363 research outputs found

    Impact of killer-immunoglobulin-like receptor and human leukocyte antigen genotypes on the efficacy of immunotherapy in acute myeloid leukemia

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    Interactions between killer-immunoglobulin-like receptors (KIRs) and their HLA class I ligands are instrumental in natural killer (NK) cell regulation and protect normal tissue from NK cell attack. Human KIR haplotypes comprise genes encoding mainly inhibitory receptors (KIR A) or activating and inhibitory receptors (KIR B). A substantial fraction of humans lack ligands for inhibitory KIRs (iKIRs), that is, a 'missing ligand' genotype. KIR B/x and missing ligand genotypes may thus give rise to potentially autoreactive, unlicensed NK cells. Little is known regarding the impact of such genotypes in untransplanted acute myeloid leukemia (AML). For this study, NK cell phenotypes and KIR/HLA genotypes were determined in 81 AML patients who received immunotherapy with histamine dihydrochloride and low-dose IL-2 for relapse prevention (NCT01347996). We observed that presence of unlicensed NK cells impacted favorably on clinical outcome, in particular among patients harboring functional NK cells reflected by high expression of the natural cytotoxicity receptor (NCR) NKp46. Genotype analyses suggested that the clinical benefit of high NCR expression was restricted to patients with a missing ligand genotype and/or a KIR B/x genotype. These data imply that functional NK cells are significant anti-leukemic effector cells in patients with KIR/HLA genotypes that favor NK cell autoreactivity

    Penile Degloving Injury in an Adolescent with Congenital Hypothyroid

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    This case follows a 17-year-old boy with congenital hypothyroidism who sustained penile skin avulsion secondary to a dog bite. Initially, an attempt was made to repair the wound using the avulsed skin flap itself as coverage. The repair was done immediately upon presentation to enhance the chances of adequate flap viability; however, the dorsal portion of the reconstruction necrosed within the following week. Ultimately a full thickness surgical graft (FTSG) repair was performed to ensure the most desirable outcome

    Role of regulatory T cells in acute myeloid leukemia patients undergoing relapse-preventive immunotherapy

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    Regulatory T cells (Tregs) have been proposed to dampen functions of anti-neoplastic immune cells and thus promote cancer progression. In a phase IV trial (Re:Mission Trial, NCT01347996, http://www.clinicaltrials.gov ) 84 patients (age 18-79) with acute myeloid leukemia (AML) in first complete remission (CR) received ten consecutive 3-week cycles of immunotherapy with histamine dihydrochloride (HDC) and low-dose interleukin-2 (IL-2) to prevent relapse of leukemia in the post-consolidation phase. This study aimed at defining the features, function and dynamics of Foxp3+CD25highCD4+ Tregs during immunotherapy and to determine the potential impact of Tregs on relapse risk and survival. We observed a pronounced increase in Treg counts in peripheral blood during initial cycles of HDC/IL-2. The accumulating Tregs resembled thymic-derived natural Tregs (nTregs), showed augmented expression of CTLA-4 and suppressed the cell cycle proliferation of conventional T cells ex vivo. Relapse of AML was not prognosticated by Treg counts at onset of treatment or after the first cycle of immunotherapy. However, the magnitude of Treg induction was diminished in subsequent treatment cycles. Exploratory analyses implied that a reduced expansion of Tregs in later treatment cycles and a short Treg telomere length were significantly associated with a favorable clinical outcome. Our results suggest that immunotherapy with HDC/IL-2 in AML entails induction of immunosuppressive Tregs that may be targeted for improved anti-leukemic efficiency

    Anthracycline-based consolidation may determine outcome of post-consolidation immunotherapy in AML

