Molecular genetics of β-thalassemia: A narrative review

β-thalassemia is a hereditary hematological disease caused by over 350 mutations in the β-globin gene (HBB). Identifying the genetic variants affecting fetal hemoglobin (HbF) production combined with the α-globin genotype provides some prediction of disease severity for β-thalassemia. However, the generation of an additive composite genetic risk score predicts prognosis, and guide management requires a larger panel of genetic modifiers yet to be discovered.Presently, using data from prior clinical trials guides the design of further research and academic studies based on gene augmentation, while fundamental insights into globin switching and new technology developments have inspired the investigation of novel gene therapy approaches.Genetic studies have successfully characterized the causal variants and pathways involved in HbF regulation, providing novel therapeutic targets for HbF reactivation. In addition to these HBB mutation-independent strategies involving HbF synthesis de-repression, the expanding genome editing toolkit provides increased accuracy to HBB mutation-specific strategies encompassing adult hemoglobin restoration for personalized treatment of hemoglobinopathies. Allogeneic hematopoietic stem cell transplantation was, until very recently, the curative option available for patients with transfusion-dependent β-thalassemia. Gene therapy currently represents a novel therapeutic promise after many years of extensive preclinical research to optimize gene transfer protocols.We summarize the current state of developments in the molecular genetics of β-thalassemia over the last decade, including the mechanisms associated with ineffective erythropoiesis, which have also provided valid therapeutic targets, some of which have been shown as a proof-of-concept.     

Identification and characterization of an atypical Gαs-biased β2AR agonist that fails to evoke airway smooth muscle cell tachyphylaxis

G protein–coupled receptors display multifunctional signaling, offering the potential for agonist structures to promote conformational selectivity for biased outputs. For β₂-adrenergic receptors (β₂AR), unbiased agonists stabilize conformation(s) that evoke coupling to Gαs (cyclic adenosine monophosphate [cAMP] production/human airway smooth muscle [HASM] cell relaxation) and β-arrestin engagement, the latter acting to quench Gαs signaling, contributing to receptor desensitization/tachyphylaxis. We screened a 40-million-compound scaffold ranking library, revealing unanticipated agonists with dihydroimidazolyl-butyl-cyclic urea scaffolds. The S-stereoisomer of compound C1 shows no detectable β-arrestin engagement/signaling by four methods. However, C1-S retained Gαs signaling—a divergence of the outputs favorable for treating asthma. Functional studies with two models confirmed the biasing: β₂AR-mediated cAMP signaling underwent desensitization to the unbiased agonist albuterol but not to C1-S, and desensitization of HASM cell relaxation was observed with albuterol but not with C1-S. These HASM results indicate biologically pertinent biasing of C1-S, in the context of the relevant physiologic response, in the human cell type of interest. Thus, C1-S was apparently strongly biased away from β-arrestin, in contrast to albuterol and C5-S. C1-S structural modeling and simulations revealed binding differences compared with unbiased epinephrine at transmembrane (TM) segments 3,5,6,7 and ECL2. C1-S (R2 = cyclohexane) was repositioned in the pocket such that it lost a TM6 interaction and gained a TM7 interaction compared with the analogous unbiased C5-S (R2 = benzene group), which appears to contribute to C1-S biasing away from β-arrestin. Thus, an agnostic large chemical-space library identified agonists with receptor interactions that resulted in relevant signal splitting of β₂AR actions favorable for treating obstructive lung disease.

Most G protein–coupled receptors (GPCRs) are now recognized as multisignal transducers (1, 2). Early concepts of agonist–receptor interactions were based on the idea that there was a single “active” receptor conformation induced by the binding of any agonist, resulting in an interaction with the heterotrimeric G protein and a universal, singular signal. Generally, the α-subunit of the G protein, upon its dissociation, was considered the primary activator (or inhibitor) of the effector, resulting in the intracellular signal. Subsequently, it became clear that multiple signaling outcomes from activation of a given GPCR can occur from a single agonist due to specific molecular determinants of the receptor triggering independent mechanisms (3–5). As these multiple functions were being identified, it was apparent that agonists with different structures could act at a given receptor to preferentially activate one signal with minimal engagement of others, a property later termed signal biasing (6–8). Biased agonists, then, could represent important advantages over nonbiased agonists due to this signal selectivity, activating a specified therapeutic pathway while minimally evoking unnecessary or deleterious signaling. The pathway selectivity of biased agonists is thought to be established by the stabilization of specific conformation(s) of the agonist–receptor complex via a set of interactions that differ from those of unbiased (also called balanced) agonists (9–12). While it is conceivable that small modifications of established cognate agonists might yield such specialized signaling, significant deviation from common agonist structures may be necessary to meet this goal (13).The signals/functions of a given GPCR that might be sought for selective activation are defined by the cell type, disease, and desired final physiologic function. In asthma and chronic obstructive pulmonary disease (COPD), active human airway smooth muscle (HASM) cellular contraction limits airflow, representing a major cause of morbidity and mortality. β₂-adrenergic receptors (β₂ARs) expressed on HASM cells are the targets for binding of therapeutically administered β-agonists, which relax the cells via a cyclic adenosine monophosphate–mediated mechanism (14). β-agonists are used for treating acute bronchospasm as well as for long-term prevention. However, the HASM bronchodilator response to acute β-agonist is attenuated by receptor desensitization (15), with typical treatments of humans, or isolated HASM cells, leading to a loss of receptor function over time (16–18), clinically termed tachyphylaxis.Agonist-promoted desensitization of β₂AR (and other GPCRs) is due to partial uncoupling of the receptor to the G protein, which is initiated by phosphorylation of intracellular Ser/Thr residues of the receptor by G protein–coupled receptor kinases (GRKs) (19, 20). The GRK-phosphorylated β₂AR recruits β-arrestin1 or β-arrestin2 to these receptors, with subsequent interactions that appear to compete with the receptor for its binding to the Gα subunit, thus attenuating the intracellular response (11, 21). Such competition has been strongly inferred for the β₂AR (22, 23) and is compelling for rhodopsin–arrestin interactions (24). In addition, β-arrestin binding to GPCRs can initiate receptor internalization and other events such as receptor activation of ERK1/2 (25) through its multiprotein adapter functions. Thus β-arrestin engagement can be considered an early “second signal” of the β₂AR as well as a desensitization initiator for attenuating the Gs signal. An agonist that is biased toward Gαs coupling (cAMP production and airway smooth muscle [ASM] relaxation) and away from β-arrestin binding (desensitization) would be desirable in treating obstructive lung diseases, since efficacy would not be attenuated acutely, nor would tachyphylaxis be experienced from extended treatment. While biased agonists favoring either G protein or β-arrestin (6) signaling have been described for some GPCRs (such as μ-opioid and type 1 angiotensin II receptors), Gαs biasing has not been apparent from most studies with catecholamine-like compounds for the β₂AR. Thus, we have little information as to whether the two β₂AR pathways can be differentially activated in a selective manner by an efficacious agonist, nor is it apparent from a structural standpoint what strategy might be employed to design agonists biased in this manner for this receptor.In order to find this type of biasing for the β₂AR, we screened a 40-million-compound scaffold ranking (SR) library that was agnostic to known β₂AR agonist structures. We found a scaffold in which substitutions of certain R groups led to individual compounds that are apparently Gαs-biased agonists for β₂AR with no apparent engagement of β-arrestin in model systems. Additional studies in HASM cells revealed a lack of tachyphylaxis of the relaxation effect by the lead compound compared with the most widely utilized β₂AR agonist, albuterol. The structure of this biased agonist is very different from that of catecholamine-like agonists. To ascertain the mechanism that may underlie this biased activity, we used structural modeling and molecular simulations and studied homologous compounds with different R groups and receptor mutagenesis to predict the interaction sites with the activated β₂AR. Such studies uncovered distinct structural characteristics that may be responsible for the biasing effect.     

