Crystallographic analysis of endogenous peptides associated with HLA-DR1 suggests a common, polyproline II-like conformation for bound peptides.

The structure of the human major histocompatibility complex (MHC) class II molecule HLA-DR1 derived from the human lymphoblastoid cell line LG-2 has been determined in a complex with the Staphylococcus aureus enterotoxin B superantigen. The HLA-DR1 molecule contains a mixture of endogenous peptides derived from cellular or serum proteins bound in the antigen-binding site, which copurify with the class II molecule. Continuous electron density for 13 amino acid residues is observed in the MHC peptide-binding site, suggesting that this is the core length of peptide that forms common interactions with the MHC molecule. Electron density is also observed for side chains of the endogenous peptides. The electron density corresponding to peptide side chains that interact with the DR1-binding site is more clearly defined than the electron density that extends out of the binding site. The regions of the endogenous peptides that interact with DRI are therefore either more restricted in conformation or sequence than the peptide side chains or amino acids that project out of the peptide-binding site. The hydrogen-bond interactions and conformation of a peptide model built into the electron density are similar to other HLA-DR-peptide structures. The bound peptides assume a regular conformation that is similar to a polyproline type II helix. The side-chain pockets and conserved asparagine residues of the DR1 molecule are well-positioned to interact with peptides in the polyproline type II conformation and may restrict the range of acceptable peptide conformations.

Activation of a serine/threonine kinase signaling pathway by transforming growth factor type beta.

Transforming growth factor type beta (TGF-beta) is a multifunctional factor that regulates proliferation and differentiation of many cell types. TGF-beta mediates its effects by binding to and activating cell surface receptors that possess serine/threonine kinase activity. However, the intracellular signaling pathways through which TGF-beta receptors act remain largely unknown. Here we show that TGF-beta activates a 78-kDa protein (p78) serine/threonine kinase as evidenced by an in-gel kinase assay. Ligand-induced activation of the kinase was near-maximal 5 min after TGF-beta addition to the cells and occurred exclusively on serine and threonine residues. This kinase is distinct from TGF-beta receptor type II, as well as several cytoplasmic serine/threonine kinases of similar size, including protein kinase C, Raf, mitogen-activated protein kinase kinase kinase, and ribosomal S6 kinase. Indeed, these kinases can be separated almost completely from p78 kinase by immunoprecipitation with specific antibodies. Furthermore, using different cell lines, we demonstrate that p78 kinase is activated only in cells for which TGF-beta can act as a growth inhibitory factor. These data raise the interesting possibility that protein serine/threonine kinases contribute to the intracellular relay of biological signals originating from receptor serine/threonine kinases such as the TGF-beta receptors.

Proteolysis of major histocompatibility complex class II-associated invariant chain is regulated by the alternatively spliced gene product, p41.

Invariant chain (Ii) is an intracellular type II transmembrane glycoprotein that is associated with major histocompatibility complex class II molecules during biosynthesis. Ii exists in two alternatively spliced forms, p31 and p41. Both p31 and p41 facilitate folding of class II molecules, promote egress from the endoplasmic reticulum, prevent premature peptide binding, and enhance localization to proteolytic endosomal compartments that are thought to be the sites for Ii degradation, antigen processing, and class II-peptide association. In spite of the dramatic and apparently equivalent effects that p31 and p41 have on class II biosynthesis, the ability of invariant chain to enhance antigen presentation to T cells is mostly restricted to p41. Here we show that degradation of Ii leads to the generation of a 12-kDa amino-terminal fragment that in p41-positive, but not in p31-positive, cells remains associated with class II molecules for an extended time. Interestingly, we find that coexpression of the two isoforms results in a change in the pattern of p31 degradation such that endosomal processing of p31 also leads to extended association of a similar 12-kDa fragment with class II molecules. These data raise the possibility that p41 may have the ability to impart its pattern of proteolytic processing on p31 molecules expressed in the same cells. This would enable a small number of p41 molecules to modify the post-translational transport and/or processing of an entire cohort of class II-Ii complexes in a manner that could account for the unique ability of p41 to enhance antigen presentation.

A secretion inhibitory signal transduction molecule on mast cells is another C-type lectin.

