The Relationship between Cobalamin Deficiency and Neurological Dysfunction in Older Adults

The prevalence of cobalamin (Obi) deficiency among older adults is higher than among younger adults, and is estimated to be between 14% and 23%. Persistent Cbl deficiency can cause a variety of neurological deficits. Neurological dysfunction occurs commonly among older adults, raising the research question whether or not there is a relationship between the high prevalence of Cbl deficiency and neurological dysfunction among older adults. This case-control study enrolled 120 subjects with and without neurological dysfunction through the Faculty Medical Offices\u27 Internal Medicine and Neurology Outpatient Clinics. All subjects received a neurological and cognitive exam. Blood samples were drawn to assess serum Cbl, methylmalonic acid (MMA), and serum total homocysteine (tHcys) levels. To test the hypothesis whether Cbl deficient subjects consumed less crystalline (free) Cbl, Cbl found in fortified foods and supplements, a food frequency questionnaire was designed. The prevalence of Cbl deficiency was 16.6% among the true controls, and 25% among the cases (Odds Ratio = 1.7, 95% confidence interval = 0.54 - 5.1). True controls had perfect neurological scores, while other control subjects had reduced vibration sense. Cbl deficiency in older adults was related to low free Cbl intake, not dietary Cbl intake. Subjects who obtained a daily average of 0 and 1.0 meg of free Cbl were most likely to be Cbl deficient (41.5%), while those who obtained 2.0 meg of free Cbl were least likely to be Cbl deficient (13%)(P=.008). This study was unable to show that older adults with neurological dysfunction are at greater odds of a Cbl deficiency than a control group. Another study is needed to determine whether or not older adults with neurological dysfunction are at greater odds of a Cbl deficiency than a control group without reduced vibration sense. Furthermore, the relationship between reduced vibration sense in older and Cbl deficiency needs to be further investigated. Prophylactic use of Cbl containing supplements among older adults seems prudent. The current RDA of 2 meg for Cbl needs to be reevaluated in terms of crystalline Cbl and protein-bound Cbl requirements in older adults

The clinical success of empirically fit soft toric contact lenses versus fitting using diagnostic trial lenses and ToriTrack

To improve the efficiency of fitting toric soft contact lenses Cooper Vision designed Tori Track, software that calculates the final prescription using any trial lens of known power and SCOR without the estimation of rotation. The clinical success of traditional empirical fitting versus using a randomly selected diagnostic lens with Tori Track was compared using 28 eyes with at least 1.50D of cylinder. The initial visit included empirically fitting the subjects with Frequency 55 toric lenses by vertex correcting their manifest refraction. Following equilibration and an acceptable fit, acuities were taken using Snellen and high and low contrast Bailey Lovie charts. On a second visit, a -3.00-1.25 x040 lens was fit on all the patients and a SCOR was performed. ToriTrack was then used to predict the final lens parametres. The results of the initial visit were compared to the second visit. We found that on average ToriTrack predicted the final lens to undercorrect by 0.33D (spherical equivalent) more than the initial visit. Cylinder power was consistant between both parts, but the axis showed a shift of 15 degrees in 14 out of the 28 eyes. Even with the large axis shift, acuities were not significantly affected. Using ToriTrack and a diagnostic lens did not appear to be significantly more efficient than emprically fitting the lens. However, ToriTrack was useful for the built in vertex calculator, comprehensive catalogue of CooperVision lenses and maintaining patient records

Production, secretion and purification of a correctly folded staphylococcal antigen in Lactococcus lactis.

