Comparison of PREDICTS atherosclerosis biomarker changes after initiation of new treatments in patients with SLE

Objective Patients with SLE have an increased risk ofatherosclerosis (ATH) that is not adequately explainedby traditional risk factors. We previously described thePredictors of Risk for Elevated Flares, Damage Progression,and Increased Cardiovascular disease in PaTients withSLE (PREDICTS) atherosclerosis-risk panel, which includesproinflammatory HDL (piHDL), leptin, soluble tumournecrosis factor-like weak inducer of apoptosis (sTWEAK)and homocysteine, as well as age and diabetes. A highPREDICTS score confers 28-fold increased odds forfuture atherosclerosis in SLE. The aim of this study is todetermine whether PREDICTS biomarkers are modifiable bycommon lupus therapies.Methods This prospective observational study includedSLE subjects started on new lupus treatments. Leptin,sTWEAK, homocysteine and antioxidant function of HDLwere measured at baseline (prior to drug initiation), 6weeks and 12 weeks.Results 16 subjects started mycophenolate (MMF), 18azathioprine (AZA) and 25 hydroxychloroquine (HCQ).In MMF-treated subjects, HDL function progressivelyimproved from 2.23 ± 1.32 at baseline to 1.37±0.81at 6 weeks (p=0.02) and 0.93±0.54 at 12 weeks(p=0.009). sTWEAK levels also improved in MMF-treatedsubjects from 477.5±447.1 to 290.3±204.6 pg/mLafter 12 weeks (p=0.04), but leptin and homocysteinelevels were not significantly changed. In HCQ-treatedsubjects, only HDL function improved from 1.80±1.29 atbaseline to 1.03±0.74 after 12 weeks (p=0.05). Therewere no changes in the AZA group. MMF treatmentwas still associated with significant improvements inHDL function after accounting for potential confounderssuch as total prednisone dose and changes in diseaseactivity. Overall, the mean number of high-risk PREDICTSbiomarkers at week 12 significantly decreased in theentire group of patients started on a new lupus therapy(2.1±0.9 to 1.8±0.9, p=0.02) and in the MMF-treatedgroup (2.4±0.8 vs 1.8±0.9, p=0.003), but not in theAZA or HCQ groups. In multivariate analysis, the odds ofhaving a high PREDICTS atherosclerosis risk score at 12weeks were lower with MMF treatment (OR 0.002, 95%CI 0.000 to 0.55, p=0.03).Conclusions 12 weeks of MMF therapy improves theoverall PREDICTS atherosclerosis biomarker profile.Further studies will determine whether biomarkerchanges reflect decreases in future cardiovascularevents

High plasma leptin levels confer increased risk of atherosclerosis in women with systemic lupus erythematosus, and are associated with inflammatory oxidised lipids.

BackgroundPatients with systemic lupus erythematosus (SLE) are at increased risk of atherosclerosis, even after accounting for traditional risk factors. High levels of leptin and low levels of adiponectin are associated with both atherosclerosis and immunomodulatory functions in the general population.ObjectiveTo examine the association between these adipokines and subclinical atherosclerosis in SLE, and also with other known inflammatory biomarkers of atherosclerosis.MethodsCarotid ultrasonography was performed in 250 women with SLE and 122 controls. Plasma leptin and adiponectin levels were measured. Lipoprotein a (Lp(a)), oxidised phospholipids on apoB100 (OxPL/apoB100), paraoxonase, apoA-1 and inflammatory high-density lipoprotein (HDL) function were also assessed.ResultsLeptin levels were significantly higher in patients with SLE than in controls (23.7±28.0 vs 13.3±12.9 ng/ml, p<0.001). Leptin was also higher in the 43 patients with SLE with plaque than without plaque (36.4±32.3 vs 20.9±26.4 ng/ml, p=0.002). After multivariate analysis, the only significant factors associated with plaque in SLE were leptin levels in the highest quartile (≥29.5 ng/ml) (OR=2.8, p=0.03), proinflammatory HDL (piHDL) (OR=12.8, p<0.001), age (OR=1.1, p<0.001), tobacco use (OR=7.7, p=0.03) and hypertension (OR=3.0, p=0.01). Adiponectin levels were not significantly associated with plaque in our cohort. A significant correlation between leptin and piHDL function (p<0.001), Lp(a) (p=0.01) and OxPL/apoB100 (p=0.02) was also present.ConclusionsHigh leptin levels greatly increase the risk of subclinical atherosclerosis in SLE, and are also associated with an increase in inflammatory biomarkers of atherosclerosis such as piHDL, Lp(a) and OxPL/apoB100. High leptin levels may help to identify patients with SLE at risk of atherosclerosis

