Characterization of Epstein-Barr virus-specific immune responses and of the novel cytokine interleukin-26 in patients with multiple sclerosis

RÉSUMÉ La sclérose en plaques (SEP) est une maladie démyélinisante du système nerveux central (SNC) qui touche le plus souvent de jeunes femmes. Bien qu'elle ait été décrite pour la première fois il y a plus de 200 ans, son étiologie n'est pas encore complètement comprise. Contrairement à d'autres maladies purement génétiques, l'épidémiologie de la SEP ne peut être que partiellement expliquée par des facteurs génétiques. Ceci suggère que des facteurs environnementaux pourraient être impliqués dans la pathogenèse de la SEP. Parmi ceux-ci, le virus d'Epstein-Barr (EBV) est un excellent candidat, comme cela a été démontré par de larges études séroépidémiologiques ainsi que pax l'évaluation de la réponse cellulaire dans le sang. Bien que le SNC soit en fait la cible des réponses immunitaires anormales dans la SEP, peu d'études ont été accomplies sur les réponses immunitaires spécifiques à EBV dans ce compartiment. Ceci est particulièrement vrai chez des patients vivants chez lesquels des biopsies sont rarement effectuées, ainsi que pour les réponses cellulaires car très peu de cellules immunitaires peuvent être obtenues du SNC. Nous avons donc développé des conditions de cultures et un readout nous permettant d'étudier le nombre réduit de cellules disponibles dans le liquide céphalo-rachidien (LCR), qui représente le seul matériel pouvant être obtenu du SNC de patients SEP vivants. Nous avons trouvé que les réponses cellulaires et humorales spécifiques à EBV étaient augmentées dans le LCR des patients SEP comparé à du sang pairé, ainsi que par rapport à des patients avec d'autres maladies neurologiques inflammatoires et noninflammatoires. Afin de déterminer si les réponses immunitaires augmentées contre EBV étaient spécifiques à ce virus ou si elles reflétaient simplement une hyperactivation immunitaire aspécifique, nous avons comparé les réponses spécifiques à EBV avec celles spécifiques au cytomegalovirus (CNN). En effet, comme EBV, CNN est un herpesvirus neurotropique qui peut établir des infections latentes, mais ce dernier n'est pas considéré comme étant associé à la SEP. De façon intéressante, les réponses immunitaires spécifiques à CNN trouvées dans le LCR étaient plus basses que dans le sang, et ceci dans toutes les catégories de patients. Ces données suggèrent qu'une réactivation d'EBV pourrait avoir lieu dans le SNC des patients SEP à un stade précoce de la maladie et renforcent fortement l'hypothèse qu'EBV pourrait avoir un rôle déclencheur dans cette maladie. Ainsi, il pourrait être intéressant d'explorer si un traitement ou un vaccin efficace contre EBV peut prévenir le développement de la SEP. On ne connaît toujours pas la raison pour laquelle les réponses immunitaires spécifiques à EBV sont augmentées chez les patients SEP. Une hypothèse est que la réponse immunitaire est qualitativement différente chez les patients SEP par rapports aux contrôles. Pour examiner ceci, nous avons évalué le profile cytokinique de lymphocytes T CD4+ et CD8+ stimulés par EBV, mais nous n'avons pas pu mettre en évidence de différence remarquable entre patients SEP et sujets sains. Cette question reste donc ouverte et d'autres études sont justifiées. Il n'existe pas de marqueur fiable de la SEP. Ici, nous avons trouvé que la cytokine IL-26, récemment décrite, était augmentée dans les lymphocytes T CD8+ des patients avec une SEP secondairement progressive comparé à des patients SEP en poussée, des patients avec une SEP primairement progressive, des patients avec d'autres maladies neurologiques inflammatoires, ou des sujets sains. De plus, nous avons identifié des types de cellules dérivées du cerveau (astrocytes, oligodendrocytes et neurones) qui exprimaient le récepteur de l'IL-26. Ceci ouvre la voie à d'autres études afin de mieux comprendre la fonction de l'II.-26 et son interaction avec la. SEP. SUMMARY : Multiple sclerosis (MS) is a demyelinating disease affecting the central nervous system (CNS), mostly in young female adults. Although it was first described 200 years ago, its etiology is still not completely understood. Contrary to other purely genetic diseases, genetics can explain only part of MS epidemiology. Therefore, environmental factors that might be involved in MS pathogenesis were searched for. Among them, Epstein-Barr virus (EBV) is a strong potential candidate, such as shown by large seroepidemiological studies and cellular immune response assessments in the blood. Although the CNS is the actual target of abnormal immune responses in MS, few studies have been performed on EBV-specific immune responses in this compartment. This is particularly true for live patients, from which biopsy material is almost never available, and for cellular immune responses, since very few immune cells are available from the CNS. We therefore developed culture conditions and a readout that were compatible with the study of the reduced number of cells found in the cerebrospinal fluid (CSF), the only readily available material from the CNS of live ' MS patients. We found that EBV-specific cellular and humoral immune responses were increased in the CSF of MS patients as compared with paired blood, as well as compared with the CSF of patients with other inflammatory and non-inflammatory neurological diseases. To determine whether the enhanced immune responses against EBV were specific of this virus or simply reflected an aspecific immune hyperactivation, we compared the EBV- with the cytomegalovirus (CMV)-specific immune responses. Indeed, like EBV, CMV is a neurotrophic herpesvirus that can establish latent infections, but the latter is not considered to be associated with MS. Interestingly, CSF CMV-specific immune responses were lower than blood ones and this, in all patient categories. These findings suggest that EBV reactivation may be taking place in the CNS of patients at the early stages of MS and strengthen the hypothesis that EBV may have a triggering role in this disease. Therefore, it might be interesting to explore whether an efficient anti-EBV drug or vaccine is able to prevent MS development. The reason why EBV-specific immune responses are increased in MS patients is still missing. One hypothesis might be that the immune response against EBV is qualitatively different in MS patients as compared with controls. To examine this, we assessed the cytokine mRNA profile of EBV-stimulated CD4+ and CD8+ T cells, but could not find any remarkable difference between MS patients and healthy controls. Therefore, this question remains open and fiirther studies are warranted. Reliable disease markers are lacking for MS. Here, we found that the recently described cytokine IL-26 was increased in CD8+ T cells of patients with secondary progressive MS as compared with relapsing MS, primary progressive MS, other inflammatory neurological diseases and healthy controls. Moreover, we identified brain cell types (astrocytes, oligodendrocytes and neurons) that expressed the IL-26 receptor, paring the way for further studies to understand IL-26 function and its interaction with MS.

