UNRAVELLING THE MOLECULAR SIGNALLING REGULATING EMBRYONIC AND FETAL MYOGENESIS: THE ROLE OF NFIX AS ¿MASTER¿ GENE IN REGULATING FETAL GENETIC PROGRAM

Skeletal muscle development occurs through successive developmental phases, named embryonic and fetal myogenesis, involving the differentiation of distinct myogenic populations: the embryonic and fetal myoblasts. An important work developed in 2007 identified specific features of embryonic and fetal myoblasts, demonstrating that these two populations of muscle progenitors represent intrinsically different myogenic lineages. The identification of the transcriptional factor Nfix was the major step in understanding how muscle progenitor fate decisions are mediated. Nfix, expressed in fetal but not in embryonic muscles, is necessary for the acquisition of fetal myogenic identity, activating fetal-specific genes and repressing the expression of embryonic one, such as slow myosin heavy chain (MyHC-I). Another repressor of MyHC-I, during fetal myogenesis, is the transcription factor Sox6, which inhibits MyHC-I by direct binding to the proximal promoter of MyHC-I gene. Interestingly, Sox6 at variance with Nfix is also expressed during embryonic myogenesis, when embryonic myoblasts form fibers that express high level of MyHC-I. We demonstrated that Sox6 has opposite roles in regulating MyHC-I expression between embryonic and fetal myogenesis. Specifically, during embryonic myogenesis, Sox6 indirectly promotes MyHC-I expression via transcriptional activation of Mef2C. On the contrary, during fetal myogenesis, Nfix allows the proper binding of Sox6 to the MyHC-I promoter with the consequent repression of MyHC-I expression. In addition, we provide evidence that the functional interplay of Nfix and Sox6 is conserved also in zebrafish. Although Nfix functions were partially characterized, nowadays the mechanisms that regulate its expression during fetal myogenesis are still unknown. Another transcription factor more expressed during fetal myogenesis is JunB. We assessed that JunB is required and sufficient to induce the expression of Nfix, acting as direct activator of it. To better elucidate this pathway, we started to study the possible involvement of RhoA and its major kinase ROCK, since growing investigations have shown that RhoA/ROCK regulate skeletal muscle differentiation. We demonstrated that RhoA/ROCK are active only during embryonic myogenesis and their inhibition in embryonic myoblasts increased the expression of both Nfix and JunB. The interference with the RhoA/ROCK signalling led also to the increased activation of the ERK kinases, which we show are necessary for Nfix and JunB up-regulation. In summary, we have identified the RhoA/ROCK axis as an important negative regulator of JunB and Nfix expression during embryonic myogenesis, through the inhibition of ERK activity. Conversely, during fetal myogenesis, the ERK kinases are active and allow JunB and Nfix expression. Finally, Nfix is sufficient to activate the fetal genetic program and to permit the complete maturation of prenatal skeletal muscles

Deep inferior epigastric artery perforated rectus abdominis free flap for head and neck reconstruction.

4noopennoneCappiello J; Piazza C; Taglietti V; Nicolai P.Cappiello, Johnny; Piazza, Cesare; Taglietti, V; Nicolai, Pier

Lessons from in vitro perifusion of pancreatic islets isolated from 80 human pancreases.

We report the average insulin response to acute glucose measured by in vitro perifusion of pancreatic islets isolated from 80 consecutive human organs. Different perifusion parameters were considered [basal release, stimulation index (SI), time to peak, incremental area under the curve Δ-AUCa)], and the correlation among them was determined. SI positively correlated with Δ-AUCa (p < 0.001, r = 0.80) while negatively with time to peak (p < 0.05, r = −0.23). We also evaluated several variables of the isolation procedure that might affect responsiveness to glucose by human islets. Sex and age of pancreas donors, cold ischemia time, duration of the digestion, collagenase concentration, and lot characteristics (collagenase, trypsin, clostripain, and proteases activity), and final islet yield were considered. Multivariate regression analysis showed only an independent association between SI and the concentration of collagenase (p = 0.01)

Evaluation of BAFF, APRIL and CD40L in ocrelizumab-treated pwMS and infectious risk