International audienceLactococcus lactis, a lactic acid bacterium traditionally used to ferment milk and manufacture cheeses, is also, in the biotechnology field, an interesting host to produce proteins of medical interest, as it is "Generally Recognized As Safe". Furthermore, as L. lactis naturally secretes only one major endogenous protein (Usp45), the secretion of heterologous proteins in this species facilitates their purification from a protein-poor culture medium. Here, we developed and optimized protein production and secretion in L. lactis to obtain proteins of high quality, both correctly folded and pure to a high extent. As proteins to be produced, we chose the two transmembrane members of the HtrA protease family in Staphylococcus aureus, an important extra-cellular pathogen, as these putative surface-exposed antigens could constitute good targets for vaccine development. A recombinant ORF encoding a C-terminal, soluble, proteolytically inactive and tagged form of each staphylococcal HtrA protein was cloned into a lactococcal expression-secretion vector. After growth and induction of recombinant gene expression, L. lactis was able to produce and secrete each recombinant rHtrA protein as a stable form that accumulated in the culture medium in similar amounts as the naturally secreted endogenous protein, Usp45. L. lactis growth in fermenters, in particular in a rich optimized medium, led to higher yields for each rHtrA protein. Protein purification from the lactococcal culture medium was easily achieved in one step and allowed recovery of highly pure and stable proteins whose identity was confirmed by mass spectrometry. Although rHtrA proteins were monomeric, they displayed the same secondary structure content, thermal stability and chaperone activity as many other HtrA family members, indicating that they were correctly folded. rHtrA protein immunogenicity was established in mice. The raised polyclonal antibodies allowed studying the expression and subcellular localization of wild type proteins in S. aureus: although both proteins were expressed, only HtrA1 was found to be, as predicted, exposed at the staphylococcal cell surface suggesting that it could be a better candidate for vaccine development. In this study, an efficient process was developed to produce and secrete putative staphylococcal surface antigens in L. lactis and to purify them to homogeneity in one step from the culture supernatant. This allowed recovering fully folded, stable and pure proteins which constitute promising vaccine candidates to be tested for protection against staphylococcal infection. L. lactis thus proved to be an efficient and competitive cell factory to produce proteins of high quality for medical applications

Mutations in CNNM4 Cause Jalili Syndrome, Consisting of Autosomal-Recessive Cone-Rod Dystrophy and Amelogenesis Imperfecta

The combination of recessively inherited cone-rod dystrophy (CRD) and amelogenesis imperfecta (AI) was first reported by Jalili and Smith in 1988 in a family subsequently linked to a locus on chromosome 2q11, and it has since been reported in a second small family. We have identified five further ethnically diverse families cosegregating CRD and AI. Phenotypic characterization of teeth and visual function in the published and new families reveals a consistent syndrome in all seven families, and all link or are consistent with linkage to 2q11, confirming the existence of a genetically homogenous condition that we now propose to call Jalili syndrome. Using a positional-candidate approach, we have identified mutations in the CNNM4 gene, encoding a putative metal transporter, accounting for the condition in all seven families. Nine mutations are described in all, three missense, three terminations, two large deletions, and a single base insertion. We confirmed expression of Cnnm4 in the neural retina and in ameloblasts in the developing tooth, suggesting a hitherto unknown connection between tooth biomineralization and retinal function. The identification of CNNM4 as the causative gene for Jalili syndrome, characterized by syndromic CRD with AI, has the potential to provide new insights into the roles of metal transport in visual function and biomineralization

