Der Aldosteron-/Renin- und Kalium-Quotient im Vergleich zum Aldosteron-/Renin-Quotient in der Diagnostik des Conn-Syndroms

Der Aldosteron/Renin-Quotient (ARQ) ist die derzeitige Standardscreeningmethode des Primären Aldosteronismus (PA). Ziel der Arbeit war es zu überprüfen, ob eine Integration vom Serumkaliumwert in den ARQ, der ARK, den Screeningprozess verbessert. Im Rahmen des Conn Registers und der SHIP-PAGE-Studie wurden retrospektiv Daten von essentiellen Hypertonikern und Conn-Patienten analysiert. Die Receiver operating curves erbrachten größere Flächen untern den Kurven für den ARK als für den ARQ. Der ARK kann als Screeninginstrument genutzt werden und vereinfacht den Screeningprozess.The aldosterone to renin ratio (ARR) is a widely employed screening tool for primary aldosteronism (PA). We asked if correcting the ARR for serum potassium values (ARP) renders a better screening test. The German Conn registry and the SHIP-PAGE study were used to retrospectively analyze data of hypertensive patients who underwent investigation for suspected primary aldosteronism. All receiver-operating curves for the ARP had a higher area under the curve than for the ARR. This study indicates that the ARP can be used as well as the ARR and may improve or ease the screening process

A Randomized Controlled Clinical Trial in Healthy Older Adults to Determine Efficacy of Glycine and N-Acetylcysteine Supplementation on Glutathione Redox Status and Oxidative Damage.

Glycine and cysteine are non-essential amino acids that are required to generate glutathione, an intracellular tripeptide that neutralizes reactive oxygen species and prevents tissue damage. During aging glutathione demand is thought to increase, but whether additional dietary intake of glycine and cysteine contributes towards the generation of glutathione in healthy older adults is not well understood. We investigated supplementation with glycine and n-acetylcysteine (GlyNAC) at three different daily doses for 2 weeks (low dose: 2.4 g, medium dose: 4.8 g, or high dose: 7.2 g/day, 1:1 ratio) in a randomized, controlled clinical trial in 114 healthy volunteers. Despite representing a cohort of healthy older adults (age mean = 65 years), we found significantly higher baseline levels of markers of oxidative stress, including that of malondialdehyde (MDA, 0.158 vs. 0.136 µmol/L, p < 0.0001), total cysteine (Cysteine-T, 314.8 vs. 276 µM, p < 0.0001), oxidized glutathione (GSSG, 174.5 vs. 132.3 µmol/L, p < 0.0001), and a lower ratio of reduced to oxidized glutathione (GSH-F:GSSG) (11.78 vs. 15.26, p = 0.0018) compared to a young reference group (age mean = 31.7 years, n = 20). GlyNAC supplementation was safe and well tolerated by the subjects, but did not increase levels of GSH-F:GSSG (end of study, placebo = 12.49 vs. 7.2 g = 12.65, p-value = 0.739) or that of total glutathione (GSH-T) (end of study, placebo = 903.5 vs. 7.2 g = 959.6 mg/L, p-value = 0.278), the primary endpoint of the study. Post-hoc analyses revealed that a subset of subjects characterized by high oxidative stress (above the median for MDA) and low baseline GSH-T status (below the median), who received the medium and high doses of GlyNAC, presented increased glutathione generation (end of study, placebo = 819.7 vs. 4.8g/7.2 g = 905.4 mg/L, p-value = 0.016). In summary GlyNAC supplementation is safe, well tolerated, and may increase glutathione levels in older adults with high glutathione demand. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05041179, NCT05041179

Presence of Infected Gr-1intCD11bhiCD11cint Monocytic Myeloid Derived Suppressor Cells Subverts T Cell Response and Is Associated With Impaired Dendritic Cell Function in Mycobacterium avium-Infected Mice

