Systems-level analysis of age-related macular degeneration reveals global biomarkers and phenotype-specific functional networks

Abstract Background Age-related macular degeneration (AMD) is a leading cause of blindness that affects the central region of the retinal pigmented epithelium (RPE), choroid, and neural retina. Initially characterized by an accumulation of sub-RPE deposits, AMD leads to progressive retinal degeneration, and in advanced cases, irreversible vision loss. Although genetic analysis, animal models, and cell culture systems have yielded important insights into AMD, the molecular pathways underlying AMD's onset and progression remain poorly delineated. We sought to better understand the molecular underpinnings of this devastating disease by performing the first comparative transcriptome analysis of AMD and normal human donor eyes. Methods RPE-choroid and retina tissue samples were obtained from a common cohort of 31 normal, 26 AMD, and 11 potential pre-AMD human donor eyes. Transcriptome profiles were generated for macular and extramacular regions, and statistical and bioinformatic methods were employed to identify disease-associated gene signatures and functionally enriched protein association networks. Selected genes of high significance were validated using an independent donor cohort. Results We identified over 50 annotated genes enriched in cell-mediated immune responses that are globally over-expressed in RPE-choroid AMD phenotypes. Using a machine learning model and a second donor cohort, we show that the top 20 global genes are predictive of AMD clinical diagnosis. We also discovered functionally enriched gene sets in the RPE-choroid that delineate the advanced AMD phenotypes, neovascular AMD and geographic atrophy. Moreover, we identified a graded increase of transcript levels in the retina related to wound response, complement cascade, and neurogenesis that strongly correlates with decreased levels of phototransduction transcripts and increased AMD severity. Based on our findings, we assembled protein-protein interactomes that highlight functional networks likely to be involved in AMD pathogenesis. Conclusions We discovered new global biomarkers and gene expression signatures of AMD. These results are consistent with a model whereby cell-based inflammatory responses represent a central feature of AMD etiology, and depending on genetics, environment, or stochastic factors, may give rise to the advanced AMD phenotypes characterized by angiogenesis and/or cell death. Genes regulating these immunological activities, along with numerous other genes identified here, represent promising new targets for AMD-directed therapeutics and diagnostics. Please see related commentary: http://www.biomedcentral.com/1741-7015/10/21/abstrac

Introducing clinical supervision in a rural health care organisation : an Australian experience

This chapter features a summary of the process of implementing clinical supervision in an Australian rural healthcare organisation. After describing the method for the study, the five key categories or stages of the implementation process are outlined. Following this the Lynch Model of the implementation of clinical supervision is described according to its six main steps

The state of the science of clinical supervision in Australia and New Zealand

Clinical supervision (CS) for nurses in Australia and New Zealand in many ways has mirrored the experience of our nursing colleagues in the United Kingdom. Synergies can be found in the literature, in policy statements from the Departments of Health, nursing boards, peak professional and industrial bodies, from individual organisations and nurses' lived experience. Our struggles to universally define, implement and evaluate CS are not unique; similar struggles have been identified throughout the world - CS for nurses remains a global challeng (Lynch and Happell 2008; White and Winstanley 2009

An evaluation of an educational program for clinical supervision

Clinical supervision for mental health nurses has become an area of priority since the implementation of the Enterprise Bargaining Agreement of August 2000 in Victoria. Clinical supervision has been identified as a strategy to improve both the job satisfaction of nurses and the quality of care provided to consumers. A review of the literature suggests that adequate education for supervisors is crucial if this strategy is to prove successful. In response to this identified need, the Centre for Psychiatric Nursing Research and Practice developed the ‘Clinical Supervision for Health Professionals’ program. The evaluation of participants from the first 2 years of the program (n = 63) are mentioned here. The findings suggest a high level of satisfaction with the education provided and that it has been successful in improving participants’ attitudes towards, and level of confidence in providing, clinical supervision

