Denileukin Diftitox as Prophylaxis against Graft-versus-Host Disease in the Canine Hematopoietic Cell Transplantation Model

AbstractDenileukin diftitox (Ontak) was evaluated in combination with methotrexate (MTX) for preventing acute graft-versus-host disease (GVHD) in dogs given 9.2 Gy of total body irradiation and DLA-nonidentical hematopoietic cell grafts. Six dogs were given denileukin diftitox 9 μg/kg/day intravenously (IV) on days 2, 4, 5, 7, 8, and 10, in combination with MTX 0.4 mg/kg/day IV on days 1, 3, 6, and 11 after transplantation. Median survival of the dogs given MTX in combination with denileukin diftitox was 16 days (range, 13-18 days), similar to that of 35 historical controls given MTX alone (median survival, 20 days). Five of the 6 denileukin diftitox–treated dogs had clinical and pathological evidence of 3-system GVHD; 1 dog died of canine herpes virus infection without evidence of GVHD. In conclusion, denileukin diftitox did not prevent, mitigate, or delay acute GVHD in this stringent and predictive (with respect to outcomes in human patients) hematopoietic cell transplantation model

Inhibition of endothelial activation: a new way to treat cerebral malaria?

BACKGROUND: Malaria is still a major public health problem, partly because the pathogenesis of its major complication, cerebral malaria (CM), remains incompletely understood. However tumor necrosis factor (TNF) is thought to play a key role in the development of this neurological syndrome, as well as lymphotoxin alpha (LT). METHODS AND FINDINGS: Using an in vitro model of CM based on human brain-derived endothelial cells (HBEC-5i), we demonstrate the anti-inflammatory effect of LMP-420, a 2-NH2-6-Cl-9-[(5-dihydroxyboryl)-pentyl] purine that is a transcriptional inhibitor of TNF. When added before or concomitantly to TNF, LMP-420 inhibits endothelial cell (EC) activation, i.e., the up-regulation of both ICAM-1 and VCAM-1 on HBEC-5i surfaces. Subsequently, LMP-420 abolishes the cytoadherence of ICAM-1-specific Plasmodium falciparum-parasitized red blood cells on these EC. Identical but weaker effects are observed when LMP-420 is added with LT. LMP-420 also causes a dramatic reduction of HBEC-5i vesiculation induced by TNF or LT stimulation, as assessed by microparticle release. CONCLUSION: These data provide evidence for a strong in vitro anti-inflammatory effect of LMP-420 and suggest that targeting host cell pathogenic mechanisms might provide a new therapeutic approach to improving the outcome of CM patients

Minor histocompatibility antigen-specific cytotoxic T lymphocytes generated with dendritic cells from DLA-identical littermates

AbstractDonor cytotoxic T lymphocytes (CTL) specific for minor histocompatibility antigens (mHA) mediate the graft-versus-host effect whereas host mHA-specific CTL mediate graft rejection in the setting of major histocompatibility complex identical allogeneic hematopoietic stem cell transplantation. Development of a large animal model from which mHA-specific CTL can be isolated would accelerate translation in clinical studies to improve control of the graft-versus-host effect as well as prevention of graft rejection in sensitized hosts. The aims of the current study were to isolate mHA-specific CTL from dog leukocyte antigen-identical littermate nonsensitized recipients before transplantation, from stable mixed hematopoietic chimeras, and from dogs sensitized to mHA after graft rejection. Donor dendritic cells (DCs) were cultured from bone marrow-derived CD34+ cells and were used to stimulate recipient T lymphocytes on days 1, 10, and 20 of CTL culture. We reliably generated and expanded mHA-specific CTL ex vivo from sensitized dogs that were given a donor-specific blood transfusion to boost immune recall after graft rejection after a nonmyeloablative transplantation. The mHA-specific cytotoxicity measured by 51Cr release assay was enriched from less than 5% in the starting population of sensitized peripheral blood mononuclear cells to a median of 63% after 4 weeks in CTL culture. The expanded mHA-specific CTLs were not tissue-specific: hematopoietic cells, fibroblast, and stromal cell lines were lysed in an mHA-specific manner. Allogeneic DCs, but not peripheral blood mononuclear cells, were necessary for stimulating ex vivo expansion of mHA-specific CTL. We were unable to generate mHA-specific CTL from nonsensitized dogs before transplantation, from previously sensitized dogs but without recent recall immunization, or from stable mixed hematopoietic chimeras. We conclude that after recent in vivo sensitization, large-scale ex vivo expansion of mHA-specific CTL was feasible using allogeneic DCs. © 2003 American Society for Blood and Marrow TransplantationBiology of Blood and Marrow Transplantation 9:234-242 (2003