Myeloid-derived suppressor cells (MDSC) are immature myeloid cells with immunomodulatory function. To study the mechanism by which MDSC affect antimicrobial immunity, we infected mice with two M. avium strains of differential virulence, highly virulent Mycobacterium avium subsp. avium strain 25291 (MAA) and low virulent Mycobacterium avium subsp. hominissuis strain 104 (MAH). Intraperitoneal infection with MAA, but not MAH, caused severe disease and massive splenic infiltration of monocytic MDSC (M-MDSC; Gr-1intCD11bhiCD11cint) expressing inducible NO synthase (Nos2) and bearing high numbers of mycobacteria. Depletion experiments demonstrated that M-MDSC were essential for disease progression. NO production by M-MDSC influenced antigen-uptake and processing by dendritic cells and proliferation of CD4+ T cells. M-MDSC were also induced in MAA-infected mice lacking Nos2. In these mice CD4+ T cell expansion and control of infection were restored. However, T cell inhibition was only partially relieved and arginase (Arg) 1-expressing M-MDSC were accumulated. Likewise, inhibition of Arg1 also partially rescued T cell proliferation. Thus, mycobacterial virulence results in the induction of M-MDSC that block the T cell response in a Nos2- and Arg1-dependent manner

Validation of an Autoclave Procedure for Sterilization of Mouse (Mus musculus) Carcasses.

The sterilization of potentially infectious animal carcasses is an important biologic safety issue in animal facilities operating as infection or quarantine barriers. However, the literature lacks a validated protocol. Here we describe the validation of an autoclave program suitable for daily use in a small rodent biocontainment unit. We evaluated several procedures for processing mouse carcasses in a standard autoclave. Heat sensors and biologic indicators were implanted inside the peritoneal cavity of dead mice, which were loaded at various densities into IVC cages or metal boxes. Heat sensors revealed broad differences in temperature inside carcasses compared with the autoclave chamber. Achieving the appropriate sterilization temperature was considerably prolonged in carcasses compared with typical laboratory waste material. We show that for 5 cadavers placed well separated inside an IVC, a modified program for mouse cage sterilization using 134 °C for 15 min is suitable. To sterilize approximately 1 kg of carcasses in autoclavable boxes, a period of 6 h is required to reach an effective temperature of 121 °C for 60 min at the center of the waste by using an autoclave program for liquids. In conclusion, we here validated 2 protocols for the sterilization of potentially infectious mouse carcasses, to ensure the application of efficacious procedures

Presence of Infected Gr-1CD11bCD11c Monocytic Myeloid Derived Suppressor Cells Subverts T Cell Response and Is Associated With Impaired Dendritic Cell Function in -Infected Mice.

The Gram-negative bacterium, Helicobacter pylori, causes chronic gastritis, peptic ulcers, and gastric cancer in humans. Although the gastric epithelium is the primary site of H. pylori colonization, H. pylori can gain access to deeper tissues. Concurring with this notion, H. pylori has been found in the vicinity of endothelial cells in gastric submucosa. Endothelial cells play crucial roles in innate immune response, wound healing and tumorigenesis. This study examines the molecular mechanisms by which H. pylori interacts with and triggers inflammatory responses in endothelial cells. We observed that H. pylori infection of primary human endothelial cells stimulated secretion of the key inflammatory cytokines, interleukin-6 (IL-6) and interleukin-8 (IL-8). In particular, IL-8, a potent chemokine and angiogenic factor, was secreted by H. pylori-infected endothelial cells to levels ~10- to 20-fold higher than that typically observed in H. pylori-infected gastric epithelial cells. These inflammatory responses were triggered by the H. pylori type IV secretion system (T4SS) and the T4SS-associated adhesin CagL, but not the translocation substrate CagA. Moreover, in contrast to integrin α5β1 playing an essential role in IL-8 induction by H. pylori upon infection of gastric epithelial cells, both integrin α5β1 and integrin αvβ3 were dispensable for IL-8 induction in H. pylori-infected endothelial cells. However, epidermal growth factor receptor (EGFR) is crucial for mediating the potent H. pylori-induced IL-8 response in endothelial cells. This study reveals a novel mechanism by which the H. pylori T4SS and its adhesin subunit, CagL, may contribute to H. pylori pathogenesis by stimulating the endothelial innate immune responses, while highlighting EGFR as a potential therapeutic target for controlling H. pylori-induced inflammation. Introductio