Health-related quality of life, symptoms and comorbidity in inflammatory bowel disease

Health-related quality of life (HRQoL) measurement has become an important outcome in treatment trials and in health policy decisions. HRQoL can be measured by using generic or disease-specific tools. Generic instruments can be used for comparing health status among patients in different health states and conditions but they do not focus specifically on the issues relevant in a particular disease. Disease-specific tools may be more responsive to changes within a specific condition. In earlier studies, impairment of HRQoL has been evident in patients with inflammatory bowel disease (IBD), especially when the disease is active. Data about the impact of comorbidity or demographic characteristics of the patients on HRQoL are partly controversial. This study, which comprised 2913 adult IBD patients, examined HRQoL using the disease-specific IBDQ and the general 15D instruments. The 15D scores of IBD patients were compared with scores of a gender and age matched general population sample. Frequency of IBD symptoms and arrangement of therapy were studied and compared with those of IBD patients in an earlier European study. Furthermore, data of other chronic diseases of the patients were obtained from the Social Insurance Institution s reimbursement register and comorbidity of IBD patients was compared with that of age and gender matched controls. --- Of the respondents, 37% reported that they suffered from disturbing IBD symptoms weekly. In 17% of the patients, the symptoms greatly affected the ability to enjoy leisure activities, and 14% stated that these symptoms greatly affected their capacity to work. Despite that, the great majority (93%) of patients expressed satisfaction with their current treatment, which exceeded the rate observed in the other European patients. The mean IBDQ score was 163, as the possible range is 32-224, and disease activity was strongly correlated with HRQoL. Older age, comorbid diseases, and female gender were also related to impairment of HRQoL. Lower HRQoL scores were seen also in newly-diagnosed patients and in those with a history of surgery, especially after stoma or ileal pouch-anal anastomosis (IPAA) operation. The range of 15D scores was 0.30-1.00, with mean of 0.87. As with the IBDQ, disease activity, older age and history of surgery were correlated with the score. Both the newly-diagnosed patients and patients with a long-lasting disease had lower scores than average even after adjusting for age. The 15D scores of IBD patients were significantly lower than those of the control group. A strong correlation was seen between the 15D and the IBDQ scores. Comorbidity with other chronic diseases was observed in 29% of IBD patients. Connective tissue diseases, chronic obstructive pulmonary diseases, pernicious anaemia, and coronary heart disease (CHD) were significantly increased in patients with IBD. Especially female IBD patients appeared to be at increased risk for CHD, and patients who reported weekly IBD symptoms had a higher risk for having other chronic diseases in addition to IBD. Comorbidity impaired HRQoL, as measured with both generic and disease-specific tools. In conclusion, HRQoL is impaired in IBD patients. An understanding of predictors of HRQoL will help to recognise patients who will need special support.

Molecular evolution of connective tissue growth factor in Cyprinidae (Teleostei : Cypriniformes)

Connective tissue growth factor (CTGF) plays an important role in regulation of cell growth, differentiation, apoptosis and individual development in animals. The study of sequences variation and molecular evolution of CTGF gene across various species of the cyprinid could be helpful for understanding of speciation and gene divergence in this kind of fish. In this study, 19 novel sequences of CTGF gene were obtained from the representative species of the family Cyprinidae using PCR amplification, cloning and sequencing. Phylogenetic relationships of Cyprinidae were reconstructed by neighbor-joining (NJ), maximum parsimony (MP), maximum likelihood (ML) and Bayesian method. Oryzias latipes from the family Cyprinodontidae was assigned to be the outgroup taxon. Leuciscini and Barbini were clustered into the monophyletic lineages, respectively, with the high nodal supports. The estimation of the ratio of non-synonymous to synonymous substitution (dN/dS) for the various branches indicated that there stood the different evolution rates between the Leuciscini and the Barbini. With the ratio of dN/dS of the Leuciscini being lower than that of the Barbini, species within the Barbini were demonstrated to be subjected to the relatively less selection pressure and under the relaxable evolution background. A 6 by indel (insertion/deletion) was found at the 5' end of CTGF gene of Cyprinidae, and this 6 by deletion only appeared in the Leuciscini, which is a typical characteristic of the Leuciscini and provides evidence for the monophylogeny of the Leuciscini. For the amino acid sequences of CTGF protein, the most variations and indels were distributed in the signal region and IGFBP region of this protein, implying that these variations were correlated with the regulation of the CTGF gene expression and protein activity. (c) 2007 National Natural Science Foundation of China and Chinese Academy of Sciences. Published by Elsevier Limited and Science in China Press. All rights reserved.

