Cerebral amino acid levels and transport after portocaval shunt in the rat: Effects of liver arterialization

Altered plasmatic and cerebral amino acid patterns have been observed after portocaval shunt in the rat. Similar alterations have been found in plasma and in cerebrospinal fluid of cirrhotic patients and are likely to play an important role in the pathogenesis of hepatic encephalopathy. Impaired liver blood flow could contribute to these biochemical abnormalities. Therefore we wondered whether liver arterialization, by improving liver perfusion, could have any beneficial effects on the altered amino acid levels occurring in the rat after portocaval shunt. Amino acid concentrations were determined in four cerebral regions and in the plasma of shunted rats with or without liver arterialization, 4 weeks after surgery. Blood-brain barrier transport was studied with the Oldendorf's technique. After portocaval shunt, we observed lower plasma levels of the branched chain amino acids valine, isoleucine, leucine, and net higher levels of the aromatic tyrosine and phenylalanine and of glutamine. In the cerebral regions, we observed a slight increase of branched chain amino acids and an enormous increase of tyrosine, phenylalanine, tryptopan, histidine, and glutamine. Arterialization of the liver made no difference to the postportocaval shunt plasma levels of branched chain amino acids, while it almost normalized those of aromatics. In the cerebral regions, we observed a marked improvement in the level of tyrosine, phenylalanine, tryptophan, and histidine. The enhancement of blood-brain barrier transport for the neutral amino acid class, observed after portocaval shunt, was not influenced by liver arterialization. We conclude that, in our model, liver arterialization improves the pathologic amino acid levels following portocaval shunt. This would be in agreement with clinical reports suggesting that hepatic encephalopathy is less frequent after portocaval shunt when associated with arterialization of the liver.     

Carriers involved in targeting the cytostatic bile acid-cisplatin derivatives cis-diammine-chloro-cholylglycinate-platinum(II) and cis-diammine-bisursodeoxycholate-platinum(II) toward liver cells

Molecular bases for targeting bile acid-cisplatin derivatives Bamet-R2 [cis-diammine-chloro-cholylglycinate-platinum(II)] and Bamet-UD2 [cis-diammine-bisursodeoxycholate-platinum(II)] toward liver cells were investigated. Carriers for bile acids [human Na(+)-taurocholate cotransporting polypeptide (NTCP)], organic anions [organic anion transporting polypeptide (OATP)], and organic cations [organic cation transporter (OCT)] were expressed in Xenopus laevis oocytes (XO) and Chinese hamster ovary (CHO) cells. Drug uptake was measured by flameless atomic absorption of platinum. Rat Oatp1- or rat Ntcp-transfected CHO cells were able to take up Bamets, but not cisplatin, severalfold more efficiently than wild-type cells. This uptake was enhanced by butyrate-induced expression of both carriers. Uptake of both Bamets by Ntcp-transfected CHO cells was stimulated by extracellular sodium. The amount of Bamets, but not cisplatin, taken up by XO was enhanced when expressing OATP-A, OATP-C, NTCP, OCT1, or OCT2, a nonhepatic OCT isoform used for comparative purposes. Bamet uptake by XO was inhibited by known substrates of these carriers (glycocholate for NTCP and OATP-C, ouabain for OATP-A, and quinine for OCT1 and OCT2). Drug uptake versus substrate concentration revealed saturation kinetics (K(m) was in the 8-58 microM range), with the following order of efficiency of transport (V(max)/K(m)) for Bamet-R2: OATP-C > OCT2 > OATP-A > NTCP > OCT1; and the following order of efficiency of transport for Bamet-UD2: OATP-C > OCT2 > OATP-A > OCT1 > NTCP. Increasing the generation of cationic forms of Bamets by incubation in the absence of chloride increased drug uptake by OATP-A, OCT1, and OCT2 but reduced that achieved by NTCP and OATP-C. These results suggest a role for carriers of organic anions and cations in Bamet-R2 and Bamet-UD2 uptake, which may determine their ability to accumulate in liver tumor cells and/or be taken up and efficiently excreted by hepatocytes.     

Polyunsaturated fatty acids supplementation impairs anti‐oxidant high‐density lipoprotein function in heart failure

Background

The underlying reasons for the highly inconsistent clinical outcome data for omega‐3‐polyunsaturated fatty acids (n3‐PUFAs) supplementation in patients with cardiac disease have not been understood yet. The aim of this prospective, randomized, double‐blind, placebo controlled study was to determine the effects of oral treatment with n3‐PUFAs on the anti‐oxidant capacity of HDL in heart failure (HF) patients.