Secretion of inflammatory mediators by rat mast cells (line RBL-2H3) was earlier shown to be inhibited upon clustering a membrane glycoprotein by monoclonal antibody G63. This glycoprotein, named mast cell function-associated antigen (MAFA), was also shown to interfere with the coupling cascade of the type 1 Fc epsilon receptor upstream to phospholipase C gamma 1 activation by protein-tyrosine kinases. Here we report that the MAFA is expressed as both a monomer and a homodimer. Expression cloning of its cDNA shows that it contains a single open reading frame, encoding a 188-amino acid-long type II integral membrane protein. The 114 C-terminal amino acids display sequence homology with the carbohydrate-binding domain of calcium-dependent animal lectins, many of which have immunological functions. The cytoplasmic tail of MAFA contains a YXXL (YSTL) motif, which is conserved among related C-type lectins and is an essential element in the immunoreceptor tyrosine-based activation motifs. Finally, changes in the MAFA tyrosyl- and seryl-phosphorylation levels are observed in response to monoclonal antibody G63 binding, antigenic stimulation, and a combination of both treatments.

Expression of endogenous peptide-major histocompatibility complex class II complexes derived from invariant chain-antigen fusion proteins.

CD4+ T cells recognize major histocompatibility complex (MHC) class II-bound peptides that are primarily obtained from extracellular sources. Endogenously synthesized proteins that readily enter the MHC class I presentation pathway are generally excluded from the MHC class II presentation pathway. We show here that endogenously synthesized ovalbumin or hen egg lysozyme can be efficiently presented as peptide-MHC class II complexes when they are expressed as fusion proteins with the invariant chain (Ii). Similar to the wild-type Ii, the Ii-antigen fusion proteins were associated intracellularly with MHC molecules. Most efficient expression of endogenous peptide-MHC complex was obtained with fusion proteins that contained the endosomal targeting signal within the N-terminal cytoplasmic Ii residues but did not require the luminal residues of Ii that are known to bind MHC molecules. These results suggest that signals within the Ii can allow endogenously synthesized proteins to efficiently enter the MHC class II presentation pathway. They also suggest a strategy for identifying unknown antigens presented by MHC class II molecules.

Rôle de l'isoforme p35 de la chaîne invariante humaine dans la formation et le transport de complexes de CMH II

La présentation antigénique par les molécules de classe II du complexe majeur d’histocompatibilité (CMH II) est un mécanisme essentiel au contrôle des pathogènes par le système immunitaire. Le CMH II humain existe en trois isotypes, HLA-DP, DQ et DR, tous des hétérodimères composés d’une chaîne α et d’une chaîne β. Le CMH II est entre autres exprimé à la surface des cellules présentatrices d’antigènes (APCs) et des cellules épithéliales activées et a pour fonction de présenter des peptides d’origine exogène aux lymphocytes T CD4+. L’oligomérisation et le trafic intracellulaire du CMH II sont largement facilités par une chaperone, la chaîne invariante (Ii). Il s’agit d’une protéine non-polymorphique de type II. Après sa biosynthèse dans le réticulum endoplasmique (ER), Ii hétéro- ou homotrimérise, puis interagit via sa région CLIP avec le CMH II pour former un complexe αβIi. Le complexe sort du ER pour entamer son chemin vers différents compartiments et la surface cellulaire. Chez l’homme, quatre isoformes d’Ii sont répertoriées : p33, p35, p41 et p43. Les deux isoformes exprimées de manière prédominante, Iip33 et p35, diffèrent par une extension N-terminale de 16 acides aminés portée par Iip35. Cette extension présente un motif de rétention au réticulum endoplasmique (ERM) composé des résidus RXR. Ce motif doit être masqué par la chaîne β du CMH II pour permettre au complexe de quitter le ER. Notre groupe s’est intéressé au mécanisme du masquage et au mode de sortie du ER des complexes αβIi. Nous montrons ici que l’interaction directe, ou en cis, entre la chaîne β du CMH II et Iip35 dans une structure αβIi est essentielle pour sa sortie du ER, promouvant la formation de structures de haut niveau de complexité. Par ailleurs, nous démontrons que NleA, un facteur de virulence bactérien, permet d’altérer le trafic de complexes αβIi comportant Iip35. Ce phénotype est médié par l’interaction entre p35 et les sous-unités de COPII. Bref, Iip35 joue un rôle central dans la formation des complexes αβIi et leur transport hors du ER. Ceci fait d’Iip35 un régulateur clef de la présentation antigénique par le CMH II.

