Déchiffrage des mécanismes d’assemblage des filaments de septines

Les septines sont des protéines conservées de la levure à l’homme qui sont impliquées dans divers processus cellulaires tels que la cytokinèse, le transport vésiculaire et l’organisation du cortex cellulaire. Il existe 13 gènes de septines retrouvés en plusieurs isoformes chez l’humain, et seulement cinq chez Drosophila melanogaster, Sep1, Sep2, Pnut, Sep4 et Sep5, ce qui en fait un modèle idéal vu son génome simple. Les septines sont composées d’un domaine de liaison au GTP très conservé entre les espèces, dont le rôle reste à ce jour ambiguë, ainsi que de régions N et C-terminales variables. Les septines s’assemblent entre elles pour former un hexamère, composé de Sep1, Sep2 et Pnut chez Drosophila melanogaster, via l’interface N-C et G des septines. Ces hexamères s’assemblent bout à bout afin de former les filaments de septines. Ces filaments peuvent ensuite se regrouper et s’assembler en structures hautement ordonnées telles que des anneaux, des tubes, des faisceaux de filaments, des cages et elles sont retrouvées au sillon de clivage durant la cytokinèse. Le but était de déchiffrer les mécanismes d’assemblage des filaments de septines qui mènent à la formation des différentes structures, afin de mieux comprendre les mécanismes d’interaction entre les septines. Au sein des cellules S2 de Drosophila melanogaster, les septines sont retrouvées à trois structures hautement ordonnées et dépendantes de Pnut endogène : des tubes cytoplasmiques, des anneaux cytoplasmiques et le sillon de clivage durant la cytokinèse. Notre hypothèse est qu’il existe plusieurs mécanismes qui régissent la formation des structures hautement ordonnées et que ceux-ci sont dépendants des régions N et C terminales variables des septines qui sont impliquées dans plusieurs interactions. Divers mutants de Sep1, Sep2 et Pnut tronqués en N et en C-terminal ont été fusionnés à une protéine fluorescente et caractérisés par microscopie confocale. La localisation de ces mutants a été répertoriée et analysée en présence des septines endogènes ou lors de la déplétion de celles-ci. Nos résultats suggèrent que le domaine de liaison au GTP est suffisant pour le recrutement des septines au sillon de clivage durant la cytokinèse, mais que la région N-terminale est requise la formation des tubes et des anneaux cytoplasmiques dépendants de Pnut.Septins are conserved from yeast to humans and are implicated in diverse cellular processes such as cytokinesis, vesicular transport and cellular cortical organization. There are 13 known genes that encode for human septins, which also have many isoforms, while there are only five septin genes in Drosophila melanogaster: Sep1, Sep2, Pnut, Sep4 and Sep5, which makes it an ideal model system. Septins have a conserved GTP binding domain, whose role is still not fully understood, and variable N-C-termini. Septins assemble together, via N-C and G interfaces, to form a hexamer, that is composed of Sep1, Sep2 and Pnut in Drosophila melanogaster, which assemble end-to-end to form non polar filaments. These filaments can subsequently assemble together to form higher-ordered structures, such as rings, tubes, bundles, and gauzes. Furthermore, septins are recruited to the cleavage furrow during cytokinesis although their organization there is unclear. The aim of this project is to define septin assembly mechanisms that can lead to the formation of different higher ordered structures. In Drosophila melanogaster S2 cells, septins are recruited to three, readily observable septin dependent structures: cytoplasmic rings, cytoplasmic tubes, and the cleavage furrow during cytokinesis. Our hypothesis is that multiple mechanisms govern septin incorporation into these structures and that these mechanisms differentially depend on septin N-C variable termini. A panel of mutants of Sep1, Sep2 and Pnut truncated in N-C-termini were fused to fluorescent proteins and their localization in S2 cells monitored by confocal microscopy, with or without depletion of endogenous septins. My results suggest that the GTP binding domain is sufficient for septin recruitment to the cleavage furrow during cytokinesis, but that the septin N-termini are required for recruitment to the cytoplasmic tubes and rings

Patients with acute heart failure treated with the CARRESS-HF diuretic protocol in association with canrenoate potassium: Tolerance of high doses of canrenoate potassium