Mechanics of biological networks: from the cell cytoskeleton to connective tissue.

From the cell cytoskeleton to connective tissues, fibrous networks are ubiquitous in metazoan life as the key promoters of mechanical strength, support and integrity. In recent decades, the application of physics to biological systems has made substantial strides in elucidating the striking mechanical phenomena observed in such networks, explaining strain stiffening, power law rheology and cytoskeletal fluidisation - all key to the biological function of individual cells and tissues. In this review we focus on the current progress in the field, with a primer into the basic physics of individual filaments and the networks they form. This is followed by a discussion of biological networks in the context of a broad spread of recent in vitro and in vivo experiments.

Molecular analysis of inflammatory mechanisms associated with Escherichia coli and inflammatory bowel diseases

Inflammatory bowel diseases (IBD), encompasses a range of chronic, immune-mediated inflammatory disorders that are usually classified under two major relapsing conditions, Crohn’s Disease (CD) and ulcerative colitis (UC). Extensive studies in the last decades have suggested that the etiology of IBD involves environmental and genetic factors that lead to dysfunction of epithelial barrier with consequent deregulation of the mucosal immune system and inadequate responses to gut microbiota.Over the last decade, the microbial species that has attracted the most attention, with respect to CD etiology, is Eschericia coli. In CD tissue, E. coli antigens have also been identified in macrophages within the lamina propria, granulomas, and in the germinal centres of mesenteric lymph nodes of patients. They have been shown to adhere to and invade intestinal epithelial cells whilst also being able to extensively replicate within macrophages. Through the work of genome-wide association studies (GWAS), there is growing evidence to suggest that the microbial imbalance between commensal and pathogenic bacteria in the gut is aided by a defect in the innate immune system. Autophagy represents a recently investigated pathway that is believed to contribute to the pathogenesis of CD, with studies identified a variant of the autophagy gene, ATG16L1, as a susceptibility gene. The aim of my thesis was to study the cellular and molecular mechanism promoted by E.coli strains in epithelial cells and to assess their contribution to IBD pathology. To achieve this we focused on developing both an in vitro and in vivo model of AIEC infection. This allowed us to further our knowledge on possible mechanisms utilised by AIEC that promoted their survival, as well as developing a better understanding of host reactions. We demonstrate a new survival mechanism promoted by E.coli HM605, whereby it induces the expression of the anti-apoptotic proteins Bcl-XL and BCL2, all of which is exacerbated in an autophagy deficient system. We have also demonstrated the presence of AIEC-induced inflammasome responses in epithelial cells which are exacerbated in an autophagy deficient system and expression of NOD-like receptors (NLRs) which might mediate inflammasome responses in vivo. Finally, we used the Citrobacter rodentium model of infectious colitis to identify Pellino3 as an important mediator in the NOD2 pathway and regulator of intestinal inflammation. In summary, we have developed robust and versatile models of AIEC infection as well as provide new insights into AIEC mediated survival pathways. The collected data provides a new perception into why AIEC bacteria are able to prosper in conditions associated with Crohn’s disease patients with a defect in autophagy.