Cross-α/β polymorphism of PSMα3 fibrils

The formation of ordered cross-β amyloid protein aggregates is associated with a variety of human disorders. While conventional infrared methods serve as sensitive reporters of the presence of these amyloids, the recently discovered amyloid secondary structure of cross-α fibrils presents new questions and challenges. Herein, we report results using Fourier transform infrared spectroscopy and two-dimensional infrared spectroscopy to monitor the aggregation of one such cross-α–forming peptide, phenol soluble modulin alpha 3 (PSMα3). Phenol soluble modulins (PSMs) are involved in the formation and stabilization of Staphylococcus aureus biofilms, making sensitive methods of detecting and characterizing these fibrils a pressing need. Our experimental data coupled with spectroscopic simulations reveals the simultaneous presence of cross-α and cross-β polymorphs within samples of PSMα3 fibrils. We also report a new spectroscopic feature indicative of cross-α fibrils.

Amyloids are elongated fibers of proteins or peptides typically composed of stacked cross β-sheets (1, 2). Self-assembling amyloids are notorious for their involvement in human neurodegenerative diseases such as Alzheimer’s and Parkinson’s diseases (1, 2). Phenol soluble modulins (PSMs) are amyloid peptides secreted by the bacteria Staphylococcus aureus (S. aureus) (3–5). Of the PSM family, PSMα3 is of recent interest due to its unique secondary structure upon fibrillation. Whereas other PSM variants undergo conformational changes with aggregation, the α-helical PSMα3 peptide retains its secondary structure while stacking in a manner reminiscent of β-sheets, forming what has been termed cross-α fibrils (3, 4, 6). Although “α-sheet” amyloid fibrils have been previously observed in two-dimensional infrared (2DIR) (7) and associated with PSMs (8), the novel cross-α fibril is distinct from that class of structures. To avoid confusion between these two similarly named but distinct secondary structures, a comparison between the α-sheet domain in cytosolic phosphatase A2 (9) (Protein Data Bank [PDB] identification:1rlw) (10) and cross-α fibrils adopted by PSMα3 (PDB ID:5i55) (3) has been highlighted in SI Appendix, Fig. S1. Interestingly, shorter terminations of PSMα3 have been shown to exhibit β-sheet polymorphs (11). The proposed cross-α fibril structure of the full-length PSMα3 peptide has been confirmed with X-ray diffraction and circular dichroism (4). The present study aims to further characterize these fibrils with linear and nonlinear infrared spectroscopies.S. aureus is an infectious human pathogen with the ability to form communities of microorganisms called biofilms that hinder traditional treatment methods (12–14). PSMs contribute to inflammatory response and play a crucial role in structuring and detaching biofilms (11, 12, 14). While biofilm growth requires the presence of multiple PSMs (14, 15), Andreasen and Zaman have demonstrated that PSMα3 acts as a scaffold, seeding the amyloid formation of other PSMs (5). To effectively inhibit S. aureus biofilm growth, a better understanding of PSMα3 aggregation is needed.The α-helical structure of PSMα3 (12) presents a challenge for probing the vibrational modes and secondary structure of both the monomer and the fibrils. While IR spectroscopy has been used extensively to characterize β-sheets (16–19), the spectral features associated with α-helices are difficult to distinguish from those of the random coil secondary structure (20, 21). This limitation has left researchers to date with an incomplete picture of the spectroscopic features unique to cross-α fibers. The present work combines a variety of 2DIR methods to remove these barriers and probe the active infrared vibrational modes of cross-α fibers.The full-length, 22-residue PSMα3 peptide was synthesized and prepared for aggregation studies following reported methods (3, 4, 11). A total of 10 mM PSMα3 was incubated in D₂O at room temperature over 7 d. These data were compared to the monomer treated under similar conditions. Monomeric samples were prepared at a significantly lower concentration of 0.5 mM to prevent aggregation. Fiber formation was confirmed by transmission electron microscopy (see SI Appendix, Fig. S2 for details). Fourier transform infrared (FTIR) spectra were taken for both the fibrils in solution as well as the low concentration monomers. Spectroscopic simulations of the PSMα3 monomer and fibers were performed on previously reported PDB structures (PDB identification: 5i55) (3) (Fig. 1).Open in a separate windowFig. 1.PDB structures of PSMα3 (A) monomers and (B) cross-α fibers extended along the screw axis. (C) FTIR spectra of 0.5 mM monomeric PSMα3 (blue) compared to the 10 mM PSMα3 fibril (red) in D₂O upon aggregation.     