RV contractility and exercise-induced pulmonary hypertension in chronic mountain sickness: a stress echocardiographic and tissue Doppler imaging study.

OBJECTIVES: The aim of this study was to evaluate right ventricular (RV) and left ventricular function and pulmonary circulation in chronic mountain sickness (CMS) patients with rest and stress echocardiography compared with healthy high-altitude (HA) dwellers. BACKGROUND: CMS or Monge's disease is defined by excessive erythrocytosis (hemoglobin >21 g/dl in males, 19 g/dl in females) and severe hypoxemia. In some cases, a moderate or severe increase in pulmonary pressure is present, suggesting a similar pathogenesis of pulmonary hypertension. METHODS: In La Paz (Bolivia, 3,600 m sea level), 46 CMS patients and 40 HA dwellers of similar age were evaluated at rest and during semisupine bicycle exercise. Pulmonary artery pressure (PAP), pulmonary vascular resistance, and cardiac function were estimated by Doppler echocardiography. RESULTS: Compared with HA dwellers, CMS patients showed RV dilation at rest (RV mid diameter: 36 ± 5 mm vs. 32 ± 4 mm, CMS vs. HA, p = 0.001) and reduced RV fractional area change both at rest (35 ± 9% vs. 43 ± 9%, p = 0.002) and during exercise (36 ± 9% vs. 43 ± 8%, CMS vs. HA, p = 0.005). The RV systolic longitudinal function (RV-S') decreased in CMS patients, whereas it increased in the control patients (p < 0.0001) at peak stress. The RV end-systolic pressure-area relationship, a load independent surrogate of RV contractility, was similar in CMS patients and HA dwellers with a significant increase in systolic PAP and pulmonary vascular resistance in CMS patients (systolic PAP: 50 ± 12 mm Hg vs. 38 ± 8 mm Hg, CMS vs. HA, p < 0.0001; pulmonary vascular resistance: 2.9 ± 1 mm Hg/min/l vs. 2.2 ± 1 mm Hg/min/l, p = 0.03). Both groups showed comparable systolic and diastolic left ventricular function both at rest and during stress. CONCLUSIONS: Comparable RV contractile reserve in CMS and HA suggests that the lower resting values of RV function in CMS may represent a physiological adaptation to chronic hypoxic conditions rather than impaired RV function. (Chronic Mountain Sickness, Systemic Vascular Function [CMS]; NCT01182792).

