CD40 signalling in platelet function

Le CD40 est un membre de la famille des récepteurs du facteur de nécrose tumorale ("Tumour necrosis factor", TNF), initialement identifié sur des cellules de carcinome de la vessie. L'interaction du CD40 avec son ligand (CD40L) est d'une importance cruciale pour le développement des cellules B et de la commutation d'isotype au cours de la réponse immunitaire acquise. L'expression du complexe CD40/CD40L était initialement cru d'être limiter aux cellules du système immunitaire, mais aujourd'hui il est bien connu que ce complexe est également exprimé sur les cellules du système circulatoire et vasculaire, et est impliqué dans diverses réactions inflammatoires; de sorte que le CD40L est maintenant considéré comme une molécule thrombo-inflammatoire prédictive des événements cardiovasculaires. Les plaquettes expriment constitutivement le CD40, alors que le CD40L n'est exprimé que suite à leur l'activation. Il est ensuite clivé en sa forme soluble (sCD40L) qui représente la majorité du sCD40L en circulation. Il fut démontré que le sCD40L influence l'activation plaquettaire mais son effet exact sur la fonction plaquettaire, ainsi que les mécanismes cellulaires et moléculaires sous-jacents à son action demeurent inconnus. Ainsi, ce projet a été entrepris dans le but d’adresser les objectifs spécifiques suivants: 1) évaluer les effets in vitro du sCD40L sur l'activation et l'agrégation plaquettaire; 2) identifier les récepteurs plaquettaires impliqués dans l’action du sCD40L; 3) élucider les voies signalétiques intracellulaires induits par le sCD40L; 4) évaluer les effets du sCD40L sur la formation de thrombus in vivo. Nous avons trouvé que le sCD40L augmente fortement l'activation et l'agrégation des plaquettes en réponse à de faibles concentrations d'agonistes. Les plaquettes humaines traitées avec une forme mutante du sCD40L qui n'interagit pas avec le CD40, et les plaquettes de souris déficientes en CD40 ne furent pas en mesure d'induire de telles réponses, indiquant que le récepteur principal du sCD40L au niveau des plaquettes est le CD40. En plus, nous avons identifié la présence de plusieurs membres de la famille du facteur associé du récepteur du TNF ("TNF receptor-associated factor", TRAF) dans les plaquettes et nous avons montré que seulement le TRAF2 s'associe avec le CD40 suite à la stimulation par le sCD40L. Nos résultats indiquent aussi que le sCD40L agisse sur les plaquettes au repos par l'entremise de deux voies signalétiques distinctes. La première voie implique l'activation de la petite GTPase Rac1 et de sa cible en aval, soit la protéine kinase p38 activée par le mitogène ("p38 mitogen-activated protein kinase", p38 MAPK ), menant au changement de forme plaquettaire et à la polymérisation de l'actine; alors que la deuxième voie implique l'activation de la cascade signalétique du NF-kB. Par ailleurs, à la suite d'une lésion artérielle induite par le chlorure de fer, le sCD40L exacerbe la formation de thrombus et l'infiltration leucocytaire au sein du thrombus dans les souris du type sauvage, mais pas chez les souris déficientes en CD40. En conclusion, ce projet a permis d'identifier pour la première fois deux voies signalétiques distinctes en aval du CD40 plaquettaire et a permis d'établir leur implication dans l'activation et l'agrégation plaquettaire en réponse au sCD40L. De manière plus importante, ce projet nous a permis d'établir un lien direct entre les niveaux élevés du sCD40L circulant et la formation de thrombus in vivo, tout en soulignant l'importance