79 research outputs found
Mycobacterium tuberculosis infection modulates adipose tissue biology
Mycobacterium tuberculosis (Mtb) primarily resides in the lung but can also
persist in extrapulmonary sites. Macrophages are considered the prime cellular
habitat in all tissues. Here we demonstrate that Mtb resides inside adipocytes
of fat tissue where it expresses stress-related genes. Moreover, perigonadal
fat of Mtb-infected mice disseminated the infection when transferred to
uninfected animals. Adipose tissue harbors leukocytes in addition to
adipocytes and other cell types and we observed that Mtb infection induces
changes in adipose tissue biology depending on stage of infection. Mice
infected via aerosol showed infiltration of inducible nitric oxide synthase
(iNOS) or arginase 1 (Arg1)-negative F4/80+ cells, despite recruitment of
CD3+, CD4+ and CD8+ T cells. Gene expression analysis of adipose tissue of
aerosol Mtb-infected mice provided evidence for upregulated expression of
genes associated with T cells and NK cells at 28 days post-infection.
Strikingly, IFN-γ-producing NK cells and Mtb-specific CD8+ T cells were
identified in perigonadal fat, specifically CD8+CD44-CD69+ and CD8+CD44-CD103+
subpopulations. Gene expression analysis of these cells revealed that they
expressed IFN-γ and the lectin-like receptor Klrg1 and down-regulated CD27 and
CD62L, consistent with an effector phenotype of Mtb-specific CD8+ T cells.
Sorted NK cells expressed higher abundance of Klrg1 upon infection, as well.
Our results reveal the ability of Mtb to persist in adipose tissue in a
stressed state, and that NK cells and Mtb-specific CD8+ T cells infiltrate
infected adipose tissue where they produce IFN-γ and assume an effector
phenotype. We conclude that adipose tissue is a potential niche for Mtb and
that due to infection CD8+ T cells and NK cells are attracted to this tissue
requirements for naive CD4+ T cell stimulation
Human primary dendritic cells (DCs) are heterogeneous by phenotype, function,
and tissue localization and distinct from inflammatory monocyte-derived DCs.
Current information regarding the susceptibility and functional role of
primary human DC subsets to Mycobacterium tuberculosis (Mtb) infection is
limited. Here, we dissect the response of different primary DC subsets to Mtb
infection. Myeloid CD11c+ cells and pDCs (C-type lectin 4C+ cells) were
located in human lymph nodes (LNs) of tuberculosis (TB) patients by
histochemistry. Rare CD141hi DCs (C-type lectin 9A+ cells) were also
identified. Infection with live Mtb revealed a higher responsiveness of
myeloid CD1c+ DCs compared to CD141hi DCs and pDCs. CD1c+ DCs produced
interleukin (IL)-6, tumor necrosis factor α, and IL-1β but not IL-12p70, a
cytokine important for Th1 activation and host defenses against Mtb. Yet,
CD1c+ DCs were able to activate autologous naïve CD4+ T cells. By combining
cell purification with fluorescence-activated cell sorting and gene expression
profiling on rare cell populations, we detected in responding CD4+ T cells,
genes related to effector-cytolytic functions and transcription factors
associated with Th1, Th17, and Treg polarization, suggesting multifunctional
properties in our experimental conditions. Finally, immunohistologic analyses
revealed contact between CD11c+ cells and pDCs in LNs of TB patients and in
vitro data suggest that cooperation between Mtb-infected CD1c+ DCs and pDCs
favors stimulation of CD4+ T cells
Identification and characterization of IL-10/IFN-γ–producing effector-like T cells with regulatory function in human blood
Two subsets of natural and adaptive regulatory T (T reg) cells have been described, but the identity of adaptive type 1 regulatory (Tr1)–like cells in humans is unclear. We analyzed a subset of human blood CD4+ T cells—CD45RA−CD25−interleukin (IL)-7 receptor (R)− cells—that rapidly secreted high levels of IL-10 together with interferon γ, but produced little IL-2. These IL-7R− T cells were rare, anergic, and largely Foxp3−. They expressed low levels of Bcl-2 but high levels of Ki-67 and ICOS, suggesting that they have been recently activated in vivo. Consistently, they responded selectively to persistent foreign and self-antigens under steady-state conditions. Unlike natural CD25+ T reg cells, IL-7R− cells suppressed naive and memory T cell proliferation in an IL-10–dependent fashion, and they required strong T cell receptor stimulation for suppression. To our knowledge, this is the first report that identifies Tr1-like cells in human blood. These IL-10–secreting cells have characteristics of chronically activated Th1 effector cells and are distinct from CD25+ T reg cells
Utilizarea medierii transformative în aplanarea conflictului medic − pacient (studiu de caz)
Atelier de lucru al Asociaţiei Latine pentru Analiza Sistemelor de Sănătate (ALASS) cu tema: „Malpraxis medical: actualităţi şi perspective”, organizat de Asociaţia Economie, Management şi Psihologie în Medicină din Republica Moldova, membru instituţional, 29 iunie 2012, Chișinău, Republica MoldovaSummary.
