82 research outputs found

    Life-threatening metabolic alkalosis in Pendred syndrome.

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    INTRODUCTION: Pendred syndrome, a combination of sensorineural deafness, impaired organification of iodide in the thyroid and goitre, results from biallelic defects in pendrin (encoded by SLC26A4), which transports chloride and iodide in the inner ear and thyroid respectively. Recently, pendrin has also been identified in the kidneys, where it is found in the apical plasma membrane of non-α-type intercalated cells of the cortical collecting duct. Here, it functions as a chloride-bicarbonate exchanger, capable of secreting bicarbonate into the urine. Despite this function, patients with Pendred syndrome have not been reported to develop any significant acid-base disturbances, except a single previous reported case of metabolic alkalosis in the context of Pendred syndrome in a child started on a diuretic. CASE REPORT: We describe a 46-year-old female with sensorineural deafness and hypothyroidism, who presented with severe hypokalaemic metabolic alkalosis during inter-current illnesses on two occasions, and who was found to be homozygous for a loss-of-function mutation (V138F) in SLC26A4. Her acid-base status and electrolytes were unremarkable when she was well. CONCLUSION: This case illustrates that, although pendrin is not usually required to maintain acid-base homeostasis under ambient condition, loss of renal bicarbonate excretion by pendrin during a metabolic alkalotic challenge may contribute to life-threatening acid-base disturbances in patients with Pendred syndrome

    Avid binding by B cells to the Plasmodium circumsporozoite protein repeat suppresses responses to protective subdominant epitopes

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    Antibodies targeting the NANP/NVDP repeat domain of the Plasmodium falciparum circumsporozoite protein (CSP ) can protect against malaria. However, it has also been suggested that the CSP is a decoy that prevents the immune system from mounting responses against other domains of CSP. Here, we show that, following parasite immunization, B cell responses to the CSP are immunodominant over responses to other CSP domains despite the presence of similar numbers of naive B cells able to bind these regions. We find that this immunodominance is driven by avid binding of the CSP to cognate B cells that are able to expand at the expense of B cells with other specificities. We further show that mice immunized with repeat-truncated CSP molecules develop responses to subdominant epitopes and are protected against malaria. These data demonstrate that the CSP functions as a decoy, but truncated CSP molecules may be an approach for malaria vaccination.We thank Rajagopal Murugan and Hedda Wardemann (Deutsches Krebsforschungszentrum, Heidelberg, Germany) for providing the C-terminal antibodies 1710 and 3919 and Azza Idris, Joe Francica, and Robert Seder (Vaccine Research Center, National Institutes of Health, Bethesda, MD) for the provision of mAb15 and CSPCterm and CSPNterm peptides. We thank Michael Devoy, Harpreet Vohra, and Catherine Gillespie of the Imaging and Cytometry Facility at the John Curtin School of Medical Research for assistance with flow cytometry and multi-photon microscopy. We also thank Theresa Neeman of the ANU statistical consulting unit for assistance with statistical analysis of the data. This work was funded by the Bill and Melinda Gates Foundation (OPP1151018) and the National Health and Medical Research Council (GNT1158404). D.C. is supported by Deutsche Forschungsgemeinschaft International Research Training Group 2290 and is the recipient of PhD scholarship from the Australian National Universit

    Border crossings in the African travel narratives of Ibn Battuta, Richard Burton and Paul Theroux

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    This article compares the representation of African borders in the 14th-century travelogue of Ibn Battuta, the 19th-century travel narrative of Richard Burton and the 21st-century travel writing of Paul Theroux. It examines the mutually constitutive relationship between conceptions of literal territorial boundaries and the figurative boundaries of the subject that ventures across borders in Africa. The border is seen as a liminal zone which paradoxically separates and joins spaces. Accounts of border crossings in travel writing from different periods suggest the historicity and cultural specificity of conceptions of geographical borders, and the way they index the “boundaries” of the subjects who cross them. Tracing the transformations in these conceptions of literal and metaphorical borders allows one to chart the emergence of the dominant contemporary idea of “Africa” as the inscrutable, savage continent

    Clientelism as civil society? Unpacking the relationship between clientelism and democracy at the local level in South Africa