du CD40 dans ce processus. Par conséquent, l'axe CD40/CD40L joue un rôle important dans l'activation des plaquettes, les prédisposant à une thrombose accrue en réponse à une lésion vasculaire. Ces résultats peuvent expliquer en partie la corrélation entre les taux circulants élevés du sCD40L et l'incidence des maladies cardiovasculaires.CD40 is a member of the tumour necrosis factor (TNF) receptor family, originally identified on human bladder carcinoma cells. Interaction of CD40 with its ligand (CD40L) is of crucial importance for B cell development and immunoglobulin isotype switching during the adaptive immune response. Expression of the CD40/CD40L dyad was initially thought to be restricted to cells of the immune system, but today it is known to be also expressed on cells of the circulatory and vascular systems, and have important implications in various inflammatory reactions, such that CD40L is now regarded as a thrombo-inflammatory molecule and a reliable predictor of cardiovascular events. Platelets constitutively express CD40, whereas CD40L is expressed upon activation and subsequently cleaved into its soluble form (sCD40L), accounting for the majority of circulating sCD40L. Soluble CD40L has been shown to influence platelet activation but its precise effect on platelet function, and the underlying cellular and molecular mechanisms remain undefined; hence the purpose of this project. The specific aims of this study are: 1) to evaluate the in vitro effects of sCD40L on platelet activation and aggregation; 2) to determine the receptor(s) on platelets involved in the action of sCD40L; 3) to elucidate the intracellular signalling pathways induced by sCD40L; and 4) to evaluate the in vivo effects of sCD40L on thrombus formation. We have showed that sCD40L strongly enhances activation and aggregation of washed human platelets in response to sub-threshold concentrations of agonists. Human platelets treated with a mutated form of sCD40L that lacks CD40 binding, and platelets from CD40 deficient mice failed to elicit such responses, indicating that CD40 is the major platelet receptor for sCD40L. Moreover, we identified the presence of multiple members of the TNF receptor-associated factor (TRAF) in platelets and showed that only TRAF2 associates with CD40 after sCD40L stimulation. Interestingly, sCD40L primes resting platelets through two distinct signalling pathways. The first pathway involves activation of the small GTPase Rac1 and its downstream target p38 mitogen-activated protein kinase, leading to platelet shape change and actin polymerization; whereas the second pathway involves activation of the NF-κB signalling cascade. Furthermore, sCD40L exacerbates thrombus formation and leukocyte infiltration within the thrombus mass in wild-type mice but not in CD40 deficient mice following ferric chloride-induced arterial injury. In conclusion, we have identified for the first time two distinct signalling pathways downstream of platelet CD40, and established their implication in platelet activation and aggregation in response to sCD40L. Noticeably, we established a direct link between elevated levels of sCD40L and in vivo thrombus formation, while emphasizing the requirement of CD40 in this process. Therefore, the CD40/CD40L dyad plays an important role in platelet priming that predisposes platelets to enhanced thrombus formation in response to vascular injury. These results may partly explain the correlation between elevated circulating levels of sCD40L and the incidence of cardiovascular diseases