International audienceBackground: Oral mineralocorticoid receptor antagonists have failed to prove their efficacy for decongestion and potassium homeostasis in acute heart failure. Intravenous mineralocorticoid receptor antagonists have yet to be studied.Aim: The aim of this study was to confirm the safety of high-dose potassium canrenoate in association with classic diuretics in acute heart failure.Methods: This retrospective single-centre study included consecutive patients who were hospitalized with acute heart failure between 2013 and 2018. One hundred patients with overload treated with the standardized diuretic protocol from the CARRESS-HF trial were included. There were no exclusion criteria relating to creatinine or kalaemia at the time of admission. Two groups were constituted on the basis of potassium canrenoate posology: a low-dose group (<300mg/day) and a high-dose group (≥300mg/day); the groups were similar in terms of baseline characteristics.Results: Mean daily potassium canrenoate doses were 198mg/day (range 100-280mg/day) in the low-dose group and 360mg/day (range 300-600mg/day) in the high-dose group. There was no significant difference between the high-dose and low-dose groups in terms of mortality, dialysis, renal function, hyperkalaemia, haemorrhage, sepsis or confusion.Conclusions: Potassium canrenoate at high doses can be used safely in association with standard diuretics in acute heart failure, even in patients with altered renal function. A prospective study is required to evaluate the efficacy of high-dose potassium canrenoate in preventing hypokalaemia and improving decongestion

CMR - Late gadolinium enhancement characteristics associated with monomorphic ventricular arrhythmia in patients with non-ischemic cardiomyopathy

International audienceObjectives: To evaluate short- and long-term safety and efficacy of embolization with Onyx® for recurrent pulmonary arteriovenous malformations (PAVMs) in hereditary hemorrhagic telangiectasia (HHT). Methods: In total, 45 consecutive patients (51% women, mean (SD) age 53 (18) years) with HHT referred to a reference center for treatment of recurrent PAVM were retrospectively included from April 2014 to July 2021. Inclusion criteria included evidence of PAVM recurrence on CT or angiography, embolization using Onyx® and a minimal 1-year-follow-up CT or angiography. Success was defined based on the standard of reference criteria on unenhanced CT or pulmonary angiography if a recurrence was suspected. PAVMs were analyzed in consensus by two radiologists. The absence of safety distance, as defined by a too-short distance for coil/plug deployment, i.e., between 0.5 and 1 cm, between the proximal extremity of the primary embolic material used and a healthy upstream artery branch, was reported. Results: In total, 70 PAVM were analyzed. Mean (SD) follow-up was 3 (1.3) years. Safety distance criteria were missing in 33 (47%) PAVMs. All procedures were technically successful, with a short-term occlusion rate of 100% using a mean (SD) of 0.6 (0.5) mL of Onyx®. The long-term occlusion rate was 60%. No immediate complication directly related to embolization was reported, nor was any severe long-term complication such as strokes or cerebral abscesses. Conclusions: In HHT, treatment of recurrent PAVM with Onyx® showed satisfactory safety and efficacy, with an immediate occlusion rate of 100% and a long-term rate of 60%

Operationalizing a 3-year standalone, accelerated medical school curriculum to nurture physicians to become primary care and health system leaders

The United States faces a shortage of primary care physicians. To address this, there have been pioneering efforts to develop accelerated pathways with a primary care focused curriculum for undergraduate medical education. The New York University Grossman Long Island School of Medicine (NYU GLISOM) was conceptualized as the first standalone, accelerated, tuition-free program in the US in over 100 years, with mission-centered curriculum on primary care and health system leadership. The aim of this article is to map the process for the development of a three-year integrated curriculum, describe the pedagogical approach that guided the design of the longitudinal courses, share the student and faculty’s perspective about the curriculum, and describe the early outcomes of the first two graduate classes. A major key driver for curricular design is integrating longitudinal courses of Clinical Ambulatory Practice Experience (CAPE), Health Systems Science (HSS), and Learning Community - Social Sciences, Humanities, Ethics and Professionalism (LC-SHEP) over three years and active learning through Problem Based Learning (PBL). We have successfully operationalized an accelerated, standalone, integrated medical school curriculum mission-centered on primary care and health system leadership. Our outcomes reveal a higher percentage (76% N =45) of NYU GLISOM students entering primary care compared to national benchmarks. The integration of the longitudinal courses of HSS, LC-SHEP, and CAPE is a key pillar to reinforce the tenants of primary care and health system leadership. Focused interview of graduates from the pioneer cohort consistently stated that the longitudinal courses prepared them well for residency in primary care and as a health systems’ change agent. Despite the challenges of an accelerated program, NYU GLISOM successfully integrated the longitudinal courses with optimal performance and achievement of educational program objectives. Our experience can serve as a model for innovation and design of an accelerated three-year primary care curriculum

Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

BACKGROUND The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown.OBJECTIVES The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide.METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery.RESULTS Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing.CONCLUSIONS Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation