Notch activation results in phenotypic and functional changes consistent with endothelial-to-mesenchymal transformation

Various studies have identified a critical role for Notch signaling in cardiovascular development. In this and other systems, Notch receptors and ligands are expressed in regions that undergo epithelial-to-mesenchymal transformation. However, there is no direct evidence that Notch activation can induce mesenchymal transdifferentiation. In this study we show that Notch activation in endothelial cells results in morphological, phenotypic, and functional changes consistent with mesenchymal transformation. These changes include downregulation of endothelial markers (vascular endothelial [VE]-cadherin, Tie1, Tie2, platelet-endothelial cell adhesion molecule-1, and endothelial NO synthase), upregulation of mesenchymal markers (alpha-smooth muscle actin, fibronectin, and platelet-derived growth factor receptors), and migration toward platelet-derived growth factor-BB. Notch-induced endothelial-to-mesenchymal transformation does not seem to require external regulation and is restricted to cells expressing activated Notch. Jagged1 stimulation of endothelial cells induces a similar mesenchymal transformation, and Jagged1, Notch1, and Notch4 are expressed in the ventricular outflow tract during stages of endocardial cushion formation. This is the first evidence that Jagged1-Notch interactions induce endothelial-to-mesenchymal transformation, and our findings suggest that Notch signaling may be required for proper endocardial cushion differentiation and/or vascular smooth muscle cell development.     

Critical care medicine training and certification for emergency physicians

Demand for critical care services is increasing. Unless the supply of intensivists increases, critically ill patients will not have access to intensivists. Recent critical care society recommendations include increased graduate medical education support and expansion of the J-1 visa waiver program for foreign medical graduates. This article proposes additional recommendations, based on strengthening the relationship between emergency medicine and critical care medicine. Critical care is a continuum that includes out-of-hospital, emergency department (ED), and ICU care teams. Both emergency medicine and critical care medicine require expertise in treating life-threatening acute illness, with many critically ill patients often presenting first to the ED. Increased patient volumes and acuity have resulted in longer ED lengths of stay and more critical care delivery in the ED. However, the majority of critical care medicine fellowships do not accept emergency medicine residents, and those who do successfully complete a fellowship do not have access to a US certification examination in critical care medicine. Despite these barriers, interest in critical care medicine training among emergency physicians is increasing. Dual emergency medicine- and critical care medicine-trained physicians will not only help alleviate the intensivist shortage but also strengthen critical care delivery in the ED and facilitate coordination at the ED-ICU interface. We therefore propose that all accreditation bodies work cooperatively to create a route to critical care medicine certification for emergency physicians who complete a critical care fellowship.     

A comparison of iopromide and iopamidol,two acidoCEST MRI contrast media that measure tumor extracellular pH

Acidosis within tumor and kidney tissues has previously been quantitatively measured using a molecular imaging technique known as acidoCEST MRI. The previous studies used iopromide and iopamidol, two iodinated contrast agents that are approved for clinical CT diagnoses and have been repurposed for acidoCEST MRI studies. We aimed to compare the performance of the two agents for measuring pH by optimizing image acquisition conditions, correlating pH with a ratio of CEST effects from an agent, and evaluating the effects of concentration, endogenous T₁ relaxation time and temperature on the pH–CEST ratio correlation for each agent. These results showed that the two agents had similar performance characteristics, although iopromide produced a pH measurement with a higher dynamic range while iopamidol produced a more precise pH measurement. We then compared the performance of the two agents to measure in vivo extracellular pH (pHe) within xenograft tumor models of Raji lymphoma and MCF‐7 breast cancer. Our results showed that the pHe values measured with each agent were not significantly different. Also, iopromide consistently measured a greater region of the tumor relative to iopamidol in both tumor models. Therefore, an iodinated contrast agent for acidoCEST MRI should be selected based on the measurement properties needed for a specific biomedical study and the pharmacokinetic properties of a specific tumor model. Copyright © 2015 John Wiley & Sons, Ltd.     

Clinical trial of halofantrine with modified doses for treatment of malaria in the hospital for tropical diseases

The spread of falciparum malaria resistant to chloroquine all over Southeast Asian continent has led to increasing use of alternative antimalarial drugs. Halofantrine has been shown to be effective against multidrug resistant Plasmodium falciparum. One hundred and twenty falciparum malaria cases were randomly assigned to one of three different halofantrine regimes. Group I (HA1) received 500 mg three times daily for 3 days (total dose: 4,500 mg), group II (HA2) received 500 mg three times daily for the first and the third day (total dose: 3,000 mg) and group III (HA3) received 500 mg three times for one day followed by 500 mg once daily for 7 days (total dose: 4,500 mg). No significant difference in the cure rate was observed among the three regimes (cure rate: 89%, 73%, 97% respectively). However, the cure rate was significantly higher in the HA3 group when compared to the HA2 group. There were no overt cardiac problems seen in this study. Thus, halofantrine has high efficacy in the recommended treatment dose of 500 mg three times after meals on the first day followed by 500 mg once a day after a meal for 7 days (total dose: 4,500 mg).     

Endocrine changes during natural spawning in the white sucker, Catostomus commersoni. I. Gonadotropin, growth hormone, and thyroid hormones

White suckers (Catostomus commersoni; Cypriniformes, Teleosteii) spawning in a small stream in central Alberta were captured during different stages of their spawning migrations in 1981 and 1982, blood was sampled, and the fish were examined to determine their reproductive condition. Blood samples were analyzed for gonadotropin (GtH), growth hormone (GH), triiodothyronine (T3), and thyroxine (T4) by radioimmunoassay. GtH levels in both sexes were lowest prior to the onset of spawning, increased significantly in spawning males, females in which germinal vesicle migration had begun, and ovulated females and then dropped significantly in spent fish of both sexes. GH was lowest in prespawning females, increased significantly at ovulation, and remained high in spent females. In contrast, GH levels in males were relatively constant throughout spawning. In both sexes, highest T4 levels were found in prespawning fish, and T4 decreased significantly in spent fish. Although a similar decline was seen in T3 in 1981, in 1982 there were no T3 changes associated with changes in reproductive condition. No significant diurnal variations were detected in the levels of GtH or T3; T4 levels appeared to vary on a diurnal basis in prespawning males only. Spawning activity in both sexes therefore appears to be associated with increases in GtH occurring at ovulation in females and at the initiation of spawning in males. GH levels may also be related to reproductive condition in females, but not in males. The relationship of thyroid hormone levels to reproductive condition is less clear, however, and these levels may reflect both endocrine and environmental influences on thyroid function.     

Dynamical evidence for causality between galactic cosmic rays and interannual variation in global temperature

As early as 1959, it was hypothesized that an indirect link between solar activity and climate could be mediated by mechanisms controlling the flux of galactic cosmic rays (CR) [Ney ER (1959) Nature 183:451–452]. Although the connection between CR and climate remains controversial, a significant body of laboratory evidence has emerged at the European Organization for Nuclear Research [Duplissy J, et al. (2010) Atmos Chem Phys 10:1635–1647; Kirkby J, et al. (2011) Nature 476(7361):429–433] and elsewhere [Svensmark H, Pedersen JOP, Marsh ND, Enghoff MB, Uggerhøj UI (2007) Proc R Soc A 463:385–396; Enghoff MB, Pedersen JOP, Uggerhoj UI, Paling SM, Svensmark H (2011) Geophys Res Lett 38:{"type":"entrez-nucleotide","attrs":{"text":"L09805","term_id":"177519"}}L09805], demonstrating the theoretical mechanism of this link. In this article, we present an analysis based on convergent cross mapping, which uses observational time series data to directly examine the causal link between CR and year-to-year changes in global temperature. Despite a gross correlation, we find no measurable evidence of a causal effect linking CR to the overall 20th-century warming trend. However, on short interannual timescales, we find a significant, although modest, causal effect between CR and short-term, year-to-year variability in global temperature that is consistent with the presence of nonlinearities internal to the system. Thus, although CR do not contribute measurably to the 20th-century global warming trend, they do appear as a nontraditional forcing in the climate system on short interannual timescales.The basic principles behind a possible connection between galactic cosmic rays (CR) and global temperature (GT) are as follows: It has been known since the invention of the cloud chamber in 1911 by Charles Thomson Rees Wilson that ionizing radiation leads to atmospheric cloud nucleation. Although the prime source of ionizing radiation in the global troposphere is CR, the flux of CR reaching the troposphere depends on the solar wind. The solar wind is a stream of ionized gases that blows outward from the Sun, and its intensity varies strongly with the level of surface activity on the Sun. The Earth''s magnetic field shields the planet from much of the solar wind, deflecting that wind like water around the bow of a ship. When solar activity is great, the solar wind is strong, swiping away CR arriving at the top of the atmosphere. These CR are hypothesized to affect cloud formation and cloudiness, and therefore GT. The net radiative effect of cloudiness depends on the difference between incoming solar radiation and outgoing long-wave radiation. Increased cloudiness in the upper troposphere reduces outgoing long-wave radiation, thereby resulting in warming of the planet. Increased cloudiness in the lower troposphere causes less incoming radiation, and therefore cooling of the planet. Data suggest (6) that the amount of CR is positively correlated with the amount of low-level clouds but has no effect on middle- or high-level clouds. Although this is still an open question (7, 8), the reduction in flux in CR in times of high solar activity is hypothesized to result in less cloud nucleation and fewer cloud condensation nuclei, and consequently, reduced low-level cloud amounts. This, in turn, leads to a higher solar radiation flux at the Earth’s surface, and warmer temperatures. Conversely, a weaker solar wind results in cooler temperatures. The actual chemical processes and reactions involved in this problem are complex, but a growing body of experimental and theoretical work has uncovered a chemical pathway by which CR ionization may increase nucleation rates to levels appropriate for cloud condensation nuclei (2–5, 9–11 and references therein). This suggests a superficially simple network linking the Sun, CR, and global climate, with the interaction between the Sun and CR having a potential influence on the climate system. However reasonable this may be, as described in a 2006 review (12), “The suggested mechanisms are, however, too complex to evaluate meaningfully at present.”     