A novel multilocus sequence typing scheme for the opportunistic pathogen Propionibacterium acnes and characterisation of type 1 cell surface-associated antigens

We have developed a novel multilocus sequence typing (MLST) scheme and database (http://pubmlst.org/pacnes/) for Propionibacterium acnes based on the analysis of seven core housekeeping genes. The scheme, which was validated against previously described antibody, single locus and random amplification of polymorphic DNA typing methods, displayed excellent resolution and differentiated 123 isolates into 37 sequence types (STs). An overall clonal population structure was detected with six eBURST groups representing the major clades I, II and III, along with two singletons. Two highly successful and global clonal lineages, ST6 (type IA) and ST10 (type IB1), representing 64?% of this current MLST isolate collection were identified. The ST6 clone and closely related single locus variants, which comprise a large clonal complex CC6, dominated isolates from patients with acne, and were also significantly associated with ophthalmic infections. Our data therefore support an association between acne and P. acnes strains from the type IA cluster and highlight the role of a widely disseminated clonal genotype in this condition. Characterization of type I cell surface-associated antigens that are not detected in ST10 or strains of type II and III identified two dermatan-sulphate-binding proteins with putative phase/antigenic variation signatures. We propose that the expression of these proteins by type IA organisms contributes to their role in the pathophysiology of acne and helps explain the recurrent nature of the disease. The MLST scheme and database described in this study should provide a valuable platform for future epidemiological and evolutionary studies of P. acnes.

Avaliação do desempenho de argamassas à base de cimento Portland para rejuntamento de placas cerâmicas tipo II com adição de pó de borracha de pneus

In this work it is assessed the performance of Portland cement-based mortar to the grouting of type II ceramic plates with the addition of unusable tire rubber powder. It is presented a bibliographical review about the subject in which is done the theoretical and methodological foundation of the whole investigative process. The analyzed universe comprises a sample of mortar to the grouting of conventional ceramic plates type II (reference sample) and five more samples to the grouting of ceramic plates type II, which were made up of the addition of unusable tire rubber powder in the respective proportion (in mass) of 4%, 8%, 12%, 16% and 20%. These mortar samples were subject to the trials of determination of the consistency index (Brazilian Standard NBR 13276:2005), water retention ( Brazilian Standard NBR 14992 Attachment B:2003), permeability in 240 minutes (Brazilian Standard NBR 14992 Attachment G:2003), absorption of water by immersion (Brazilian Standard NBR 9781:2013), resistance to compression (Brazilian Standard NBR14992 Attachment D: 2003), resistance to traction in the flexion (Brazilian Standard NBR 13279:2005), resistance of traction adherence (Brazilian Standard NBR 14081 part 4:2012) and hardened mass density (Brazilian Standard NBR 13280: 2005). It has been found out from the analyzes of the results in the trial the following situation: the reference mortar used met the established requirements in the norms of specifications corresponding to only six from the eight parameters assessed in the research; the mortar with addition of 4,0% of tire rubber powder met the established requirements corresponding to only the resistance to compression and the resistance of adherence to traction. Thus, the other kinds of mortar with addition of 8,0 %, 12,0 %, 16,0 % and 20,0 % of tire rubber powder met the requirements of specifications corresponding to only the resistance to compression and the resistance of adherence to traction. This result concludes that the adding of tire rubber powder does not grant improvement to the mortar of type II grouting to the laying of ceramic plates.

Avaliação do desempenho de argamassas à base de cimento Portland para rejuntamento de placas cerâmicas tipo II com adição de pó de borracha de pneus

In this work it is assessed the performance of Portland cement-based mortar to the grouting of type II ceramic plates with the addition of unusable tire rubber powder. It is presented a bibliographical review about the subject in which is done the theoretical and methodological foundation of the whole investigative process. The analyzed universe comprises a sample of mortar to the grouting of conventional ceramic plates type II (reference sample) and five more samples to the grouting of ceramic plates type II, which were made up of the addition of unusable tire rubber powder in the respective proportion (in mass) of 4%, 8%, 12%, 16% and 20%. These mortar samples were subject to the trials of determination of the consistency index (Brazilian Standard NBR 13276:2005), water retention ( Brazilian Standard NBR 14992 Attachment B:2003), permeability in 240 minutes (Brazilian Standard NBR 14992 Attachment G:2003), absorption of water by immersion (Brazilian Standard NBR 9781:2013), resistance to compression (Brazilian Standard NBR14992 Attachment D: 2003), resistance to traction in the flexion (Brazilian Standard NBR 13279:2005), resistance of traction adherence (Brazilian Standard NBR 14081 part 4:2012) and hardened mass density (Brazilian Standard NBR 13280: 2005). It has been found out from the analyzes of the results in the trial the following situation: the reference mortar used met the established requirements in the norms of specifications corresponding to only six from the eight parameters assessed in the research; the mortar with addition of 4,0% of tire rubber powder met the established requirements corresponding to only the resistance to compression and the resistance of adherence to traction. Thus, the other kinds of mortar with addition of 8,0 %, 12,0 %, 16,0 % and 20,0 % of tire rubber powder met the requirements of specifications corresponding to only the resistance to compression and the resistance of adherence to traction. This result concludes that the adding of tire rubber powder does not grant improvement to the mortar of type II grouting to the laying of ceramic plates.