Skin and bone: the face in the archaeological imagination

Thirteen unique archaeological countenances from Ireland were produced through the Manchester method of facial reconstruction. Their gaze prompts a space for a broad discourse regarding the face found within human and artefactual remains of Ireland. These faces are reminders of the human element which is at the core of the discipline of archaeology. These re-constructions create a voyeuristic relationship with the past. At once sating a curiosity about the past, facial reconstructions also provide a catharsis to our presently situated selves. As powerful visual documents, archaeological facial reconstructions illustrate re-presentations of the past as well as how the present can be connected to the past. Through engagment with Emmanuel Levinas’s (1906- 1995) main philosophical themes, the presence of the face is examined in a diachronic structure. The ‘starting point’ is the Neolithic period which has been associated with the notion of visuality with a reconstruction from the early Neolithic site of Annagh, Co. Limerick. The following layer of analysis appears with attention to intersubjectivity in the early medieval period with facial reconstructions from Dooey, Co. Donegal and Owenbristy, Co. Galway. Building upon the past concepts, the late medieval period is associated with the notion of alterity and paired with faces from Ballinderry, Co. Kildare and a sample of males from Gallen Priory, Co. Offaly. The final layer of examination culminates with the application of response and respons-ibility to the post-medieval Irish landscape with facial reconstructions from the prison on Spike Island, Co. Cork. These layers of investigation are similar to the stratigraphical composition of both the archaeological landscape and the skeletal/soft tissue landscape of the face. The separation of the neglected phenomenon of the face from the overwhelming embrace of the field of craniometrics is necessary. Through this detachment a new manner in which to discuss the face and its place within the (bio)archaeological record is possible. Encountering the faces seen in mortuary contexts, material culture, and archaeological facial reconstructions, inform and shape the archaeological imagination.

Integrated analysis of CANVAS 1 and 2: phase 3, multicenter, randomized, double-blind studies to evaluate the safety and efficacy of ceftaroline versus vancomycin plus aztreonam in complicated skin and skin-structure infection.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of complicated skin and skin-structure infection (cSSSI). Increasing antimicrobial resistance in cSSSI has led to a need for new safe and effective therapies. Ceftaroline was evaluated as treatment for cSSSI in 2 identical phase 3 clinical trials, the pooled analysis of which is presented here. The primary objective of each trial was to determine the noninferiority of the clinical cure rate achieved with ceftaroline monotherapy, compared with that achieved with vancomycin plus aztreonam combination therapy, in the clinically evaluable (CE) and modified intent-to-treat (MITT) patient populations. METHODS: Adult patients with cSSSI requiring intravenous therapy received ceftaroline (600 mg every 12 h) or vancomycin plus aztreonam (1 g each every 12 h) for 5-14 days. RESULTS: Of 1378 patients enrolled in both trials, 693 received ceftaroline and 685 received vancomycin plus aztreonam. Baseline characteristics of the treatment groups were comparable. Clinical cure rates were similar for ceftaroline and vancomycin plus aztreonam in the CE (91.6% vs 92.7%) and MITT (85.9% vs 85.5%) populations, respectively, as well as in patients infected with MRSA (93.4% vs 94.3%). The rates of adverse events, discontinuations because of an adverse event, serious adverse events, and death also were similar between treatment groups. CONCLUSIONS: Ceftaroline achieved high clinical cure rates, was efficacious against cSSSI caused by MRSA and other common cSSSI pathogens, and was well tolerated, with a safety profile consistent with the cephalosporin class. Ceftaroline has the potential to provide a monotherapy alternative for the treatment of cSSSI. TRIAL REGISTRATION: ClinicalTrials.gov identifiers: NCT00424190 for CANVAS 1 and NCT00423657 for CANVAS 2.

A model of sequential heart and composite tissue allotransplant in rats.