Discovery of Extended Blue Horizontal Branches in Two Metal-Rich Globular Clusters

We have used WFPC2 to construct B, V color-magnitude diagrams of four metal-rich globular clusters, NGC 104 (47 Tuc), NGC 5927, NGC 6388, and NGC 6441. All four clusters have well populated red horizontal branches (RHB), as expected for their metallicity. However, NGC 6388 and 6441 also exhibit a prominent blue HB (BHB) extension, including stars reaching as faint in V as the turnoff luminosity. This discovery demonstrates directly for the first time that a major population of hot HB stars can exist in old, metal-rich systems. This may have important implications for the interpretation of the integrated spectra of elliptical galaxies. The cause of the phenomenon remains uncertain. We examine the possibility that NGC 6388 and 6441 are older than the other clusters, but a simple difference in age may not be sufficient to produce the observed distributions along the HB. The high central densities in NGC 6388 and 6441 suggest that the existence of the blue HB (BHB) tails might be caused by stellar interactions in the dense cores of these clusters, which we calculate to have two of the highest collision rates among globular clusters in the Galaxy. Tidal collisions might act in various ways to enhance loss of envelope mass, and therefore populate the blue side of the HB. However, the relative frequency of tidal collisions does not seem large enough (compared to that of the clusters with pure RHBs) to account for such a drastic difference in HB morphology. While a combination of an age difference and dynamical interactions may help, prima facie the lack of a radial gradient in the BHB/RHB star ratio seems to argue against dynamical effects playing a role.Comment: LaTeX, includes one Postscript figure. To appear in ApJ

Mesenchymal Stromal Cells Fail to Prevent Acute Graft-versus-Host Disease and Graft Rejection after Dog Leukocyte Antigen-Haploidentical Bone Marrow Transplantation

Mesenchymal stromal cells (MSCs) have been shown to have immunosuppressive effects in vitro. To test the hypothesis that these effects can be harnessed to prevent graft-versus-host disease (GVHD) and graft rejection after hematopoietic cell transplantation (HCT), we administered a combination of 3 different immortalized marrow-derived MSC lines (15-30 × 106 MSCs/kg/day, 2-5 times/week) or third-party primary MSC (1.0 × 106 MSCs/kg/day, 3 times/week) to canine recipients (n = 15) of dog leukocyte antigen–haploidentical marrow grafts prepared with 9.2 Gy of total body irradiation. Additional pharmacological immunosuppression was not given after HCT. Before their in vivo use, the MSC products were shown to suppress alloantigen-induced T cell proliferation in a dose-dependent, major histocompatibility complex–unrestricted, and cell contact–independent fashion in vitro. Among 14 evaluable dogs, 7 (50%) rejected their grafts and 7 engrafted, with ensuing rapidly fatal acute GVHD (50%). These observations were not statistically different from outcomes obtained with historical controls (n = 11) not given MSC infusions (P = .69). Thus, survival curves for MSC-treated dogs and controls were virtually superimposable (median survival, 18 vs 15 days, respectively). Finally, outcomes of dogs given primary MSCs (n = 3) did not appear to be different from those given clonal MSCs (n = 12). In conclusion, our data fail to demonstrate MSC-mediated protection against GVHD and allograft rejection in this model

Formal proofs in real algebraic geometry: from ordered fields to quantifier elimination

This paper describes a formalization of discrete real closed fields in the Coq proof assistant. This abstract structure captures for instance the theory of real algebraic numbers, a decidable subset of real numbers with good algorithmic properties. The theory of real algebraic numbers and more generally of semi-algebraic varieties is at the core of a number of effective methods in real analysis, including decision procedures for non linear arithmetic or optimization methods for real valued functions. After defining an abstract structure of discrete real closed field and the elementary theory of real roots of polynomials, we describe the formalization of an algebraic proof of quantifier elimination based on pseudo-remainder sequences following the standard computer algebra literature on the topic. This formalization covers a large part of the theory which underlies the efficient algorithms implemented in practice in computer algebra. The success of this work paves the way for formal certification of these efficient methods.Comment: 40 pages, 4 figure