Recognition of the antigen-presenting molecule MR1 by a Vδ3+ γδ T cell receptor

Unlike conventional αβ T cells, γδ T cells typically recognize nonpeptide ligands independently of major histocompatibility complex (MHC) restriction. Accordingly, the γδ T cell receptor (TCR) can potentially recognize a wide array of ligands; however, few ligands have been described to date. While there is a growing appreciation of the molecular bases underpinning variable (V)δ1⁺ and Vδ2⁺ γδ TCR-mediated ligand recognition, the mode of Vδ3⁺ TCR ligand engagement is unknown. MHC class I–related protein, MR1, presents vitamin B metabolites to αβ T cells known as mucosal-associated invariant T cells, diverse MR1-restricted T cells, and a subset of human γδ T cells. Here, we identify Vδ1/2⁻ γδ T cells in the blood and duodenal biopsy specimens of children that showed metabolite-independent binding of MR1 tetramers. Characterization of one Vδ3Vγ8 TCR clone showed MR1 reactivity was independent of the presented antigen. Determination of two Vδ3Vγ8 TCR-MR1-antigen complex structures revealed a recognition mechanism by the Vδ3 TCR chain that mediated specific contacts to the side of the MR1 antigen-binding groove, representing a previously uncharacterized MR1 docking topology. The binding of the Vδ3⁺ TCR to MR1 did not involve contacts with the presented antigen, providing a basis for understanding its inherent MR1 autoreactivity. We provide molecular insight into antigen-independent recognition of MR1 by a Vδ3⁺ γδ TCR that strengthens an emerging paradigm of antibody-like ligand engagement by γδ TCRs.

Characterized by both innate and adaptive immune cell functions, γδ T cells are an unconventional T cell subset. While the functional role of γδ T cells is yet to be fully established, they can play a central role in antimicrobial immunity (1), antitumor immunity (2), tissue homeostasis, and mucosal immunity (3). Owing to a lack of clarity on activating ligands and phenotypic markers, γδ T cells are often delineated into subsets based on the expression of T cell receptor (TCR) variable (V) δ gene usage, grouped as Vδ2⁺ or Vδ2⁻.The most abundant peripheral blood γδ T cell subset is an innate-like Vδ2⁺subset that comprises ∼1 to 10% of circulating T cells (4). These cells generally express a Vγ9 chain with a focused repertoire in fetal peripheral blood (5) that diversifies through neonatal and adult life following microbial challenge (6, 7). Indeed, these Vγ9/Vδ2⁺ T cells play a central role in antimicrobial immune response to Mycobacterium tuberculosis (8) and Plasmodium falciparum (9). Vγ9/Vδ2⁺ T cells are reactive to prenyl pyrophosphates that include isopentenyl pyrophosphate and (E)-4-Hydroxy-3-methyl-but-2-enyl pyrophosphate (8) in a butyrophilin 3A1- and BTN2A1-dependent manner (10–13). Alongside the innate-like protection of Vγ9/Vδ2⁺ cells, a Vγ9⁻ population provides adaptive-like immunobiology with clonal expansions that exhibit effector function (14).The Vδ2⁻ population encompasses the remaining γδ T cells but most notably the Vδ1⁺ and Vδ3⁺ populations. Vδ1⁺ γδ T cells are an abundant neonatal lineage that persists as the predominating subset in adult peripheral tissue including the gut and skin (15–18). Vδ1⁺ γδ T cells display potent cytokine production and respond to virally infected and cancerous cells (19). Vδ1⁺ T cells were recently shown to compose a private repertoire that diversifies, from being unfocused to a selected clonal TCR pool upon antigen exposure (20–23). Here, the identification of both Vδ1⁺ T_naive and Vδ1⁺ T_effector subsets and the Vδ1⁺ T_naive to T_effector differentiation following in vivo infection point toward an adaptive phenotype (22).The role of Vδ3⁺ γδ T cells has remained unclear, with a poor understanding of their lineage and functional role. Early insights into Vδ3⁺ γδ T cell immunobiology found infiltration of Vδ3⁺ intraepithelial lymphocytes (IEL) within the gut mucosa of celiac patients (24). More recently it was shown that although Vδ3⁺ γδ T cells represent a prominent γδ T cell component of the gut epithelia and lamina propria in control donors, notwithstanding pediatric epithelium, the expanding population of T cells in celiac disease were Vδ1⁺ (25). Although Vδ3⁺ IELs compose a notable population of gut epithelia and lamina propria T cells (∼3 to 7%), they also formed a discrete population (∼0.2%) of CD4⁻CD8⁻ T cells in peripheral blood (26). These Vδ3⁺ DN γδ T cells are postulated to be innate-like due to the expression of NKG2D, CD56, and CD161 (26). When expanded in vitro, these cells degranulated and killed cells expressing CD1d and displayed a T helper (Th) 1, Th2, and Th17 response in addition to promoting dendritic cell maturation (26). Peripheral Vδ3⁺ γδ T cells frequencies are known to increase in systemic lupus erythematosus patients (27, 28), and upon cytomegalovirus (29) and HIV infection (30), although, our knowledge of their exact role and ligands they recognize remains incomplete.The governing paradigms of antigen reactivity, activation principles, and functional roles of γδ T cells remain unresolved. This is owing partly due to a lack of knowledge of bona fide γδ T cell ligands. Presently, Vδ1⁺ γδ T cells remain the best characterized subset with antigens including Major Histocompatibility Complex (MHC)-I (31), monomorphic MHC-I–like molecules such as CD1b (32), CD1c (33), CD1d (34), and MR1 (35), as well as more diverse antigens such as endothelial protein coupled receptor (EPCR) and phycoerythrin (PE) (36, 37). The molecular determinants of this reactivity were first established for Vδ1⁺ TCRs in complex with CD1d presenting sulfatide (38) and α-galactosylceramide (α-GalCer) (34), which showed an antigen-dependent central focus on the presented lipids and docked over the antigen-binding cleft.In humans, mucosal-associated invariant T (MAIT) cells are an abundant innate-like αβ T cell subset typically characterized by a restricted TCR repertoire (39–43) and reactivity to the monomorphic molecule MR1 presenting vitamin B precursors and drug-like molecules of bacterial origin (41, 44–46). Recently, populations of atypical MR1-restricted T cells have been identified in mice and humans that utilize a more diverse TCR repertoire for MR1-recognition (42, 47, 48). Furthermore, MR1-restricted γδ T cells were identified in blood and tissues including Vδ1⁺, Vδ3⁺, and Vδ5⁺ clones (35). As seen with TRAV 1-2⁻, unconventional MAITs cells the isolated γδ T cells exhibited MR1-autoreactivity with some capacity for antigen discrimination within the responding compartment (35, 48). Structural insight into one such MR1-reactive Vδ1⁺ γδ TCR showed a down-under TCR engagement of MR1 in a manner that is thought to represent a subpopulation of MR1-reactive Vδ1⁺ T cells (35). However, biochemical evidence suggested other MR1-reactive γδ T cell clones would likely employ further unusual docking topologies for MR1 recognition (35).Here, we expanded our understanding of a discrete population of human Vδ3⁺ γδ T cells that display reactivity to MR1. We provide a molecular basis for this Vδ3⁺ γδ T cell reactivity and reveal a side-on docking for MR1 that is distinct from the previously determined Vδ1⁺ γδ TCR-MR1-Ag complex. A Vδ3⁺ γδ TCR does not form contacts with the bound MR1 antigen, and we highlight the importance of non–germ-line Vδ3 residues in driving this MR1 restriction. Accordingly, we have provided key insights into the ability of human γδ TCRs to recognize MR1 in an antigen-independent manner by contrasting mechanisms.     