BACKGROUND: Some of the 600,000 patients with solid organ allotransplants need reconstruction with a composite tissue allotransplant, such as the hand, abdominal wall, or face. The aim of this study was to develop a rat model for assessing the effects of a secondary composite tissue allotransplant on a primary heart allotransplant. METHODS: Hearts of Wistar Kyoto rats were harvested and transplanted heterotopically to the neck of recipient Fisher 344 rats. The anastomoses were performed between the donor brachiocephalic artery and the recipient left common carotid artery, and between the donor pulmonary artery and the recipient external jugular vein. Recipients received cyclosporine A for 10 days only. Heart rate was assessed noninvasively. The sequential composite tissue allotransplant consisted of a 3 x 3-cm abdominal musculocutaneous flap harvested from Lewis rats and transplanted to the abdomen of the heart allotransplant recipients. The abdominal flap vessels were connected to the femoral vessels. No further immunosuppression was administered following the composite tissue allotransplant. Ten days after composite tissue allotransplantation, rejection of the heart and abdominal flap was assessed histologically. RESULTS: The rat survival rate of the two-stage transplant surgery was 80 percent. The transplanted heart rate decreased from 150 +/- 22 beats per minute immediately after transplant to 83 +/- 12 beats per minute on day 20 (10 days after stopping immunosuppression). CONCLUSIONS: This sequential allotransplant model is technically demanding. It will facilitate investigation of the effects of a secondary composite tissue allotransplant following primary solid organ transplantation and could be useful in developing future immunotherapeutic strategies.

Joint and soft tissue injections in the community: questionnaire survey of general practitioners' experiences and attitudes

To investigate the numbers and types of joint and soft tissue injections performed by general practitioners (GPs) and to explore attitudes to training in joint and soft tissue injection and perceived barriers to performing injections.

Connective tissue growth factor antagonizes transforming growth factor-beta 1/Smad signalling in renal mesangial cells

The critical involvement of TGF-beta 1 (transforming growth factor-beta 1) in DN (diabetic nephropathy) is well established. However, the role of CTGF (connective tissue growth factor) in regulating the complex interplay of TGF-beta 1 signalling networks is poorly understood. The purpose of the present study was to investigate co-operative signalling between CTGF and TGF-beta 1 and its physiological significance. CTGF was determined to bind directly to the T beta RIII (TGF-beta type III receptor) and antagonize TGF-beta 1-induced Smad phosphorylation and transcriptional responses via its N-terminal half. Furthermore, TGF-beta 1 binding to its receptor was inhibited by CTGF. A consequent shift towards non-canonical TGF-beta 1 signalling and expression of a unique profile of differentially regulated genes was observed in CTGF/TGF-beta 1-treated mesangial cells. Decreased levels of Smad2/3 phosphorylation were evident in STZ (streptozotocin)-induced diabetic mice, concomitant with increased levels of CTGF Knockdown of T beta RIII restored TGF-beta 1-mediated Smad signalling and cell contractility, suggesting that T beta RIII is key for CTGF-mediated regulation of TGF-beta 1. Comparison of gene expression profiles from CTGF/TGF-beta 1-treated mesangial cells and human renal biopsy material with histological diagnosis of DN revealed significant correlation among gene clusters. In summary, mesangial cell responses to TGF-beta 1 are regulated by cross-talk with CTGF, emphasizing the potential utility of targeting CTGF in DN.

Accounting for the effects of lipids in stable isotope (δ13C and δ15N values) analysis of skin and blubber of balaenopterid whales

