Leukocyte recruitment and control of vascular permeability in acute inflammation

The inflammatory process is fundamental in host defense against tissue injury or infection. However, the inflammatory reaction may itself cause harm to the host and contribute to tissue damage and organ dysfunction. Leukocyte recruitment and edema formation are key components of the inflammatory response. This thesis reports experiments that were undertaken to further elucidate the mechanisms controlling leukocyte extravasation and concurrent alteration of vascular permeability in acute inflammation. In order for leukocytes to penetrate the vessel wall they need to sequentially interact with the endothelial lining and the perivascular basement membrane (BM) of which laminin-411 is a major constituent. The role of BM laminin-411 in leukocyte recruitment to inflammatory loci was addressed using α4 chain deficient (Lam4-/-) and wild-type (WT) mice. Recruitment of all major leukocyte subsets (neutrophils, monocytes, and lymphocytes) was reduced in Lam4-/- mice compared to WT. With the use of intravital microscopy it was concluded that this decrease was due to impaired diapedesis through the vessel wall. Concurrent with neutrophil recruitment to extravascular tissue, there is an increase in vascular permeability. However, the mechanism behind this alteration is unknown. It was shown that stimulation of neutrophils with the potent chemoattractant leukotriene B4 (LTB4) leads to degranulation and release of, amongst others, heparin binding protein (HBP). Further, postsecretory supernatants from LTB4-stimulated neutrophils induced intracellular calcium mobilization in endothelial cells in vitro and increase in vascular permeability in vivo. Selective removal of HBP from the supernatant significantly reduced these activities indicating a role for HBP in LTB4-induced plasma extravasation. The mechanism behind neutrophil-induced alteration of endothelial barrier function was further investigated and revealed a pivotal role of the kallikrein-kinin system. Neutrophil activation was shown to enable proteolytic processing of high molecular weight kininogen bound to endothelial cells. Accordingly, plasma exudation in vivo in response to challenge with leukocyte chemoattractants was largely annulled by antagonists of the kallikrein-kinin system. Collectively, the data provide novel insight into the regulation of neutrophil-induced plasma extravasation and may help to identify better therapeutic strategies for interventions in inflammatory disease. To investigate the role of neutrophil-induced alterations in vascular permeability in a clinically relevant setting, experiments were performed using controlled cortical impact (CCI) as a model for traumatic brain injury (TBI) in normal mice and in mice that were depleted of neutrophils. Neutrophil depletion did not significantly affect plasma leakage across the bloodbrain barrier after CCI. Yet, neutrophils were found to play a role in edema formation in brain tissue after injury. At a later phase, neutropenic mice displayed a decreased number of activated microglia, and an attenuation of tissue loss after injury. These results suggest that neutrophils contribute to the secondary injury following TBI. Altogether, this thesis provides insight into the role of the BM in leukocyte recruitment and clarifies the mechanism behind neutrophil-induced edema formation in acute inflammation

Маркеры воспаления при атеросклеротических изменениях сосудистой стенки у пациентов с ишемической болезнью сердца

ишемическая болезнь сердцаатеросклерозцитокин

Активность микрофлоры как показатель токсичности морских донных отложений шельфовой зоны Черного моря и Керченского пролива

Изучена потенциальная активность донной микрофлоры в местах утечки остатков химических токсикантов, затопленных в период Второй Мировой войны ХХ в. Отмечены особенности восстановления жизнедеятельности микрофлоры при различных уровнях загрязнения донных отложений мышьяком и хлорированными органическими сульфидами. Полученные результаты перспективно использовать при оценке экологического состояния донных отложений в загрязненных прибрежных акваториях

Neutrophil depletion reduces edema formation and tissue loss following traumatic brain injury in mice

Background: Brain edema as a result of secondary injury following traumatic brain injury (TBI) is a major clinical concern. Neutrophils are known to cause increased vascular permeability leading to edema formation in peripheral tissue, but their role in the pathology following TBI remains unclear. Methods: In this study we used controlled cortical impact (CCI) as a model for TBI and investigated the role of neutrophils in the response to injury. The outcome of mice that were depleted of neutrophils using an anti-Gr-1 antibody was compared to that in mice with intact neutrophil count. The effect of neutrophil depletion on blood-brain barrier function was assessed by Evan's blue dye extravasation, and analysis of brain water content was used as a measurement of brain edema formation (24 and 48 hours after CCI). Lesion volume was measured 7 and 14 days after CCI. Immunohistochemistry was used to assess cell death, using a marker for cleaved caspase-3 at 24 hours after injury, and microglial/macrophage activation 7 days after CCI. Data were analyzed using Mann-Whitney test for non-parametric data. Results: Neutrophil depletion did not significantly affect Evan's blue extravasation at any time-point after CCI. However, neutrophil-depleted mice exhibited a decreased water content both at 24 and 48 hours after CCI indicating reduced edema formation. Furthermore, brain tissue loss was attenuated in neutropenic mice at 7 and 14 days after injury. Additionally, these mice had a significantly reduced number of activated microglia/macrophages 7 days after CCI, and of cleaved caspase-3 positive cells 24 h after injury. Conclusion: Our results suggest that neutrophils are involved in the edema formation, but not the extravasation of large proteins, as well as contributing to cell death and tissue loss following TBI in mice

