Immunità innata e tubercolosi: identificazione di ligandi molecolari coinvolti nella risposta antitubercolare e generazione di liposomi contenenti lipidi bioattivi ad attività immunomodulante

La tubercolosi (TB) è la malattia infettiva, causata da un singolo agente infettivo, più diffusa a livello mondiale ed è responsabile di più di due milioni di decessi ogni anno. L’agente eziologico della tubercolosi è il Mycobacterium tuberculosis (MTB), un patogeno intracellulare aerobio obbligato che infetta l’uomo, preferibilmente per via aereosolica, riuscendo a sopravvivere a livello intracellulare. Un meccanismo d’evasione che MTB attua per sfuggire all’azione micobattericida del macrofago è rappresentato dalla maturazione del fagolisosoma e dall’inibizione dell’enzima fosfolipasi D (PLD), il cui prodotto metabolicamente attivo è l’acido fosfatidico (PA). In questa Tesi abbiamo studiato il ruolo di ligandi d’origine microbica, quali le sequenze CpG, e ligandi naturali, come Acido Lisofosfatidico (LPA) e Sfingosina 1-fosfato (S1P), nella risposta immunitaria innata antimicobatterica in cellule epiteliali alveolari e in cellule della linea monocito/macrofagica. In questo contesto, abbiamo dimostrato che, in entrambi i tipi cellulari, la stimolazione con CpG, LPA o S1P può i) inibire la crescita intracellulare di MTB attraverso l’azione della PLD, ii) indurre l’attivazione della PLD Ca++-dipendente, iii) promuovere la maturazione del fagolisosoma mediate il coinvolgimento della PLD in cellule infettate con MTB. Questi risultati indicano che le cellule epiteliali alveolari, oltre ai monociti-macrofagi, possono svolgere un ruolo attivo nell’ambito della risposta immunitaria innata antitubercolare e che l’attivazione della PLD con la conseguente produzione di PA, è cruciale per l’attivazione della risposta antimicrobica basata sulla maturazione fagolisosomale. Su queste basi, abbiamo ideato liposomi in grado di veicolare secondi messaggeri lipidici, come il PA la cui produzione è soppressa in corso di infezione con MTB, in grado di ristabilire o potenziare la risposta immunitaria innata micobattericida. Abbiamo, quindi, prodotto liposomi asimmetrici simili a corpi apoptotici caratterizzati dalla presenza di fosfatidilserina (PS) sul foglietto lipidico esterno e PA nel foglietto interno. I nostri risultati indicano che tali liposomi possono essere efficacemente internalizzati nei macrofagi senza indurre segnali proinfiammatori. Inoltre, la stimolazione di macrofagi umani con questi liposomi i) induce un incremento dei flussi di Ca++, ii) promuove la maturazione del fagolisosoma Ca++-dipendente e iii) riduce la crescita intracellulare micobatterica in maniera dipendente dalla maturazione fagolisosomale. In conclusione, questi risultati suggeriscono la possibilità di usare i liposomi come “cavalli di Troia” per veicolare secondi messaggeri lipidici e ripristinare quei segnali molecolari frequentemente inibiti dai patogeni intracellulari come strategia di sopravvivenza nella cellula ospite.Tuberculosis (TB) is a worldwide infection disease, due to a single pathogen infection, which is estimated to kill over 2 million people annually. The causative agent of TB is Mycobacterium tuberculosis (MTB), an intracellular pathogen which infects human host and interferes with host antimicrobial pathways to allow intracellular survival, inhibiting Phospholipase D (PLD) dependent Phosphatidic Acid (PA) generation. The present study shows a novel role of synthetic oligodeoxynucleotides containing unmethylated CpG dinucleotides (CpG ODN), Lysophosphatidic Acid (LPA) and Sphingosine 1-phosphate (S1P) in the activation of antimicrobial immune response by innate immune cells, such as human monocytes/macrophages and type II human alveolar epithelial cells alveolar. In this context, we found that CpG, LPA and S1P stimulation i) induce Ca++-dependent PLD activation, ii) promote PLD-dependent phagolysosome maturation, and iii) enhance a PLD dependent intracellular mycobacterial killing. These results show that alveolar epithelial cells may represent efficient effecter cells of innate antimycobacterial immune response and that PLD activation i) is crucial for the activation of phagolysosome maturation-based antimicrobial response, ii) is conserved among cell types and iii) is at the intersection of different metabolic pathways, independent of the upstream stimulus received. In order to deliver these second lipid messengers able to recover or enhance host antimicrobial innate immune response to infected cells, a technological platform has been developed. In this context, apoptotic body-like liposomes characterized by the presence of phosphatidylserine (PS) in the outer lipid leaflet were engineered to contain PA in the inner lipid surface. We demonstrate that these liposomes can be internalized by macrophages and reduce production of proinfiammatory cytokines (IL-beta, TNF-alpha, IL-12, IL-23) by simultaneously inducing the production of IL-27. Moreover, the stimulation of human macrophages with apoptotic body like liposomes lead to Ca++ mobilization, Ca++-dependent phagolysosome maturation, and phagolysosome maturation dependent intracellular mycobacterial killing. Altogether, these results suggest the possibility to use apoptotic-like vesicles as Trojan particles to deliver second lipid messengers to restore those molecular pathways inhibited by intracellular pathogens as an intracellular survival strategy