RATIONALE Stable isotope values (d¹³C and d¹⁵N) of darted skin and blubber biopsies can shed light on habitat use and diet of cetaceans, which are otherwise difficult to study. Non-dietary factors affect isotopic variability, chiefly the depletion of C due to the presence of C-rich lipids. The efficacy of post hoc lipid-correction models (normalization) must be tested. METHODS For tissues with high natural lipid content (e.g., whale skin and blubber), chemical lipid extraction or normalization is necessary. C:N ratios, d¹³C values and d¹⁵N values were determined for duplicate control and lipid-extracted skin and blubber of fin (Balaenoptera physalus), humpback (Megaptera novaeangliae) and minke whales (B. acutorostrata) by continuous-flow elemental analysis isotope ratio mass spectrometry (CF-EA-IRMS). Six different normalization models were tested to correct d¹³C values for the presence of lipids. RESULTS Following lipid extraction, significant increases in d¹³C values were observed for both tissues in the three species. Significant increases were also found for d¹⁵N values in minke whale skin and fin whale blubber. In fin whale skin, the d¹⁵N values decreased, with no change observed in humpback whale skin. Non-linear models generally out-performed linear models and the suitability of models varied by species and tissue, indicating the need for high model specificity, even among these closely related taxa. CONCLUSIONS Given the poor predictive power of the models to estimate lipid-free d13C values, and the unpredictable changes in d N values due to lipid-extraction, we recommend against arithmetical normalization in accounting for lipid effects on d13C values for balaenopterid skin or blubber samples. Rather, we recommend that duplicate analysis of lipid-extracted (d13C values) and non-treated tissues (d15N values) be used. Copyright © 2012 John Wiley & Sons, Ltd.

Electrospun fibrous mats for skin and abdominal wall repair

Esta tese centra-se no desenvolvimento de materiais biodegradáveis e nãodegradáveis produzidos por eletrofiação com aplicação na área biomédica. O poli(3-hidroxibutirato-co-3-hidroxivalerato) (PHBV), um poliéster biodegradável, foi selecionado como base dos materiais biodegradáveis, enquanto o poli(tereftalato de etileno) (PET), um polímero sintético, estável e biocompatível, foi selecionado para a produção das matrizes não degradáveis. Adicionou-se quitosana aos sistemas com o objetivo de melhorar o processo de eletrofiação e as propriedades morfológicas, físico-químicas e biológicas dos materiais resultantes. A composição química, bem como as características morfológicas e físicoquímicas dos materiais em estudo, foram manipuladas de modo a otimizar a sua performance como suportes celulares para engenharia de tecidos. Foram realizados estudos in vitro com cultura de fibroblastos L929 para avaliar o comportamento das células, i.e. viabilidade, adesão, proliferação e morte, quando cultivadas nas matrizes produzidas por eletrofiação. Adicionalmente foram realizados ensaios in vivo para investigar o potencial dos materiais em estudo na regeneração cutânea e como tela abdominal. Os principais resultados encontrados incluem: o desenvolvimento de novas matrizes híbridas (PHBV/quitosana) adequadas ao crescimento de fibroblastos e ao tratamento de lesões de pele; o desenvolvimento de um sistema de eletrofiação com duas seringas para a incorporação de compostos bioativos; diversas estratégias para manipulação das características morfológicas dos materiais de PHBV/quitosana e PET/quitosana produzidos por eletrofiação; uma melhoria do conhecimento das interações fibroblastos-suporte polimérico; a verificação de uma resposta inflamatória desencadeada pelos materiais nãodegradáveis quando utilizados no tratamento de defeitos da parede abdominal, o que sugere a necessidade de novos estudos para avaliar a segurança do uso de biomateriais produzidos por eletrofiação.

Mandatory infectious diseases consultation for MRSA bacteremia is associated with reduced mortality.

