Pathogenesis and Pathology of Invasive Aspergillosis

Purpose of Review

Invasive aspergillosis occurs in immunosuppressed individuals and is associated with high morbidity and mortality. Understanding the host defenses and pathogen characters is important in the causation of disease.

Recent Findings

Neutropenia and/or corticosteroid administration increase the risk of invasive infections and majority are due to Aspergillus fumigatus. The size of the conidia, thermotolerance, hydrophobins and melanin on conidial surface, adaptability to host environment, and angioinvasive nature contribute to pathogenecity. The large conidial size, hot and humid environment, and constant exposure to high spore content are implicated in the pathogenesis of chronic invasive infections in a normal host due to Aspergillus flavus. Pathology depends on the immune status and varies from granuloma with fibrosis or suppuration to abscess or infarction.

Summary

The risk factors and the interplay of host pathogen in the pathogenesis of invasive aspergillosis are reviewed. Genetic predisposition and identification of such genetic factors are necessary for prevention and treatment.

     

Current Concepts of Cancer Chemotherapy

The most impressive regressions obtained to date with the use of chemotherapy are in metastatic choriocarcinoma of females. In the management of Hodgkin''s disease, leukemia, and lymphoma, chemotherapy is a useful and accepted form of therapy. In many cases radiation and chemotherapy are interdependent. In disseminated carcinomas arising in the lung, ovary or breast, there is less likelihood of significant improvement with the use of chemotherapy, but if the disease is not amenable to radiotherapy, useful palliation can be obtained at times.While newer chemotherapeutic agents for cancer, notably the pyrimidine analogues, have a broader spectrum of antitumor effects than others investigated earlier, they should be regarded as providing a valuable research stimulus in the continued search for more effective and less toxic agents.     

CD38 Is Expressed on Inflammatory Cells of the Intestine and Promotes Intestinal Inflammation

The enzyme CD38 is expressed on a variety of hematopoietic and non-hematopoietic cells and is involved in diverse processes such as generation of calcium-mobilizing metabolites, cell activation, and chemotaxis. Here, we show that under homeostatic conditions CD38 is highly expressed on immune cells of the colon mucosa of C57BL/6 mice. Myeloid cells recruited to this tissue upon inflammation also express enhanced levels of CD38. To determine the role of CD38 in intestinal inflammation, we applied the dextran sulfate sodium (DSS) colitis model. Whereas wild-type mice developed severe colitis, CD38^-/- mice had only mild disease following DSS-treatment. Histologic examination of the colon mucosa revealed pronounced inflammatory damage with dense infiltrates containing numerous granulocytes and macrophages in wild-type animals, while these findings were significantly attenuated in CD38^-/- mice. Despite attenuated histological findings, the mRNA expression of inflammatory cytokines and chemokines was only marginally lower in the colons of CD38^-/- mice as compared to wild-type mice. In conclusion, our results identify a function for CD38 in the control of inflammatory processes in the colon.     

Knockout Mice Challenge our Concepts of Glucose Homeostasis and the Pathogenesis of Diabetes

A central component of type 2 diabetes and the metabolicsyndrome is insulin resistance. Insulin exerts a multifacetedand highly integrated series of actions via its intracellularsignaling systems. Generation of mice carrying null mutationsof the genes encoding proteins in the insulin signalingpathway provides a unique approach to determining therole of individual proteins in the molecular mechanism ofinsulin action and the pathogenesis of insulin resistance anddiabetes. The role of the four major insulin receptor substrates(IRS1-4) in insulin and IGF-1 signaling have beenexamined by creating mice with targeted gene knockouts.Each produces a unique phenotype, indicating the complementaryrole of these signaling components. Combined heterozygousdefects often produce synergistic or epistatic effects,although the final severity of the phenotype dependson the genetic background of the mice. Conditional knockoutsof the insulin receptor have also been created using theCre-lox system. These tissue specific knockouts have provideunique insights into the control of glucose homeostasisand the pathogenesis of type 2 diabetes, and have led to developmentof new hypotheses about the nature of the insulinaction and development of diabetes.     

Inflammatory Lesions of the Breast: Diagnosis By Fine Needle Aspiration

Amongst 1061 breast lesions diagnosed by fine needle aspiration (FNA) over a period of 6 years (1985-1990), 128 were reported to be showing changes consistent with an inflammatory lesion. On review, the cytodiagnosis was found to be inaccurate in 31 cases. The cytological features of the 97 cases that were correctly reported are described in this report. The cytological diagnoses issued in these 97 cases were acute mastitis or breast abscess (57 cases) and tuberculous mastitis (30 cases). Non-specific chronic mastitis and miscellaneous conditions accounted for four and six cases respectively. Acid fast bacilli (AFB) were demonstrated in 28.0% of tuberculous mastitis cases and 10.0% of those diagnosed as acute mastitis or breast abscess. FNA cytology was found to be useful for the diagnosis of inflammatory lesions of breast and their classification, as only five out of 57 cases of acute mastitis/breast abscess and one out of 30 tuberculous mastitis cases were suspected on clinical grounds.     

