Digesting gluten with oral endopeptidases to improve the management of celiac disease

In our editorial,we want to comment on the article by Stefanolo et al titled“Effect of Aspergillus niger prolyl endopeptidase in patients with celiac disease on a long-term gluten-free diet”.Celiac disease is an immune-mediated disorder triggered by dietary gluten in genetically predisposed individuals.Although avoiding gluten can permit patients to live symptom-free,ongoing voluntary or involuntary exposure to gluten is common and associated with persistent villous atrophy in small bowel mucosa.As villous atrophy predisposes patients to life threatening complications,such as osteoporotic fractures or malignancies,therapeutic adjuncts to gluten-free diet become important to improve patients’quality of life and,if these adjuncts can be shown to improve villous atrophy,avoid complications.Oral administration of enzyme preparations,such as endopeptidases that digest gluten and mitigate its antigenicity to trigger inflam-mation,is one clinical strategy under investigation.The article is about the utility of one endopeptidase isolated from Aspergillus niger.We critique findings of this clinical trial and also summarize endopeptidase-based as well as other strategies and how they can complement gluten-free diet in the management of celiac disease.

Endoscopic imaging of Barrett's esophagus

The incidence of esophageal adenocarcinoma (EAC) has dramatically increased in the United States as well as Western European countries. The majority of esophageal adenocarcinomas arise from a backdrop of Barrett’s esophagus (BE), a premalignant lesion that can lead to dysplasia and cancer. Because of the increased risk of EAC, GI society guidelines recommend endoscopic surveillance of patients with BE. The emphasis on early detection of dysplasia in BE through surveillance endoscopy has led to the development of advanced endoscopic imaging technologies. These techniques have the potential to both improve mucosal visualization and characterization and to detect small mucosal abnormalities which are difficult to identify with standard endoscopy. This review summarizes the advanced imaging technologies used in evaluation of BE.

Autophagy activation and the mechanism of retinal microvascular endothelial cells in hypoxia

AIM： To explore the state of autophagy and related mechanisms in the murine retinal microvascular endothelial cells（RMECs） under hypoxia stimulation.METHODS： The murine RMECs were primarily cultured and randomly divided into three groups： hypoxia group（cultured in 1% O_2 environment）, hypoxia＋autophagy inhibition group [pretreated with 5 mmol/L 3-methyladenine（3-MA） for 4 h followed by incubation in 1% O_2] and control group（cultured under normoxic condition）. The state of autophagy in RMECs was examined by assaying the turnover of light chain 3 B（LC3BB） and expression of Beclin-1, Atg3 and Atg5 proteins with Western blotting, by detecting formation of autophagosomes with transmission electron microscopy（TEM） and by counting the number of GFP＋ puncta in RMECs. The protein levels of AMPK, P-AMPK, Akt, P-Akt, m-TOR and P-m TOR were also assayed by Western blotting.RESULTS： Primary murine RMECs were successfully cultured. Under hypoxic conditions, the ratio of LC3BB-Ⅱ/Ⅰ and the expression of Beclin-1, Atg3 and Atg5 proteins were increased when compared with the control group. In addition, the numbers of autophagosome and the GFP＋ puncta were also increased under hypoxia. However, pretreatment with 3-MA obviously attenuated these changes in autophagy in RMECs under hypoxia. Protein expression of P-Akt and P-AMPK was increased but P-m TOR level was decreased in cells exposed to hypoxia. CONCLUSION： In murine RMECs autophagy is activated under hypoxia possibly through activation of the AMPK/mTOR signaling pathway.

Effects of lipid-lowering agents on diabetic retinopathy: a Meta-analysis and systematic review