Synthesis,Structural, and Mechanical Behavior of β-Ca3(PO4)2–ZrO2 Composites Induced by Elevated Thermal Treatments

Biocompatible β-Ca₃(PO₄)₂ and mechanically stable t-ZrO₂ composites are currently being combined to overcome the demerits of the individual components. A series of five composites were synthesized using an aqueous precipitation technique. Their structural and mechanical stability was examined through X-ray diffraction, Rietveld refinement, FTIR, Raman spectroscopy, high-resolution scanning electron microscopy, and nanoindentation. The characterization results confirmed the formation of β-Ca₃(PO₄)₂–t-ZrO₂ composites at 1100 °C. Heat treatment above 900 °C resulted in the degradation of the composites because of cationic interdiffusion between Ca²⁺ ions and O⁻² vacancy in Zr⁴⁺ ions. Sequential thermal treatments correspond to four different fractional phases: calcium-deficient apatite, β-Ca₃(PO₄)₂, t-ZrO₂, and m-ZrO₂. The morphological features confirm in situ synthesis, which reveals abnormal grain growth with voids caused by the upsurge in ZrO₂ content. The mechanical stability data indicate significant variation in Young’s modulus and hardness throughout the composite.     

FLUKA Simulations of Kβ/Kα Intensity Ratios of Copper in Ag–Cu Alloys

The numerical simulations of Cu Kα and Cu Kβ fluorescence lines induced by Rh X-ray tube and by monoenergetic radiation have been presented. The copper Kβ/Kα intensity ratios for pure elements as well as for Ag–Cu alloys have been modeled. The results obtained by use of the FLUKA code, based on the Monte-Carlo approach, have been compared to available experimental and theoretical values. A visible relationship was found between the simulated Kβ/Kα intensity ratios and the copper content of the Ag–Cu alloy: As the Cu content increases, the Kβ/Kα coefficient decreases. The results can play role in elemental material analysis, especially in archaeometry.     

Functional Materials Based on Cyclometalated Platinum(II) β-Diketonate Complexes: A Review of Structure–Property Relationships and Applications

Square planar organoplatinum(II) complexes have garnered immense interest in the area of materials research. The combination of the Pt(II) fragment with mono-, bi- tri- and tetradentate organic ligands gives rise to a large variety of complexes with intriguing properties, especially cyclometalated Pt(II) complexes in which ligands are connected through covalent bonds demonstrate higher stability, excellent photoluminescence properties, and diverse applications. The properties and applications of the Pt(II)-based materials can be smartly fine-tuned via a judicious selection of the cyclometalating as well as ancillary ligands. In this review, attempts have been made to provide a brief review of the recent developments of neutral Pt(II) organometallic complexes bearing bidentate cyclometalating ligands and β-diketonate ancillary ligands, i.e., (C^N)Pt(O^O) and (C^C)Pt(O^O) derivatives. Both small (monomeric, dimeric) and large (polymeric) materials have been considered. We critically assessed the role of functionalities (ligands) on photophysical properties and their impact on applications.     

A therapeutic convection–enhanced macroencapsulation device for enhancing β cell viability and insulin secretion

Islet transplantation for type 1 diabetes treatment has been limited by the need for lifelong immunosuppression regimens. This challenge has prompted the development of macroencapsulation devices (MEDs) to immunoprotect the transplanted islets. While promising, conventional MEDs are faced with insufficient transport of oxygen, glucose, and insulin because of the reliance on passive diffusion. Hence, these devices are constrained to two-dimensional, wafer-like geometries with limited loading capacity to maintain cells within a distance of passive diffusion. We hypothesized that convective nutrient transport could extend the loading capacity while also promoting cell viability, rapid glucose equilibration, and the physiological levels of insulin secretion. Here, we showed that convective transport improves nutrient delivery throughout the device and affords a three-dimensional capsule geometry that encapsulates 9.7-fold-more cells than conventional MEDs. Transplantation of a convection-enhanced MED (ceMED) containing insulin-secreting β cells into immunocompetent, hyperglycemic rats demonstrated a rapid, vascular-independent, and glucose-stimulated insulin response, resulting in early amelioration of hyperglycemia, improved glucose tolerance, and reduced fibrosis. Finally, to address potential translational barriers, we outlined future steps necessary to optimize the ceMED design for long-term efficacy and clinical utility.