PenQuest Volume 4, Number 1

Table of Contents for this Volume: Poetry by Brad Ross Untitled by Bruce Abbey it\u27s back by Leslie M. Brown De-thinging the Thingumbob by Michael R. McMahon Untitled by Mark Davis Fractures by Peggy De Broux Until I Knew by Lori Loper Untitled by Mark Davis The Local Art of Darkness by Michael R. McMahon Home by Peggy de Broux Untitled by Bruce Abbey Hooked by Robert M. Hart Parable of the Balloon (Demonstrated by the Poet to his Dog) by Michael R. McMahon Flight by Brad Ross The Stucco Room by Peggy de Broux Growing Up In America by E. R. Sukovich I Hear Them Scratching by Brad Ross It\u27s In The Bag by Susan Torode Untitled by Mark Davis Lawrence at Seventeen Coming Home by Brad Ross Untitled by Brad Ross Jere\u27s Antiques by Susan Torode Untitled by Bruce Abbey Simpson\u27s, for lunch, of course by Joni E. Dooley Untitled by Mark Davis Moments For an autobiography by Jocelyn W. Griffo Untitled by Bruce Abbe

Six2 and Wnt Regulate Self-Renewal and Commitment of Nephron Progenitors through Shared Gene Regulatory Networks

A balance between Six2-dependent self-renewal and canonical Wnt signaling-directed commitment regulates mammalian nephrogenesis. Intersectional studies using chromatin immunoprecipitation and transcriptional profiling identified direct target genes shared by each pathway within nephron progenitors. Wnt4 and Fgf8 are essential for progenitor commitment; cis-regulatory modules flanking each gene are co-bound by Six2 and β-catenin, and dependent on conserved Lef/Tcf binding sites for activity. In vitro and in vivo analyses suggest that Six2 and Lef/Tcf factors form a regulatory complex that promotes progenitor maintenance while entry of β-catenin into this complex promotes nephrogenesis. Alternative transcriptional responses associated with Six2 and β-catenin co-binding events occur through non-Lef/Tcf DNA binding mechanisms highlighting the regulatory complexity downstream of Wnt signaling in the developing mammalian kidney

Transcriptional regulatory control of mammalian nephron progenitors revealed by multi-factor cistromic analysis and genetic studies

Nephron progenitor number determines nephron endowment; a reduced nephron count is linked to the onset of kidney disease. Several transcriptional regulators including Six2, Wt1, Osr1, Sall1, Eya1, Pax2, and Hox11 paralogues are required for specification and/or maintenance of nephron progenitors. However, little is known about the regulatory intersection of these players. Here, we have mapped nephron progenitor-specific transcriptional networks of Six2, Hoxd11, Osr1, and Wt1. We identified 373 multi-factor associated ‘regulatory hotspots’ around genes closely associated with progenitor programs. To examine their functional significance, we deleted ‘hotspot’ enhancer elements for Six2 and Wnt4. Removal of the distal enhancer for Six2 leads to a ~40% reduction in Six2 expression. When combined with a Six2 null allele, progeny display a premature depletion of nephron progenitors. Loss of the Wnt4 enhancer led to a significant reduction of Wnt4 expression in renal vesicles and a mildly hypoplastic kidney, a phenotype also enhanced in combination with a Wnt4 null mutation. To explore the regulatory landscape that supports proper target gene expression, we performed CTCF ChIP-seq to identify insulator-boundary regions. One such putative boundary lies between the Six2 and Six3 loci. Evidence for the functional significance of this boundary was obtained by deep sequencing of the radiation-induced Brachyrrhine (Br) mutant allele. We identified an inversion of the Six2/Six3 locus around the CTCF-bound boundary, removing Six2 from its distal enhancer regulation, but placed next to Six3 enhancer elements which support ectopic Six2 expression in the lens where Six3 is normally expressed. Six3 is now predicted to fall under control of the Six2 distal enhancer. Consistent with this view, we observed ectopic Six3 in nephron progenitors. 4C-seq supports the model for Six2 distal enhancer interactions in wild-type and Br/+ mouse kidneys. Together, these data expand our view of the regulatory genome and regulatory landscape underpinning mammalian nephrogenesis

Transcriptional regulatory control of mammalian nephron progenitors revealed by multi-factor cistromic analysis and genetic studies.