The Role of HMGB1 in the Pathogenesis of Inflammatory and Autoimmune Diseases

High-mobility group box 1 (HMGB1) protein is a highly abundant protein that can promote the pathogenesis of inflammatory and autoimmune diseases once it is in an extracellular location. This translocation can occur with immune cell activation as well as cell death, with the conditions for release associated with the expression of different isoforms. These isoforms result from post-translational modifications, with the redox states of three cysteines at positions 23, 45 and 106 critical for activity. Depending on the redox states of these residues, HMGB1 can induce cytokine production via toll-like receptor 4 (TLR4) or promote chemotaxis by binding the chemokine CXCL12 for stimulation via CXCR4. Fully oxidized HMGB1 is inactive. During the course of inflammatory disease, HMGB1 can therefore play a dynamic role depending on its redox state. As a mechanism to generate alarmins, cell death is an important source of HMGB1, although each major cell death form (necrosis, apoptosis, pyroptosis and NETosis) can lead to different isoforms of HMGB1 and variable levels of association of HMGB1 with nucleosomes. The association of HMGB1 with nucleosomes may contribute to the pathogenesis of systemic lupus erythematosus by producing nuclear material whose immunological properties are enhanced by the presence of an alarmin. Since HMGB1 levels in blood or tissue are elevated in many inflammatory and autoimmune diseases, this molecule can serve as a unique biomarker as well as represent a target of novel therapies to block its various activities.     

Complement System in the Pathogenesis of Benign Lymphoepithelial Lesions of the Lacrimal Gland

Objective

We aimed to examine the potential involvement of local complement system gene expression in the pathogenesis of benign lymphoepithelial lesions (BLEL) of the lacrimal gland.

Methods

We collected data from 9 consecutive pathologically confirmed patients with BLEL of the lacrimal gland and 9 cases with orbital cavernous hemangioma as a control group, and adopted whole genome microarray to screen complement system-related differential genes, followed by RT-PCR verification and in-depth enrichment analysis (Gene Ontology analysis) of the gene sets.

Results

The expression of 14 complement system-related genes in the pathologic tissue, including C2, C3, ITGB2, CR2, C1QB, CR1, ITGAX, CFP, C1QA, C4B|C4A, FANCA, C1QC, C3AR1 and CFHR4, were significantly upregulated while 7 other complement system-related genes, C5, CFI, CFHR1|CFH, CFH, CD55, CR1L and CFD were significantly downregulated in the lacrimal glands of BLEL patients. The microarray results were consistent with RT-PCR analysis results. Immunohistochemistry analysis of C3c and C1q complement component proteins in the resected tissue were positive in BLEL patients, while the control group had negative expression of these proteins. Gene ontology (GO) analysis revealed that activation of the genes of complement system-mediated signaling pathways were the most enriched differential gene group in BLEL patients.

Conclusions

Local expression of complement components is prominently abnormal in BLEL, and may well play a role in its pathogenesis.     

APL的发病分子机制和治疗进展

急性前髓细胞性白血病(APL)是急性髓细胞样白血病(AML)的一个亚型,它的分子生物学特征为95%的患者有15号染色体前髓细胞性白血病基因(PML)与17号染色体视黄酸受体(RARα)基因的融合易位表达.维甲酸(ATRA)单药治疗能使APL患者达90%的缓解率,化疗药物与ATRA的联合应用更能降低患者复发率,改善生存;三氧化二砷(ATO)能使复发患者缓解率达到90%.这篇文章主要综述APL的发病分子机制和治疗进展.     

Microbiota-Independent Ameliorative Effects of Antibiotics on Spontaneous Th2-Associated Pathology of the Small Intestine

We have previously generated a mouse model of spontaneous Th2-associated disease of the small intestine called TRAF6ΔDC, in which dendritic cell (DC)-intrinsic expression of the signaling mediator TRAF6 is ablated. Interestingly, broad-spectrum antibiotic treatment ameliorates TRAF6ΔDC disease, implying a role for commensal microbiota in disease development. However, the relationship between the drug effects and commensal microbiota status remains to be formally demonstrated. To directly assess this relationship, we have now generated TRAF6ΔDC bone marrow chimera mice under germ-free (GF) conditions lacking commensal microbiota, and found, unexpectedly, that Th2-associated disease is actually exacerbated in GF TRAF6ΔDC mice compared to specific pathogen-free (SPF) TRAF6ΔDC mice. At the same time, broad-spectrum antibiotic treatment of GF TRAF6ΔDC mice has an ameliorative effect similar to that observed in antibiotics-treated SPF TRAF6ΔDC mice, implying a commensal microbiota-independent effect of broad-spectrum antibiotic treatment. We further found that treatment of GF TRAF6ΔDC mice with broad-spectrum antibiotics increases Foxp3⁺ Treg populations in lymphoid organs and the small intestine, pointing to a possible mechanism by which treatment may directly exert an immunomodulatory effect. To investigate links between the exacerbated phenotype of the small intestines of GF TRAF6ΔDC mice and local microbiota, we performed microbiotic profiling of the luminal contents specifically within the small intestines of diseased TRAF6ΔDC mice, and, when compared to co-housed control mice, found significantly increased total bacterial content characterized by specific increases in Firmicutes Lactobacillus species. These data suggest a protective effect of Firmicutes Lactobacillus against the spontaneous Th2-related inflammation of the small intestine of the TRAF6ΔDC model, and may represent a potential mechanism for related disease phenotypes.     

Current Concepts of Viral Hepatitis and A Peek into the Future

New information has prompted revision of the conceptual framework for considering the epidemiology and virology of viral hepatitis. The means are now at hand to identify infections due to either Hepatitis A or B, as well as to implicate other etiologic agents in hepatitis. Immunologic evidence of variation in the antigens associated with Hepatitis B, and possibly in Hepatitis A, may explain some well known epidemiologic phenomena and has important implications in immune serum globulin prophylaxis. The ambiguous relationship of antigenemia and viremia in Hepatitis B is explored in relation to the hepatitis hazard of blood products, to trials of immune serum globulin, and to the potential role of the carrier-health worker in hepatitis transmission. The emerging concept of non-parenteral transmission of Hepatitis B is reviewed and future developments in the production of hepatitis vaccines and in experimental viral hepatitis in non-human primates is briefly discussed.