Condition, disease and immune defence

Life-history traits and secondary sexual characters often demonstrate condition-dependence, and reproductive success thus ultimately appears to be determined by condition. Here we test the hypothesis that anti-parasite defence is condition-dependent and thus ultimately limits fitness. Animal hosts defend themselves against parasites by an efficient immune system that changes its activity level depending on level of infection. Since immune function is costly, as demonstrated by several field studies, we predicted that large immune defence organs should be maintained when the costs of an elevated immune response were reduced, or when the benefits were increased. Hence, the size of immune defence organs was predicted to increase in response to disease due to increased benefits of investment in immune function, and the; size was predicted to increase in response to high body condition because of reduced costs of investment in immune function. A comparative study of birds demonstrated that the size of the spleen was significantly increased among individuals suffering from parasitic infections and signs of disease as compared to healthy individuals. Furthermore, we found evidence for a positive association between spleen size and body condition. These findings are consistent with the hypothesised cost of immune function and hence a cost of anti-parasite defence.

Formation of the long range Dpp morphogen gradient.

The TGF-β homolog Decapentaplegic (Dpp) acts as a secreted morphogen in the Drosophila wing disc, and spreads through the target tissue in order to form a long range concentration gradient. Despite extensive studies, the mechanism by which the Dpp gradient is formed remains controversial. Two opposing mechanisms have been proposed: receptor-mediated transcytosis (RMT) and restricted extracellular diffusion (RED). In these scenarios the receptor for Dpp plays different roles. In the RMT model it is essential for endocytosis, re-secretion, and thus transport of Dpp, whereas in the RED model it merely modulates Dpp distribution by binding it at the cell surface for internalization and subsequent degradation. Here we analyzed the effect of receptor mutant clones on the Dpp profile in quantitative mathematical models representing transport by either RMT or RED. We then, using novel genetic tools, experimentally monitored the actual Dpp gradient in wing discs containing receptor gain-of-function and loss-of-function clones. Gain-of-function clones reveal that Dpp binds in vivo strongly to the type I receptor Thick veins, but not to the type II receptor Punt. Importantly, results with the loss-of-function clones then refute the RMT model for Dpp gradient formation, while supporting the RED model in which the majority of Dpp is not bound to Thick veins. Together our results show that receptor-mediated transcytosis cannot account for Dpp gradient formation, and support restricted extracellular diffusion as the main mechanism for Dpp dispersal. The properties of this mechanism, in which only a minority of Dpp is receptor-bound, may facilitate long-range distribution.

ATP release due to Thy-1-integrin binding induces P2X7-mediated calcium entry required for focal adhesion formation.