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    Consolidation chemotherapy in acute myeloid leukemia (AML) aims at eradicating residual leukemic cells and mostly comprises high-dose cytarabine with or without the addition of anthracyclines, including daunorubicin. Immunogenic cell death (ICD) may contribute to the efficacy of anthracyclines in solid cancer, but the impact of ICD in AML is only partly explored. We assessed aspects of ICD, as reflected by calreticulin expression, in primary human AML blasts and observed induction of surface calreticulin upon exposure to daunorubicin but not to cytarabine. We next assessed immune phenotypes in AML patients in complete remission (CR), following consolidation chemotherapy with or without anthracyclines. These patients subsequently received immunotherapy with histamine dihydrochloride (HDC) and IL-2. Patients who had received anthracyclines for consolidation showed enhanced frequencies of CD8(+) T-EM cells in blood along with improved survival. We propose that the choice of consolidation therapy prior to AML immunotherapy may determine clinical outcome

    Isolated Limb Perfusion With Melphalan Triggers Immune Activation in Melanoma Patients

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    Hyperthermic isolated limb perfusion with melphalan (M-ILP) is a treatment option for melanoma patients with metastases confined to the limbs. This study aimed at defining the role of cellular immunity for the clinical response to M-ILP in melanoma patients. It was observed that patients with enhanced cytotoxic CD8+ T cell reactivity to common antigens (HCMV/EBV/influenza virus) prior to M-ILP were more likely to achieve a complete disappearance of macroscopic tumors (complete response). Following M-ILP treatment, the proportions of CD16+ intermediate and non-classical monocytes in peripheral blood were significantly enhanced along with induction of HLA-DR on CD4+ and CD8+ T cells. For further studies of the mechanism behind melphalan-induced immune activation an in vitro model, aiming at mimicking the clinical M-ILP protocol, was established, where PBMCs were co-cultured with melanoma cells, which had been pre-exposed to melphalan under mild hyperthermia. Upon exposure to melphalan, melanoma cells showed increased expression of immune-related markers including MHC class I and Hsp70. Moreover, when the melphalan-treated melanoma cells were co-cultured with PBMCs, this triggered an increased proportion of CD33+CD14+CD16++ non-classical monocytes among the PBMCs. Furthermore, the melphalan-treated melanoma cells stimulated the expansion of CD8+ T cells in the co-cultured PBMCs. These cells produced enhanced levels of IFN-γ and granzyme B and were capable of killing melanoma cells. To further verify an immunogenic role of melphalan, mice were vaccinated with melphalan-exposed murine melanoma cells. When challenged with live melanoma cells, vaccinated mice showed reduced tumor growth and enhanced infiltration of tumor-specific T cells into tumors. We conclude that melphalan-exposed melanoma cells trigger expansion of CD16+ monocytes and activate cytotoxic T cells and that these events may contribute to the antitumoral efficacy of M-ILP

    Propiedades psicométricas y baremos del Cuestionario de Burnout Granada en profesionales de Enfermería

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    Nurses are an occupational group with extremely high levels of burnout. The most accepted definition of the burnout syndrome was proposed by Maslach and Jackson, who characterized it in terms of three dimensions: (i) Emotional Exhaustion; (ii) Depersonalization; (iii) Personal Accomplishment. This definition was the basis for the Granada Burnout Questionnaire (GBQ). The objective of this research was to evaluate the psychometric properties of the GBQ and to elaborate an evaluation scale to measure burnout in nursing professionals in Spain. A total of 1,177 nurses participated in this study and successfully completed the GBQ. Evidence of construct validity was verified by cross-validation and convergent validity, and evidence of criteria validity was checked by concurrent validity. Cronbach's alpha was used to measure internal consistency. The results obtained in our study show satisfactory fit values in the confirmatory factor analysis and in the evidence of convergent and concurrent validity. All of the Cronbach alpha values were greater than .83. This signifies that the GBQ has good psychometric properties that are applicable to nurses. For this purpose a scale of T-scores and centiles was created that permitted the evaluation of burnout in Spanish nursing professionals.Los enfermeros son uno de los colectivos profesionales que presentan mayores niveles de burnout. La definición más aceptada de este trastorno fue propuesta por Maslach y Jackson, y se caracteriza por Cansancio Emocional, Despersonalización y Realización Personal. Esta definición operativa fue usada en la elaboración del Cuestionario de Burnout Granada (CBG). El objetivo de la presente investigación fue evaluar las propiedades psicométricas del CBG y elaborar un baremo para profesionales de enfermería españoles. El CBG era cumplimentado por 1177 enfermeros. Las evidencias de validez de constructo fueron examinadas usando estrategias de validez cruzada y validez convergente, y las evidencias de validez de criterio mediante la validez concurrente. El coeficiente alfa de Cronbach se utilizó para medir la consistencia interna. Los resultados indican índices de ajuste satisfactorio en el análisis factorial confirmatorio, y en las evidencias de validez convergente y concurrente. Todos los valores de alfa de Cronbach fueron superiores a 0,83. Los resultados muestran que el CBG tiene buenas propiedades psicométricas para ser usado en enfermeros. Se elaboró un baremo en puntuaciones T y centiles que permite evaluar burnout en enfermeros españoles.This work was funded by the Excellence Research Project P11HUM-7771 (Junta de Andalucía-Spain) and the Research Project mP_BS_6 (CEI BioTic Granada and Ministerio de Ciencia e Innovación-Spain).Open Access funded by Asociacion Espanola de Psicologia Conductua