OBJECTIVES: Although infectious disease (ID) consultation has been associated with lower mortality in Staphylococcus aureus bloodstream infections, it is still not mandatory in many centers. This study aimed at assessing the impact of ID consultation on diagnostic and therapeutic management of methicillin-resistant S. aureus (MRSA) bacteremia. METHODS: Retrospective cohort study of all patients with MRSA bacteremia from 2001 to 2010. ID consultations were obtained on request between 2001 and 2006 and became mandatory since 2007. RESULTS: 156 episodes of MRSA bacteremia were included, mostly from central venous catheter (32%) and skin and soft tissue (19%) infections. ID consultation coverage was 58% between 2001 and 2006 and 91% between 2007 and 2010. ID consultation was associated with more echocardiography (59% vs. 26%, p < 0.01), vancomycin trough level measurements (99% vs. 77%, p < 0.01), follow-up blood cultures (71% vs. 50%, p = 0.05), deep-seated infections (43% vs. 16%, p < 0.01), more frequent infection source control (83% vs. 57%, p = 0.03), a longer duration of MRSA-active therapy (median and IQR: 17 days, 13-30, vs. 12, 3-14, p < 0.01) and a 20% reduction in 7-day, 30-day and in-hospital mortality. CONCLUSIONS: ID consultation was associated with a better management of patients with MRSA bacteremia and a reduced mortality.

The role of Microsomal prostaglandin synthase-1 (mPGES-1) and Ephrin B2 in Scleroderma