Resposta clínica periodontal e controle glicêmico em pacientes com e sem diabetes tipo II portadores de periodontite crônica ao tratamento periodontal “full mouth desinfection”

There is a bidirectional association between periodontal disease (PD) and diabetes mellitus, in which diabetes favors the development of PD and PD, if left untreated, can worsen the metabolic control of diabetes. Thus, periodontal disease should be treated to restore periodontal health and reduce the complications of diabetes. Therefore, the objective is assess the effect of full mouth periodontal therapy decontamination (Full Mouth Desinfection - FMD) in diabetic type II patients with chronic periodontitis during 12 months. Thirty-one patients in group one (G1) and 12 in group two (G2) were followed at baseline, 03, 06 09 and 12 months. There following clinical parameters were accessed: probing on bleeding (BOP), visible plaque index (PI), probing depth (PD), clinical attachment level (CAL) and gingival recession (GR). For diabetic patients, there were also made laboratory tests to evaluate blood parameters: fasting glucose and glycated hemoglobin. The results had been analyzed in two ways: all sites in the mouth and another with diseased sites. The Mann-Whitney, Friedman and Wilcoxon tests were used with 5% significance. Intergroup analysis of all sites it is clear that there was no significant difference over time concerning PD, BOP, PI, CAL and RG. However, when evaluating the diseased sites, we observed significant difference for CAL and PD, with higher values in G1. The intragroup analysis for all sites showed a statistically significant reduction at PD, PI and BOP in both groups. Intragroup analysis of periodontal affected sites showed a statistically significant reduction in PD, BOP and CAL in both groups. There was also a statistically significant increase in RG values. There was no significant change concerning glycated hemoglobin and fasting glucose in the G1. Therefore, it can be concluded that there were improvements in periodontal parameters over the 12 months of research, but without changes in glycemic levels of diabetic patients. Thus, periodontal therapy proved effective in maintaining oral health.

Sjuksköterskans omvårdnadsåtgärder och råd till egenvård för att förebygga fotkomplikationer hos personer med diabetes mellitus typ II : En litteraturstudie

Bakgrund: Diabetes mellitus typ 2 (DMT2) ökar i världen och kan leda till allvarliga fotkomplikationer. Det har påvisats brister i den förbyggande vården för att undvika fotkomplikationer. Sjuksköterskan ansvarar för att stötta personer med DMT2 och målet är att få dem att känna sig självständiga och delaktiga i sin egenvård. Syfte: Syftet med studien var att belysa omvårdnadsåtgärder och egenvård som förebygger fotkomplikationer för personer med DMT2 Metod: En litteraturstudie som utgår ifrån 20 vetenskapliga artiklar med kvantitativ uppbyggnad. Sökningarna av Artiklarna är sökta i databaserna Cinahl och Pubmed. Samtliga artiklar är kvalitetsgranskade. Resultat: Identifiering av risker är en viktig faktor i förebyggandet av fotkomplikationer. Dagliga inspektioner och undersökningar av fötterna är viktiga egenvårdsråd som sjuksköterskan bör tilldela genom individuell undervisning. Sjuksköterskan skall efter bästa förmåga stötta och motivera personer med DMT2 till god egenvård. Slutsats: Sjuksköterskan bör undervisa och ge personer med DMT2 tillräcklig kunskap, för att självständigt kunna utföra förebyggande egenvård.