TRPC6 channel translocation into phagosomal membrane augments phagosomal function

Defects in the innate immune system in the lung with attendant bacterial infections contribute to lung tissue damage, respiratory insufficiency, and ultimately death in the pathogenesis of cystic fibrosis (CF). Professional phagocytes, including alveolar macrophages (AMs), have specialized pathways that ensure efficient killing of pathogens in phagosomes. Phagosomal acidification facilitates the optimal functioning of degradative enzymes, ultimately contributing to bacterial killing. Generation of low organellar pH is primarily driven by the V-ATPases, proton pumps that use cytoplasmic ATP to load H⁺ into the organelle. Critical to phagosomal acidification are various channels derived from the plasma membrane, including the anion channel cystic fibrosis transmembrane conductance regulator, which shunt the transmembrane potential generated by movement of protons. Here we show that the transient receptor potential canonical-6 (TRPC6) calcium-permeable channel in the AM also functions to shunt the transmembrane potential generated by proton pumping and is capable of restoring microbicidal function to compromised AMs in CF and enhancement of function in non-CF cells. TRPC6 channel activity is enhanced via translocation to the cell surface (and then ultimately to the phagosome during phagocytosis) in response to G-protein signaling activated by the small molecule (R)-roscovitine and its derivatives. These data show that enhancing vesicular insertion of the TRPC6 channel to the plasma membrane may represent a general mechanism for restoring phagosome activity in conditions, where it is lost or impaired.Chronic infection and inflammation in the airways in cystic fibrosis (CF), as well as chronic obstructive pulmonary disease (COPD), tuberculosis, and asthma are now among the most common chronic diseases. Pulmonary infection associated with these diseases has historically been treated with antibiotics that kill bacteria but also select for development of resistance in the pathogen in the chronically infected lung (1, 2). One solution to antimicrobial drug resistance is to target the host rather than the pathogen. This strategy necessitates finding alternative targets or signaling strategies amplifying or restoring bactericidal capacity in the cells charged with the task of resolving chronic infection.Mononuclear phagocytes orchestrate the innate immune response in the lung through the combinatorial interplay between the phagocytic uptake and killing of bacterial invaders, clearance of apoptotic cells, antigen presentation, and secretion of vesicle-bound signaling molecules to recruit help in the resolution of infection. Ionic fluxes across the phagosomal membrane that encloses the pathogen produce a hostile acidic environment developed through the action of a V-ATPase proton translocation. However, a positive intraphagosomal membrane potential generated by proton translocation minimizes the proton content of the phagosome. An influx of Cl⁻ via Cl⁻ channels reduces the membrane potential generated by the proton pump, thereby, allowing maximal acidification of the phagolysosomal compartment, which in turn maximizes the activation of lysosomal degradative enzymes, generation of hypochlorous acid, and consequent bacterial killing (3, 4). We have previously demonstrated that murine alveolar macrophages (AMs) use the anion channel cystic fibrosis transmembrane conductance regulator (CFTR) as a Cl⁻ permeation pathway in the phagosomal membrane. In CF, loss of functional CFTR in the AM alkalinizes the phagosomal lumen and allows antimicrobial-resistant bacterial pathogens to survive macrophage surveillance.Not all tissue macrophages use CFTR as a charge compensation pathway in phagolysosomal acidification (4). In fact, recent data suggest that multiple V-ATPase charge-shunt pathways can exist in diverse macrophage lineages (5) via lysosomal recruitment and membrane insertion upon particle uptake. This observation led us to search for possible alternative charge-shunt pathways in pulmonary macrophages and how they might be activated or targeted to the maturing phagosome. Could a pharmacological tool circumvent the defect in CF AMs and activate alternative pathways to rescue both organellar acidification and bactericidal activity in cells expressing mutations in CFTR? Such a tool might activate parallel charge-shunt pathways used in peritoneal macrophages for maximum acidification, thereby allowing them to clear bacteria independently of CFTR expression as well as amplify the microbicidal response in the presence of functional CFTR. The transport proteins and channels active in peritoneal macrophage bacterial clearance have not been described but may involve a K⁺/H⁺ exchanger important in promoting excitatory synaptic vesicle filling (6) or a cation channel moving positive charge out of the phagolysosomal compartment, as has been suggested for macrophage cell lines (7).We began our investigations pursuing a novel pharmacological strategy to identify compounds that would resolve bacterial infection in the CF lung without the use of antimicrobials. We picked a cellular defect in CF because of the availability of animal models and extended our observations to non-CF human pulmonary cells. We designed screening assays of phagosome function, which could be used in a clinical setting as both diagnostic and investigational tools. We interrogated host function by studying surface receptor-mediated mechanisms that might provide parallel signaling pathways in subcellular organellar function in the resolution of disease.We report that a series of small molecules first identified in chemotherapeutics, (R)-roscovitine [2-(R)-(1-ethyl-2-hydroxyethylamino)-6-benzylamino-9-isopropylpurine] and its derivatives, restore microbicidal function to compromised AMs in CF and enhance function in non-CF cells. The compounds use a G protein-mediated signaling pathway, which results in the mobilization of transient receptor potential canonical-6 (TRPC6) calcium-permeable, nonselective cation channels to the plasma membrane and subsequently to the phagosomal membrane. Members of the TRP channel family have been implicated in a number of critical phagocytic functions, including particle uptake, migration, and reactive oxygen species (ROS) production (5, 8–11). Numerous studies (12–15) have suggested TRP channels as potential targets for the development of therapies in pulmonary inflammation because of their abundant and diverse cellular expression throughout the respiratory tree. Although TRPC6 channels have been previously identified in lung macrophages and shown to be up-regulated in COPD, their precise role in the pathophysiology of the disease is yet to be determined (16). Perhaps more relevant to our study, a TRPC6-mediated Ca²⁺ influx is increased in human CF airway epithelial cells, possibly because of a functional association between CFTR and TRPC6 that is lost in CF (17), with unknown consequences. To our knowledge, this study is the first to associate TRPC6 channels a specific drug-targeting strategy for the resolution chronic pulmonary infection.     

