A 22-year-old man was referred for palpitations. On transthoracic echocardiography, he was found to have a right ventricular outflow tract mass. Further cardiac imaging was conducted by means of transesophageal echocardiography, computed tomography, and cardiac magnetic resonance. Complete surgical resection of the tumor was achieved, and pathologic examination revealed the lesion to be a myxoma.
Cardiac tumors located in the right ventricular outflow tract are rare and can present unusual diagnostic and therapeutic challenges. Cardiac computed tomography and magnetic resonance are becoming more widely available and can be useful adjuncts in the management of such tumors.
Heart neoplasms; magnetic resonance imaging; myxoma/diagnosis/surgery; tomography, X-ray computed; ventricular outflow tract, right
IL-17 and IL-23 are absolutely central to psoriasis pathogenesis as drugs targeting either cytokine are highly effective treatments for this disease. The efficacy of these drugs has been attributed to blocking the function of IL-17-producing T cells and their IL-23-induced expansion. However, we demonstrate that mast cells and neutrophils, not T cells, are the predominant cell types that contain IL-17 in human skin. IL-17+ mast cells and neutrophils are found at higher densities than IL-17+ T cells in psoriasis lesions and frequently release IL-17 in the process of forming specialized structures called extracellular traps (MCETs and NETs, respectively). Furthermore, we find that IL-23 and IL-1β can induce MCET formation and degranulation of human mast cells. Release of IL-17 from innate immune cells may be central to the pathogenesis of psoriasis, representing a fundamental mechanism by which the IL-23-IL-17 axis mediates host defense and autoimmunity.
An abnormal neutrophil subset has been identified in the PBMC fractions from lupus patients. We have proposed that these “low density granulocytes” (LDGs) play an important role in lupus pathogenesis by damaging endothelial cells and synthesizing increased levels of proinflammatory cytokines and type I interferons. To directly establish LDGs as a distinct neutrophil subset, their gene array profiles were compared to those of autologous normal density neutrophils and control neutrophils. LDGs significantly overexpress mRNA of various immunostimulatory bactericidal proteins and alarmins, relative to lupus and control neutrophils. In contrast, gene profiles of lupus normal density neutrophils do not differ from those of controls. LDGs have heightened capacity to synthesize extracellular traps (NETs) which display increased externalization of bactericidal, immunostimulatory proteins and autoantigens, including LL-37, IL-17, and double-stranded DNA (dsDNA). Through NETosis, LDGs have increased capacity to kill endothelial cells and to stimulate IFN-α synthesis by pDCs. Affected skin and kidneys from lupus patients are infiltrated by netting neutrophils, which expose LL-37 and ds-DNA. Tissue NETosis is associated with increased anti-dsDNA in sera. These results expand the potential pathogenic roles of aberrant lupus neutrophils and suggest that dysregulation of NET formation and its subsequent responses may play a prominent deleterious role.
A new class of proteasome inhibitors was synthesized using lithocholic acid as a scaffold. Modification at the C-3 position of lithocholic acid with a series of acid acyl groups yielded compounds with a range of potency on proteasome inhibition. Among them, the phenylene diacetic acid hemiester derivative (13) displayed the most potent proteasome inhibition with IC50 = 1.9 μM. Enzyme kinetic analysis indicates that these lithocholic acid derivatives are non-competitive inhibitors of the proteasome.