Simple Summary Since B cells have been linked to multiple sclerosis (MS) and its progression as well as T cells, the second-generation anti-CD20 recombinant humanized monoclonal antibody ocrelizumab has been approved for MS treatment. Although ocrelizumab efficiently depletes B cells in peripheral blood, some B cells and CD20 negative plasma cells persist in lymphatic organs, and their survival is regulated by the B-cell-activating factor (BAFF)/a proliferation-inducing ligand (APRIL) system. Moreover, ocrelizumab may result in higher infectious risk. Herein, we investigated plasma BAFF, APRIL and CD40L levels and their relationship with infectious risk in ocrelizumab-treated people with (pw) MS at baseline, at 6 months and at 12 months after starting the treatment, comparing the above-mentioned findings with a control group. At baseline, plasma levels of all three cytokines were higher compared to the control group. In pwMS, the longitudinal assessment showed a significant increase in plasma BAFF levels and a significant reduction in plasma APRIL and CD40L. Moreover, when stratifying pwMS according to the onset of an infectious event during the 12-month follow-up period, significantly higher plasma BAFF levels were found at all time-points in the group with an infectious event than in the group without an infectious event. Hence, BAFF may have a role as a marker of immune dysfunction and infectious risk. Background: The anti-CD20 monoclonal antibody ocrelizumab has been widely employed in the treatment of people with multiple sclerosis (pwMS). However, its B-cell-depleting effect may induce a higher risk of infectious events and alterations in the secretion of B-cell-activating factors, such as BAFF, APRIL and CD40L. Methods: The aim of this study was to investigate plasma BAFF, APRIL and CD40L levels and their relationship with infectious risk in ocrelizumab-treated pwMS at baseline (T0), at 6 months (T6) and at 12 months (T12) after starting the treatment. As a control group, healthy donors (HD) were enrolled too. Results: A total of 38 pwMS and 26 HD were enrolled. At baseline, pwMS showed higher plasma BAFF (p &lt; 0.0001), APRIL (p = 0.0223) and CD40L (p &lt; 0.0001) levels compared to HD. Compared to T0, plasma BAFF levels were significantly increased at both T6 and T12 (p &lt; 0.0001 and p &lt; 0.0001, respectively). Whereas plasma APRIL and CD40L levels were decreased at T12 (p = 0.0003 and p &lt; 0.0001, respectively). When stratifying pwMS according to the development of an infectious event during the 12-month follow-up period in two groups-with (14) and without an infectious event (24)-higher plasma BAFF levels were observed at all time-points; significantly, in the group with an infectious event compared to the group without an infectious event (T0: p &lt; 0.0001, T6: p = 0.0056 and T12: p = 0.0400). Conclusions: BAFF may have a role as a marker of immune dysfunction and of infectious risk

Silencing Nfix rescues muscular dystrophy by delaying muscle regeneration

Muscular dystrophies are severe disorders due to mutations in structural genes, and are characterized by skeletal muscle wasting, compromised patient mobility, and respiratory functions. Although previous works suggested enhancing regeneration and muscle mass as therapeutic strategies, these led to no long-term benefits in humans. Mice lacking the transcription factor Nfix have delayed regeneration and a shift toward an oxidative fiber type. Here, we show that ablating or silencing the transcription factor Nfix ameliorates pathology in several forms of muscular dystrophy. Silencing Nfix in postnatal dystrophic mice, when the first signs of the disease already occurred, rescues the pathology and, conversely, Nfix overexpression in dystrophic muscles increases regeneration and markedly exacerbates the pathology. We therefore offer a proof of principle for a novel therapeutic approach for muscular dystrophies based on delaying muscle regeneration

Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia

Prophylactic low molecular weight heparin (pLMWH) is currently recommended in COVID-19 to reduce the risk of coagulopathy. The aim of this study was to evaluate whether the antinflammatory effects of pLMWH could translate in lower rate of clinical progression in patients with COVID-19 pneumonia. Patients admitted to a COVID-hospital in Rome with SARS-CoV-2 infection and mild/moderate pneumonia were retrospectively evaluated. The primary endpoint was the time from hospital admission to orotracheal intubation/death (OTI/death). A total of 449 patients were included: 39% female, median age 63 (IQR, 50–77) years. The estimated probability of OTI/death for patients receiving pLMWH was: 9.5% (95% CI 3.2–26.4) by day 20 in those not receiving pLMWH vs. 10.4% (6.7–15.9) in those exposed to pLMWH; p-value = 0.144. This risk associated with the use of pLMWH appeared to vary by PaO_{2}/FiO_{2} ratio aHR 1.40 (95% CI 0.51–3.79) for patients with an admission PaO_{2}/FiO_{2} ≤ 300 mmHg and 0.27 (0.03–2.18) for those with PaO_{2}/FiO_{2} > 300 mmHg; p-value at interaction test 0.16. pLMWH does not seem to reduce the risk of OTI/death mild/moderate COVID-19 pneumonia, especially when respiratory function had already significantly deteriorated. Data from clinical trials comparing the effect of prophylactic vs. therapeutic dosage of LMWH at various stages of COVID-19 disease are needed

No Efficacy of the Combination of Lopinavir/Ritonavir Plus Hydroxychloroquine Versus Standard of Care in Patients Hospitalized With COVID-19: A Non-Randomized Comparison

