Monitoring of clinical signs in goats with transmissible spongiform encephalopathies

Background  

As there is limited information about the clinical signs of BSE and scrapie in goats, studies were conducted to describe the clinical progression of scrapie and BSE in goats and to evaluate a short clinical protocol for its use in detecting scrapie-affected goats in two herds with previously confirmed scrapie cases. Clinical assessments were carried out in five goats intracerebrally infected with the BSE agent as well as five reported scrapie suspects and 346 goats subject to cull from the two herds, 24 of which were retained for further monitoring. The brain and selected lymphoid tissue were examined by postmortem tests for disease confirmation.     

Distinct Functional Properties of Isoamylase-Type Starch Debranching Enzymes in Monocot and Dicot Leaves

Isoamylase-type starch debranching enzymes (ISA) play important roles in starch biosynthesis in chloroplast-containing organisms, as shown by the strict conservation of both catalytically active ISA1 and the noncatalytic homolog ISA2. Functional distinctions exist between species, although they are not understood yet. Numerous plant tissues require both ISA1 and ISA2 for normal starch biosynthesis, whereas monocot endosperm and leaf exhibit nearly normal starch metabolism without ISA2. This study took in vivo and in vitro approaches to determine whether organism-specific physiology or evolutionary divergence between monocots and dicots is responsible for distinctions in ISA function. Maize (Zea mays) ISA1 was expressed in Arabidopsis (Arabidopsis thaliana) lacking endogenous ISA1 or lacking both native ISA1 and ISA2. The maize protein functioned in Arabidopsis leaves to support nearly normal starch metabolism in the absence of any native ISA1 or ISA2. Analysis of recombinant enzymes showed that Arabidopsis ISA1 requires ISA2 as a partner for enzymatic function, whereas maize ISA1 was active by itself. The electrophoretic mobility of recombinant and native maize ISA differed, suggestive of posttranslational modifications in vivo. Sedimentation equilibrium measurements showed recombinant maize ISA1 to be a dimer, in contrast to previous gel permeation data that estimated the molecular mass as a tetramer. These data demonstrate that evolutionary divergence between monocots and dicots is responsible for the distinctions in ISA1 function.Semicrystalline starch enables photosynthetic eukaryotes to store large quantities of Glc over extended time periods compared with other species, in which the soluble polymer glycogen functions to store carbohydrate reserves (Ball and Morell, 2003). Eukaryotes gained the capacity to photosynthesize after the capture of a cyanobacterial endosymbiont by a glycogen-metabolizing host cell. In the lineage that evolved subsequently, known as the Archaeplastida, select glucan-storage enzymes encoded within the host nucleus, the endosymbiont, and potentially a prokaryotic parasite located within the host cell developed so as to generate the branched glucan polymer amylopectin (Ball et al., 2011, 2013). Such molecules are highly similar to glycogen in terms of chemical structure, but the molecular architecture of amylopectin enables the formation of semicrystalline structures (Buléon et al., 1998). These latter then assemble into higher order structures leading to starch granule formation. The advent of starch granules is likely to have been critical for the evolution of chloroplast-containing organisms, including the spread of land plants on the Earth’s surface, because they enable the storage of photosynthetically generated Glc for many hours in tissues such as leaves during diurnal cycles or for months to years in seeds.An important aspect of the evolutionary change from glycogen to starch is the use of particular α(1→6)-glucosidases, referred to as isoamylase-type starch debranching enzymes (ISA), in the production of amylopectin (Ball et al., 1996; Myers et al., 2000; Hennen-Bierwagen et al., 2012). A suite of genes encoding the enzymes that accomplish starch biosynthesis was established early in the evolution of chloroplast-containing organisms (i.e. the Chloroplastida) prior to the divergence of distantly related groups including green algae and land plants. Included in this gene set are three paralogs that encode the proteins ISA1, ISA2, and ISA3, each of which is highly conserved in chloroplast-containing species. ISA1 of vascular plants and bryophytes, for example, are approximately 70% identical over more than 600 residues, and between land