Thy-1, an abundant mammalian glycoprotein, interacts with αvβ3 integrin and syndecan-4 in astrocytes and thus triggers signaling events that involve RhoA and its effector p160ROCK, thereby increasing astrocyte adhesion to the extracellular matrix. The signaling cascade includes calcium-dependent activation of protein kinase Cα upstream of Rho; however, what causes the intracellular calcium transients required to promote adhesion remains unclear. Purinergic P2X7 receptors are important for astrocyte function and form large non-selective cation pores upon binding to their ligand, ATP. Thus, we evaluated whether the intracellular calcium required for Thy-1-induced cell adhesion stems from influx mediated by ATP-activated P2X7 receptors. Results show that adhesion induced by the fusion protein Thy-1-Fc was preceded by both ATP release and sustained intracellular calcium elevation. Elimination of extracellular ATP with Apyrase, chelation of extracellular calcium with EGTA, or inhibition of P2X7 with oxidized ATP, all individually blocked intracellular calcium increase and Thy-1-stimulated adhesion. Moreover, Thy-1 mutated in the integrin-binding site did not trigger ATP release, and silencing of P2X7 with specific siRNA blocked Thy-1-induced adhesion. This study is the first to demonstrate a functional link between αvβ3 integrin and P2X7 receptors, and to reveal an important, hitherto unanticipated, role for P2X7 in calcium-dependent signaling required for Thy-1-stimulated astrocyte adhesion.

Causal assessment in finite extensive-form games

Two finite extensive-form games are empirically equivalent when theempirical distribution on action profiles generated by every behaviorstrategy in one can also be generated by an appropriately chosen behaviorstrategy in the other. This paper provides a characterization ofempirical equivalence. The central idea is to relate a game's informationstructure to the conditional independencies in the empirical distributionsit generates. We present a new analytical device, the influence opportunitydiagram of a game, describe how such a diagram is constructed for a givenextensive-form game, and demonstrate that it provides a complete summaryof the information needed to test empirical equivalence between two games.

Comparison of human chromosome 21 conserved nongenic sequences (CNGs) with the mouse and dog genomes shows that their selective constraint is independent of their genic environment.

The analysis of conservation between the human and mouse genomes resulted in the identification of a large number of conserved nongenic sequences (CNGs). The functional significance of this nongenic conservation remains unknown, however. The availability of the sequence of a third mammalian genome, the dog, allows for a large-scale analysis of evolutionary attributes of CNGs in mammals. We have aligned 1638 previously identified CNGs and 976 conserved exons (CODs) from human chromosome 21 (Hsa21) with their orthologous sequences in mouse and dog. Attributes of selective constraint, such as sequence conservation, clustering, and direction of substitutions were compared between CNGs and CODs, showing a clear distinction between the two classes. We subsequently performed a chromosome-wide analysis of CNGs by correlating selective constraint metrics with their position on the chromosome and relative to their distance from genes. We found that CNGs appear to be randomly arranged in intergenic regions, with no bias to be closer or farther from genes. Moreover, conservation and clustering of substitutions of CNGs appear to be completely independent of their distance from genes. These results suggest that the majority of CNGs are not typical of previously described regulatory elements in terms of their location. We propose models for a global role of CNGs in genome function and regulation, through long-distance cis or trans chromosomal interactions.

Comparative morphology of the mandibles of female polistine social wasps (Hymenoptera, Vespidae, Polistinae)

Comparative morphology of the mandibles of female polistine social wasps (Hymenoptera, Vespidae, Polistinae). Diversity of mandibular forms in female polistines is explored and compared among 116 species of all polistine genera. Inferences about function are made and discussed based on observed form differences. Mandible length and width measurements are analyzed for a subset of polistine species plus two vespines and two eumenines. A variable expressing the ratio between these variables is also considered in morphometric analyses. The following mechanical interactions among mandible structural elements are highlighted: opposition and crossing of mandibles' apical teeth at the middle of the closing trajectory; shearing action of the apical teeth against mesial denticles of the opposite mandible; shearing action of the mandible anterior margin against the ventral margin of the clypeus. In the genera Agelaia and Angiopolybia, exceptionally developed mesial mandibular structures may be related to necrophagy. In some epiponine genera, poorly developed mesial denticles and strong torsion of mandibles may be partially related to use of short wood fibers in nest construction as advanced by Sarmiento (2004). The considerable morphological variation found across the subfamily Polistinae is certain to be important in taxonomic and phylogenetic studies at the genus and species levels.

Human nature and institutional analysis

This essay reviews some findings in cognition sciences and examines their consequences for the analysis of institutions. It starts by exploring how humans specialization in producing knowledge ensures our success in dominating the environment but also changes fast our environment. So fast that it did not give time to natural selection to adapt our biology, causing it to be potentially maladapted in important dimensions. A main function of institutions is therefore to fill the gap between the demands of our relatively new environment and our biology, still adapted to our ancestral environment as hunter-gatherers. Moreover, institutions are built with the available elements, which include our instincts. A deeper understanding of both aspects, their adaptive function and this recruitment of ancestral instincts, will add greatly to our ability to manage institutions.