Muscle Weakness in Rheumatoid Arthritis: The Role of Ca2+ and Free Radical Signaling

In addition to the primary symptoms arising from inflammatory processes in the joints, muscle weakness is commonly reported by patients with rheumatoid arthritis (RA). Muscle weakness not only reduces the quality of life for the affected patients, but also dramatically increases the burden on society since patients' work ability decreases. A 25–70% reduction in muscular strength has been observed in pateints with RA when compared with age-matched healthy controls. The reduction in muscle strength is often larger than what could be explained by the reduction in muscle size in patients with RA, which indicates that intracellular (intrinsic) muscle dysfunction plays an important role in the underlying mechanism of muscle weakness associated with RA. In this review, we highlight the present understanding of RA-associated muscle weakness with special focus on how enhanced Ca2+ release from the ryanodine receptor and free radicals (reactive oxygen/nitrogen species) contributes to muscle weakness, and recent developments of novel therapeutic interventions

Peer Teaching in Undergraduate Medical Education: What are the Learning Outputs for the Student-Teachers? A Systematic Review

Introduction: To achieve quality in medical education, peer teaching, understood as students taking on roles as educators for peers, is frequently used as a teaching intervention. While the benefits of peer teaching for learners and faculty are described in detail in the literature, less attention is given to the learning outputs for the student-teachers. This systematic review focuses on the learning outputs for medical undergraduates acting as student-teachers in the last decade (2012– 2022). Aim: Our aim is to describe what learning outputs student-teachers have from peer teaching, and map what research methods are used to assess the outputs. We defined learning outputs in a broad sense, including all types of learning experiences, intended and non-intended, associated with being a peer teacher. Methods: A literature search was conducted in four electronic databases. Title, abstract and full text were screened by 8 independent reviewers and selection was based on predefined eligibility criteria. We excluded papers not describing structured peer teaching interventions with student-teachers in a formalized role. From the included articles we extracted information about the learning outputs of being a student-teacher as medical undergraduate. Results: From 668 potential titles, 100 were obtained as full-texts, and 45 selected after close examination, group deliberation, updated search and quality assessment using MERSQI score (average score 10/18). Most articles reported learning outputs using mixed methods (67%). Student-teachers reported an increase in subject-specific learning (62%), pedagogical knowledge and skills (49%), personal outputs (31%) and generic skills (38%). Most articles reported outputs using self-reported data (91%). Conclusion: Although there are few studies that systematically investigate student-teachers learning outputs, evidence suggests that peer teaching offers learning outputs for the student-teachers and helps them become better physicians. Further research is needed to enhance learning outputs for student-teachers and systematically investigate student-teachers’ learning outputs and its impact on student-teachers.publishedVersio

Neutrophils engage the kallikrein-kinin system to open up the endothelial barrier in acute inflammation

Neutrophil recruitment and plasma exudation are key elements in the immune response to injury or infection. Activated neutrophils stimulate opening of the endothelial barrier; however, the underlying mechanisms have remained largely unknown. In this study, we identified a pivotal role of the proinflammatory kallikrein-kinin system and consequent formation of bradykinin in neutrophil-evoked vascular leak. In mouse and hamster models of acute inflammation, inhibitors of bradykinin generation, and signaling markedly reduced plasma exudation in response to chemoattractant activation of neutrophils. The neutrophil-driven leak was likewise suppressed in mice deficient in either the bradykinin B2 receptor or factor XII (initiator of the kallikrein-kinin system). In human endothelial cell monolayers, material secreted from activated neutrophils induced cytoskeletal rearrangement, leading to paracellular gap formation in a bradykinin-dependent manner. As a mechanistic basis, we found that a neutrophil-derived heparin-binding protein (HBP/azurocidin) displaced the bradykinin precursor high-molecular-weight kininogen from endothelial cells, thereby enabling proteolytic processing of kininogen into bradykinin by neutrophil and plasma proteases. These data provide novel insight into the signaling pathway by which neutrophils open up the endothelial barrier and identify the kallikrein-kinin system as a target for therapeutic interventions in acute inflammatory reactions.-Kenne, E., Rasmuson, J., Renné, T., Vieira, M. L., Müller-Esterl, W., Herwald, H., Lindbom, L. Neutrophils engage the kallikrein-kinin system to open up the endothelial barrier in acute inflammation