Optimal Capacity Utilization and Reallocation in a German Bank Branch Network: Exploring Some Strategic Scenarios

Quite a few studies have considered efficiency at the bank branch level by comparing mostly a single branch network, while an abundance of studies have focused on comparing banking institutions. However, to the best of our knowledge no study has ever assessed performance at the level of the branch bank network by looking for ways to reallocate resources such that overall performance improves. Here, we introduce the Johansen-Färe measure of plant capacity of the firm into a multi-output, frontier-based version of the short-run Johansen industry model. The first stage capacity model carefully checks for the impact of the convexity assumption on the estimated capacity utilization results. Policy scenarios considered for the short-run Johansen industry model vary in terms of their tolerance with respect to existing bank branch inefficiencies, the formulation of closure policies, the reallocation of labor in terms of integer units, etc. The application to a network of 142 bank branches of a German savings bank in the year 1998 measures their efficiency and capacity utilization and demonstrate that by this industry model approach one can improve the performance of the whole branch network.Bank Branch Network, Efficiency, Capacity, Reallocation

Open Latarjet with Metal-Free Cerclage Fixation

Despite multiple modifications, the Latarjet is still the most popular procedure for recurrent anterior shoulder instability with glenoid bone loss. Partial or subtotal resorption of the graft is common, potentially leading to hardware prominence and risk of anterior soft-tissue impingement. To minimize the technical difficulties and morbidity associated with metallic implants, a coracoid and conjoint tendon transfer with a mini-open approach using Cerclage tape suture is described, as an alternative for the Latarjet procedure typically performed with metal screws and plates

Anti-inflammatory, antibacterial and antioxidant activities of the medicinal species <em>Atractylis cancellata</em>

This research is focused on the estimation of total bioactive contents and the evaluation of in vitro pharmacological activities of crude extracts (petroleum ether, ethyl acetate and n-butanol) obtained from the species Atractylis cancellata. The antioxidant activity was assessed by three different techniques. The antibacterial activity was determined using the agar disk diffusion assay against five bacterial strains. Furthermore, the anti-inflammatory activity was evaluated by the ovalbumin method. According to the results, A. cancellata extracts are rich in several classes of secondary metabolites, especially steroids, triterpenoids, flavonoids, and alkaloids. In addition, the tested extracts showed very interesting antioxidant activities in DPPH and FRAP assays and important correlation coefficients between the results of antioxidant activities and total phenolic and flavonoid contents were found. Moreover, all the tested extracts displayed an antibacterial effect at least against three bacterial strains. The petroleum ether extract inhibited the growth of all the tested bacteria in a dose-dependent manner except Escherichia coli ATCC 25922 and it revealed a strong anti-inflammatory activity (81.77±0.05%). We conclude that A. cancellata could be an important source of natural pharmacological candidates against oxidative stress, inflammatory and microbial diseases

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations - Part II.

This article is freely available via Open Access. Click on the 'Additional Link' above to access the full-text via the publisher's site.Published (Open Access

Les infections bactériennes materno fœtale « dépistage clinique et biologique

L’infection bactérienne néonatale par contamination maternofoetale a fait l’objet de nombreuses recommandations au cours de la dernière décennie du fait de sa fréquence et de sa gravité. Le but de ces démarches est le dépistage de Streptococcus agalactiae afin de l’éradiquer par une antibiothérapie per partum. La revue de la littérature tente d’en effectuer la synthèse, de présenter les recommandations françaises et nord-américaines publiées, et d’exposer les différents inconvénients de ces recommandations successives: leur difficulté d’application ; leurs risques maternels en rapport avec l’antibiothérapie, en particulier l’émergence des bactéries à Gram négatif résistantes; leurs risques néonatals, certaines conséquences de ces stratégies aboutissant à l’impression de leur inefficacité (recrudescence des infections néonatales à bactéries résistantes, survenue plus tardive des sepsis, utilisation d’antibiothérapie à spectre de plus en plus large et augmentation des infections nosocomiales à bactéries résistantes) ; puis d’aborder les facteurs de risque d’infection et les propositions de prise en charge

The potential of the 3-UPU translational parallel manipulator and a procedure to select the best architecture

The 3-UPU three degrees of freedom fully parallel manipulator, where U and P are for universal and prismatic pair respectively, is a very well known manipulator that can provide the platform with three degrees of freedom of pure translation, pure rotation or mixed translation and rotation with respect to the base, according to the relative directions of the revolute pair axes (each universal pair comprises two revolute pairs with intersecting and perpendicular axes). In particular, pure translational parallel 3-UPU manipulators (3-UPU TPMs) received great attention. Many studies have been reported in the literature on singularities, workspace, and joint clearance influence on the platform accuracy of this manipulator. However, much work has still to be done to reveal all the features this topology can offer to the designer when different architecture, i.e. different geometry are considered. Therefore, this dissertation will focus on this type of the 3-UPU manipulators. The first part of the dissertation presents six new architectures of the 3-UPU TPMs which offer interesting features to the designer. In the second part, a procedure is presented which is based on some indexes, in order to allows the designer to select the best architecture of the 3-UPU TPMs for a given task. Four indexes are proposed as stiffness, clearance, singularity and size of the manipulator in order to apply the procedure