Diabetes mellitus currently burdens over 387 million people worldwide, of which 5 to ∼10% are accounted by patients with type 1 diabetes (T1D) (1). T1D is characterized by the immune destruction of insulin-secreting β cells and the loss of glycemic regulation. Although intensive insulin injection regimens and the use of glucose monitors have been shown to effectively regulate blood glucose, patients are still unable to meet glycemic control targets. In particular, those with severe hypoglycemic events and glycemic lability cannot be effectively stabilized with these technologies (2). In 2000, the Edmonton protocol was developed as a procedure that directly infuses pancreatic islets, isolated from cadaveric donors, into the portal vein of T1D patients. This procedure led to insulin independence in patients for a short period postinfusion (3, 4). However, poor long-term graft survival due to alloimmune and autoimmune rejections and engraftment inefficiency prevents sustained, therapeutic effects (5–7). Although immunosuppressants are coadministered with the transplanted cells to prevent graft rejection, 56% of patients experience partial to complete graft loss after 1 y, and only 10% of patients remain insulin independent after 5 y (4, 8). The majority of patients also experience complications from immunosuppression, including elevated risk of opportunistic infections and cancer (4, 8, 9). In addition, islet transplantation is burdened by a major islet donor shortage, since often two or more human pancreases are needed to achieve a sufficient number of islets (10).The complications of immune rejection could be overcome with macroencapsulation devices (MEDs), in which glucose-sensing, insulin-secreting cell sources like pluripotent, stem cell–derived β clusters (SC-βCs) (11), or other islet sources, are transplanted within an immune-isolating vehicle to promote cell survival and function. In MEDs, islets are housed in a single compartment that selectively permits the exchange of nutrients while obstructing host immune effectors such as cells and antibodies. Over the past few decades, MEDs have successfully restored insulin independence and normoglycemia in T1D animal models (10). However, scaling these devices for human applications has been challenging. Currently, passive diffusion-based MEDs, including Encaptra, βAir Βio-Artificial Pancreas, Cell Pouch, and MAILPAN, are being explored in phase I/II clinical trials (12–14). Nevertheless, these diffusion-based devices still suffer from limitations in the transport of glucose, insulin, and other biomolecules to the core of these devices, which compromise the survival and function of encapsulated cells. Ultimately, these devices are restricted in geometry, thickness, and cell-loading capacity.More specifically, a significant portion of encapsulated cells become nonviable immediately after transplantation because of the lack of vascularization, which results in hypoxia and limited nutrient availability. Thus, during the initial prevascularization period, which lasts ∼14-d posttransplantation, solute exchange and insulin secretion cannot occur effectively using conventional MEDs (15–17). For this reason, many encapsulated cells prematurely lose their function and eventually die. Various strategies have been developed to expediate angiogenesis around the device, especially during the initial hypoxic period after device transplantation, to reduce cell loss. Examples include prevascularization of the device, infusion of vascular endothelial growth factor, and cotransplantation of mesenchymal stem cells (15, 18–21). In another instance, βAir Βio-Artificial Pancreas incorporated a daily refillable oxygen chamber in between two islet slabs to maintain adequate oxygen supply, but the chamber is 15- to 30-fold thicker than islet layers. Despite improvements in cell viability, these strategies still cannot guarantee adequate glucose sensing and insulin release kinetics of the islets, and they further limit the available space for cell packing (22).To supply cells with enough nutrients, it has been suggested that the islet density of the MEDs should be set to 5 to ∼10% of the volume fraction (23). Consequently, a limited mass of islets must be placed within a large device to ensure optimal nutrient distribution. Otherwise, devices exhibit extreme cell loss. For instance, TheraCyte, which packs 70 to ∼216 islet equivalent (IEQ) in 4.5 μL or 1,000 IEQ in 40 μL volume, exhibited poor cell survival (19). The remaining cells were neither capable of restoring euglycemia in rodents (1,000 to ∼2,000 IEQ required) nor sustaining a therapeutic dosage needed for humans (∼500,000 islets) in a reasonably sized device (13, 24–26).To overcome these nutrient delivery challenges and improve cell-loading capacity, we designed a convection-enhanced MED (ceMED) to perfuse the device continuously. We hypothesized that convective nutrient transport in ceMED would 1) deliver more nutrients compared with diffusion-based devices, 2) increase cell survival beyond the distance limit of diffusion, 3) support a three-dimensional (3D), expanded cell layer to increase the loading capacity, 4) improve glucose sensitivity and timely insulin secretion via faster biomolecule transport, and 5) show efficacy in vivo by reducing hyperglycemia before vascularization. Overall, we demonstrated that the convective motion promotes survival of insulin-secreting β cells encapsulated at high density. We also demonstrated that it effectively captures the dynamics of glucose concentrations in the transplantation site, resulting in more appropriate insulin secretion with faster on/off responses. Finally, the ceMED showed early, vascular-independent reduction in blood glucose levels in hyperglycemic rat models several days prior to the critical 14-d posttransplantation.     

Structural insights into α-synuclein monomer–fibril interactions

Protein aggregation into amyloid fibrils is associated with multiple neurodegenerative diseases, including Parkinson’s disease. Kinetic data and biophysical characterization have shown that the secondary nucleation pathway highly accelerates aggregation via the absorption of monomeric protein on the surface of amyloid fibrils. Here, we used NMR and electron paramagnetic resonance spectroscopy to investigate the interaction of monomeric α-synuclein (α-Syn) with its fibrillar form. We demonstrate that α-Syn monomers interact transiently via their positively charged N terminus with the negatively charged flexible C-terminal ends of the fibrils. These intermolecular interactions reduce intramolecular contacts in monomeric α-Syn, yielding further unfolding of the partially collapsed intrinsically disordered states of α-Syn along with a possible increase in the local concentration of soluble α-Syn and alignment of individual monomers on the fibril surface. Our data indicate that intramolecular unfolding critically contributes to the aggregation kinetics of α-Syn during secondary nucleation.

Synucleinopathies, including Parkinson’s disease (PD), are associated with the accumulation of intracellular neuronal aggregates termed as Lewy bodies and Lewy neuritis, which contain high concentration of the protein α-synuclein (α-Syn) in an aggregated state (1, 2). The disease-relevant role of α-Syn is further highlighted by mutations in the α-Syn gene (SNCA) causing familial PD [i.e., A30P (3), E46K (4), H50Q (5), G51D (6), A53E (7), and A53T (8)] and the duplication or triplication of the SNCA leading to early-onset PD in affected families (9, 10). α-Syn is a 140-residue intrinsically disordered protein (IDP) in solution (11) but adopts a helical structure in the presence of acidic lipid surfaces (12, 13). The positively charged N terminus (residues 1 to 60) is rich in lysine residues and contains KTKEGV binding repeats associated with vesicle binding (14). Moreover, the N-terminal domain includes all known SNCA familial PD mutations. The central region (residues 61 to 95) defines the non-amyloid-β component (NAC) (15), which is essential for α-Syn aggregation (16), while the C terminus (residues 96 to 140) is highly negatively charged.In vitro, α-Syn forms polymorphic amyloid fibrils (17–19) with unique arrangements of cross-β-sheet motifs (20–22). When injected into model animals, these fibrils induce a PD-like pathology (23) where the aggregation pathway of α-Syn plays a key role in the development of the disease (24). A detailed analysis of the aggregation kinetics of α-Syn into amyloids is therefore important toward understanding the toxic mechanisms relevant for synucleinopathies.Amyloid formation of α-Syn is very sensitive to solution conditions, including pH (25), temperature (26), and salt concentration (27). It further requires the presence of an air–water interface (28) or negatively charged lipid membranes (29) for which α-Syn has a high affinity. Previous studies suggest that amyloid fibril growth of α-Syn occurs via a nucleation-dependent polymerization reaction (30). Following a fairly slow primary nucleus formation, α-Syn fibrils are elongated by addition of single monomers. In a next step, the amyloid fibrils multiply by fragmentation or can catalyze the formation of new amyloids from monomers on their surface—a process known as secondary nucleation that was first described for sickle cell anemia 40 y ago (31). Fragmentation and secondary nucleation critically depend on the fibril mass and accelerate the aggregation kinetics (30). In the case of α-Syn aggregation under quiescent condition fragmentation does not exist and only the described secondary nucleation process occurs. While detailed kinetic experiments showed no significant secondary nucleation at pH 7, it strongly contributes at pH values lower than 6 (25, 30). However, mechanistic or structural information of the secondary nucleation process in α-Syn aggregation has been lacking so far.In this study we investigated the structural properties of α-Syn monomer–fibril interactions by NMR and electron paramagnetic resonance (EPR) spectroscopy. Our results provide insights into how monomeric α-Syn transiently interacts in vitro via its positively charged N terminus with the negatively charged C-terminal residues of the α-Syn fibrils, giving detailed insights into the mechanism of the secondary nucleation process.     