Pathogenèse du cancer de l'endomètre de type I : de l'hyperplasie au cancer [Pathogenesis of type I endometrial carcinoma: From hyperplasia to cancer]

Les carcinomes de l'endomètre sont classés en deux types cliniques (types I et II), cinq types histologiques et quatre types moléculaires. Le type I correspond à l'adénocarcinome endométrioïde de grade 1 ou 2, précédé par des lésions d'hyperplasie atypique. Ce cancer est souvent révélé à un stade précoce par des saignements vaginaux postménopausiques et son pronostic est globalement favorable. Les facteurs de risque à l'origine de la majorité des cas (indice de masse corporelle [IMC] élevé, diabète de type II, traitement hormonal substitutif, tamoxifène) agissent par le biais d'une hyperestrogénie non contrecarrée par la progestérone. Moins de 5 % des cas surviennent dans le contexte d'un syndrome de Lynch (anomalie germinale d'un gène de réparation de l'ADN, à transmission autosomique dominante) chez des femmes plus jeunes dont l'IMC est typiquement bas. Les cancers de l'endomètre de type II (carcinomes séreux, à cellules claires, indifférenciés), plus rares, sont des tumeurs agressives diagnostiquées typiquement chez des femmes plus âgées et à un stade plus avancé, de pronostic défavorable.

iNOS-producing inflammatory dendritic cells constitute the major infected cell type during the chronic Leishmania major infection phase of C57BL/6 resistant mice.

Leishmania major parasites reside and multiply in late endosomal compartments of host phagocytic cells. Immune control of Leishmania growth absolutely requires expression of inducible Nitric Oxide Synthase (iNOS/NOS2) and subsequent production of NO. Here, we show that CD11b+ CD11c+ Ly-6C+ MHC-II+ cells are the main iNOS-producing cells in the footpad lesion and in the draining lymph node of Leishmania major-infected C57BL/6 mice. These cells are phenotypically similar to iNOS-producing inflammatory DC (iNOS-DC) observed in the mouse models of Listeria monocytogenes and Brucella melitensis infection. The use of DsRed-expressing parasites demonstrated that these iNOS-producing cells are the major infected population in the lesions and the draining lymph nodes. Analysis of various genetically deficient mouse strains revealed the requirement of CCR2 expression for the recruitment of iNOS-DC in the draining lymph nodes, whereas their activation is strongly dependent on CD40, IL-12, IFN-gamma and MyD88 molecules with a partial contribution of TNF-alpha and TLR9. In contrast, STAT-6 deficiency enhanced iNOS-DC recruitment and activation in susceptible BALB/c mice, demonstrating a key role for IL-4 and IL-13 as negative regulators. Taken together, our results suggest that iNOS-DC represent a major class of Th1-regulated effector cell population and constitute the most frequent infected cell type during chronic Leishmania major infection phase of C57BL/6 resistant mice.

Études de la liaison du complexe Ku aux télomères et du délai de croissance des survivants de type I chez Saccharomyces cerevisiae