Lithocholic acid; proteasome; proteasome inhibitor
Oxidative stress occurs in the liver of rats fed alcohol chronically due to ethanol metabolism by CYP2E1, causing liver injury. The proteasome is considered as an antioxidant defense in the cell because of its activity in removing damaged and oxidized proteins, but a growing body of evidence shows that proteasome inhibitor treatment, at a non toxic low dose, provides protection against oxidative stress. In the present study, rats were fed ethanol for 4 weeks and were treated with the proteasome inhibitor PS-341 (Bortezomib, Velcade®). Exposure to proteasome inhibitor elicited the elevation of antioxidative defense by enhancing the levels of mRNA and protein expression transcripts of glutathione reductase (GSR), glutathione synthetase (GSS), glutathione peroxidase 2 (GPX2), and superoxide dismutase 2 (SOD2) in the liver of rats fed ethanol chronically, while ethanol alone did not increase these genes mRNA. Our results also showed that glutamate cysteine ligase catalytic subunit (GCLC), a rate-limiting enzyme in glutathione biosynthesis, was also up regulated in the liver of rats fed ethanol and injected with PS-431. Nrf2 mRNA level was significantly decreased in the liver of ethanol fed rats, as well as in the livers of animal fed ethanol and treated with proteasome inhibitor, indicating that the mechanism by which proteasome inhibitor up regulates the antioxidant response element is not due to regulation of Nrf2. However, ATF4, a major regulator of antioxidant response elements, was significantly up regulated by proteasome inhibitor treatment. The beneficial effects of proteasome inhibitor treatment also reside in the reversibility of the drug because the proteasome activity was significantly increased 72h post treatment. In conclusion, proteasome inhibitor treatment used at a non toxic low dose has potential protective effects against oxidative stress due to chronic ethanol feeding.
Ethanol feeding; Oxidative stress; Proteasome inhibitor
Mallory-Denk bodies (MDBs) are found in chronic liver diseases. Previous studies showed that Diethyl-1, 4-dihydro-2,4,6,-trimethyl-3,5-pyridinedicarboxylate (DDC) induced formation of MDBs and the up regulation of UbD expression in mouse liver. UbD is a protein over expressed in hepatocellular carcinomas. It is a potential preneoplastic marker in the mouse. It is hypothesized that inflammatory cytokines play a critical role in UbD up regulation and MDB formation. TNFa and IFNg treatment of HCC cell line Hepa 1–6, induced the expression of UbD and the expression of genes coding for the immunoproteasome (LMP2, LMP7, and MECL-1 subunits). TNFa and IFNg induced the activity of the UbD promoter, using a luciferase assay. The co-treatment with TNFa and IFNg induced the activity of the UbD promoter through an Interferon Sequence Responsive Element (ISRE). In addition, long term treatment with TNFa and IFNg induced the formation of MDB-like aggresomes in Hepa 1–6 cells, which emphasizes the role of inflammation in the formation of MDBs leading to the formation of liver tumors, in the mouse. Identifying the mechanism that regulates gene expression of UbD supports the hypothesis that down regulation of UbD and the proinflammatory gene expression would prevent MDBs and HCC formation. Previous studies indicate that S-adenosylmethionine or betaine prevented IFNg induced UbD and MDB formation.
MDB: Mallory-Denk Bodies; IFNg: Interferon gamma; TNFa: Tumor Necrosis Factor alpha; ISRE: Interferon stimulated response element; UbD: Di-Ubiquitin (Fat10); Ub: Ubiquitin
Mallory-Denk body (MDB) formation is a component of alcoholic and non alcoholic hepatitis. In the present study, the role of the toll-like receptor (TLR) signaling pathway was investigated in the mechanism of MDB formation in the DDC-fed mouse model. Microarray analysis data mining, performed on the livers of drug primed mice refed DDC, showed that TLR2/4 gene expression was significantly up regulated by DDC refeeding. SAMe supplementation prevented this up regulation and prevented the formation of MDBs. qRT-PCR analysis confirmed these results. TLR2/4 activates the adapter protein MyD88. The levels of MyD88 were increased by DDC refeeding. The increase of MyD88 was also prevented by SAMe supplementation. Results showed that MyD88-independent TLR3/4-TRIF-IRF3 pathway was not up regulated in the liver of DDC refed mice. Tumor necrosis factor receptor-associated factor 6 (TRAF6) is the down stream protein recruited by the MyD88/IRAK protein complex, and is involved in the regulation of innate immune responses. Results showed a significant increase in the levels of TRAF-6. TRAF-6 activation leads to activation of NFkB and the mitogen-activated protein kinase (MAPK) cascade. The TRAF-6 increase was ameliorated by SAMe supplementation. These results suggest that DDC induces MDB formation through the TLR2/4 and MyD88-dependent signaling pathway. In conclusion, SAMe blocked the over-expression of TLR2/4, and their downstream signaling components MyD88 and TRAF-6. SAMe prevented the DDC-induced up regulation of the TLR signaling pathways, probably by preventing the up regulation of INF-γ receptors by DDC feeding. INFγ stimulates the up regulation of TLR2. The ability of SAMe feeding to prevent TLR signaling up regulation has not been previously described.