New distances to RAVE stars

Probability density functions are determined from new stellar parameters for the distance moduli of stars for which the RAdial Velocity Experiment (RAVE) has obtained spectra with S/N>=10. Single-Gaussian fits to the pdf in distance modulus suffice for roughly half the stars, with most of the other half having satisfactory two-Gaussian representations. As expected, early-type stars rarely require more than one Gaussian. The expectation value of distance is larger than the distance implied by the expectation of distance modulus; the latter is itself larger than the distance implied by the expectation value of the parallax. Our parallaxes of Hipparcos stars agree well with the values measured by Hipparcos, so the expectation of parallax is the most reliable distance indicator. The latter are improved by taking extinction into account. The effective temperature absolute-magnitude diagram of our stars is significantly improved when these pdfs are used to make the diagram. We use the method of kinematic corrections devised by Schoenrich, Binney & Asplund to check for systematic errors for general stars and confirm that the most reliable distance indicator is the expectation of parallax. For cool dwarfs and low-gravity giants tends to be larger than the true distance by up to 30 percent. The most satisfactory distances are for dwarfs hotter than 5500 K. We compare our distances to stars in 13 open clusters with cluster distances from the literature and find excellent agreement for the dwarfs and indications that we are over-estimating distances to giants, especially in young clusters.Comment: 20 pages accepted by MNRAS. Minor changes to the submitted versio

Adoptive immunotherapy against allogeneic kidney grafts in dogs with stable hematopoietic trichimerism.

Dogs given nonmyeloablative conditioning and marrow grafts from 2 dog leukocyte antigen (DLA)-identical littermate donors developed stable trichimerism and stably accepted a subsequent kidney graft from one of the marrow donors without the need for immunosuppression. In this study, we used trichimeras to evaluate strategies for adoptive immunotherapy to solid tumors, using the kidney as a tumor surrogate. Three DLA-identical trichimeric recipients were established by simultaneously infusing marrow from 2 DLA-identical donor dogs into a DLA-identical recipient conditioned with 2 Gy of total body irradiation (TBI) and given a short course of postgraft immunosuppression. After stable hematopoietic engraftment was confirmed, a kidney was transplanted from 1 of the 2 marrow donors into each respective trichimeric recipient. Peripheral blood lymphocytes from each kidney donor were then used to sensitize the alternate marrow donor. The trichimeric recipients were given donor lymphocyte infusions (DLIs) from the sensitized dogs and monitored for chimerism, graft-versus-host disease (GVHD), and kidney rejection. After DLI, we observed both prompt rejection of the transplanted marrow and donor kidney and disappearance of corresponding hematopoietic chimerism. Presumably due to shared minor histocompatibility antigens, host chimerism also disappeared, and GVHD in skin, gut, and liver developed. The native kidneys, although exhibiting lymphocytic infiltration, remained functionally normal. This study demonstrates that under certain experimental conditions, the kidney--an organ ordinarily not involved in graft-versus-host reactions--can be targeted by sensitized donor lymphocytes

Isolated congenital cleft mitral valve leaflet: a rare cause of refractory cardiogenic shock complicating acute myocardial infarction

We report a unique presentation of isolated congenital cleft mitral valve complicating cardiogenic shock from acute myocardial infarction. Isolated cleft mitral valve is an uncommon diagnosis that can have significant clinical implications, especially if not recognized in patients presenting to the catheterization lab with acute myocardial infarction and cardiogenic shock. A review of this rare diagnosis including the options and timing of therapeutic interventions, which can include MitraClip, is important for publication. The case is of a patient who presented with an anterior acute ST elevation myocardial infarction. Despite early coronary revascularization and conventional support, refractory cardiogenic shock ensued requiring mechanical circulatory support escalation to Veno-arterial extracorporeal membrane oxygenation. Subsequently, left ventriculography revealed a massively dilated left atrium and severe mitral regurgitation raising concerns for a mechanical mitral valve complication. The patient was taken to the operating room for possible mitral valve surgery, but a preoperative transesophageal echocardiogram revealed an isolated posterior cleft mitral valve. Since the patient had stabilized on mechanical circulatory support, emergent surgery was deferred. The patient successfully recovered during index hospitalization with mechanical circulatory support and discharged on guideline directed medical therapy. In conclusion, isolated cleft mitral valve is a rare diagnosis that can often be underrecognized without comprehensive 3-dimensional transesophageal echocardiography evaluation. If diagnosed early with significant regurgitation, surgical treatment results in good outcomes and preservation of LV systolic function. Percutaneous correction of a CMVL with MitraClip has been described and may offer an alternative approach for high risk surgical patients