Rheumatoid cachexia in rheumatoid arthritis patients treated in the current treat-to-target era: An exploration of the incidence, mechanisms, effects on physical function, and a potential nutritional treatment

Rheumatoid cachexia (RC), i.e. muscle wasting and adiposity gain in rheumatoid arthritis (RA), is driven by inflammation and is a major contributor to reduced strength and physical function. Current treatment for RA is based on approaches that aim to tightly control inflammation from diagnosis onwards. This is best exemplified by ‘treat-to-target’ (T2T), which targets low disease activity, preferably ‘clinical remission’. The success of T2T in controlling inflammation is well-established, but whether it has attenuated RC is unknown. In a cross-sectional trial, we demonstrated that, despite well controlled disease activity, RC and substantially impaired physical function was still present in patients treated by T2T. Consequently, adjunct interventions are required to restore body composition and function. Nutritional creatine (Cr) supplementation may provide a safe and easy means of improving muscle mass and physical function. In a randomised control trial, 12 weeks Cr supplementation significantly increased muscle mass, but was unable to improve objective measures of physical function. To investigate their associations with body composition, using serum from RA patients with: treated versus untreated disease; patients versus healthy controls; and patients before and after anabolic interventions (PRT or Cr supplementation), we were unable to identify serum biomarkers (i.e. tumor necrosis factor (TNF)-α, soluble TNF-α receptor-I, interleukin-6, insulin-like growth factor (IGF)-1, IGF-binding protein 3, myostatin, adiponectin, and leptin) for RC. Following an unexpected, and substantial, loss of muscle mass in a patient in our Cr supplementation trial, we investigated and identified a probable catabolic effect of intramuscular (IM) corticosteroid (CS) injections used to treat active disease. Preliminary findings from an ongoing study revealed significant muscle loss in all five RA patients tested within 4 weeks of IM CS injection to treat a disease flare. These findings raise concerns about this routine and recommended treatment, and provide a further potential mechanism for RC

Proteomic Insights into the Hidden World of Phloem Sap Feeding

The physical interface between a phloem-feeding insect and its host plant is a single cell buried deep within the plant tissue. As such, the molecular interactions between these notorious agricultural pests and the crop plants upon which they feed are diffi cult to study. ‘Omic’ technologies have proved crucial in revealing some of the fascinating detail of the molecular interplay between these partners. Here we review the role of proteomics in identifying putative components of the secreted saliva of phloem-feeding insects, particularly aphids, and discuss the limited knowledge concerning the function of these proteins

Integrated Metabonomic-Proteomic Analysis of an Insect-Bacterial Symbiotic System

The health of animals, including humans, is dependent on their resident microbiota, but the complexity of the microbial communities makes these associations difficult to study in most animals. Exceptionally, the microbiology of the pea aphid Acyrthosiphon pisum is dominated by a single bacterium Buchnera aphidicola (B. aphidicola). A 1H NMR-based metabonomic strategy was applied to investigate metabolic profiles of aphids fed on a low essential amino acid diet and treated by antibiotic to eliminate B. aphidicola. In addition, differential gel electrophoresis (DIGE) with mass spectrometry was utilized to determine the alterations of proteins induced by these treatments. We found that these perturbations resulted in significant changes to the abundance of 15 metabolites and 238 proteins. Ten (67%) of the metabolites with altered abundance were amino acids, with nonessential amino acids increased and essential amino acids decreased by both perturbations. Over-represented proteins in the perturbed treatments included catabolic enzymes with roles in amino acid degradation and glycolysis, various cuticular proteins, and a C-type lectin and regucalcin with candidate defensive roles. This analysis demonstrates the central role of essential amino acid production in the relationship and identifies candidate proteins and processes underpinning the function and persistence of the association

High index contrast photonic platforms for on-chip Raman spectroscopy

Nanophotonic waveguide enhanced Raman spectroscopy (NWERS) is a sensing technique that uses a highly confined waveguide mode to excite and collect the Raman scattered signal from molecules in close vicinity of the waveguide. The most important parameters defining the figure of merit of an NWERS sensor include its ability to collect the Raman signal from an analyte, i.e. "the Raman conversion efficiency" and the amount of "Raman background" generated from the guiding material. Here, we compare different photonic integrated circuit (PIC) platforms capable of on-chip Raman sensing in terms of the aforementioned parameters. Among the four photonic platforms under study, tantalum oxide and silicon nitride waveguides exhibit high signal collection efficiency and low Raman background. In contrast, the performance of titania and alumina waveguides suffers from a strong Raman background and a weak signal collection efficiency, respectively

The CSF immune response in HIV-1-associated cryptococcal meningitis: macrophage activation, correlates of disease severity and effect of antiretroviral therapy.