Using transformative mediation in settling
the confl ict between doctors and patients
(case study).
Transformative mediation has been adapted
(by Me.Dia.Re association) and experienced
for the fi rst time in the Italian healthcare
sector in 2005. Since then it has been
proposed and applied in selected cases in
most public healthcare structures in northern
Italy, to prevent and reduce litigation.
Transformative mediation (not mandatory)
encourages each party to understand the
needs, interests and views of the opposite
party, aiming to transform relations between
the parties. Thus it contributes to reduce
litigation. In this article, the mediation team
of the National Institute of Cancer in Milan
describes and illustrates the transformative
mediation tool, through two real cases from
the experience of the Mediation Service,
created in 2010.Rezumat.
Utilizarea medierii transformative în
aplanarea conflictului medic – pacient
(studiu de caz).
Medierea transformativă a fost adaptată (de
către asociaţia Me.Dia.Re) şi experimentată
pentru prima dată în sectorul sanitar italian
în 2005. De atunci a fost propusă şi
aplicată, în cazuri atent selecţionate, pentru
prevenirea şi reducerea contenciosului în
majoritatea structurilor sanitare publice
din nordul Italiei. Medierea transformativă
(care nu este obligatorie) încurajează fi ecare
parte să înţeleagă nevoile, interesele şi
punctele de vedere ale părţii opuse, având
scopul de a transforma relaţiile dintre părţi.
În acest fel, ea contribuie la reducerea
contenciosului. În acest articol, echipa de
mediatori a Institutului Naţional de Tumori
din Milano descrie şi ilustrează metoda
medierii transformative, cu ajutorul a două
cazuri concrete din experienţa Serviciului de
Mediere, creat în 2010
Mycobacterium tuberculosis Invasion of the Human Lung: First Contact
Early immune responses to Mycobacterium tuberculosis (Mtb) invasion of the human lung play a decisive role in the outcome of infection, leading to either rapid clearance of the pathogen or stable infection. Despite their critical impact on health and disease, these early host–pathogen interactions at the primary site of infection are still poorly understood. In vitro studies cannot fully reflect the complexity of the lung architecture and its impact on host–pathogen interactions, while animal models have their own limitations. In this study, we have investigated the initial responses in human lung tissue explants to Mtb infection, focusing primarily on gene expression patterns in different tissue-resident cell types. As first cell types confronted with pathogens invading the lung, alveolar macrophages, and epithelial cells displayed rapid proinflammatory chemokine and cytokine responses to Mtb infection. Other tissue-resident innate cells like gamma/delta T cells, mucosal associated invariant T cells, and natural killer cells showed partially similar but weaker responses, with a high degree of variability across different donors. Finally, we investigated the responses of tissue-resident innate lymphoid cells to the inflammatory milieu induced by Mtb infection. Our infection model provides a unique approach toward host–pathogen interactions at the natural port of Mtb entry and site of its implantation, i.e., the human lung. Our data provide a first detailed insight into the early responses of different relevant pulmonary cells in the alveolar microenvironment to contact with Mtb. These results can form the basis for the identification of host markers that orchestrate early host defense and provide resistance or susceptibility to stable Mtb infection
Muscle quantitative MRI as a novel biomarker in hereditary transthyretin amyloidosis with polyneuropathy: a cross-sectional study
BACKGROUND:
The development of reproducible and sensitive outcome measures has been challenging in hereditary transthyretin (ATTRv) amyloidosis. Recently, quantification of intramuscular fat by magnetic resonance imaging (MRI) has proven as a sensitive marker in patients with other genetic neuropathies. The aim of this study was to investigate the role of muscle quantitative MRI (qMRI) as an outcome measure in ATTRv.