Ultrastructure of calcified cartilage in the endoskeletal tesserae of sharks

The tesserate pattern of endoskeletal calcification has been investigated in jaws, gill arches, vertebral arches and fins of the sharks Carcharhinus menisorrah, Triaenodon obesus and Negaprion brevirostris by techniques of light and electron microscopy. Individual tesserae develop peripherally at the boundary between cartilage and perichondrium. An inner zone, the body, is composed of calcified cartilage containing viable chondrocytes separated by basophilic contour lines which have been called Liesegang waves or rings. The outer zone of tesserae, the cap, is composed of calcified tissue which appears to be produced by perichondrial fibroblasts more directly, i.e., without first differentiating as chondroblasts. Furthermore, the cap zone is penetrated by acidophilic Sharpey fibers of collagen. It is suggested that scleroblasts of the cap zone could be classified as osteoblasts. If so, the cap could be considered a thin veneer of bone atop the calcified cartilage of the body of a tessera. By scanning electron microscopy it was observed that outer and inner surfaces of tesserae differ in appearance. Calcospherites and hydroxyapatite crystals similar to those commonly seen on the surface of bone are present on the outer surface of the tessera adjacent to the perichondrium. On the inner surface adjoining hyaline cartilage, however, calcospherites of variable size are the predominant surface feature. Transmission electron microscopy shows calcification in close association with coarse collagen fibrils on the outer side of a tessera, but such fibrils are absent from the cartilaginous matrix along the under side of tesserae. Calcified cartilage as a tissue type in the endoskeleton of sharks is a primitive vertebrate characteristic. Calcification in the tesserate pattern occurring in modern Chondrichthyes may be derived from an ancestral pattern of a continuous bed of calcified cartilage underlying a layer of perichondral bone, as theorized by Ørvig (1951); or the tesserate pattern in these fish may itself be primitive.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50272/1/1051600106_ftp.pd

In vitro models of collagen biomineralization

Over the last several years, significant progress has been made toward understanding the mechanisms involved in the mineralization of hard collagenous tissues, such as bone and dentin. Particularly notable are the identification of transient mineral phases that are precursors to carbonated hydroxyapatite, the identification and characterization of non-collagenous proteins that are involved in controlling mineralization, and significant improvements in our understanding of the structure of collagen. These advances not only represent a paradigm shift in the way collagen mineralization is viewed and understood, but have also brought new challenges to light. In this review, we discuss how recent in vitro models have addressed critical questions regarding the role of the non-collagenous proteins in controlling mineralization, the nature of the interactions between amorphous calcium phosphate and collagen during the early stages of mineralization, and the role of collagen in the mineralization process. We discuss the significance of these findings in expanding our understanding of collagen biomineralization, while addressing some of the limitations that are inherent to in vitro systems

Partial selective T cell depletion of periphral blood stem cell is efficiency and safety : alloreactivity study, anti-infectious and anti-tumoural response of the CD4+T lymphocyte sub-population