Relationships between tumor grade and neurocognitive functioning in patients with glioma of the left temporal lobe prior to surgical resection

Background

Various tumor characteristics have been associated with neurocognitive functioning (NCF), though the role of tumor grade has not been adequately examined.

Methods

Seventy-two patients with histologically confirmed grade IV glioma (n = 37), grade III glioma (n = 20), and grade II glioma (n = 15) in the left temporal lobe completed preoperative neuropsychological assessment. Rates of impairment and mean test performances were compared by tumor grade with follow-up analysis of the influence of other tumor- and patient-related characteristics on NCF.

Results

NCF impairment was more frequent in patients with grade IV tumor compared with patients with lower-grade tumors in verbal learning, executive functioning, as well as language abilities. Mean performances significantly differed by tumor grade on measures of verbal learning, processing speed, executive functioning, and language, with the grade IV group exhibiting worse performances than patients with lower-grade tumors. Group differences in mean performances remained significant when controlling for T1-weighted and fluid attenuated inversion recovery MRI-based lesion volume. Performances did not differ by seizure status or antiepileptic and steroid use.

Conclusions

Compared with patients with grade II or III left temporal lobe glioma, patients with grade IV tumors exhibit greater difficulty with verbal learning, processing speed, executive functioning, and language. Differences in NCF associated with glioma grade were independent of lesion volume, seizure status, and antiepileptic or steroid use, lending support to the concept of “lesion momentum” as a primary contributor to deficits in NCF of newly diagnosed patients prior to surgery.