AIM：To clarify this controversy and to provide evidence for application of lipid lowering agents in treatment of diabetic retinopathy（DR）.METHODS：We searched the databases of Pub Med,Embase and Cochrane Library Central Register of Controlled Trials（CENTRAL）and abstracts from main annual meetings up to January 1,2017.Google scholar and Clinical Trials.gov were also searched for unpublished relevant studies.We included randomized controlled trials（RCTs）that studied lipid-lowering agents in type 1 or type 2 diabetes in this Meta-analysis.The primary endpoint was the progression of DR,and the secondary endpoints included vision loss,development of diabetic macular edema（DME）and aggravation of hard exudates.The pooled odds ratios（OR）with corresponding 95%confidence intervals（95%CIs）were calculated.RESULTS：After systemic and manual literature search by two independent investigators,we included 8 RCTs from 7 published articles with 13 454 participants in this Meta-analysis.The results revealed that lipid-lowering drugs were associated with reduced risk in DR progression[OR=0.77（95%CI：0.62,0.96）,P=0.02].Lipid-lowering agents might have protective effect on DME compared to placebo,although the difference was not statistically significant[OR=0.60（95%CI：0.34,1.08）,P=0.09].However,no significant differences in the worsening of vision acuity[OR=0.96（95%CI：0.81,1.14）,P=0.64]and hard exudates[OR=0.50（95%CI：0.15,1.74）,P=0.28]were found between the lipidlowering drugs and the placebo groups.CONCLUSION：In DR patients,lipid-lowering agents show a protective effect on DR progression and might be associated with reduced risk in the development of DME.However,lipid-lowering agents have no effects on vision loss and hard exudates aggravation.Further clinical trials in larger scale are required to confirm the conclusion of this study and thus justify the use of intensive control lipids with anti-lipid agents at the early stages of DR.

Investigation of fundo-antral reflex in human beings

AIM： To examine the sensory and motor response（s） of the stomach following fundic distention and to assess whether cholinergic mechanisms influence these responses. METHODS： Fundic tone, gastric sensory responses and antral motility were evaluated in eight healthy volunteers after a probe with two sensors was placed in the antrum and a highly compliant balloon in the fundus. Isobaric balloon distentions were performed with a barostat. Study was repeated in six volunteers after intravenous atropine was given. RESULTS： Fundic antral contractions curve was higher First sensation distention induced large amplitude in all subjects. The area under the （P〈0.05） during fundic distention. was reported at 12±4 mmHg, moderate sensation at 18±4 mmHg and discomfort at 21±4 mmHg. Discomfort was associated with a decrease in antral motility. After atropine was given, the area under the curve of pressure waves and fundic tone decreased （P〈0.05）. Sensory thresholds were not affected. CONCLUSIONS： Fundic balloon distention induces an antral motor response, the fundo-antral reflex, which in part may be mediated by cholinergic mechanisms.

Reducing the Rate of Catheter-Associated Urinary Tract Infection in the Non-ICU Setting

Background: In 2008, the catheter associated urinary tract infection (CAUTI) rate at King Fahad Medical City (KFMC) was 3.8/1000 urinary catheter days with some variability between departments. KFMC is the newest tertiary, referral and teaching hospital with 1100 beds in Riyadh, Saudi Arabia. The Infection Control Department at KFMC decided to implement a quality improvement project by applying the bladder bundle in our general ward (Non-ICU) using the model of National Health Service (NHS) hospitals in England even though there was good evidence supporting this infection control practice only in ICU patients?[1][2]. Our objective was to decrease CAUTI in two non-ICU units by at least 50% in one year. Study design: This was a prospective interventional quality improvement project aiming to decrease CAUTI in two non-ICU inpatient units with a total of?193 beds including children and adult patients. Our intervention includes insertion and maintenance components. Results: CAUTI decreased significantly in both departments from 23 infections in?2008 (Rate: 5.03/1000 CDs) to 12 infections in 2009 (Rate: 1.92/1000 CDs) (P?= 0.0001);in RH (Rehabilitation hospital) from 18 in 2008 (Rate: 4/1000 CDs) to 11 infections in 2009 (Rate: 0.36/1000?CDs) (P?< 0.0001) and in NSI (National Neuroscience Institute) from 5 in 2008 (Rate: 5.42/1000?CDs) to 1 infections in 2009 (Rate: 3.16/1000 CDs) (P?< 0.0001). Conclusion: Implementation of urinarycatheter insertion and daily care bundles, and creation of a competitive spirit among employees were associated with a significant reduction in catheter associated urinary tract infections.