plants and prasinophyte algae this value is about 60%. ISA1 or ISA2 deficiencies in potato (Solanum tuberosum) tuber, Arabidopsis (Arabidopsis thaliana) leaf, Chlamydomonas reinhardtii cells, and cereal endosperms result in reduced starch content, altered amylopectin structure, and the appearance of soluble, branched glucans similar to native glycogen (James et al., 1995; Mouille et al., 1996; Nakamura et al., 1996; Bustos et al., 2004; Delatte et al., 2005; Wattebled et al., 2005). Such soluble polymers, referred to as phytoglycogen, have not been observed in wild-type plants. Thus, ISA1 and ISA2 functions are important determinants of whether storage glucans are semicrystalline or soluble. ISA3, in contrast, functions primarily in starch catabolism (Wattebled et al., 2005; Delatte et al., 2006).ISA1 and ISA2 appear to function together in Arabidopsis leaf as a single entity, because essentially identical phenotypes are observed in single mutants lacking either protein or double mutants lacking both of them (Zeeman et al., 1998; Delatte et al., 2005; Wattebled et al., 2005). Biochemical analysis of native and recombinant proteins has shown directly that ISA1 and ISA2 function together in a complex. ISA activity was first purified from potato tuber and found to contain two distinct polypeptides identified as ISA1 and ISA2 (Ishizaki et al., 1983; Hussain et al., 2003). Heteromultimers containing these two proteins were also purified from rice (Oryza sativa) and maize (Zea mays) endosperm (Utsumi and Nakamura, 2006; Kubo et al., 2010). Finally, a mixture of native and recombinant rice proteins demonstrated directly that specific enzymatic activities are provided by ISA1 and ISA2 functioning together in a heteromultimeric complex (Utsumi and Nakamura, 2006). ISA1 is the catalytic subunit within this complex, whereas ISA2 is noncatalytic, owing to amino acid substitutions at residues that are essentially invariant in the GH13 family of glycoside hydrolases (i.e. the α-amylase superfamily), several of which participate in the catalytic mechanism (Hussain et al., 2003; Utsumi and Nakamura, 2006). Despite lacking catalytic activity, ISA2 proteins are conserved in all chloroplast-containing species that have been examined, which rules out recently evolved mutations and, to the contrary, suggests a functional selective advantage.The necessity for the ISA1/ISA2 heteromultimer is not obvious in light of the fact that, in some instances, ISA1 by itself can condition normal levels of starch and the suppression of phytoglycogen accumulation. Cyanidioschyzon merolae, a species within the Rhodophyta lineage of the Archaeplastida family, contains semicrystalline starch and amylopectin with physical characteristics similar to that of Chloroplastida species (Hirabaru et al., 2010). The C. merolae genome contains elements that encode ISA1 and ISA3 yet lacks a homolog encoding ISA2 (Coppin et al., 2005). Thus, in some instances, starch can be generated, and phytoglycogen accumulation suppressed, without an ISA2 protein. Cereal endosperms provide additional evidence that ISA2 is not strictly required for normal starch levels and the suppression of phytoglycogen accumulation. Mutants or transgenic lines lacking ISA2 are known in rice (Utsumi et al., 2011) and maize (Kubo et al., 2010). Endosperm from these plants exhibits normal starch levels, with amylopectin structure essentially the same as the wild type, and lacks phytoglycogen. ISA activity presumably is provided in the endosperm of these mutants by a homomultimeric enzyme containing only ISA1.The reason why ISA2 is strictly conserved in the Chloroplastida is not understood yet. Two explanations can be considered. One possibility is that the inherent structure of ISA1 in cereals, resulting from mutations accumulated specifically in this evolutionary lineage, allows it to act without ISA2. Another possibility is that metabolic differences in specific tissues (e.g. leaf versus endosperm) require specialized enzymatic properties of the ISA1/ISA2 heteromer that ISA1 by itself does not provide. To test these hypotheses, this study combined maize and Arabidopsis ISA1 and ISA2 isoforms both in vitro and in vivo. Maize ISA1 was found to be active without any ISA2 protein, either in vitro or in Arabidopsis leaves, whereas Arabidopsis ISA1 required an ISA2 partner in all instances. Thus, ISA1 appears to have evolved in the cereal lineage so that it no longer requires ISA2 for enzymatic activity or metabolic function in the generation of starch and the suppression of phytoglycogen accumulation.     

Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: A cohort study

BackgroundThere is limited evidence on the use of high-sensitivity C-reactive protein (hsCRP) as a biomarker for selecting patients for advanced cardiovascular (CV) therapies in the modern era. The prognostic value of mildly elevated hsCRP beyond troponin in a large real-world cohort of unselected patients presenting with suspected acute coronary syndrome (ACS) is unknown. We evaluated whether a mildly elevated hsCRP (up to 15 mg/L) was associated with mortality risk, beyond troponin level, in patients with suspected ACS.Methods and findingsWe conducted a retrospective cohort study based on the National Institute for Health Research Health Informatics Collaborative data of 257,948 patients with suspected ACS who had a troponin measured at 5 cardiac centres in the United Kingdom between 2010 and 2017. Patients were divided into 4 hsCRP groups (<2, 2 to 4.9, 5 to 9.9, and 10 to 15 mg/L). The main outcome measure was mortality within 3 years of index presentation. The association between hsCRP levels and all-cause mortality was assessed using multivariable Cox regression analysis adjusted for age, sex, haemoglobin, white cell count (WCC), platelet count, creatinine, and troponin.Following the exclusion criteria, there were 102,337 patients included in the analysis (hsCRP <2 mg/L (n = 38,390), 2 to 4.9 mg/L (n = 27,397), 5 to 9.9 mg/L (n = 26,957), and 10 to 15 mg/L (n = 9,593)). On multivariable Cox regression analysis, there was a positive and graded relationship between hsCRP level and mortality at baseline, which remained at 3 years (hazard ratio (HR) (95% CI) of 1.32 (1.18 to 1.48) for those with hsCRP 2.0 to 4.9 mg/L and 1.40 (1.26 to 1.57) and 2.00 (1.75 to 2.28) for those with hsCRP 5 to 9.9 mg/L and 10 to 15 mg/L, respectively. This relationship was independent of troponin in all suspected ACS patients and was further verified in those who were confirmed to have an ACS diagnosis by clinical coding. The main limitation of our study is that we did not have data on underlying cause of death; however, the exclusion of those with abnormal WCC or hsCRP levels >15 mg/L makes it unlikely that sepsis was a major contributor.ConclusionsThese multicentre, real-world data from a large cohort of patients with suspected ACS suggest that mildly elevated hsCRP (up to 15 mg/L) may be a clinically meaningful prognostic marker beyond troponin and point to its potential utility in selecting patients for novel treatments targeting inflammation.Trial registrationClinicalTrials.gov - {"type":"clinical-trial","attrs":{"text":"NCT03507309","term_id":"NCT03507309"}}NCT03507309

Amit Kaura and colleagues investigate whether mildly elevated high sensitivity C-reactive protein is associated with mortality risk in patients with suspected acute coronary syndromes.     

Early conversion of maternal androgens affects the embryo already in the first week of development

Maternal androgen exposure has potent effects on offspring development. As substantial levels of maternal androgens are deposited in avian egg yolks, avian eggs are frequently used to study maternal effects, with a strong focus on post-natal development. However, the underlying pathways are largely unknown. Since the hormones are taken up during the embryonic phase, and these are rapidly metabolized by avian embryos into metabolites such as etiocholanolone, we studied the effects of yolk androgens (testosterone and androstenedione) and their metabolite etiocholanolone during the first few days of embryonic development. As embryonic heart rate is often used as an indicator of embryonic development, we measured the heart rate from day 3 to day 6 of incubation by using a shell-less culture technique in rock pigeon eggs (Columba livia). Increased androgen exposure increased heart rate, and increased etiocholanolone mimicked this effect, albeit in a small sample size. This indicates that exposure to maternal androgens increases embryonic overall metabolism which may account for the developmental outcomes found in previous studies such as increased growth. Moreover, etiocholanolone is likely to be an important metabolite in a non-genomic pathway underlying the androgen-mediated maternal effect.     