Electrospun Nisin-Loaded Poly(ε-caprolactone)-Based Active Food Packaging

Packaging for fresh fruits and vegetables with additional properties such as inhibition of pathogens grown can reduce food waste. With its biodegradability, poly(ε-caprolactone) (PCL) is a good candidate for packaging material, especially in the form of an electrospun membrane. The preparation of nonwoven fabric of PCL loaded with food additive, antimicrobial nisin makes them an active packaging with antispoilage properties. During the investigation of the nonwoven fabric mats, different concentrations of nisin were obtained from the solution of PCL via the electrospinning technique. The obtained active porous PCL loaded with varying concentrations of nisin inhibited the growth of Staphylococcus aureus and Escherichia coli. Packages made of PCL and PCL/nisin fibrous mats demonstrated a prolongation of the fruits’ freshness, improving their shelf life and, consequently, their safety.     

Hypertrophic cardiomyopathy β-cardiac myosin mutation (P710R) leads to hypercontractility by disrupting super relaxed state

Hypertrophic cardiomyopathy (HCM) is the most common inherited form of heart disease, associated with over 1,000 mutations, many in β-cardiac myosin (MYH7). Molecular studies of myosin with different HCM mutations have revealed a diversity of effects on ATPase and load-sensitive rate of detachment from actin. It has been difficult to predict how such diverse molecular effects combine to influence forces at the cellular level and further influence cellular phenotypes. This study focused on the P710R mutation that dramatically decreased in vitro motility velocity and actin-activated ATPase, in contrast to other MYH7 mutations. Optical trap measurements of single myosin molecules revealed that this mutation reduced the step size of the myosin motor and the load sensitivity of the actin detachment rate. Conversely, this mutation destabilized the super relaxed state in longer, two-headed myosin constructs, freeing more heads to generate force. Micropatterned human induced pluripotent derived stem cell (hiPSC)–cardiomyocytes CRISPR-edited with the P710R mutation produced significantly increased force (measured by traction force microscopy) compared with isogenic control cells. The P710R mutation also caused cardiomyocyte hypertrophy and cytoskeletal remodeling as measured by immunostaining and electron microscopy. Cellular hypertrophy was prevented in the P710R cells by inhibition of ERK or Akt. Finally, we used a computational model that integrated the measured molecular changes to predict the measured traction forces. These results confirm a key role for regulation of the super relaxed state in driving hypercontractility in HCM with the P710R mutation and demonstrate the value of a multiscale approach in revealing key mechanisms of disease.

Hypertrophic cardiomyopathy (HCM) is one of the most prevalent genetic diseases of the heart, affecting over 1 in 200 individuals (1, 2), and is a leading cause of sudden cardiac death (3). HCM is characterized by cardiomyocyte hypertrophy, myofibril disarray, hypercontractility, and diastolic dysfunction, although there are substantial heterogeneity and complexity in the presentation of HCM in patients (4, 5). Tissue remodeling, including interstitial fibrosis, can eventually progress to heart failure and death (5–7). Over 1,000 causative mutations have been identified, with the majority in genes encoding sarcomeric proteins responsible for generating and regulating contraction. Roughly a third of mutations are located in β-cardiac myosin, the primary ventricular motor protein in humans (8). Increased ejection fraction has been observed in patients with pathogenic mutations in β-cardiac myosin without left ventricular (LV) hypertrophy, which suggests that hypercontractility may precede hypertrophic remodeling in some patients with HCM mutations in β-cardiac myosin (9).Because hypercontractility is often observed in HCM patients with mutations in β-cardiac myosin, HCM mutations were hypothesized to increase the activity of myosin at the protein level, resulting in increased force production at the sarcomere and cellular levels that propagates to the whole-organ level (10). Myosin protein activity is characterized by biochemical and biophysical measurements. The activity of actively cycling myosin interacting with actin is characterized by the rate of ATP turnover, the rate of detachment from actin, force production, step size, and actin-sliding velocity. Myosin that is not actively cycling resides in a super relaxed state (SRX) (11), associated with a folded-back conformation not available for actin interaction. Biochemical and biophysical assessments of HCM mutations in purified human β-cardiac myosin have revealed various changes in both actively cycling myosin (12–16) and SRX proportions (17–20).Myosin is a mechanoenzyme that harnesses the chemical energy from ATP hydrolysis to perform a force-producing power stroke. Its converter domain plays a critical role in facilitating this power stroke by coupling conformational changes originating from its nucleotide pocket to the rotation of its lever arm. This domain is a hot spot for pathogenic mutations (21–24). The P710 residue is located at the proximal edge of the converter domain, and at least three HCM mutations have been identified at this site, including P710R (25–27). The P710R mutation was identified in a cohort of patients with pediatric onset HCM (defined based on LV hypertrophy in patients 13 or younger), and echocardiograms of this cohort found significantly reduced LV end systolic dimension and increased fraction shortening suggesting hypercontractility (27). According to a recent meta-analysis, the average age of disease onset for HCM in patients without a known mutation is 44 y, and the average age of onset with mutations in β-cardiac myosin is 35 y (28). A previous report characterizing both early-onset and late-onset HCM mutations found that actively cycling heads with the P710R mutation have lower ATP turnover activity and duty ratio compared with both wild-type (WT) myosin and other HCM mutations (29). The discrepancy between this reduced function in actively cycling myosin and a potentially hypercontractile, early-onset clinical phenotype invites a comprehensive, multiscale assessment of the effects of the P710R mutation on myosin activity and SRX proportions.In the past, it has been difficult to determine early mechanisms of HCM disease triggered by mutations in β-MHC because of the inability to culture human cardiomyocytes. Samples from hearts obtained at the time of transplant or myectomy reflect a combination of primary and secondary pathologies. Rodents fail to recapitulate many human heart diseases, and their adult ventricles predominantly express the α-MHC isoform, which has different kinetics from β-MHC (30–32). However, the expansion of CRISPR/Cas-9 protocols for human induced pluripotent derived stem cell (hiPSC) gene editing coupled with efficient differentiation into cardiomyocytes (hiPSC-CMs) provides a valuable model system for studying early mechanisms of disease, especially mechanisms related to contractile alterations, in a controlled context (31). In the past, hiPSC-CM models have been limited by the relative immaturity of the cardiomyocytes and high population heterogeneity (33). In traditional two-dimensional culture, these cells have disorganized myofibrils, impaired calcium handling, and immature cell signaling (34, 35). However, recent advances in microengineered environments can provide external environmental cues that better recapitulate in vivo conditions to promote myofibril alignment and accelerate maturation of both contractile machinery and cell signaling (35, 36). While these engineering solutions can improve the functional maturity of hiPSC-CMs, they are still immature relative to adult cardiomyocytes in the heart (33). We have previously developed a hydrogel platform with rectangles of extracellular matrix (ECM) at a 7:1 aspect ratio (similar to that of cardiomyocytes in the left ventricle) that, combined with traction force microscopy (TFM), allows for single-cell assessment of both cellular organization and biomechanics (35–37). When combined with measurements of myosin function at the molecular level, these cellular measurements can provide validation of the molecular basis of force generation and resultant disease mechanisms of HCM.Finally, computational models can provide key insights into the interactions between related dynamic parameters and the resultant implications for the total production of force. Computational models incorporating different degrees of detail and different components of sarcomere structure have been used for decades to answer questions relating to fundamental muscle mechanics (38–47) and alterations to thin filament regulation in the context of cardiac disease and HCM (48, 49). A new model of myosin activity that incorporates an OFF state representative of the SRX state has recently been validated against experimental measurements of cardiac muscle (50). This study concluded that force-sensitive regulation of the OFF state significantly improves the fit to experimental data, but this model has not previously been used in the context of MHY7 mutations nor hiPSC-CMs (50).In this work, we used multiscale experimental techniques to assess the biomechanical effects of the HCM mutation P710R, which demonstrates decreased activity at the level of the motor domain yet increased force generation at the cell level. We furthermore used a computational model to integrate the molecular findings and found that altered regulation of the SRX state is an essential driver of hypercontractility for this mutation. Our multiscale experimental findings combined with computational modeling enabled us to assess the relative contributions of individual molecular parameters to cellular contraction.     