Different Concentrations of Notoginsenoside Rg1 Attenuate Hypoxic and Hypercapnia Pulmonary Hypertension by Reducing the Expression of ERK in Rat PASMCs

Pulmonary arterial hypertension (PAH) is a serious disease which is characterized by increased vascular resistance and pressure. We have previously hypothesized that panax notoginseng saponins (PNS) might attenuate pulmonary vasoconstriction under hypoxia and hypercapnia condition. This study aims to investigate the effect of notoginsenoside Rg1, a main ingredient of PNS, with various concentrations (8, 40, 100 mg/L, respectively) on extracellular signal regulated kinase (ERK1/2) signaling pathway in pulmonary arterial smooth muscle cells (PASMCs). In addition, PASMCs were randomly divided into six groups: SD rat under normoxic condition as control group (N group), hypoxia hypercapnia group (H group), DMSO control group (HD group), Rg1-treatment groups (RgLRgM and RgH group). Western-blot and RT-PCR were used to test the expression of p-ERK protein and the expression of ERK1 mRNA and ERK2 mRNA. This study provided the evidence that the expression of p-ERK protein and the expression of ERK1 mRNA and ERK2 mRNA in HD group and H group were obviously higher than that in N group (P < 0.01), Whereas the level of ERK1/2 mRNA in Rg1-treatment groups was significantly lower than that in HD group and H group (P < 0.01), and the proper concentration of Rg1 is 40 mg/L. These results suggested that notoginsenoside Rg1 can attenuate pulmonary vasoconstriction which may lead to HHPV through reducing the expression of ERK1/2.

Notoginsenoside R₁Attenuates Hypoxia and Hypercapnia-Induced Vasoconstriction <i>In Vitro</i>by Reducing the Expression of p38

Notoginsenoside R1, the main active ingredient of Panax notoginseng saponins (PNS), has been proposed to play fatal roles in the development of hypoxic hypercapnia-induced pulmonary vasoconstriction (HHPV). Subsequently, pulmonary arterial smooth muscle cells (PASMCs) lead to pulmonary vascular system remodeling and chronic pulmonary disease in the development of HHPV. Despite considerable studies have contributed to pulmonary disease, the mechanism of how Notoginsenoside R1 affects HHPV remains unclear. In this view, we will discuss the effect of notoginsenoside R1 by investigating the expression of p38 mitogen-activated protein kinase (p38 MAPK) signaling pathway in PASMCs under hypoxia and hypercapnia condition. The third order PASMCs of Sprague Dawley (SD) rats were cultured with various concentrations (8, 40, 100 mg/L, respectively) of Notoginsenoside R1. Our data showed that the protein and mRNA expression levels of p-38 MAPK were higher in hypoxic hypercapnia group compared with hypoxic DMSO and normoxia control groups (p 1 treatment groups, the level of p-p38 MAPK protein and p38 MAPK mRNA were significantly decreased with different degrees (p 1 treatment may contribute to attenuate HHPV via decreasing the protein and mRNA expression levels of p-38 MAPK.

Antimicrobial lipids:Emerging effector molecules of innate host defense

The antimicrobial properties of host-derived derived lipids have become increasingly recognized and evidence is mounting that antimicrobial lipids （AMLs）, like antimicrobial peptides, are effector molecules of the innate immune system and are regulated by its conserved pathways. This review, with primary focus on the human body, provides some background on the biochemistry of lipids, summarizes their biological functions, expands on their antimicrobial properties and site-specifc composition, presents modes of synergism with antimicrobial peptides, and highlights the more recent reports on the regulation of AML production as well as bacterial resistance mechanisms. Based on extant data a concept of innate epithelial defense is proposed where epithelial cells, in response to microbial products and proinflammatory cytokines and through activation of conserved innate signaling pathways, increase their lipid uptake and up-regulate transcription of enzymes involved in antimicrobial lipid biosynthesis, and induce transcription of antimicrobial peptides as well as cytokines and chemokines. The subsequently secreted antimicrobial peptides and lipids then attack and eliminate the invader, assisted by or in synergism with other antimicrobial molecules delivered by other defense cells that have been recruited to the site of infection, in most of the cases. This review invites reconsideration of the interpretation of cholesteryl ester accumulation in macrophage lipid droplets in response to infection as a solely proinflammatory event, and proposes a direct antimicrobial role of lipid droplet- associated cholesteryl esters. Finally, for the interested, but new- to- the-feld investigator some starting points for the characterization of AMLs are provided. Before it is possible to utilize AMLs for anti-infectious therapeutic and prophylactic approaches, we need to better understand pathogen responses to these lipids and their role in the pathogenesis of chronic infectious disease.