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    This article, building on analyses from the global south, attempts to reframe democratic expectations by considering where previously maligned practices such as clientelism may hold moments of democracy. It does so by comparing the theory of civil society with that of clientelism, and its African counterpart neo-patrimonialism. It argues that clientelism as civil society may fulfil democratic tasks such as holding the (local) state accountable, strengthening civil and political liberties and providing channels of access for previously marginalised groups. Clientelism is not necessarily a reflection of imposed power relations but, at times, can demonstrate a conscious political strategy, to generate development, on the part of its protagonists.IS

    Homozygous loss-of-function mutations in SLC26A7 cause goitrous congenital hypothyroidism.

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    Defects in genes mediating thyroid hormone biosynthesis result in dyshormonogenic congenital hypothyroidism (CH). Here, we report homozygous truncating mutations in SLC26A7 in 6 unrelated families with goitrous CH and show that goitrous hypothyroidism also occurs in Slc26a7-null mice. In both species, the gene is expressed predominantly in the thyroid gland, and loss of function is associated with impaired availability of iodine for thyroid hormone synthesis, partially corrected in mice by iodine supplementation. SLC26A7 is a member of the same transporter family as SLC26A4 (pendrin), an anion exchanger with affinity for iodide and chloride (among others), whose gene mutations cause congenital deafness and dyshormonogenic goiter. However, in contrast to pendrin, SLC26A7 does not mediate cellular iodide efflux and hearing in affected individuals is normal. We delineate a hitherto unrecognized role for SLC26A7 in thyroid hormone biosynthesis, for which the mechanism remains unclear

    Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

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    Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

    Analysing cycling as a social practice: An empirical grounding for behaviour change

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    © 2014 The Authors. Published by Elsevier Ltd. Despite significant national and local efforts over the last decade to stimulate uptake of cycling in the UK, levels of cycling (particularly utility cycling) remain at around 2% of journeys. Understanding of cycling behaviour and subsequent development of interventions has typically been undertaken using an individualist approach, often relying on psychologically based models of behaviour. This paper argues that Social Practice Theory (SPT) may be a valuable addition to practitioner's toolboxes by providing an alternative means of understanding the complex dynamics between the elements that constitute the practice of utility cycling, allowing it to be considered as a social issue, rather than focusing solely on individual behaviour. This is demonstrated within the paper by the use of SPT to reanalyse quantitative and qualitative datasets that explore views and experiences of both cyclists and non-cyclists. Therein, the practice of utility cycling is described according to its three elements; materials, meaning and competences and the potential benefits of this approach are discussed; particularly its ideological shift away from 'victim blaming' and its natural support of interdisciplinary intervention design

    An examination of polygenic score risk prediction in individuals with first-episode psychosis

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    Background Polygenic risk scores (PRSs) have successfully summarized genome-wide effects of genetic variants in schizophrenia with significant predictive power. In a clinical sample of first-episode psychosis (FEP) patients, we estimated the ability of PRSs to discriminate case-control status and to predict the development of schizophrenia as opposed to other psychoses. Methods The sample (445 case and 265 control subjects) was genotyped on the Illumina HumanCore Exome BeadChip with an additional 828 control subjects of African ancestry genotyped on the Illumina Multi-Ethnic Genotyping Array. To calculate PRSs, we used the results from the latest Psychiatric Genomics Consortium schizophrenia meta-analysis. We examined the association of PRSs with case-control status and with schizophrenia versus other psychoses in European and African ancestry FEP patients and in a second sample of 248 case subjects with chronic psychosis. Results PRS had good discriminative ability of case-control status in FEP European ancestry individuals (9.4% of the variance explained, p < 10−6), but lower in individuals of African ancestry (R2 = 1.1%, p = .004). Furthermore, PRS distinguished European ancestry case subjects who went on to acquire a schizophrenia diagnosis from those who developed other psychotic disorders (R2 = 9.2%, p = .002). Conclusions PRS was a powerful predictor of case-control status in a European sample of patients with FEP, even though a large proportion did not have an established diagnosis of schizophrenia at the time of assessment. PRS was significantly different between those case subjects who developed schizophrenia from those who did not, although the discriminative accuracy may not yet be sufficient for clinical utility in FEP
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