Nephron progenitor number determines nephron endowment; a reduced nephron count is linked to the onset of kidney disease. Several transcriptional regulators including Six2, Wt1, Osr1, Sall1, Eya1, Pax2, and Hox11 paralogues are required for specification and/or maintenance of nephron progenitors. However, little is known about the regulatory intersection of these players. Here, we have mapped nephron progenitor-specific transcriptional networks of Six2, Hoxd11, Osr1, and Wt1. We identified 373 multi-factor associated \u27regulatory hotspots\u27 around genes closely associated with progenitor programs. To examine their functional significance, we deleted \u27hotspot\u27 enhancer elements for Six2 and Wnt4. Removal of the distal enhancer for Six2 leads to a ~40% reduction in Six2 expression. When combined with a Six2 null allele, progeny display a premature depletion of nephron progenitors. Loss of the Wnt4 enhancer led to a significant reduction of Wnt4 expression in renal vesicles and a mildly hypoplastic kidney, a phenotype also enhanced in combination with a Wnt4 null mutation. To explore the regulatory landscape that supports proper target gene expression, we performed CTCF ChIP-seq to identify insulator-boundary regions. One such putative boundary lies between the Six2 and Six3 loci. Evidence for the functional significance of this boundary was obtained by deep sequencing of the radiation-induced Brachyrrhine (Br) mutant allele. We identified an inversion of the Six2/Six3 locus around the CTCF-bound boundary, removing Six2 from its distal enhancer regulation, but placed next to Six3 enhancer elements which support ectopic Six2 expression in the lens where Six3 is normally expressed. Six3 is now predicted to fall under control of the Six2 distal enhancer. Consistent with this view, we observed ectopic Six3 in nephron progenitors. 4C-seq supports the model for Six2 distal enhancer interactions in wild-type and Br/+ mouse kidneys. Together, these data expand our view of the regulatory genome and regulatory landscape underpinning mammalian nephrogenesis

Radio Astronomy

Contains table of contents for Section 4 and reports on ten research projects.National Science Foundation Grant AST 90-22501Alfred P. Sloan FellowshipDavid and Lucile Packard Fellowship Award for Science and EngineeringNational Aeronautics and Space AdministrationNational Science Foundation Presidential Young Investigator AwardNational Aeronautics and Space Administration Grant NAGW-2310MIT Lincoln Laboratory Agreement BX-4975National Aeronautics and Space Administration/Goddard Space Flight Center Contract NAS 5-31276MIT Leaders for Manufacturing Progra

Radio Astronomy

Contains table of contents for Section 4 and reports on ten research projects.National Science Foundation Grant AST 90-22501National Aeronautics and Space Administration Grant NAGW 1386National Science Foundation Presidential Young Investigator AwardDavid and Lucile Packard Fellowship for Science and EngineeringNational Aeronautics and Space Administration Grant NAGW-2310MIT Lincoln LaboratorySM Systems and Research CorporationNational Aeronautics and Space Administration/Goddard Space Flight Center Contract NAS 5-30791National Aeronautics and Space Administration/Goddard Space Flight Center Grant NAG 5-10MIT Leaders for Manufacturing Progra

Single DermaVir Immunization: Dose-Dependent Expansion of Precursor/Memory T Cells against All HIV Antigens in HIV-1 Infected Individuals

BACKGROUND: The GIHU004 study was designed to evaluate the safety and immunogenicity of three doses of DermaVir immunization in HIV-infected subjects on fully suppressive combination antiretroviral therapy (cART). METHODOLOGY/PRINCIPAL FINDINGS: This first-in-human dose escalation study was conducted with three topical DermaVir doses targeted to epidermal Langerhans cells to express fifteen HIV antigens in draining lymph nodes: 0.1 mg DNA targeted to two, 0.4 mg and 0.8 mg DNA targeted to four lymph nodes. Particularly, in the medium dose cohort 0.1 mg DNA was targeted per draining lymph node via ∼8 million Langerhans cells located in 80 cm(2) epidermis area. The 28-days study with 48-week safety follow-up evaluated HIV-specific T cell responses against Gag p17, Gag p24 and Gag p15, Tat and Rev antigens. DermaVir-associated side effects were mild, transient and not dose-dependent. Boosting of HIV-specific effector CD4(+) and CD8(+) T cells expressing IFN-gamma and IL-2 was detected against several antigens in every subject of the medium dose cohort. The striking result was the dose-dependent expansion of HIV-specific precursor/memory T cells with high proliferation capacity. In low, medium and high dose cohorts this HIV-specific T cell population increased by 325-, 136,202 and 50,759 counts after 4 weeks, and by 3,899, 9,878 and 18,382 counts after one year, respectively, compared to baseline. CONCLUSIONS/SIGNIFICANCE: Single immunization with the DermaVir candidate therapeutic vaccine was safe and immunogenic in HIV-infected individuals. Based on the potent induction of Gag, Tat and Rev-specific memory T cells, especially in the medium dose cohort, we speculate that DermaVir boost T cell responses specific to all the 15 HIV antigens expressed from the single DNA. For durable immune reactivity repeated DermaVir immunization might be required since the frequency of DermaVir-boosted HIV-specific memory T cells decreased during the 48-week follow up. TRIAL REGISTRATION: ClinicalTrial.gov NCT00712530