METHODS:
Calf- and thigh-centered multi-echo T2-weighted spin-echo and gradient-echo sequences were obtained in patients with ATTRv amyloidosis with polyneuropathy (n = 24) and healthy controls (n = 12). Water T2 (wT2) and fat fraction (FF) were calculated. Neurological assessment was performed in all ATTRv subjects. Quantitative MRI parameters were correlated with clinical and neurophysiological measures of disease severity.
RESULTS:
Quantitative imaging revealed significantly higher FF in lower limb muscles in patients with ATTRv amyloidosis compared to controls. In addition, wT2 was significantly higher in ATTRv patients. There was prominent involvement of the posterior compartment of the thighs. Noticeably, FF and wT2 did not exhibit a length-dependent pattern in ATTRv patients. MRI biomarkers correlated with previously validated clinical outcome measures, Polyneuropathy Disability scoring system, Neuropathy Impairment Score (NIS) and NIS-lower limb, and neurophysiological parameters of axonal damage regardless of age, sex, treatment and TTR mutation.
CONCLUSIONS:
Muscle qMRI revealed significant difference between ATTRv and healthy controls. MRI biomarkers showed high correlation with clinical and neurophysiological measures of disease severity making qMRI as a promising tool to be further investigated in longitudinal studies to assess its role at monitoring onset, progression, and therapy efficacy for future clinical trials on this treatable condition
CCR6 is expressed on an IL-10-producing, autoreactive memory T cell population with context-dependent regulatory function
Interleukin (IL)-10 produced by regulatory T cell subsets is important for the prevention of autoimmunity and immunopathology, but little is known about the phenotype and function of IL-10–producing memory T cells. Human CD4+CCR6+ memory T cells contained comparable numbers of IL-17– and IL-10–producing cells, and CCR6 was induced under both Th17-promoting conditions and upon tolerogenic T cell priming with transforming growth factor (TGF)–. In normal human spleens, the majority of CCR6+ memory T cells were in the close vicinity of CCR6+ myeloid dendritic cells (mDCs), and strikingly, some of them were secreting IL-10 in situ. Furthermore, CCR6+ memory T cells produced suppressive IL-10 but not IL-2 upon stimulation with autologous immature mDCs ex vivo, and secreted IL-10 efficiently in response to suboptimal T cell receptor (TCR) stimulation with anti-CD3 antibodies. However, optimal TCR stimulation of CCR6+ T cells induced expression of IL-2, interferon-, CCL20, and CD40L, and autoreactive CCR6+ T cell lines responded to various recall antigens. Notably, we isolated autoreactive CCR6+ T cell clones with context-dependent behavior that produced IL-10 with autologous mDCs alone, but that secreted IL-2 and proliferated upon stimulation with tetanus toxoid. We propose the novel concept that a population of memory T cells, which is fully equipped to participate in secondary immune responses upon recognition of a relevant recall antigen, contributes to the maintenance of tolerance under steady-state conditions
Humanized Mouse Model Mimicking Pathology of Human Tuberculosis for in vivo Evaluation of Drug Regimens
Human immune system mice are highly valuable for in vivo dissection of human immune responses. Although they were employed for analyzing tuberculosis (TB) disease, there is little data on the spatial organization and cellular composition of human immune cells in TB granuloma pathology in this model. We demonstrate that human immune system mice, generated by transplanted human fetal liver derived hematopoietic stem cells develop a continuum of pulmonary lesions upon Mycobacterium tuberculosis aerosol infection. In particular, caseous necrotic granulomas, which contribute to prolonged TB treatment time, developed, and had cellular phenotypic spatial-organization similar to TB patients. By comparing two recommended drug regimens, we confirmed observations made in clinical settings: Adding Moxifloxacin to a classical chemotherapy regimen had no beneficial effects on bacterial eradication. We consider this model instrumental for deeper understanding of human specific features of TB pathogenesis and of particular value for the pre-clinical drug development pipeline