Host Factors Alter Effects of Angiopoietin-Like Protein 8 on Glucose Homeostasis in Diabetic Mice

Recovery of functional beta cell mass offers a biological cure for type 1 diabetes. However, beta cell mass is difficult to regain once lost since the proliferation rate of beta cells after youth is very low. Angiopoietin like-protein 8 (ANGPTL8), a peptide that has a role in the regulation of lipoprotein lipase activity, was reported to increase beta cell proliferation in mice in 2013. Subsequent studies of human ANGPTL8 for short term (3 to 8 days) in non-diabetic mice showed little or no increase in beta cell proliferation. Here, we examined the effect of ANGPTL8 on glucose homeostasis in models that have not been examined previously. We expressed mouse ANGPTL8 using adenovirus in 2 mouse models of diabetes (streptozotocin and Non-Obese Diabetic (NOD) mice) over 2 weeks. Also, we tested ANGPTL8 in NOD mice deficient in leukocyte 12-lipoxygenase (12LO), an enzyme that contributes to insulitis and loss of beta cell function in NOD, in an effort to determine whether 12LO deficiency alters the response to ANGPTL8. Adenovirus-mediated expression of ANGPTL8 lowered blood glucose levels in streptozotocin treated mice without an increase in beta cell proliferation or serum insulin concentration. While ANGPTL8 did not reverse hyperglycemia in overtly hyperglycemic NOD mice or alter glucose homeostasis of non-diabetic NOD mice, ANGPTL8 reduced blood glucose levels in 12LOKO NOD mice. However, the lower glucose levels in 12LOKO NOD were not associated with higher serum insulin levels or beta cell proliferation. In summary, while mouse ANGPTL8 does not increase beta cell proliferation in NOD mice or streptozotocin treated mice in agreement with studies in non-diabetic mice, it lowers blood glucose levels in multiple low-dose streptozotocin induced diabetes and 12LO deficiency indicating that host factors influence the impact of ANGPTL8 on glucose homeostasis.

Evaluating the performance of the Alere PBP2a SA Culture Colony Test with the Vitek 2 Antimicrobial Susceptibility Test Card System as reference standard in coagulase-negative Staphylococcus species

Background The Alere PBP2a SA Culture Colony Test is an FDA-cleared in vitro immunochromatographic assay for rapid detection of penicillin-binding protein2a(PBP2a)in Staphylococcus aureus.Methods We investigated the performance of the PBP2a SA Culture Colony Test with 78 coagulase-negative Staphylococcus(CoNS)isolates from different body sites,with the Vitek 2 Antimicrobial Susceptibility Test(AST)as a reference standard.Results The CoNS species were 62 S.epidermidis;6 S.lugdenensis;3 S.hominis;2 S.capitis;2 S.haemolyticus;and 1 each of S.simulans,S.auricularis,and S.warneri.Of the 78 CoNS isolates,68 showed concordance in the PBP2a IC assay and Vitek 2 AST.Discordance was seen for 10 S.epidermidis isolates,which showed negative in the PBP2a assay,despite oxacillin-resistance detection using the Vitek 2 AST(66.7%sensitivity and 100%specificity).All non-S.epidermidis CoNS were identified with 100%concordance using the PBP2a IC assay and Vitek 2 AST.Conclusion We demonstrated that,while the PBP2a IC assay has low sensitivity in determining the susceptibility of S.epidermidis to oxacillin,it highly accurately predicted the susceptibility of non-S.epidermidis CoNS to oxacillin.The diagnostic accuracy for non-S.epidermidis CoNS needs further assessment with more isolates to confirm our findings.

Regulator of G protein signaling 6 mediates exercise-induced recovery of hippocampal neurogenesis,learning,and memory in a mouse model of Alzheimer’s disease