Human Adenovirus Type 26 Induced IL-6 Gene Expression in an αvβ3 Integrin- and NF-κB-Dependent Manner

The low seroprevalent human adenovirus type 26 (HAdV26)-based vaccine vector was the first adenovirus-based vector to receive marketing authorization from European Commission. HAdV26-based vaccine vectors induce durable humoral and cellular immune responses and, as such, represent a highly valuable tool for fighting infectious diseases. Despite well-described immunogenicity in vivo, the basic biology of HAdV26 still needs some refinement. The aim of this study was to determine the pro-inflammatory cytokine profile of epithelial cells infected with HAdV26 and then investigate the underlying molecular mechanism. The expression of studied genes and proteins was assessed by quantitative polymerase chain reaction, western blot, and enzyme-linked immunosorbent assay. Confocal microscopy was used to visualize HAdV26 cell uptake. We found that HAdV26 infection in human epithelial cells triggers the expression of pro-inflammatory cytokines and chemokines, namely IL-6, IL-8, IL-1β, and TNF-α, with the most pronounced difference shown for IL-6. We investigated the underlying molecular mechanism and observed that HAdV26-induced IL-6 gene expression is αvβ3 integrin dependent and NF-κB mediated. Our findings provide new data regarding pro-inflammatory cytokine and chemokine expression in HAdV26-infected epithelial cells, as well as details concerning HAdV26-induced host signaling pathways. Information obtained within this research increases our current knowledge of HAdV26 basic biology and, as such, can contribute to further development of HAdV26-based vaccine vectors.     

Enhancing Stability of High-Concentration β-Tricalcium Phosphate Suspension for Biomedical Application

We propose a novel process to efficiently prepare highly dispersed and stable Tricalcium Phosphate (β-TCP) suspensions. TCP is coupled with a polymer to enhance its brittleness to be used as an artificial hard tissue. A high solid fraction of β-TCP is mixed with the polymer in order to improve the mechanical strength of the prepared material. The high solid fractions led to fast particle aggregation due to Van der Waals forces, and sediments appeared quickly in the suspension. As a result, we used a dispersant, dispex AA4040 (A40), to boost the surface potential and steric hindrance of particles to make a stable suspension. However, the particle size of β-TCP is too large to form a suspension, as the gravity effect is much more dominant than Brownian motion. Hence, β-TCP was subjected to wet ball milling to break the aggregated particles, and particle size was reduced to ~300 nm. Further, to decrease sedimentation velocity, cellulose nanocrystals (CNCs) are added as a thickening agent to increase the overall viscosity of suspension. Besides the viscosity enhancement, CNCs were also wrapped with A40 micelles and increase the stability of the suspension. These CNC/A40 micelles further facilitated stable suspension of β-TCP particles with an average hydration radius of 244.5 nm. Finally, β-TCP bone cement was formulated with the suspension, and the related cytotoxicity was estimated to demonstrate its applicability for hard tissue applications.     

Interlocking activities of DNA polymerase β in the base excision repair pathway

Base excision repair (BER) is a major cellular pathway for DNA damage repair. During BER, DNA polymerase β (Polβ) is hypothesized to first perform gap-filling DNA synthesis by its polymerase activity and then cleave a 5′-deoxyribose-5-phosphate (dRP) moiety via its dRP lyase activity. Through gel electrophoresis and kinetic analysis of partial BER reconstitution, we demonstrated that gap-filling DNA synthesis by the polymerase activity likely occurred after Schiff base formation but before β-elimination, the two chemical reactions catalyzed by the dRP lyase activity. The Schiff base formation and β-elimination intermediates were trapped by sodium borohydride reduction and identified by mass spectrometry and X-ray crystallography. Presteady-state kinetic analysis revealed that cross-linked Polβ (i.e., reduced Schiff base) exhibited a 17-fold higher polymerase efficiency than uncross-linked Polβ. Conventional and time-resolved X-ray crystallography of cross-linked Polβ visualized important intermediates for its dRP lyase and polymerase activities, leading to a modified chemical mechanism for the dRP lyase activity. The observed interlocking enzymatic activities of Polβ allow us to propose an altered mechanism for the BER pathway, at least under the conditions employed. Plausibly, the temporally coordinated activities at the two Polβ active sites may well be the reason why Polβ has both active sites embedded in a single polypeptide chain. This proposed pathway suggests a corrected facet of BER and DNA repair, and may enable alternative chemical strategies for therapeutic intervention, as Polβ dysfunction is a key element common to several disorders.