Human Monocytic Suppressive Cells Promote Replication of Mycobacterium tuberculosis and Alter Stability of in vitro Generated Granulomas
Tuberculosis (TB) has tremendous public health relevance. It most frequently affects the lung and is characterized by the development of unique tissue lesions, termed granulomas. These lesions encompass various immune populations, with macrophages being most extensively investigated. Myeloid derived suppressor cells (MDSCs) have been recently identified in TB patients, both in the circulation and at the site of infection, however their interactions with Mycobacterium tuberculosis (Mtb) and their impact on granulomas remain undefined. We generated human monocytic MDSCs and observed that their suppressive capacities are retained upon Mtb infection. We employed an in vitro granuloma model, which mimics human TB lesions to some extent, with the aim of analyzing the roles of MDSCs within granulomas. MDSCs altered the structure of and affected bacterial containment within granuloma-like structures. These effects were partly controlled through highly abundant secreted IL-10. Compared to macrophages, MDSCs activated primarily the NF-κB and MAPK pathways and the latter largely contributed to the release of IL-10 and replication of bacteria within in vitro generated granulomas. Moreover, MDSCs upregulated PD-L1 and suppressed proliferation of lymphocytes, albeit with negligible effects on Mtb replication. Further comprehensive characterization of MDSCs in TB will contribute to a better understanding of disease pathogenesis and facilitate the design of novel immune-based interventions for this deadly infection
CCR6 is expressed on an IL-10–producing, autoreactive memory T cell population with context-dependent regulatory function
Interleukin (IL)-10 produced by regulatory T cell subsets is important for the prevention of autoimmunity and immunopathology, but little is known about the phenotype and function of IL-10–producing memory T cells. Human CD4+CCR6+ memory T cells contained comparable numbers of IL-17– and IL-10–producing cells, and CCR6 was induced under both Th17-promoting conditions and upon tolerogenic T cell priming with transforming growth factor (TGF)–β. In normal human spleens, the majority of CCR6+ memory T cells were in the close vicinity of CCR6+ myeloid dendritic cells (mDCs), and strikingly, some of them were secreting IL-10 in situ. Furthermore, CCR6+ memory T cells produced suppressive IL-10 but not IL-2 upon stimulation with autologous immature mDCs ex vivo, and secreted IL-10 efficiently in response to suboptimal T cell receptor (TCR) stimulation with anti-CD3 antibodies. However, optimal TCR stimulation of CCR6+ T cells induced expression of IL-2, interferon-γ, CCL20, and CD40L, and autoreactive CCR6+ T cell lines responded to various recall antigens. Notably, we isolated autoreactive CCR6+ T cell clones with context-dependent behavior that produced IL-10 with autologous mDCs alone, but that secreted IL-2 and proliferated upon stimulation with tetanus toxoid. We propose the novel concept that a population of memory T cells, which is fully equipped to participate in secondary immune responses upon recognition of a relevant recall antigen, contributes to the maintenance of tolerance under steady-state conditions
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