Hippocampal neuronal loss causes cognitive dysfunction in Alzheimer’s disease.Adult hippocampal neurogenesis is reduced in patients with Alzheimer’s disease.Exercise stimulates adult hippocampal neurogenesis in rodents and improves memory and slows cognitive decline in patients with Alzheimer’s disease.However,the molecular pathways for exercise-induced adult hippocampal neurogenesis and improved cognition in Alzheimer’s disease are poorly understood.Recently,regulator of G protein signaling 6(RGS6)was identified as the mediator of voluntary running-induced adult hippocampal neurogenesis in mice.Here,we generated novel RGS6fl/fl;APP_(SWE) mice and used retroviral approaches to examine the impact of RGS6 deletion from dentate gyrus neuronal progenitor cells on voluntary running-induced adult hippocampal neurogenesis and cognition in an amyloid-based Alzheimer’s disease mouse model.We found that voluntary running in APP_(SWE) mice restored their hippocampal cognitive impairments to that of control mice.This cognitive rescue was abolished by RGS6 deletion in dentate gyrus neuronal progenitor cells,which also abolished running-mediated increases in adult hippocampal neurogenesis.Adult hippocampal neurogenesis was reduced in sedentary APP_(SWE) mice versus control mice,with basal adult hippocampal neurogenesis reduced by RGS6 deletion in dentate gyrus neural precursor cells.RGS6 was expressed in neurons within the dentate gyrus of patients with Alzheimer’s disease with significant loss of these RGS6-expressing neurons.Thus,RGS6 mediated voluntary running-induced rescue of impaired cognition and adult hippocampal neurogenesis in APP_(SWE) mice,identifying RGS6 in dentate gyrus neural precursor cells as a possible therapeutic target in Alzheimer’s disease.

益气活血通络解毒方通过抑制caspase-12减轻小鼠肺缺血/再灌注损伤

目的：探讨益气活血通络解毒方（Yiqi Huoxue Tongluo Jiedu Fang,YHTJF）对小鼠肺部缺血/再灌注损伤及caspase-12表达的影响。方法：选取雄性10~12周龄C57BL/6J小鼠70只,体重21~25g,复制在体左肺缺血/再灌注（ischemia-reperfusion,I/R）损伤模型。随机分为7组：正常对照（control）组,羧甲基纤维素钠（carboxyl methyl cellulose-Na,CMC-Na）组,假手术（sham）组,I/R模型组,YHTJF低（low,L）、中（meddle,M）、高（high,H）浓度干预组。CMC-Na、sham和I/R组术前连续7 d腹腔注射CMC-Na溶液,YHTJF-L、YHTJF-M和YHTJF-H组术前连续7 d腹腔注射低、中、高浓度的YHTJF溶液。术毕,取左肺测定肺组织湿/干比值（W/D）及总肺含水量（TLW）,行肺泡损伤评估（IQA）;光、电镜观察肺组织形态学及超微结构改变;原位末端标记法（TUNEL）测组织细胞凋亡指数（AI）;RT-PCR和Western blot分别检测caspase-12和葡萄糖调节蛋白78（GRP78）的mRNA和蛋白表达量。结果：相比control组,I/R组的W/D、TLW、IQA和AI明显升高（P〈0.01）,肺组织形态学破坏显著,caspase-12和GRP78的mRNA和蛋白表达量增加（P〈0.01）,而CMC-Na组和sham组各项指标与control组无明显差异;与I/R组比较,YHTJF-L组、YHTJF-M组和YHTJF-H组各项指标（除GRP78外）数值均下降（P〈0.01）,组织损伤明显减轻。结论：YHTJF可有效减轻小鼠缺血/再灌注性肺损伤,其机制可能与其抑制caspase-12通路所致凋亡有关。

益气活血通络解毒方对小鼠肺缺血／再灌注损伤的作用及其机制

目的:探讨益气活血通络解毒方(YHTJF)对小鼠的肺部缺血/再灌注(I/R)损伤,及对I/R引起的氧化应激反应的作用。方法:成年雄性10~12周龄C57BL/6J小鼠70只,体重(21~25)g,采用在体左肺门夹闭法复制缺血/再灌注损伤模型。随机分为7组:正常对照组(C),羧甲基纤维素钠carboxyl methyl cellulose-Na(CMC-Na)+正常对照组(CC),羧甲基纤维素钠+假手术组(CS),羧甲基纤维素钠+I/R模型组(CIR),羧甲基纤维素钠+YHTJF低、中、高浓度干预组(CYL、CYM、CYH)。CN、CS、CIR组术前连续7 d腹腔注射CMC溶液,CYL、CYM、CYH组术前连续7 d腹腔注射低、中、高浓度的YHTJF溶液。术毕,取左肺测定肺组织干湿比(W/D)及总肺含水量(TLW),行肺组织损伤评估(IQA),光镜观察肺组织形态学结构改变。TUNEL测组织细胞凋亡指数(AI)。检测血清超氧化物歧化酶(SOD)、丙二醛(MDA)、髓过氧化物酶(MPO)。结果:相比C组,CC组和CS组所有检测指标均无明显差异,CIR组的W/D、TLW、IQA、AI明显升高(P<0.01),肺组织形态学破坏显著;MDA含量、MPO活力明显升高,SOD活性显著降低。与CIR组比较,CYL组、CYM组、CYH组W/D、TLW、IQA、AI的表达均明显下降(P<0.01),组织损伤明显减轻,CYM组各项指标数值改善最明显,组织损伤最轻;3个用药组的MDA含量、MPO活力明显下降,SOD活性显著升高,其中中剂量用药组氧化应激指标变化最突出。结论:YHTJF可有效减轻小鼠缺血/再灌注性肺损伤,以中剂量效果为最佳,其机制可能与其抑制体内氧化应激反应、减轻肺组织细胞凋亡有关。

