40 research outputs found
Transcriptome Analysis of Neisseria meningitidis in Human Whole Blood and Mutagenesis Studies Identify Virulence Factors Involved in Blood Survival
During infection Neisseria meningitidis (Nm) encounters multiple
environments within the host, which makes rapid adaptation a crucial factor for
meningococcal survival. Despite the importance of invasion into the bloodstream
in the meningococcal disease process, little is known about how Nm adapts to
permit survival and growth in blood. To address this, we performed a time-course
transcriptome analysis using an ex vivo model of human whole
blood infection. We observed that Nm alters the expression of ≈30% of
ORFs of the genome and major dynamic changes were observed in the expression of
transcriptional regulators, transport and binding proteins, energy metabolism,
and surface-exposed virulence factors. In particular, we found that the gene
encoding the regulator Fur, as well as all genes encoding iron uptake systems,
were significantly up-regulated. Analysis of regulated genes encoding for
surface-exposed proteins involved in Nm pathogenesis allowed us to better
understand mechanisms used to circumvent host defenses. During blood infection,
Nm activates genes encoding for the factor H binding proteins, fHbp and NspA,
genes encoding for detoxifying enzymes such as SodC, Kat and AniA, as well as
several less characterized surface-exposed proteins that might have a role in
blood survival. Through mutagenesis studies of a subset of up-regulated genes we
were able to identify new proteins important for survival in human blood and
also to identify additional roles of previously known virulence factors in
aiding survival in blood. Nm mutant strains lacking the genes encoding the
hypothetical protein NMB1483 and the surface-exposed proteins NalP, Mip and
NspA, the Fur regulator, the transferrin binding protein TbpB, and the L-lactate
permease LctP were sensitive to killing by human blood. This increased knowledge
of how Nm responds to adaptation in blood could also be helpful to develop
diagnostic and therapeutic strategies to control the devastating disease cause
by this microorganism
A randomized, controlled trial of 3.0 mg of liraglutide in weight management
BACKGROUND Obesity is a chronic disease with serious health consequences, but weight loss is difficult to maintain through lifestyle intervention alone. Liraglutide, a glucagonlike peptide-1 analogue, has been shown to have potential benefit for weight management at a once-daily dose of 3.0 mg, injected subcutaneously. METHODS We conducted a 56-week, double-blind trial involving 3731 patients who did not have type 2 diabetes and who had a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of at least 30 or a BMI of at least 27 if they had treated or untreated dyslipidemia or hypertension. We randomly assigned patients in a 2:1 ratio to receive once-daily subcutaneous injections of liraglutide at a dose of 3.0 mg (2487 patients) or placebo (1244 patients); both groups received counseling on lifestyle modification. The coprimary end points were the change in body weight and the proportions of patients losing at least 5% and more than 10% of their initial body weight. RESULTS At baseline, the mean (±SD) age of the patients was 45.1±12.0 years, the mean weight was 106.2±21.4 kg, and the mean BMI was 38.3±6.4; a total of 78.5% of the patients were women and 61.2% had prediabetes. At week 56, patients in the liraglutide group had lost a mean of 8.4±7.3 kg of body weight, and those in the placebo group had lost a mean of 2.8±6.5 kg (a difference of -5.6 kg; 95% confidence interval, -6.0 to -5.1; P<0.001, with last-observation-carried-forward imputation). A total of 63.2% of the patients in the liraglutide group as compared with 27.1% in the placebo group lost at least 5% of their body weight (P<0.001), and 33.1% and 10.6%, respectively, lost more than 10% of their body weight (P<0.001). The most frequently reported adverse events with liraglutide were mild or moderate nausea and diarrhea. Serious events occurred in 6.2% of the patients in the liraglutide group and in 5.0% of the patients in the placebo group. CONCLUSIONS In this study, 3.0 mg of liraglutide, as an adjunct to diet and exercise, was associated with reduced body weight and improved metabolic control. (Funded by Novo Nordisk; SCALE Obesity and Prediabetes NN8022-1839 ClinicalTrials.gov number, NCT01272219.)
Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes
BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events
Transcriptional Profiling of Serogroup B Neisseria meningitidis Growing in Human Blood: An Approach to Vaccine Antigen Discovery
Neisseria meningitidis is a nasopharyngeal commensal of humans which occasionally invades the blood to cause septicaemia. The transcriptome of N. meningitidis strain MC58 grown in human blood for up to 4 hours was determined and around 10% of the genome was found to be differentially regulated. The nuo, pet and atp operons, involved in energy metabolism, were up-regulated, while many house-keeping genes were down-regulated. Genes encoding protein chaperones and proteases, involved in the stress response; complement resistant genes encoding enzymes for LOS sialylation and biosynthesis; and fHbp (NMB1870) and nspA (NMB0663), encoding vaccine candidates, were all up-regulated. Genes for glutamate uptake and metabolism, and biosynthesis of purine and pyrimidine were also up-regulated. Blood grown meningococci are under stress and undergo a metabolic adaptation and energy conservation strategy. The localisation of four putative outer membrane proteins encoded by genes found to be up-regulated in blood was assessed by FACS using polyclonal mouse antisera, and one (NMB0390) showed evidence of surface expression, supporting its vaccine candidacy
Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.
Abstract
BACKGROUND:
The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown.
METHODS:
We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy.
RESULTS:
In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups.
CONCLUSIONS:
Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)
An Online Investigation of Imagery to Attenuate Paranoia in College Students
Onset of psychosis typically occurs in young adulthood, and is likely to be preceded by anxiety, low mood, suspiciousness and perceptual anomalies. Where these develop into mild or brief psychotic experience, and impact on functioning, young people are identified as being at risk of psychosis. Early intervention may reduce severity or delay transition to psychosis, and yield significant healthcare cost savings. This study examined the impact of an online attachment-based imagery task on paranoia, anxiety, mood and self-esteem, in college students. An experimental design was used to compare the effects of secure and anxious-ambivalent attachment imagery. A total of 301 college students, aged 18–48 years (M = 20.1, SD = 2.976), were randomly assigned to one of the two imagery conditions, and assessed pre and post imagery task on standardised measures of paranoia, anxiety, mood and self-esteem. A series of mixed model analyses of variance showed that participants in the secure attachment imagery condition reported lower levels of paranoia, anxiety and negative mood, and higher levels of positive mood and self-esteem, compared with those in the anxious-ambivalent attachment imagery condition. The study is limited by the lack of a neutral control condition and follow-up measures. Nevertheless, study demonstrated the impact of attachment-based imagery on paranoia. If these effects are replicated with ‘at risk mental state’ groups, and maintained at follow-up, online imagery may provide a safe and highly accessible means of attenuating paranoia in young people at risk of developing psychosis
Influenza Infections in Solid Organ and Stem Cell Transplant Recipients
Influenza virus is a common respiratory virus in solid organ and stem cell transplant recipients. Influenza infection in immunocompromised hosts can result in severe disease, as compared to general population. Risk factors for severe influenza infection in transplant recipients include treatment with antilymphocyte globulin, presence of lower respiratory disease, and infection early after transplantation. Transplant programs should act to optimize prevention, early diagnosis, and treatment of influenza infection in this population in order to achieve better transplant outcomes