Osso e infiammazione

Negli ultimi due decenni molti studiosi hanno messo in evidenza le complesse interazioni tra tessuto osseo e sistema immunitario, le quali hanno portato allo sviluppo di una branca di ricerca classificata come Osteoimmunologia. La ricerca in questo campo ha un grande potenziale, quello di poter fornire una migliore comprensione della patogenesi di numerose malattie che colpiscono entrambi i sistemi, osseo e immunitario, chiarendo così le basi molecolari per sviluppare nuove strategie terapeutiche

HDAC4 preserves skeletal muscle structure following long-term denervation by mediating distinct cellular responses

BACKGROUND: Denervation triggers numerous molecular responses in skeletal muscle, including the activation of catabolic pathways and oxidative stress, leading to progressive muscle atrophy. Histone deacetylase 4 (HDAC4) mediates skeletal muscle response to denervation, suggesting the use of HDAC inhibitors as a therapeutic approach to neurogenic muscle atrophy. However, the effects of HDAC4 inhibition in skeletal muscle in response to long-term denervation have not been described yet. METHODS: To further study HDAC4 functions in response to denervation, we analyzed mutant mice in which HDAC4 is specifically deleted in skeletal muscle. RESULTS: After an initial phase of resistance to neurogenic muscle atrophy, skeletal muscle with a deletion of HDAC4 lost structural integrity after 4 weeks of denervation. Deletion of HDAC4 impaired the activation of the ubiquitin-proteasome system, delayed the autophagic response, and dampened the OS response in skeletal muscle. Inhibition of the ubiquitin-proteasome system or the autophagic response, if on the one hand, conferred resistance to neurogenic muscle atrophy; on the other hand, induced loss of muscle integrity and inflammation in mice lacking HDAC4 in skeletal muscle. Moreover, treatment with the antioxidant drug Trolox prevented loss of muscle integrity and inflammation in in mice lacking HDAC4 in skeletal muscle, despite the resistance to neurogenic muscle atrophy. CONCLUSIONS: These results reveal new functions of HDAC4 in mediating skeletal muscle response to denervation and lead us to propose the combined use of HDAC inhibitors and antioxidant drugs to treat neurogenic muscle atrophy