维甲酸X受体对缺氧/复氧诱导的大鼠肺泡Ⅱ型上皮细胞自噬的调控作用

目的:探讨维甲酸X受体(RXR)对缺氧/复氧(H/R)诱导的大鼠肺泡Ⅱ型上皮细胞(AECⅡ)自噬的调控作用及分子机制。方法:常氧培养大鼠肺泡Ⅱ型上皮细胞,将生长至对数生长期的细胞随机分为5组:(1)对照组:细胞于正常条件下培养30 h;(2)缺氧/复氧组:细胞缺氧6 h,复氧24 h;(3)溶剂DMSO组:细胞于造模前1.5 h用浓度低于0.1%的DMSO进行预处理,其余处理同H/R组;(4)9-顺式维甲酸(9-RA)组:细胞于缺氧前1 h用9-RA(100 nmol/L)预处理;(5)HX531组:细胞先用9-RA处理0.5 h,然后用HX531(2.5μmol/L)处理1 h。采用CCK-8法检测各组细胞活力;免疫荧光染色法观察各组细胞RXRα表达变化;用透射电镜观察细胞内部超微结构的改变;RT-PCR检测腺苷酸活化蛋白激酶(AMPK)、自噬相关蛋白beclin 1及LC3、哺乳动物雷帕霉素靶蛋白(mTOR)和P62 mRNA水平的表达。Western blot检测p-AMPK、beclin 1、LC3-Ⅱ、p-mTOR和P62蛋白的表达。结果:与对照组相比,其余4组细胞的细胞活力显著降低,AMPK、beclin 1和LC3 mRNA表达显著增多,p-AMPK、beclin 1和LC3-Ⅱ蛋白表达显著增多,而mTOR和P62 mRNA表达降低,p-mTOR和P62蛋白表达降低(P<0.05);与缺氧/复氧和HX531组相比,9-RA组细胞损伤减轻,自噬水平也显著降低(P<0.05)。结论:(1)缺氧/复氧可诱导AECⅡ自噬水平升高;(2)激活RXR可一定程度上减轻缺氧/复氧引起的AECⅡ损伤,其机制可能与抑制细胞自噬有关。

Progressive <I>β</i>Cell Failure in Type 2 Diabetes Mellitus: Microvascular Pancreatic Isletopathy?

Background: UKPDS suggested relentless deterioration of β cell function as a part of natural course of type 2 diabetes mellitus. However, the course was apparently not universal since many patients maintained glycemic goal (HbA1c β cell failure occurred around the same time as the time of onset of microvascular complications. Finally, the exact mechanism of progressive β cell failure remains to be defined. It is plausible that β cell failure may be due to fibrosis of pancreatic islets secondary to microangiopathy since no organ or tissue is exempt from this complication. Objective: To assess epidemiologic correlation between presence of b cell failure and microvascular complications by determining the prevalence of β cell failure in subjects with type 2 diabetes with increasing number of known microvascular complications. Methods: 650 Subjects with ages 40-75 years and duration of DM 4-23 years were divided into 4 groups according to number of microvascular complications, e.g. retinopathy, nephropathy, and neuropathy. β cell failure (β -?ve ) is defined as HbA1c > 7.0% with any therapy or HbA1c β cell function is deemed “preserved” (β + ve) with HbA1c b cell failure progressively rose with increasing number of microvascular complications from 0 to 2 with no further significant rise with 3 complications whereas subjects with preserved β cell function declined with increasing number of microvascular complications (p β cell failure (p β cell failure/β cell preserved with increasing number of microvascular complications as well as the greater duration of Diabetes. However, a significantly (p β cell failure persisted for rising number of microvascular complications even after eliminating the influence of age and duration of diabetes. Conclusion: β cell failure may be a manifestation of microvascular pancreatic isletopathy similar to other microvascular complications.

