correction of setup errors in patients with primary rectal cancer. Methods: The clinicopathological data of 17 patients with primary rectal cancer in Department of Radiotherapy, Third Hospital of Peking University from July 2013 to January 2014 were collected. There were 14 males and 3 females, a median age of 65 years. The difference of CBCT and 6-DOF bed combined with CBCT online correction of patients with positioning error were retrospectively analyzed. Results: Before position correction, the first CBCT verification of setup errors in the three translation directions including X (left and right), Y (in and out) and Z (up and down) directions were (0.06±0.25) cm, (0.13±0.40) cm and (-0.28±0.31) cm, respectively. The setup errors of RX (rotation pitch), RY(rolling) and RZ (left and right rotation) directions were (0.62±1.15)°, (-0.19±0.99)°, and (-0.34 ± 0.84)°, respectively . After correction of IGRT combined with six freedom of bed, the setup errors of translation X, Y and Z were (0.01±0.09) cm, (-0.01±0.05) cm and (-0.03±0.08) cm, respectively, and the setup errors of rotation RX, RY and RZ directions were (-0.16±0.40)°, (0.36±0.31)°and (-0.01±0.25)°, respectively. There were significant differences in translation direction (X, Y and Z direction) and rotation direction (Rx, RY and RZ) before and after 6-DOF bed combined with CBCT correction (all P<0.05). In the translation direction, the higher frequency range of Z-direction error value was 0.20-0.79 cm. In the rotation direction, the frequency range of error in Rx direction was 0.20°-2.99°. There was no significant difference between bone mode and gray scale model registration (P>0.05). With the progress of radiotherapy, the setup errors of X, Z, Rx, RY and RZ directions increased except Y direction. Conclusions: In radiotherapy, six freedom bed combined with CBCT is helpful to correct the setup errors of patients with primary rectal cancer. Six freedom bed may be used to correct the setup errors of patients with primary rectal cancer online. Image-guided radiation therapy (IGRT) is recommended for bone pattern registration in patients with rectal cancer.

Cervical spinal epidural abscess following needle-knife acupotomy, with an initial presentation that mimicked an acute stroke: A case report

Introduction: A spinal epidural abscess is difficult to diagnose and it can sometimes mimic an acute ischemic stroke.Case presentation: We report a 69-year-old woman attended our emergency department because of gross hematuria for 1 week, with fever and bilateral flank pain. Two weeks earlier, she had received needle-knife acupotomy (a more invasive procedure than the traditional acupuncture) for chronic neck pain. Acute pyelonephritis was diagnosed; however, 4 h later, she developed weakness of both right limbs. Acute lacunar infarction was tentatively diagnosed. After admission, weakness of the left limbs developed, with a feeling of fullness and discomfort around the entire T6 dermatome with urinary retention. Neck magnetic resonance imaging showed extensive cervical epidural abscesses from C3 to T1. After an operation, her neck pain and the weakness of the four limbs gradually improved.Discussion: Spinal epidural abscess is a rare complication, and which should be considered for patients who have undergone invasive cervical procedures. Needle-knife acupotomy is a more invasive procedure than the traditional acupuncture. Conclusion: Although it is considered safe and effective for cervical spondylosis, it can be complicated by spinal infection. Careful disinfection should therefore be performed, and disposable needleknives should be used.

Structure, interaction and electron transfer between cytochrome b5, its E44A and/or E56A mutants and cytochrome c

Site-directed mutagenesis has been used to produce variants of a tryptic fragment of bovine liver cytochrome b5 in which Glu44 and Glu56 are mutated to alanine. The reduction potentials measured by spectroelectrochemical titration (in the presence of 1 mM (Ru(NH3)6)3+, pH 7.0 and I=0.1 M) are 4.5, 6.0, 6.0 and 7.5 mV versus the standard hydrogen electrode (SHE) for the wild-type and E44A, E56A and E44/56A mutants of cytochrome b5, respectively. A comparative two-dimensional NMR study of cytochrome b5 and its E44/56A mutant in water solution has been achieved. Resonance assignments of side-chains have been completed successfully. The NMR results suggest that the secondary structures and global folding of the E44/56A mutant remain unchanged, but the mutation of both Glu44 and Glu56 to hydrophobic alanine may lead to the two helices containing mutated residues contracting towards the heme center. The inner mobility of the Gly42 approximately Glu44 segment in cytochrome b5 may be responsible for the difference of the binding mode between Glu44 and Glu56 with cytochrome c. The binding between cytochrome c and cytochrome b5 was studied by optical difference spectra of cytochrome c and variants of cytochrome b5. The association constants (KA) for the wild-type, E44A, E56A, and E44/56A mutants of cytochrome b5 with cytochrome c, are 4.70(+/-0. 10)x10(6) M-1, 1.88(+/-0.03)x10(6) M-1, 2.70(+/-0.13)x10(6) M-1, and 1.14(+/-0.05)x10(6) M-1, respectively. This is indicative that both Glu44 and Glu56 are involved in the complex formation between cytochrome b5 and cytochrome c. The reduction of horse heart ferricytochrome c by recombinant ferrocytochrome b5 and its mutants has been studied. The rate constant of the electron transfer reaction between ferricytochrome c and wild-type ferrocytochrome b5 (1.074(+/-0.49)x10(7) M-1 s-1) is higher than those of the mutant protein E44A (8.98(+/-0.20)x10(6) M-1 s-1), E56A (8.76(+/-0. 39)x10(6) M-1 s-1), and E44/56A (8.02(+/-0.38)x10(6) M-1 s-1) at 15 degreesC, pH 7.0, I=0.35 M. The rate constants are strongly dependent on ionic strength and temperature. These studies, by means of a series of techniques, provide conclusive results that the interaction between cytochrome b5 and cytochrome c is electrostatically guided, and, more importantly, that both Glu44 and Glu56 participate in the electron transfer reaction.