The interferon type I signature towards prediction of non-response to rituximab in rheumatoid arthritis patients

Introduction

B cell depletion therapy is efficacious in rheumatoid arthritis (RA) patients failing on tumor necrosis factor (TNF) blocking agents. However, approximately 40% to 50% of rituximab (RTX) treated RA patients have a poor response. We investigated whether baseline gene expression levels can discriminate between clinical non-responders and responders to RTX.

Methods

In 14 consecutive RA patients starting on RTX (test cohort), gene expression profiling on whole peripheral blood RNA was performed by Illumina^® HumanHT beadchip microarrays. Supervised cluster analysis was used to identify genes expressed differentially at baseline between responders and non-responders based on both a difference in 28 joints disease activity score (ΔDAS28 < 1.2) and European League against Rheumatism (EULAR) response criteria after six months RTX. Genes of interest were measured by quantitative real-time PCR and tested for their predictive value using receiver operating characteristics (ROC) curves in an independent validation cohort (n = 26).

Results

Genome-wide microarray analysis revealed a marked variation in the peripheral blood cells between RA patients before the start of RTX treatment. Here, we demonstrated that only a cluster consisting of interferon (IFN) type I network genes, represented by a set of IFN type I response genes (IRGs), that is, LY6E, HERC5, IFI44L, ISG15, MxA, MxB, EPSTI1 and RSAD2, was associated with ΔDAS28 and EULAR response outcome (P = 0.0074 and P = 0.0599, respectively). Based on the eight IRGs an IFN-score was calculated that reached an area under the curve (AUC) of 0.82 to separate non-responders from responders in an independent validation cohort of 26 patients using Receiver Operator Characteristics (ROC) curves analysis according to ΔDAS28 < 1.2 criteria. Advanced classifier analysis yielded a three IRG-set that reached an AUC of 87%. Comparable findings applied to EULAR non-response criteria.

Conclusions

This study demonstrates clinical utility for the use of baseline IRG expression levels as a predictive biomarker for non-response to RTX in RA.     

Inhibiting citrullination in rheumatoid arthritis: taking fuel from the fire

Citrullination is a post-translational modification catalysed by peptidylarginine deiminase and is a common feature of inflammation. The presence of anti-citrullinated protein/peptide antibodies (ACPA), however, is unique to rheumatoid arthritis. Several lines of evidence suggest that ACPA are important in the pathogenesis of rheumatoid arthritis. A popular hypothesis for this pathogenesis is a two-hit model. The first hit gives rise to ACPA, and the second hit, an unrelated episode of synovial inflammation accompanied by citrullination, is perpetuated by the pre-existing antibodies. This model suggests that reducing citrullination might ameliorate disease. Recent findings indicate that citrullination closely correlates with inflammation, and that glucocorticoids decrease peptidylarginine deiminase expression independent of their other anti-inflammatory effects.     

Definition of common carotid wall thickness affects risk classification in relation to degree of internal carotid artery stenosis: the Plaque At RISK (PARISK) study

Background

Mean or maximal intima-media thickness (IMT) is commonly used as surrogate endpoint in intervention studies. However, the effect of normalization by surrounding or median IMT or by diameter is unknown. In addition, it is unclear whether IMT inhomogeneity is a useful predictor beyond common wall parameters like maximal wall thickness, either absolute or normalized to IMT or lumen size. We investigated the interrelationship of common carotid artery (CCA) thickness parameters and their association with the ipsilateral internal carotid artery (ICA) stenosis degree.

Methods

CCA thickness parameters were extracted by edge detection applied to ultrasound B-mode recordings of 240 patients. Degree of ICA stenosis was determined from CT angiography.

Results

Normalization of maximal CCA wall thickness to median IMT leads to large variations. Higher CCA thickness parameter values are associated with a higher degree of ipsilateral ICA stenosis (p?<?0.001), though IMT inhomogeneity does not provide extra information. When the ratio of wall thickness and diameter instead of absolute maximal wall thickness is used as risk marker for having moderate ipsilateral ICA stenosis (>50%), 55 arteries (15%) are reclassified to another risk category.

Conclusions

It is more reasonable to normalize maximal wall thickness to end-diastolic diameter rather than to IMT, affecting risk classification and suggesting modification of the Mannheim criteria.

Trial registration

Clinical trials.gov NCT01208025.