Objectives: No specific treatment has been approved for COVID-19. Lopinavir/ritonavir (LPV/r) and hydroxychloroquine (HCQ) have been used with poor results, and a trial showed advantages of combined antiviral therapy vs. single antivirals. The aim of the study was to assess the effectiveness of the combination of antivirals (LPV/r and HCQ) or their single use in COVID-19 hospitalized patients vs. standard of care (SoC). Methods: Patients ≥18 years with SARS-CoV-2 infection, defined as positive RT-PCR from nasal/oropharyngeal (NP/OP) swab or positive serology, admitted at L. Spallanzani Institute (Italy) were included. Primary endpoint: time to invasive ventilation/death. Secondary endpoint: time to two consecutive negative SARS-CoV-2 PCRs in NP/OP swabs. In order to control for measured confounders, a marginal Cox regression model with inverse probability weights was used. Results: A total of 590 patients were included in the analysis: 36.3% female, 64 years (IQR 51-76), and 91% with pneumonia. Cumulative probability of invasive ventilation/death at 14 days was 21.2% (95% CI 17.6, 24.7), without difference between SOC, LPV/r, hydroxychloroquine, HCQ + LPV/r, and SoC. The risk of invasive ventilation/death in the groups appeared to vary by baseline ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2). Overall cumulative probability of confirmed negative nasopharyngeal swabs at 14 days was 44.4% (95% CI 38.9, 49.9), without difference between groups. Conclusion: In this retrospective analysis, we found no difference in the rate of invasive ventilation/death or viral shedding by different strategies, as in randomized trials performed to date. Moreover, even the combination HCQ + LPV/r did not show advantages vs. SoC

Silver activation on thin films of Ag-ZrCN coatings for antimicrobial activity

Nowadays, with the increase of elderly population and related health problems, knee and hip joint prosthesis are being widely used worldwide. However, failure of these invasive devices occurs in a high percentage thus demanding the revision of the chirurgical procedure. Within the reasons of failure, microbial infections, either hospital or subsequently-acquired, contribute in high number to the statistics. Staphylococcus epidermidis (S. epidermidis) has emerged as one of the major nosocomial pathogens associated with these infections. Silver has a historic performance in medicine due to its potent antimicrobial activity, with a broad-spectrum on the activity of different types of microorganisms. Consequently, the main goal of this work was to produce Ag-ZrCN coatings with antimicrobial activity, for the surface modification of hip prostheses. Thin films of ZrCN with several silver concentrations were deposited onto stainless steel 316 L, by DC reactive magnetron sputtering, using two targets, Zr and Zr with silver pellets (Zr + Ag target), in an atmosphere containing Ar, C2H2 and N2. The antimicrobial activity of the modified surfaces was tested against S. epidermidis and the influence of an activation step of silver was assessed by testing samples after immersion in a 5 % (w/v) NaClO solution for 5 minutes. The activation procedure revealed to be essential for the antimicrobial activity, as observed by the presence of an inhibition halo on the surface with 11 at. % of Ag. The morphology analysis of the surface before and after the activation procedure revealed differences in silver distribution indicating segregation/diffusion of the metallic element to the films surface. Thus, the results indicate that the silver activation step is responsible for an antimicrobial effect of the coatings, due to silver oxidation and silver ion release.IF acknowledges the financial support of FCT-Fundacao para a Ciencia e a Tecnologia through grant SFRH/BD/71139/2010.This research is partially sponsored by FEDER funds through the program COMPETE-Programa Operacional Factores de Competitividade and by Portuguese national funds through FCT-Fundacao para a Ciencia e a Tecnologia, under the projects ANTIMICROBCOAT-PTDC/CTM/102853/2008 and in the framework of the Strategic Projects PEST-C/FIS/UI607/2011, and PEST-C/EME/UI0285/2011.The authors thank the FCT Strategic Project PEST-OE/EQB/LA0023/2013 and the Project "BioHealth-Biotechnology and Bioengineering approaches to improve health quality", Ref. NORTE-07-0124-FEDER-000027, co-funded by the Programa Operacional Regional do Norte (ON.2 - O Novo Norte), QREN, FEDER. The authors also acknowledge the project "Consolidating Research Expertise and Resources on Cellular and Molecular Biotechnology at CEB/IBB", Ref. FCOMP-01-0124-FEDER-027462

Sj\uf6gren's syndrome: state of the art on clinical practice guidelines

Sj\uf6gren's syndrome (SS) is a complex autoimmune rheumatic disease that specifically targets salivary and lachrymal glands. As such, patients typically had ocular and oral dryness and salivary gland swelling. Moreover, skin, nasal and vaginal dryness are frequently present. In addition to dryness, musculoskeletal pain and fatigue are the hallmarks of this disease and constitute the classic symptom triad presented by the vast majority of patients. Up to 30% to 50 % of patients with SS may present systemic disease; moreover, there is an increased risk for the development of non-Hodgkin's lymphoma that occurs in a minority of patients. The present work was developed in the framework of the European Reference Network (ERN) dedicated to Rare and Complex Connective Tissue and Musculoskeletal Diseases (ReCONNET). In line with its goals of aiming to improve early diagnosis, treatment and care of rare connective and musculoskeletal diseases, ERN-ReCONNET set to review the current state of clinical practice guidelines (CPGs) in the rare and complex connective tissue diseases of interest of the network. Therefore, the present work was aimed at providing a state of the art of CPGs for SS