Véritable immunothérapie adoptive, l’allogreffe de Cellules Souches Hématopoïétiques (CSH) est destinée à prévenir la rechute d’une hémopathie maligne grâce au combat immunologique du greffon contre la maladie (effet GVL, Graft Versus Leukemia), dans lequel les lymphocytes T apportés par le greffon sont déterminants. Ils peuvent aussi compromettre le résultat escompté, en induisant une réaction du greffon contre l'hôte (GVH, Graft Versus Host) qui reste une complication redoutée de l’allogreffe. Dans une précédente étude prospective portant sur 62 couples donneur/receveur nous avons pu étudier l'impact de la composition du greffon en cellules T de phénotypes naïfs et mémoires sur le devenir des receveurs d’allogreffes à partir d'un donneur HLA-identique apparenté ou non; et nous avons pu démontrer qu’une proportion élevée de lymphocytes T CD4+CCR7+ dans le greffon était un facteur de risque de la survenue, la précocité et la sévérité de la GVH aiguë, sans influence sur la GVH chronique ou la rechute. Dans le but de séparer l’effet GVL de la GVH, nous avons voulu à travers des travaux de cette thèse, étudier le concept d’une T déplétion partielle et sélective du greffon en lymphocytes T CD4+CCR7+. Nous travaux se sont scindés en trois parties :1) Au plan clinique, nous avons pu confirmer nos précédents résultats sur une cohorte additionnelle de 137 patients. Non seulement, nous avons confirmé qu’une proportion élevée de lymphocytes T CD4+CCR7+ dans le greffon était un facteur de risque de la survenue, de la GVH aiguë, mais également, nous avons observé un effet préférentielle de la sous-population naïve des lymphocytes T CD4+ sur l’incidence de la GVH aiguë. Bien entendu, aucun impact sur l’incidence de la rechute post-allogreffe n’a été enregistré.2) Dans un modèle expérimental utilisant des cultures lymphocytaires en présence des cellules dendritiques provenant des six couples (frère/sœur) HLA-identiques, nous avons pu démontrer que les lymphocytes T CD4+ naïfs déclenchaient la réponse allogénique la plus importante et avec un degré moindre les cellules mémoires centrales par rapport aux effecteurs mémoires T CD4+. Ces résultats non seulement, valident in vitro les constatations cliniques mais aussi mettent l’accent sur le rôle prépondérant des lymphocytes T naïfs dans l’alloréactivité, notamment en situation de compatibilité HLA.3) Nous avons dans la troisième partie pu démontrer qu’une déplétion partielle sélective des greffons en lymphocytes T CD4+CCR7+ n’altère pas la réponse immunologique secondaires vis-à-vis des virus.La suite de nos travaux se focalise sur l’effet de la déplétion partielle sélective des greffons en lymphocytes T CD4+CCR7+ sur la réaction anti-tumorale du greffon dans la situation HLA compatibilité chez l’homme.Nos résultats constituent une pierre angulaire dans le concept de déplétion partielle sélective des greffons en lymphocytes T CD4+CCR7+, ex vivo chez l’homme, en vue de réduire l’incidence de la GVHD sans altérer la réponse anti-infectieuse ou tumorale du greffon notamment chez les donneurs présentant un taux élevé de lymphocytes T CD4+ naïfs et/ou mémoire centrale .A genuine adoptive immunotherapy, Haematopoietic Stem Cell (HSC) allotransplantation aims to prevent the recurrence of a malignant blood disease via an immunological action of the graft against disease (GVL or Graft Versus Leukaemia effect), in which the T lymphocytes supplied by the transplant play a key role. They may also compromise the targeted result, by triggering a GVH (Graft Versus Host) reaction, which remains a serious complication of allotransplantation. In a previous prospective study conducted in 62 donor/recipient pairings, we examined the impact of the transplant\\\'s naive and memory phenotype T cell composition on the fate of recipients of allotransplants from an HLA-identical donor, related to the recipient or otherwise. We demonstrated that a high proportion of CD4+CCR7+ T lymphocytes in the transplant was a risk factor for the development, early onset and severity of acute GVHD, with no influence on chronic GVHD or recurrence. With the objective of separating the GVL effect from the GVH effect, we wanted to investigate the concept of partial and selective CD4+CCR7+ T cell depletion of the graft in the studies conducted as part of this research. Our studies were split into three parts:1) Clinically, we confirmed our previous results in an additional cohort of 137 patients. In addition to confirming that a high proportion of CD4+CCR7+ T lymphocytes in the transplant was a risk factor for the development of acute GVH, we also observed a preferential effect of the naive CD4+T lymphocyte sub-population on the incidence of acute GVHD. Obviously, no impact on the incidence of post-allotransplantation recurrence was recorded.2) In an experimental model using lymphocyte cultures in the presence of dendritic cells taken from six HLA-identical pairings (brother/sister), we demonstrated that naive CD4+ T lymphocytes triggered the greatest allogenic response and, to a lesser degree, central memory cells compared to effector memory CD4+ T cells. Not only do these results validate the clinical observations made in vitro, they also highlight the dominant role of naive T lymphocytes in alloreactivity, particularly in situations of HLA incompatibility.3) In the third part, we demonstrated that selective partial CD4+CCR7+ T cell depletion of the transplants does not impair the secondary immunological response to viruses.The next phase of our research focuses on the effect of selective partial CD4+CCR7+ T cell depletion of grafts on the transplant's anti-tumoural reaction in situations of HLA compatibility in humans.Our results represent a cornerstone in the concept of partial selective T CD4+CCR7+ T cell depletion of transplants, ex vivo in humans, with a view to reducing the incidence of GVHD, without impairing the anti-infectious or anti-tumoural response of the graft, particularly in donors with high levels of naive and/or central memory CD4+ T lymphocytes