Classification of stillbirths is an ongoing dilemma

Aim: To compare different classification systems in a cohort of stillbirths undergoing a comprehensive workup; to establish whether a particular classification system is most suitable and useful in determining cause of death, purporting the lowest percentage of unexplained death. Methods: Cases of stillbirth at gestational age 22–41 weeks occurring at the Department of Gynecology and Obstetrics of Foggia University during a 4 year period were collected. The World Health Organization (WHO) diagnosis of stillbirth was used. All the data collection was based on the recommendations of an Italian diagnostic workup for stillbirth. Two expert obstetricians reviewed all cases and classified causes according to five classification systems. Results: Relevant Condition at Death (ReCoDe) and Causes Of Death and Associated Conditions (CODAC) classification systems performed best in retaining information. The ReCoDe system provided the lowest rate of unexplained stillbirth (14%) compared to de Galan-Roosen (16%), CODAC (16%), Tulip (18%), Wigglesworth (62%). Conclusion: Classification of stillbirth is influenced by the multiplicity of possible causes and factors related to fetal death. Fetal autopsy, placental histology and cytogenetic analysis are strongly recommended to have a complete diagnostic evaluation. Commonly employed classification systems performed differently in our experience, the most satisfactory being the ReCoDe. Given the rate of “unexplained” cases, none can be considered optimal and further efforts are necessary to work out a clinically useful system

Tadalafil improves lean mass and endothelial function in nonobese men with mild ED/LUTS: in vivo and in vitro characterization

PURPOSE: Phosphodiesterase type-5 inhibitor administration in diabetic men with erectile dysfunction (ED) is associated with reduced waist circumference. We evaluated potential effects of daily tadalafil administration on body composition and investigated its possible mechanism(s) of action in C2C12 skeletal muscle cells in vitro. METHODS: Forty-three men on stable caloric intake (mean age 48.5 ± 7; BMI 25.5 ± 0.9 kg/m2) complaining mild ED and/or low urinary tract symptoms (LUTS) were randomly assigned to receive tadalafil (TAD) 5 mg/daily (once-a-day=OAD-TAD; n = 23) or 20 mg on-demand (on-demand=OD-TAD; n = 20) for 2 months. Primary outcomes were variations of body composition measured by Dual-energy X-ray absorptiometry; secondary outcomes were ED/LUTS questionnaire scores along with hormone (testosterone, estradiol, insulin) and endothelial function (Endopat2000) variations. RESULTS: OAD-TAD increased abdominal lean mass (p < 0.01) that returned to baseline after 2 months withdrawal. LUTS scores improved (p<0.01) in OD-TAD while ED scores improved (p < 0.01) in both groups. We found significant improvements in endothelial function (p < 0.05) that directly correlated with serum insulin (p < 0.01; r = 0.3641) and inversely correlated with estradiol levels (p < 0.01; r = 0.3655) even when corrected for potential confounders. Exposure of C2C12 cells upon increasing tadalafil concentrations (10-7 to 10-6 M) increased total androgen receptor mRNA and protein expression as well as myogenin protein expression after 24 and 72 h (2.8 ± 0.4-fold and 1.4 ± 0.02-fold vs. control, respectively, p < 0.05). CONCLUSIONS: Daily tadalafil improved lean mass content in non-obese men probably via enhanced insulin secretion, estradiol reduction, and improvement of endothelial function in vivo. The in vitro increased myogenin and androgen receptor protein expression in skeletal muscle cells suggests a translational action of phosphodiesterase type-5 on this receptor

Denervation does not induce muscle atrophy through oxidative stress

Denervation leads to the activation of the catabolic pathways, such as the ubiquitin-proteasome and autophagy, resulting in skeletal muscle atrophy and weakness. Furthermore, denervation induces oxidative stress in skeletal muscle, which is thought to contribute to the induction of skeletal muscle atrophy. Several muscle diseases are characterized by denervation, but the molecular pathways contributing to muscle atrophy have been only partially described. Our study delineates the kinetics of activation of oxidative stress response in skeletal muscle following denervation. Despite the denervation-dependent induction of oxidative stress in skeletal muscle, treatments with anti-oxidant drugs do not prevent the reduction of muscle mass. Our results indicate that, although oxidative stress may contribute to the activation of the response to denervation, it is not responsible by itself of oxidative damage or neurogenic muscle atrophy

Is obesity in women protective against osteoporosis?