Model selection and error estimation

We study model selection strategies based on penalized empirical loss minimization. We point out a tight relationship between error estimation and data-based complexity penalization: any good error estimate may be converted into a data-based penalty function and the performance of the estimate is governed by the quality of the error estimate. We consider several penalty functions, involving error estimates on independent test data, empirical {\sc vc} dimension, empirical {\sc vc} entropy, andmargin-based quantities. We also consider the maximal difference between the error on the first half of the training data and the second half, and the expected maximal discrepancy, a closely related capacity estimate that can be calculated by Monte Carlo integration. Maximal discrepancy penalty functions are appealing for pattern classification problems, since their computation is equivalent to empirical risk minimization over the training data with some labels flipped.

Epilepsy meets cancer: when, why, and what to do about it?

The lifetime risk of having epileptic seizures is profoundly increased in patients with cancer: about 20% of all patients with systemic cancer may develop brain metastases. These patients and those with primary brain tumours have a lifetime risk of epilepsy of 20-80%. Moreover, exposure to chemotherapy or radiotherapy to the brain, cancer-related metabolic disturbances, stroke, and infection can provoke seizures. The management of epilepsy in patients with cancer includes diagnosis and treatment of the underlying cerebral pathological changes, secondary prophylaxis with antiepileptic drugs, and limiting of the effect of epilepsy and its treatment on the efficacy and tolerability of anticancer treatments, cognitive function, and quality of life. Because of the concern of drug-drug interactions, the pharmacological approach to epilepsy requires a multidisciplinary approach, specifically in a setting of rapidly increasing choices of agents both to treat cancer and cancer-associated epilepsy.

Small airways function declines after allogeneic haematopoietic stem cell transplantation.

Bronchiolitis obliterans (BO) following allogeneic haematopoietic stem cell transplantation (HSCT) affects peripheral airways. Detection of BO is presently delayed by the low sensitivity of spirometry. We examined the relationship between peripheral airway function and time since HSCT, and compared it with spirometry and clinical indices in 33 clinically stable allogeneic HSCT recipients. The following measurements were performed: lung function, exhaled nitric oxide, forced oscillatory respiratory system resistance and reactance, acinar (S(acin)) and conductive airways ventilation heterogeneity and lung clearance index (LCI) measured by multiple breath nitrogen washout. 22 patients underwent repeat visits from which short-term changes were examined. Median time post HSCT was 12 months. Eight patients were clinically diagnosed as having BO. In multivariate analysis, time since HSCT was predicted by S(acin) and forced expiratory volume in 1 s % predicted. 20 patients had abnormal S(acin) with normal spirometry, whereas none had airflow obstruction with normal S(acin). S(acin) and LCI were the only measures to change significantly between two visits, with both worsening. Change in S(acin) was the only parameter to correlate with change in chronic graft-versus-host disease grade. In conclusion, peripheral airways ventilation heterogeneity worsens with time after HSCT. S(acin) may be more sensitive than spirometry in detecting BO at an early stage, which needs confirmation in a prospective study.

Regional coronary endothelial function is closely related to local early coronary atherosclerosis in patients with mild coronary artery disease: pilot study.

BACKGROUND: Coronary endothelial function is abnormal in patients with established coronary artery disease and was recently shown by MRI to relate to the severity of luminal stenosis. Recent advances in MRI now allow the noninvasive assessment of both anatomic and functional (endothelial function) changes that previously required invasive studies. We tested the hypothesis that abnormal coronary endothelial function is related to measures of early atherosclerosis such as increased coronary wall thickness. METHODS AND RESULTS: Seventeen arteries in 14 healthy adults and 17 arteries in 14 patients with nonobstructive coronary artery disease were studied. To measure endothelial function, coronary MRI was performed before and during isometric handgrip exercise, an endothelial-dependent stressor, and changes in coronary cross-sectional area and flow were measured. Black blood imaging was performed to quantify coronary wall thickness and indices of arterial remodeling. The mean stress-induced change in cross-sectional area was significantly higher in healthy adults (13.5%±12.8%, mean±SD, n=17) than in those with mildly diseased arteries (-2.2%±6.8%, P<0.0001, n=17). Mean coronary wall thickness was lower in healthy subjects (0.9±0.2 mm) than in patients with coronary artery disease (1.4±0.3 mm, P<0.0001). In contrast to healthy subjects, stress-induced changes in cross-sectional area, a measure of coronary endothelial function, correlated inversely with coronary wall thickness in patients with coronary artery disease (r=-0.73, P=0.0008). CONCLUSIONS: There is an inverse relationship between coronary endothelial function and local coronary wall thickness in patients with coronary artery disease but not in healthy adults. These findings demonstrate that local endothelial-dependent functional changes are related to the extent of early anatomic atherosclerosis in mildly diseased arteries. This combined MRI approach enables the anatomic and functional investigation of early coronary disease.

Mfn2 downregulation in excitotoxicity causes mitochondrial dysfunction and delayed neuronal death.

Mitochondrial fusion and fission is a dynamic process critical for the maintenance of mitochondrial function and cell viability. During excitotoxicity neuronal mitochondria are fragmented, but the mechanism underlying this process is poorly understood. Here, we show that Mfn2 is the only member of the mitochondrial fusion/fission machinery whose expression is reduced in in vitro and in vivo models of excitotoxicity. Whereas in cortical primary cultures, Drp1 recruitment to mitochondria plays a primordial role in mitochondrial fragmentation in an early phase that can be reversed once the insult has ceased, Mfn2 downregulation intervenes in a delayed mitochondrial fragmentation phase that progresses even when the insult has ceased. Downregulation of Mfn2 causes mitochondrial dysfunction, altered calcium homeostasis, and enhanced Bax translocation to mitochondria, resulting in delayed neuronal death. We found that transcription factor MEF2 regulates basal Mfn2 expression in neurons and that excitotoxicity-dependent degradation of MEF2 causes Mfn2 downregulation. Thus, Mfn2 reduction is a late event in excitotoxicity and its targeting may help to reduce excitotoxic damage and increase the currently short therapeutic window in stroke.

The influence of drugs used in cardiac anaesthesia and critical care on multiple electrode aggregometry: an in-vitro volunteer study.

BACKGROUND: Multiple electrode aggregometry (MEA) is a point-of-care test evaluating platelet function and the efficacy of platelet inhibitors. In MEA, electrical impedance of whole blood is measured after addition of a platelet activator. Reduced impedance implies platelet dysfunction or the presence of platelet inhibitors. MEA plays an increasingly important role in the management of perioperative platelet dysfunction. In vitro, midazolam, propofol, lidocaine and magnesium have known antiplatelet effects and these may interfere with MEA interpretation. OBJECTIVE: To evaluate the extent to which MEA is modified in the presence of these drugs. DESIGN: An in-vitro study using blood collected from healthy volunteers. SETTING: Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, 2010 to 2011. PATIENTS: Twenty healthy volunteers. INTERVENTION: Measurement of baseline MEA was using four activators: arachidonic acid, ADP, TRAP-6 and collagen. The study drugs were then added in three increasing, clinically relevant concentrations. MAIN OUTCOME MEASURE: MEA was compared with baseline for each study drug. RESULTS: Midazolam, propofol and lidocaine showed no effect on MEA at any concentration. Magnesium at 2.5 mmol l had a significant effect on the ADP and TRAP tests (31 ± 13 and 96 ± 39 AU, versus 73 ± 21 and 133 ± 28 AU at baseline, respectively), and a less pronounced effect at 1 mmol l on the ADP test (39 ± 0 AU). CONCLUSION: Midazolam, propofol and lidocaine do not interfere with MEA measurement. In patients treated with high to normal doses of magnesium, MEA results for ADP and TRAP-tests should be interpreted with caution. TRIAL REGISTRATION: Clinicaltrials.gov (no. NCT01454427).