Mediator Complex Dependent Regulation of Cardiac Development and Disease

Cardiovascular disease （CVD） is a leading cause of morbidity and mortality. The risk factors for CVD include environmental and genetic components. Human mutations in genes involved in most aspects of cardiovascular function have been identified, many of which are involved in transcriptional regulation. The Mediator complex serves as a pivotal transcriptional reg- ulator that functions to integrate diverse cellular signals by multiple mechanisms including recruit- ing RNA polymerase II, chromatin modifying proteins and non-coding RNAs to promoters in a context dependent manner. This review discusses components of the Mediator complex and the contribution of the Mediator complex to normal and pathological cardiac development and func- tion. Enhanced understanding of the role of this core transcriptional regulatory complex in the heart will help us gain further insights into CVD.

Endophthalmitis secondary to globe penetration from hydrogel scleral buckle

Dear Sir,Iam Dr Katrina A.Mears,from the Department of Ophthalmology and Visual Sciences,University of Iowa Carver College of Medicine,200 Hawkins Drive,Iowa City,Iowa,USA.I wish to present a case of endophthalmitis secondary to globe penetration from a hydrogel scleral buckle which,to the best of our knowledge,is the first reported case

Contribution of alternative splicing to breast cancer metastasis

Alternative splicing is a major contributor to transcriptome and proteome diversity in eukaryotes. Comparing to normal samples, about 30% more alternative splicing events were recently identified in 32 cancer types included in The Cancer Genome Atlas database. Some alternative splicing isoforms and their encoded proteins contribute to specific cancer hallmarks. In this review, we will discuss recent progress regarding the contributions of alternative splicing to breast cancer metastasis. We plan to dissect the role of MTDH, CD44 and their interaction with other mRNA splicing factors. We believe an in-depth understanding of the mechanism underlying the contribution of splicing to breast cancer metastasis will provide novel strategies to the management of breast cancer.

Regulatory T cells suppress autoreactive CD4^+ T cell response to bladder epithelial antigen

AIM： To investigate the role of regulatory T （Treg） cells in CD4^＋ T cell-mediated bladder autoimmune infammation. METHODS： Urothelium-ovalbumin （URO-OVA）/OT-II mice, a double transgenic line that expresses the membrane form of the model antigen （Ag） OVA as a self-Ag on the urothelium and the OVA-specific CD4^＋ T cell receptor specifc for the I-Ab/OVA323-339 epitope in the periphery, were developed to provide an autoimmune environment for investigation of the role of Treg cells in bladder autoimmune infammation. To facilitate Treg cell analysis, we further developed URO-OVA^GFP-Foxp3/OT-II mice, a derived line of URO-OVA/OT-II mice that express the green fuorescent protein （GFP）-forkhead box protein P3 （Foxp3） fusion protein. RESULTS： URO-OVA/OT-II mice failed to develop bladder infammation despite the presence of autoreactive CD4^＋ T cells. By monitoring GFP-positive cells, bladder infltration of CD4^＋ Treg cells was observed in URO-OVA^GFP-Foxp3/OT-II mice. The infiltrating Treg cells were functionally active and expressed Treg cell effector molecule as well as marker mRNAs including transforming growth factor-β, interleukin （IL）-10, fibrinogen-like protein 2, and glucocorticoid-induced tumor necrosis factor receptor （GITR）. Studies further revealed that Treg cells from URO-OVA^GFP-Foxp3/OT-II mice were suppressive and inhibited autoreactive CD4^＋ T cell proliferation and interferon （IFN）-g production in response to OVA Ag stimulation. Depletion of GITR-positive cells led to spontaneous development of bladder infammation and expression of inflammatory factor mRNAs for IFN-γ, IL-6, tumor necrosis factor-α and nerve growth factor in URO-OVA^GFP-Foxp3/OT-II mice. CONCLUSION： Treg cells specifc for bladder epithelial Ag play an important role in immunological homeostasis and the control of CD4^＋ T cell-mediated bladder autoimmune infammation.