L’extrémité des chromosomes linéaires est une structure nucléoprotéique très conservée chez les organismes eucaryotes. Elle est constituée du télomère et des régions sous-télomériques répétées (STR) qui sont placées en amont du télomère. Chez la levure bourgeonnante, on trouve deux types de télomère, les télomères XY’ et les télomères X, qui se distinguent par la nature des STR positionnées en amont des répétitions télomériques. Le télomère et les STR sont liés par pas moins de dix protéines qui vont participer au maintien et à la régulation de l’extrémité chromosomique nécessaires à la stabilité du génome. Le télomère protège ainsi le chromosome de dégradations ou encore de fusions avec d’autres chromosomes. Le maintien de la taille du télomère est assuré par la télomérase, une transcriptase inverse, qui permet l’ajout de répétitions pour pallier leur perte lors de la phase de réplication durant le cycle cellulaire. Lorsque la télomérase est absente, deux types particuliers de cellules, les survivants de type I et les survivants de type II, peuvent maintenir leurs télomères grâce aux mécanismes de recombinaison homologue. Chez l’humain, les répétitions télomériques sont également liées par un certain nombre de protéines nécessaires au maintien de la stabilité de l’extrémité chromosomique. L’implication des télomères dans les processus de cancérisation, de vieillissement, mais également dans des maladies congénitales fait de cette structure un pivot dans le domaine de la recherche fondamentale. Dans 10 % des cas de cancers, l’allongement n’est pas dû à une réactivation de la télomérase comme c’est en général le cas, mais est inhérent à des processus de recombinaison homologue, comme chez la levure. Les homologies de séquences, de protéines, mais aussi de mécanismes de régulation des télomères avec les cellules humaines, font de S. cerevisiae un excellent modèle d’étude. Cette thèse se divise en trois chapitres. Les deux premiers traitent de l’interaction du complexe yKu avec les télomères de type XY’ dans le chapitre 1 puis de son interaction avec les télomères de type X dans le chapitre 2. Le chapitre 3 traite du comportement d’un type de survivant chez S. cerevisiae. Le chapitre 1 porte donc sur l’analyse des sites de liaison aux télomères XY’ du complexe yKu par la technique de ChEC in vivo. yKu intervient dans de nombreux processus de régulation des télomères, mais aussi dans un mécanisme de réparation des cassures double-brin de l’ADN (DSBs), la NHEJ (Non homologous end-joining). Les résultats présentés dans cette partie appuient un modèle dans lequel yKu aurait plusieurs sites de liaison aux télomères et dans les répétitions télomériques interstitielles. Nous supposons que la liaison du complexe se ferait lors de la formation d’une cassure de type « one-sided break » générée à la suite du passage de la fourche de réplication à l’intérieur des répétitions télomériques. Le chapitre 2 est également une étude des sites de liaison par la technique de ChEC in vivo du complexe yKu, mais cette fois-ci aux télomères X. Les observations faites dans cette partie viennent corroborer les résultats du chapitre 1 de la liaison de yKu à la jonction entre le télomère et les STRs, de plus elle met en évidence des interactions potentielles du complexe avec les éléments X laissant supposer l’existence d’un potentiel repliement du télomère sur la région sous-télomérique chez la levure. Enfin, le chapitre 3 est axé sur l’étude du comportement des survivants de type I, des cellules post-sénescences qui maintiennent leurs télomères par un processus de recombinaison homologue, le mécanisme de BIR (break-induced replication) en l’absence de télomérase. Les survivants de type I présentent une croissance lente liée à un arrêt du cycle cellulaire en phase G2/M qui dépend de la protéine de contrôle Rad9, dont l’activité est en général induite par des cassures double-brin. Ce chapitre a permis d’apporter des précisions sur la croissance lente probablement inhérente à un berceau télomérique très restreint chez ce type cellulaire.

Quantification of variable palmar ligaments around the triquetrum-hamate joint determined by lunate type

The ligaments of the wrist are highly variable and poorly described, which is more obvious on the ulnar side of the wrist. Previous studies highlighted the potential differences within the ligaments of the wrist but no consensus has been reached. Poor tissue description and inconsistent use of terminology hindered the reproducibility of the results. Improved understanding of the morphological variations between carpal bones may facilitate improved understanding of the ligamentous structure within the wrist. This study aims to identify the potential variations between carpal bones that could be used to separate palmar ligamentous patterns around the triquetrum-hamate joint into subgroups within the sample population. Investigations were performed following a detailed nomenclature and a clear definition of ligamentous structures to facilitate detailed description and reproducible results. Quantitative analyses were conducted using 3D modelling technique. Histological sections were then analysed to identify the structure of each ligamentous attachment. Variable patterns of ligamentous attachments were identified. Differences were not only obvious between samples but also between the right and left hands of the same person. These identifications suggested that the palmar ligamentous patterns around the triquetrum-hamate joint are best described as a spectrum with a higher affinity of the triquetrum-hamate-capitate ligament and the lunate-triquetrum ligament to be associated with type I lunate wrists on one extreme and type II lunate wrists with the palmar triquetrum-hamate ligament, triquetrum-hamate-capitate ligament and palmar radius-lunate-triquetrum ligament attachments at the other extreme. Histological analyses confirmed pervious established work regarding the mechanical role of ligaments in wrist joint biomechanics. Also, there were no significant differences between the quantitative data obtained from the Genelyn-embalmed and unembalmed specimens (p>0.05). The current study demonstrated variable ligamentous patterns that suggest different bone restraints and two different patterns of motion. These findings support previous suggestions regarding separating the midcarpal joint into two distinct functional types. Type I wrists were identified with ligamentous attachments that are suggestive of rotating/translating hamate whilst type II wrists identified with ligamentous attachments that are suggestive of flexing/extending hamate motion based upon the patterns of the ligamentous attachments in relation to the morphological features of the underlying lunate type of the wrist. This opens the horizon for particular consideration and/or modification of surgical procedures, which may enhance the clinical management of wrist dysfunction.