La sclérodermie (sclérose systémique, ScS) est une maladie auto-immune du tissu conjonctif caractérisée  par  l’épaississement  de  la  peau,  l’apparition  spontanée de lésions cicatricielles, des maladies   des   vaisseaux   sanguins,   divers   degrés   d’inflammation,   en   association   avec   un   système   immunitaire hyperactif. La pathogénèse exacte de cette maladie est inconnue et aucun traitement approprié   n’est   disponible.   La fibrose est un élément distinctif de la maladie de ScS et est considérée   résulter   d’une   incapacité   à   mettre   fin   de   façon   appropriée   à   la   réponse   normale   de   réparation   des   plaies.   L’analyse   histologique   du   stade   initial   de   la   ScS   révèle   une   infiltration   périvasculaire de cellules mononucléaires dans le derme, associée à une synthèse accrue de collagène dans les fibroblastes environnants. Ainsi, la compréhension des moyens de contrôler le stade inflammatoire de la ScS pourrait être bénéfique pour contrôler la progression de la maladie peu après son apparition. La mPGES-1 est une enzyme inductible qui agit en aval de la cyclo- oxygénase (COX) pour catalyser spécifiquement la conversion de la prostaglandine (PG) H2 en PGE2. La mPGES-1  joue  un  rôle  clé  dans  l’inflammation,  la  douleur  et  l’arthrite;;  toutefois,  le   rôle de la mPGES-1 dans les mécanismes de fibrose, spécifiquement en rapport avec la ScS humaine, est inconnu. Mon laboratoire a précédemment montré que les souris à mPGES-1 nulle sont résistantes à la fibrose   cutanée   induite   par   la   bléomycine,   à   l’inflammation,   à   l’épaississement  cutané,  à  la  production  de  collagène  et  à  la  formation  de  myofibroblastes.  Sur  la   base  de  ces  résultats,  j’ai  formulé  l’hypothèse  que  l’inhibition pharmacologique de la mPGES-1 régulera à la baisse la production de médiateurs pro-inflammatoires et pro-fibreux au cours de la maladie   de   ScS.   Afin   d’explorer   le   rôle   de   la   mPGES-1   dans   l’inflammation   et   la   fibrose   associées  à  la  maladie  de  ScS,  j’ai  d’abord  examiné  l’expression  de  la  mPGES-1 dans la peau normale comparativement à des biopsies de peau extraites de patients atteints de ScS. Mes résultats ont montré que la mPGES-1 est nettement élevée dans la peau de patients atteints de ScS en comparaison avec la peau humaine normale. De plus, les niveaux de PGE2 dérivés de la mPGES-1 étaient également significativement plus élevés dans les fibroblastes cutanés isolés de patients  atteints  de  ScS  comparativement  aux  fibroblastes  isolés  de  témoins  sains.  J’ai  également   étudié  l’effet  de  l’inhibition pharmacologique de la mPGES-1  sur  l’expression  de  marqueurs  pro- fibreux.   Mes   études   ont   montré   que   l’expression   de   médiateurs   pro-fibreux clés (α-SMA, endothéline-1, collagène de type 1 et facteur de croissance du tissu conjonctif (FCTC)) est élevée dans les fibroblastes cutanés ScS en comparaison avec les fibroblastes cutanés normaux. Un traitement avec un inhibiteur de la mPGES-1 a eu pour effet de réduire significativement l’expression  de  l’α-SMA,  de  l’endothéline-1, du collagène de type 1 mais pas du FCTC dans les fibroblastes  ScS,  sans  effet  significatif  sur  les  fibroblastes  normaux.  J’ai  en  outre  examiné  l’effet   de  l’inhibition  de  la  mPGES-1 sur des cytokines pro-inflammatoires clés impliquées dans la pathologie de la ScS, incluant IL-6, IL-8 et MCP-1.  L’inhibition  pharmacologique  de  la  mPGES- 1 a eu pour effet de réduire significativement les niveaux de production de cytokines pro- inflammatoires IL6, IL8 et MCP-1 dans les fibroblastes avec lésion ScS comparativement à des fibroblastes non traités. De plus, les patients atteints de ScS ont présenté des niveaux plus élevés de p-AKT, de p-FAK et de p-SMAD3 en comparaison avec les fibroblastes cutanés normaux. L’inhibiteur  de  la  mPGES-1 a pu réguler à la baisse cette expression accrue de p-AKT et de p- FAK, mais pas de p-SMAD3,  dans  les  fibroblastes  ScS.  Ces  résultats  ont  suggéré  que  l’inhibition   de la mPGES-1 pourrait être une méthode viable pour réduire le développement de sclérose cutanée et constituent une cible thérapeutique potentielle pour contrôler les mécanismes fibreux et inflammatoires associés à la pathophysiologie de la maladie de ScS. L’un   des   autres   processus   critiques   reliés   à   l’évolution de la réponse fibreuse associée à la maladie de ScS est la différenciation des fibroblastes en des cellules activées spécialisées iii iv appelées myofibroblastes, responsables de déclencher une signalisation adhésive excessive et le dépôt excessif de matrice extracellulaire,   conduisant   à   la   destruction   de   l’architecture   de   l’organe.   Ainsi,   l’identification   des   facteurs   endogènes   qui   initient/   favorisent   la   différenciation   fibroblaste-myofibroblaste peut mener à des stratégies thérapeutiques prometteuses pour contrôler  l’excès  de  signalisation  adhésive  et  de  fibrose  associé  à  la  maladie  de  ScS.  Des  études   antérieures  dans  le  domaine  de  la  biologie  du  cancer  ont  suggéré  que  l’éphrine  B2,  une  protéine   transmembranaire appartenant à la famille des éphrines, est impliquée dans la signalisation adhésive   et   le   remodelage   extracellulaire.   Cependant,   son   rôle   dans   la   fibrose   n’a   jamais   été   exploré.   Dans   la   deuxième   partie   de   mon   étude,   j’ai   donc   étudié   le   rôle   de   l’éphrine   B2   dans   la   fibrose.   Mes   études   montrent   que   l’expression   de   l’éphrine   B2   est   significativement   augmentée   dans la peau humaine ScS comparativement à la peau normale. Plus important encore, le traitement in vitro de   fibroblastes   de   la   peau   humaine   normale   avec   de   l’éphrine   B2   recombinante est capable de transformer des fibroblastes en cellules myofibroblastiques manifestant toutes les caractéristiques myofibroblastiques typiques, incluant la formation accrue de  fibres  de  tension,  des  adhérences  focales,  l’activation  accrue  de  la  FAK,  un  accroissement  de   l’expression  et  de  la  migration  de  fibroblastes  et  de  leur  adhérence  à  la  fibronectine  à  la  fois  chez   les   fibroblastes   cutanés   normaux   et   ScS.   En   outre,   j’ai   traité   des   souris   avec   de   l’éphrine   B2   recombinante et montré que ces souris ont développé une fibrose cutanée significative associée à une épaisseur dermique et à une synthèse de collagène augmentées, une teneur en hydroxyproline (teneur en collagène) accrue et un nombre accru de myofibroblastes exprimant de   l’α-SMA, une activation augmentée de la FAK et de marqueurs pro-fibreux incluant le collagène de type 1 et le FCTC. Dans  l’ensemble,  mes  études  ont  identifié  deux  médiateurs  endogènes  cruciaux  impliqués  dans  la   propagation  de  l’inflammation  et  de  la  fibrose  associées  à  la  maladie  de  ScS.  L’inhibition  de  la   mPGES-1   pourrait   représenter   une   bonne   stratégie   alternative   pour   contrer   l’inflammation   et   la   fibrose au moins durant les stades précoces de la maladie de ScS. De plus, une signalisation excessive   de   l’éphrine B2 favorise la signalisation adhésive et fibreuse en déclenchant la différenciation   de   fibroblastes   en   myofibroblastes   par   l’activation   de   la   voie   de   signalisation   de   la  FAK.  Ainsi,  l’inhibition  d’éphrine  B2  bloquera  la  formation  de  fibroblastes-myofibroblastes et régulera à la baisse la fibrose associée à la maladie de ScS. En somme, la mPGES-1  et  l’éphrine   B2 semblent toutes deux des cibles attrayantes pour le traitement de la ScS et des troubles fibreux qui y sont reliés.

Hallazgos radiológicos de la enfermedad pulmonar en pacientes Colombianos con esclerodermia

La esclerosis sistémica (ES) es una enfermedad autoinmune multisistémica que afecta principalmente la piel, los pulmones, el tracto gastrointestinal, el corazón y los riñones. La enfermedad pulmonar, presente en casi el 100% de los casos, es el factor con mayor influencia en la mortalidad. El propósito de este estudio es realizar un análisis detallado de la enfermedad pulmonar por tomografía computarizada de alta resolución(TCAR) en pacientes Colombianos con ES, para lo cual se realizó un estudio de prevalencia analítica en 44 pacientes con ES valorados en el Hospital Universitario Mayor Méderi en los últimos 7 años. Los resultados mostraron características demográficas y clínicas similares a las previamente descritas. La prevalencia de enfermedad pulmonar intersticial fue alta, y los hallazgos de fibrosis pulmonar como vidrio esmerilado y panal de abejas se asociaron con la presencia del autoanticuerpo antiSCL70. La medida del diámetro esofágico por TCAR fue mayor en los pacientes con disfagia, antiSCL 70 y linfopenia, los cuales son marcadores de mal pronóstico.

Aluminium and human breast diseases

The human breast is exposed to aluminium from many sources including diet and personal care products, but dermal application of aluminium-based antiperspirant salts provides a local long-term source of exposure. Recent measurements have shown that aluminium is present in both tissue and fat of the human breast but at levels which vary both between breasts and between tissue samples from the same breast. We have recently found increased levels of aluminium in noninvasively collected nipple aspirate fluids taken from breast cancer patients (mean 268±28 g/l) compared with control healthy subjects (mean 131±10 g/l) providing evidence of raised aluminium levels in the breast microenvironment when cancer is present. The measurement of higher levels of aluminium in type I human breast cyst fluids (median 150g/l) compared with human serum (median 6g/l) or human milk (median 25g/l) warrants further investigation into any possible role of aluminium in development of this benign breast disease. Emerging evidence for aluminium in several breast structures now requires biomarkers of aluminium action in order to ascertain whether the presence of aluminium has any biological impact. To this end, we report raised levels of proteins that modulate iron homeostasis (ferritin, transferrin) in parallel with raised aluminium in nipple aspirate fluids in vivo, and we report overexpression of mRNA for several S100 calcium binding proteins following long-term exposure of MCF-7 human breast cancer cells in vitro to aluminium chlorhydrate.