The belief that obesity is protective against osteoporosis has recently come into question. The latest epidemiologic and clinical studies have shown that a high level of fat mass might be a risk factor for osteoporosis and fragility fractures. Further, increasing evidence seems to indicate that different components of the metabolic syndrome, ie, hypertension, increased triglycerides, reduced high-density lipoprotein cholesterol, are also potential risk factors for the development of low bone mineral density and osteoporosis. This review considers both the older and more recent data in the literature in order to evaluate further the relationship between fat tissue and bone tissue

Osteoporosis and Sarcopenia Increase Frailty Syndrome in the Elderly

Musculoskeletal aging is a major public health interesting and strain due to the significant demographic modifications in the population, and it is linked to high risk of falls, loss of autonomy in elderly individuals and institutionalization with small health outcomes. Thus, this pathological status is related to high morbidity and health care rates. Bone mass and muscle mass and strength increase during late adolescence and early adulthood but start to reduce noticeably from the fifth decade of life and are closely linked. Bone and muscle tissues were increasingly recognized, as endocrine target organs and endocrine organs themselves, interacting through paracrine and endocrine signals. During growth, bone mineral content closely correlates with muscle mass, and several evidences suggest that osteoporosis and sarcopenia present common pathophysiological factors and show the correlation between low bone mineral density and sarcopenia in both men and women. Then, sarcopenia and osteoporosis, typical features of aging, are often associated with each other and with the frailty syndrome. In particular, sarcopenia and osteoporosis are major contributors to disability and frailty and the common denominators are age-related chronic inflammation, changes in body composition and hormonal imbalance. Frailty syndrome is characterized by a reduced response to stress, triggering the decline of the physiological functioning of the various systems. Frailty syndrome, typical of the older people, is frequently associated with a reduction in the quality of life and mobility. Falls often are the basis of reduced mobility and ability to perform the common functions of daily life and the increase in the number of institutionalizations. Moreover, the reduction of muscle mass, associated with altered muscle composition, fat and fibrous infiltration and alterations in innervations, and the increase in fat mass, have a synergistic effect on the increase in cardiovascular risk. The aim of this review is to analyze the pathophysiological mechanisms underlying the frailty syndrome and its association with sarcopenia and osteoporosis, and investigate possible intervention measures

Laryngeal sensitivity in patients with amyotrophic lateral sclerosis

Recent studies have shown the involvement of the sensory nervous system in patients with amyotrophic lateral sclerosis (ALS). The aim of our study was to investigate the correlation between the laryngeal sensitivity deficit and the type of ALS onset (bulbar or spinal) in a large series of 114 consecutive ALS patients. Participants were subdivided into two groups, bulbar and spinal ALS, according to the clinical onset of disease and submitted to a clinical and instrumental evaluation of swallowing, including a fiber-optic endoscopic evaluation of swallowing with sensory testing. Dysphagia severity was scored using the Penetration–Aspiration Scale (PAS) and the Pooling score (P-score). In addition, three patients with laryngeal sensitivity deficit were submitted to a laryngeal biopsy to assess the status of the sensory innervation. All patients showed a normal glottal closure during phonation and volitional cough. Fifty-six subjects (49%), 14 spinal- and 42 bulbar-onset ALS, showed dysphagia at the first clinical observation (PAS score &gt;1; P-score &gt;5). Dysphagia resulted more frequently in bulbar-onset ALS (P&nbsp;&lt;&nbsp;0.01). Thirty-eight (33%) patients had a sensory deficit of the larynx. The sensory deficit of the larynx was significantly more frequent in bulbar-onset ALS (P&nbsp;&lt;&nbsp;0.01). The sensory deficit of the larynx among dysphagic patients was also significantly more frequent in bulbar-onset ALS (P&nbsp;=&nbsp;0.02). Several abnormalities were found in all three subjects who underwent a laryngeal biopsy: in one patient, no intraepidermal fiber was found; in the other two, the fibers showed morphological changes. Our observations are important to consider for assessment and management of dysphagia in patients with AL