TLRs; 26s proteasome; immunoproteasome; interferon γ; proinflammatory cytokines
The neurologic examination is a challenging component of the physical examination for medical students. In response, primarily based on expert consensus, medical schools have supplemented their curricula with standardized patient (SP) sessions that are focused on the neurologic examination. Hypothesis-driven quantitative data are needed to justify the further use of this resource-intensive educational modality, specifically regarding whether using SPs to teach the neurological examination effects a long-term benefit on the application of neurological examination skills.
This study is a cross-sectional analysis of prospectively collected data from medical students at Weill Cornell Medical College. The control group (n=129) received the standard curriculum. The intervention group (n=58) received the standard curriculum and an additional SP session focused on the neurologic examination during the second year of medical school. Student performance on the neurologic examination was assessed in the control and intervention groups via an OSCE administered during the fourth year of medical school. A Neurologic Physical Exam (NPE) score of 0.0 to 6.0 was calculated for each student based on a neurologic examination checklist completed by the SPs during the OSCE. Composite NPE scores in the control and intervention groups were compared with the unpaired t-test.
In the fourth year OSCE, composite NPE scores in the intervention group (3.5±1.1) were statistically significantly greater than those in the control group (2.2±1.1) (p<0.0001).
SP sessions are an effective tool for teaching the neurologic examination. We determined that a single, structured SP session conducted as an adjunct to our traditional lectures and small groups is associated with a statistically significant improvement in student performance measured 2 years after the session.
neurology education; neurological examination; standardized patient; OSCE; outcomes
The authors report that epidermal growth factor (EGF)-induced corneal epithelial migration in the wound-healing process requires activation of a unique cytosolic HDAC6. Subsequently, EGF-induced activation of HDAC6 deacetylates α-tubulin to facilitate corneal epithelial wound healing.
Epidermal growth factor (EGF) stimulates migration in corneal epithelial wound healing. The purpose of this study was to investigate the effect of EGF-induced α-tubulin deacetylation through activating HDAC6 on migration in corneal epithelial wound healing.
Human corneal epithelial (HCE) cells were cultured in DMEM/F12 medium containing 10% FBS in a 37°C incubator supplied with 5% CO2. Western blot analysis was used to determine protein expression. Activity of HDAC6 was suppressed by trichostatin A (TSA) and by siRNA specific to HDAC6. Corneal epithelial cell migration was measured by using scratch-induced directional migration assay in cultured cells and by corneal epithelial debridement using a mouse whole-eye organ culture model.
The authors found EGF stimulated corneal epithelial cell migration in wound healing by enhancing HDAC6 activity, resulting in the deacetylation of α-tubulin. EGF stimulated HDAC6 enzymatic activity and protein translocation toward the leading edge of the cell. Inhibition of HDAC6 activity by TSA significantly suppressed EGF-induced cell migration and delayed EGF-induced wound healing in epithelially debrided mouse corneas. In the meantime, knockdown of HDAC6 mRNA with specific siRNA effectively abolished EGF-induced deacetylation of α-tubulin, resulting in the inhibition of cell migration.
These results reveal an important mechanism that involves EGF-induced HDAC6 activation and α-tubulin deacetylation, subsequently affecting corneal epithelial migration in the wound-healing process.
Translation in axons is required for growth cone chemotropic responses to many guidance cues. Although locally synthesized proteins are beginning to be identified, how specific mRNAs are selected for translation remains unclear. Control of poly(A) tail length by cytoplasmic polyadenylation element (CPE) binding protein 1 (CPEB1) is a conserved mechanism for mRNA-specific translational regulation that could be involved in regulating translation in axons.
We show that cytoplasmic polyadenylation is required in Xenopus retinal ganglion cell (RGC) growth cones for translation-dependent, but not translation-independent, chemotropic responses in vitro, and that inhibition of CPE binding through dominant-negative interference severely reduces axon outgrowth in vivo. CPEB1 mRNA transcripts are present at low levels in RGCs but, surprisingly, CPEB1 protein was not detected in eye or brain tissue, and CPEB1 loss-of-function does not affect chemotropic responses or pathfinding in vivo. UV cross-linking experiments suggest that CPE-binding proteins other than CPEB1 in the retina regulate retinal axon development.
These results indicate that cytoplasmic polyadenylation and CPE-mediated translational regulation are involved in retinal axon development, but that CPEB1 may not be the key regulator of polyadenylation in the developing retina.
Local protein synthesis regulates the turning of growth cones to guidance cues yet little is known about which proteins are synthesized or how they contribute to directional steering. Here we show that β-actin mRNA resides in Xenopus retinal growth cones where it binds to the RNA-binding protein, Vg1RBP. Netrin-1 induces the movement of Vg1RBP granules into filopodia suggesting that it may direct the localization and translation of mRNAs in growth cones. Indeed, a gradient of netrin-1 activates the translation initiation regulator, eIF4E-BP, asymmetrically and triggers a polarized increase in β-actin translation on the near side of the growth cone prior to growth cone turning. Inhibition of β-actin translation abolishes both the asymmetric rise in β-actin and attractive, but not repulsive, turning. Our data suggest that newly synthesized β-actin, concentrated near sites of signal reception, provides the directional bias for polymerizing actin in the direction of an attractive stimulus.
netrin-1; β-actin; retinal ganglion cell; translation; Vg1RBP
Percutaneous transluminal angioplasty (PTA) and stenting is commonly used to treat subclavian artery stenosis (SAS). In this study, the outcomes of 43 consecutive cases, performed at one institution from October 1997 to October 2005, were analyzed. Mean stenosis was 84.41% pre-intervention and 6.83% post-intervention. Five of the procedures were angioplasty alone; 38 were angioplasty with stenting. Technical success was achieved in 42 out of 43 patients. The 30-day mortality rate was 0%. At one-month post intervention, all patients were symptom free. Ten patients redeveloped symptoms by one year. Demographic data, patient comorbidities, and indication to treat were analyzed. It was found that prior coronary intervention led to a statistically significant higher rate of symptom reoccurrence (p = 0.036). Additionally, a divergence in the rate of symptom reoccurrence based on indication to treat SAS was noted with the highest rate of symptom reoccurrence in the pre-coronary artery bypass grafting (CABG) group and the lowest rate of symptom reoccurrence in the subclavian steal syndrome (SSS) group. The coronary subclavian steal (CSS) group had an intermediate rate of symptom reoccurrence. During this time period, 1154 CABGs were performed. Flow-limiting stenosis was noted on angiography in 17 of these patients, giving pre-CABG prevalence of 1.46%.
subclavian artery stenosis; coronary steal syndrome; subclavian steal syndrome; coronary artery bypass graft; percutaneous intervention; restenosis
Proteolytic activation of membrane-bound transcription factors has emerged as an important mechanism for the regulation of gene expression. Two membrane-bound transcription factors regulated in this manner are the Saccharomyces cerevisiae proteins Mga2p and Spt23p, which direct transcription of the Δ9-fatty acid desaturase gene OLE1. We now show that a membrane-associated complex containing the highly conserved Npl4p, Ufd1p, and Cdc48p proteins mediates the proteasome-regulated cleavage of Mga2p and Spt23p. Mutations in NPL4, UFD1, and CDC48 cause a block in Mga2p and Spt23p processing, with concomitant loss of OLE1 expression. Taken together, our data indicate that the Npl4 complex may serve to target the proteasome to the ubiquitinated endoplasmic reticulum membrane-bound proteins Mga2p and Spt23p. Given the recent finding that NPL4 is allelic to the ERAD gene HRD4, we further propose that this NPL4 function extends to all endoplasmic reticulum-membrane–associated targets of the proteasome.