One of the major cellular pathways for repair of DNA damage is base excision repair (BER) (1–5). In this pathway (Scheme 1A), DNA lesions are removed by glycosylases (e.g., uracil by uracil–DNA glycosylase [UDG]) before the damaged DNA strand is incised by apurinic/apyrimidinic (AP) endonuclease, resulting in a single-nucleotide gap flanked by a 3′-OH and a 5′-deoxyribose-5-phosphate (dRP) moiety. Subsequently, DNA polymerase β (Polβ) is presumed to first catalyze gap-filling DNA synthesis through its DNA polymerase activity and then perform dRP cleavage via its dRP lyase activity, leaving a nicked DNA substrate for ligation by either Ligase III/XRCC1 or Ligase I (6–12).Open in a separate windowScheme 1.The BER pathway. (A) The BER pathway in the literature as cited in the Introduction. (B) Our proposed BER pathway.The dRP lyase active site resides within the 8-kDa N-terminal domain of Polβ, whereas the polymerase active site sits at the palm subdomain (SI Appendix, Fig. S1A) (7). Previously, Polβ has been shown to remove a dRP moiety through a Schiff base–mediated β-elimination reaction (13) rather than through hydrolysis (7–10, 14, 15). A Schiff base is generated following nucleophilic attack by the side chain of an active site lysine residue on the sugar C1′ atom of the dRP moiety (step 1 in Scheme 2). Whereas biochemical data suggest that K72 in human polymerase-β (hPolβ) acts as the active site nucleophile, conflicting evidence as well as a lack of supporting structural data have complicated understanding of the dRP cleavage mechanism (10, 14, 15). For instance, mutation of K72 to alanine does not fully abrogate the dRP lyase activity, suggesting that a different residue may support the nucleophilic attack on the C1′ (11). Furthermore, only limited conclusions can be drawn from the existing binary crystal structures of hPolβ bound to either a single-nucleotide gapped DNA substrate (hPolβ•DNA^P) (SI Appendix, Fig. S2B) containing only a 5′-phosphate, rather than a full dRP moiety, on the downstream primer (SI Appendix, Fig. S2 A, i) (16) or a nicked DNA substrate (hPolβ•DNA^THF) (SI Appendix, Fig. S2C) containing a 5′-dRP mimic (SI Appendix, Fig. S2 A, ii) (11). Due to the lack of the deoxyribose moiety in the structure of hPolβ•DNA^P, information about the dRP cleavage mechanism is lacking. On the other hand, in the structure of hPolβ•DNA^THF, the nonnatural dRP mimic was bound in a nonproductive docking site stabilized through the interaction between its 5′-phosphate and K68 (SI Appendix, Fig. S2C). This nonproductive site is distinct from the putative dRP lyase active site as the Nε atom of K72 is more than 10 Å from the dRP sugar C1′ (11). In fact, from this position, the dRP must rotate ∼120° around the 3′-phosphate to be in close-enough proximity to the Nε atom of K72 for nucleophilic attack to occur (SI Appendix, Fig. S2C). Furthermore, the active site residues responsible for stabilizing the reactive ring-opened aldehyde state of the dRP moiety and abstracting a proton from the ribose C2′ atom to facilitate β-elimination (Scheme 2) remain unidentified.Open in a separate windowScheme 2.Proposed chemical mechanism for the dRP lyase activity of hPolβ. Specific water molecules are denoted as X, Y, and Z.Biochemical studies of the processing of dRP moieties in yeast cell-free extract (17), steady-state kinetic studies of fully reconstituted human BER (4), and investigation of the numbers of endogenous AP sites in genomic DNA of rats and human tissue (5) all suggest that dRP cleavage is the rate-limiting step of the entire BER pathway. However, there is no experimental evidence to indicate that all potential steps associated with dRP cleavage by the lyase activity of Polβ (Scheme 2) occur after gap-filling DNA synthesis catalyzed by the polymerase activity. For example, if facile Schiff base formation occurs before and faster than nucleotide incorporation, the covalently linked Polβ–DNA intermediate, rather than the noncovalent binary complex Polβ•DNA, may catalyze gap-filling DNA synthesis. This possibility has never been investigated, and all previously published in vitro studies have used DNA substrates like either DNA^P (SI Appendix, Fig. S2 A, i) (18–24) or a gapped DNA substrate containing a dRP mimic (SI Appendix, Fig. S2 A, ii) (11, 25).Here, we generated a natural dRP moiety by using either UDG to process a nicked DNA substrate containing a 2′-deoxyuridine or UDG and apurinic/apyrimidinic endonuclease 1 (APE1) to initiate BER on a double-stranded DNA substrate containing a 2′-deoxyuridine. Addition of hPolβ, correct deoxynucleoside triphosphate (dNTP), and then, sodium borohydride (NaBH₄) to the dRP-containing DNA products allowed for the capture of a reduced Schiff base and a β-elimination intermediate produced via hPolβ-catalyzed dRP cleavage (Scheme 2). Through X-ray crystallographic, kinetic, and mass spectrometric (MS) analysis of these cross-linked hPolβ complexes, we envisioned a detailed chemical mechanism for the dRP lyase activity of hPolβ. In addition, we utilized presteady-state kinetic methods to evaluate the impact of the reduced Schiff base intermediate on the efficiency and fidelity of gap-filling DNA synthesis by the polymerase activity of hPolβ. Finally, we employed time-resolved X-ray crystallography to structurally characterize intermediates of gap-filling DNA synthesis by cross-linked hPolβ. Based on several lines of experimental evidence, we proposed a modified BER pathway (Scheme 1B), which posits an interlocking mechanism in which gap-filling DNA synthesis by the polymerase activity occurs between Schiff base formation and β-elimination, the two steps catalyzed by the lyase activity.