    Establishment of a Novel Fluorescence-Based Method to Evaluate Chaperone-Mediated Autophagy in a Single Neuron

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    Background: Chaperone-mediated autophagy (CMA) is a selective autophagy-lysosome protein degradation pathway. The role of CMA in normal neuronal functions and in neural disease pathogenesis remains unclear, in part because there is no available method to monitor CMA activity at the single-cell level. Methodology/Principal Findings: We sought to establish a single-cell monitoring method by visualizing translocation of CMA substrates from the cytosol to lysosomes using the HaloTag (HT) system. GAPDH, a CMA substrate, was fused to HT (GAPDH-HT); this protein accumulated in the lysosomes of HeLa cells and cultured cerebellar Purkinje cells (PCs) after labeling with fluorescent dye-conjugated HT ligand. Lysosomal accumulation was enhanced by treatments that activate CMA and prevented by siRNA-mediated knockdown of LAMP2A, a lysosomal receptor for CMA, and by treatments that inactivate CMA. These results suggest that lysosomal accumulation of GAPDH-HT reflects CMA activity. Using this method, we revealed that mutant cPKC, which causes spinocerebellar ataxia type 14, decreased CMA activity in cultured PCs. Conclusion/Significance: In the present study, we established a novel fluorescent-based method to evaluate CMA activity in a single neuron. This novel method should be useful and valuable for evaluating the role of CMA in various neurona

    The development and validation of the Addiction-like Eating Behaviour Scale

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    Background: Overeating and obesity are frequently attributed to an addiction to food. However, there is currently a lack of evidence to support the idea that certain foods contain any specific addictive substance. An alternative approach is to focus on dimensions of observable behaviour, which may underpin a behavioural addiction to eating. To facilitate this, it is necessary to develop a tool to quantify addiction-like eating behaviour, which is not based on the clinical criteria for substance dependence. The current study provides initial validation of the Addiction-like Eating Behaviour Scale (AEBS). Methods: English speaking male and female participants (N=511) from a community sample completed the AEBS, alongside a range of other health- and eating-related questionnaires including the Yale Food Addiction Scale (YFAS) and Binge Eating Scale (BES). Participants also provided their height and weight to enable calculation of body mass index (BMI). Finally, to assess test–retest reliability, an additional 70 participants completed the AEBS twice, 2 weeks apart. Results: Principle components analysis revealed that a two-factor structure best accounted for the data. Factor 1 consisted of items that referred to appetitive drive, whereas factor two consisted of items that referred to dietary control practices. Both subscales demonstrated good internal reliability and test–retest reliability, and a confirmatory factor analysis confirmed the two-factor scale structure. AEBS scores correlated positively with body mass index (BMI) (P<0.001) and other self-report measures of overeating. Importantly, the AEBS significantly predicted variance in BMI above that accounted for by both the YFAS and BES (P=0.027). Conclusions: The AEBS provides a valid and reliable tool to quantify the behavioural features of a potential ‘eating addiction’. In doing so, the AEBS overcomes many limitations associated with applying substance-dependence criteria to eating
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