Immune modulation may improve outcome in HIV-associated cryptococcal meningitis. Animal studies suggest alternatively activated macrophages are detrimental but human studies are limited. We performed a detailed assessment of the cerebrospinal fluid (CSF) immune response and examined immune correlates of disease severity and poor outcome, and the effects of antiretroviral therapy (ART). We enrolled persons ≥18 years with first episode of HIV-associated cryptococcal meningitis. CSF immune response was assessed using flow cytometry and multiplex cytokine analysis. Principal component analysis was used to examine relationships between immune response, fungal burden, intracranial pressure and mortality, and the effects of recent ART initiation (<12 weeks). CSF was available from 57 persons (median CD4 34/μL). CD206 (alternatively activated macrophage marker) was expressed on 54% CD14+ and 35% CD14- monocyte-macrophages. High fungal burden was not associated with CD206 expression but with a paucity of CD4+, CD8+ and CD4-CD8- T cells and lower IL-6, G-CSF and IL-5 concentrations. High intracranial pressure (≥30cmH2O) was associated with fewer T cells, a higher fungal burden and larger Cryptococcus organisms. Mortality was associated with reduced interferon-gamma concentrations and CD4-CD8- T cells but lost statistical significance when adjusted for multiple comparisons. Recent ART was associated with increased CSF CD4/CD8 ratio and a significantly increased macrophage expression of CD206. Paucity of CSF T cell infiltrate rather than alternative macrophage activation was associated with severe disease in HIV-associated cryptococcosis. ART had a pronounced effect on the immune response at the site of disease

Continuous low-dose antibiotic prophylaxis for adults with repeated urinary tract infections (AnTIC): a randomised, open-label trial

Funder: UK National Institute for Health Research. Open Access funded by Department of Health UK Acknowledgments We thank all the participants for their commitment to the study, Sheila Wallace for updating the systematic review, members of the Trial Steering Committee and members of the Data Monitoring Committee for their valuable guidance. We thank the National Health Service organisations, principal investigators and local research staff who hosted and ran the study at site. We thank the Health Technology Assessment Programme of the UK NIHR for funding the study (no. 11/72/01). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Government Department of Health. A full report of the study30 has been published by the NIHR Library.Peer reviewedPublisher PD

Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT

Peer reviewedPublisher PD

Flow cytometry to assess CSF fungal burden in cryptococcal meningitis

Fungal burden in the cerebrospinal fluid is an important determinant of mortality in cryptococcal meningitis but its use to aid clinical decision-making is hampered by the time involved to perform quantitative cultures. Here we demonstrate the potential of flow cytometry as a novel and rapid technique to address this

A New Concept for Kilotonne Scale Liquid Argon Time Projection Chambers

We develop a novel Time Projection Chamber (TPC) concept suitable for deployment in kilotonne-scale detectors, with a charge-readout system free from reconstruction ambiguities, and a robust TPC design that reduces high-voltage risks while increasing the coverage of the light-collection system and maximizing the active volume. This novel concept could be used as a far detector module in the Deep Underground Neutrino Experiment (DUNE). For the charge-readout system, we used the charge-collection pixels and associated application-specific integrated circuits currently being developed for the liquid argon (LAr) component of the DUNE Near Detector design, ArgonCube. In addition, we divided the TPC into a number of shorter drift volumes, reducing the total voltage used to drift the ionization electrons, and minimizing the stored energy per TPC. Segmenting the TPC also contains scintillation light, allowing for precise trigger localization and a more expansive light-readout system. Furthermore, the design opens the possibility of replacing or upgrading components. These augmentations could substantially improve the reliability and the sensitivity, particularly for low-energy signals, in comparison to traditional monolithic LArTPCs with projective-wire charge readouts

α-Klotho expressison in human tissue

Context: α-Klotho has emerged as a powerful regulator of the aging process. To-date, the expression profile of α-Klotho in human tissues is unknown and its existence in some human tissue types is subject to much controversy. Objective: This is the first study to characterize system-wide tissue expression of transmembrane α-Klotho in humans. We have employed next generation targeted proteomic analysis using Parallel Reaction Monitoring (PRM) in parallel with conventional antibody-based methods to determine the expression and spatial distribution of human α-Klotho expression in health. Results: The distribution of α-Klotho in human tissues from various organ systems, including arterial, epithelial, endocrine, reproductive and neuronal tissues was first identified by immunohistochemistry. Kidney tissues showed strong α-Klotho expression, while liver did not reveal a detectable signal. These results were next confirmed by western blotting of both whole tissues and primary cells. To validate our antibody-based results, α-Klotho expressing tissues were subjected to PRM mass spectrometry identifying peptides specific for the full length, transmembrane α-Klotho isoform. Conclusions: The data presented confirms α-Klotho expression in the kidney tubule and in artery, and provides evidence of α-Klotho expression across organ systems and cell-types that have not previously been described in humans.K.L. received a Genzyme-Sanofi Fellowship in Nephrology grant. T.F.H. is funded by the NIHR award to the Cambridge Biomedical Research Centre and by NIHR grant 14/49/147. The Cambridge Aorta Study is funded by the British Heart Foundation.This is the author accepted manuscript. The final version is available from the Endocrine Society via http://dx.doi.org/10.1210/jc.2015-1800