Cryopreservation of Plasmodium Sporozoites

Malaria is a deadly disease caused by the parasite, Plasmodium, and impacts the lives of millions of people around the world. Following inoculation into mammalian hosts by infected mosquitoes, the sporozoite stage of Plasmodium undergoes obligate development in the liver before infecting erythrocytes and causing clinical malaria. The most promising vaccine candidates for malaria rely on the use of attenuated live sporozoites to induce protective immune responses. The scope of widespread testing or clinical use of such vaccines is limited by the absence of efficient, reliable, or transparent strategies for the long-term preservation of live sporozoites. Here we outline a method to cryopreserve the sporozoites of various human and murine Plasmodium species. We found that the structural integrity, viability, and in vivo or in vitro infectiousness were conserved in the recovered cryopreserved sporozoites. Cryopreservation using our approach also retained the transgenic properties of sporozoites and immunization with cryopreserved radiation attenuated sporozoites (RAS) elicited strong immune responses. Our work offers a reliable protocol for the long-term storage and recovery of human and murine Plasmodium sporozoites and lays the groundwork for the widespread use of live sporozoites for research and clinical applications

FimW Is a Negative Regulator Affecting Type 1 Fimbrial Expression in Salmonella enterica Serovar Typhimurium

Type 1 fimbriae are proteinaceous surface appendages that carry adhesins specific for mannosylated glycoproteins. These fimbriae are found on most members of the family Enterobacteriaceae and are known to facilitate binding to a variety of eukaryotic cells, including those found on the mucosal surfaces of the alimentary tract. We have shown that the regulation of type 1 fimbrial expression in Salmonella enterica serovar Typhimurium is controlled, in part, by the products of four genes found within the fim gene cluster: fimZ, fimY, fimW, and fimU. To better understand the specific role of FimW in fimbrial expression, a mutation was constructed in this gene by the insertion of a kanamycin resistance DNA cassette into the chromosome. The resulting fimW mutation was characterized by mannose-sensitive hemagglutination and agglutination with fimbria-specific antiserum. Assays suggested that this mutant was more strongly fimbriate than the parental strain, exhibiting a four- to eightfold increase in fimbrial production. The fimW mutation was introduced into a second strain of Salmonella enterica serovar Typhimurium, and this mutant was also found to be strongly fimbriate compared to the parental strain. Consistent with the role of this protein as a negative regulator, fimA-lacZ expression in serovar Typhimurium, as well as in Escherichia coli, was increased twofold in the absence of functional FimW. Primer extension analysis determined that fimW transcription is initiated from its own promoter 31 bp upstream of the translation start site. Analysis using a fimW-lacZ reporter indicated that fimW expression in serovar Typhimurium was increased under conditions that select for poorly fimbriate bacteria and low fimA expression. FimW also appears to act as an autoregulator, since expression from the fimW-lacZ reporter was increased in a fimW mutant. FimW was partially purified by fusion with the E. coli maltose-binding protein. Use of this FimW protein extract, as well as others, in DNA-binding assays was unable to identify a specific binding site for FimW in the fimA, fimZ, fimY, or fimW promoter regions. To analyze protein-protein interactions, FimW was expressed in a LexA-based two-hybrid system in E. coli. A significant interaction between FimW and the DNA-binding activator protein, FimZ, was detected using this system. These results indicate that FimW is a negative regulator of serovar Typhimurium type 1 fimbrial expression and may function by interfering with FimZ-mediated activation of fimA expression

Kinetics of vaccine-specific IgG levels in children during the dry season and after acute malaria.

<p><b>(A)</b> The study was designed to take advantage of the sharply demarcated and intense 6-month malaria season (July—December) and 6-month dry season (January—June; negligible malaria transmission) in Mali. Shown is the number of febrile malaria episodes per day over two years at the study site in a cohort of 695 children and adults. <b>(B)</b> IgG levels specific for routine vaccines administered under one year of age (tetanus, measles and Hepatitis B) were measured in plasma collected from 54 children at four time points (vertical arrows): before and after the 6-month dry season, 10 days after the first acute malaria episode of the ensuing malaria season, and after the second dry season. Shown for each subject are IgG titers specific for <b>(C)</b> tetanus, <b>(D)</b> measles and <b>(E)</b> hepatitis B vaccines at the time points indicated in <b>(B)</b>. The x-axis indicates the age at which the respective time points occurred for each subject. In red are subjects who experienced an accelerated decline in vaccine-specific IgG titers following acute malaria (between 2^nd and 3^rd time points) relative to each child’s own rate of change during the preceding dry season (between 1^st and 2^nd time points). The percentage of subjects for whom malaria was associated with an accelerated decline in IgG is shown in red text for each vaccine. A linear mixed effects model that included three time points over 18 months (before and after the first dry season, and after the second dry season) was used to estimate average IgG half-lives for all subjects (black dashed line) and separately for children aged ≤3 years (green dotted line) and >3 years of age (blue dash-dot line).</p