Methods

A total of 40 patients with advanced HF of nonischaemic origin, defined by NT‐proBNP levels of >2000 pg/mL, NYHA class III or IV and a LVEF <35% who were on stable optimized medical therapy for ≥3 months, were consecutively enrolled into this prospective, double‐blind, placebo‐controlled trial and randomized in a 1:1:1 fashion to receive 1 g/day or 4 g/day of n3‐PUFA, or placebo, respectively, for 12 weeks.

Results

After 12 weeks of treatment, the anti‐oxidant function of HDL, measured by the HDL inflammatory index, was found significantly impaired in the treatment group in a dose‐dependent fashion with 0.67 [IQR 0.49‐1.04] for placebo vs 0.71 [IQR 0.55‐1.01] for 1 g/day n3‐PUFA vs 0.98 [IQR 0.73‐1.16] for 4 g/day n3‐PUFA (P for trend = 0.018).

Conclusion

We provide evidence for an adverse effect of n3‐PUFA supplementation on anti‐oxidant function of HDL in nonischaemic heart failure patients, establishing a potential mechanistic link for the controversial outcome data on n3‐PUFA supplementation.     

Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study

AIMS:

to evaluate the accuracy of the Braden and Waterlow risk assessment scales in critically ill inpatients.

METHOD:

this prospective cohort study, with 55 patients in intensive care units, was performed through evaluation of sociodemographic and clinical variables, through the application of the scales (Braden and Waterlow) upon admission and every 48 hours; and through the evaluation and classification of the ulcers into categories.

RESULTS:

the pressure ulcer incidence was 30.9%, with the Braden and Waterlow scales presenting high sensitivity (41% and 71%) and low specificity (21% and 47%) respectively in the three evaluations. The cut off scores found in the first, second and third evaluations were 12, 12 and 11 in the Braden scale, and 16, 15 and 14 in the Waterlow scale.

CONCLUSION:

the Braden scale was shown to be a good screening instrument, and the Waterlow scale proved to have better predictive power.     

CT colonography evaluation of the relationship between colon anatomy and diverticula

Objectives:In this study, we aimed at investigating the relationship between diverticula and in vivo colonic features such as total colon length (TCL), using CTC. We also evaluated polyps, neoplastic lesions and the correlation among them.Methods:This retrospective study considered a series of patients who underwent CTC in our Hospital from 2010 to 2018. We evaluated TCL, the length of each colon segments and sigmoid colon diameter using dedicated software. We verified the presence of diverticula, polyps and neoplasm and measured the number of diverticula using a five-point class scale, evaluating the colonic segments involved by the disease and the number of diverticula for each segment. A logistic regression model was used to analyse the relationship between diverticula and the patients’ age, sigmoid colonic diameter and the length of each colonic segments.Results:The population finally included 467 patients, 177 males and 290 females (average age of 67 ± 12; range 45–96). The mean TCL was 169 ± 25 cm (range 115–241 cm). Out of the 467, 323 patients (69%) had at least one analyse. The patients with diverticula had a mean TCL significantly shorter than patients without diverticula (164 ± 22 vs 181 ± 27 cm; p = 0.001). Among the different variables, sigmoid colon length, sigmoid colon diameter and patient’s age were correlated with diverticula (p < 0.01). Otherwise there is no association among diverticula, polyps and neoplasm.Conclusions:The presence of colonic diverticula was significantly inversely correlated with TCL.The TCL was not significantly correlated with polyps and cancers.Advances in knowledge:The presence of colonic diverticula was significantly inversely correlated with total colon length, and in particular they significantly decreased with increasing colon length; our observation could contribute to the comprehension of diverticula pathogenesis.     

Prespacers formed during primed adaptation associate with the Cas1–Cas2 adaptation complex and the Cas3 interference nuclease–helicase

For Type I CRISPR-Cas systems, a mode of CRISPR adaptation named priming has been described. Priming allows specific and highly efficient acquisition of new spacers from DNA recognized (primed) by the Cascade-crRNA (CRISPR RNA) effector complex. Recognition of the priming protospacer by Cascade-crRNA serves as a signal for engaging the Cas3 nuclease–helicase required for both interference and primed adaptation, suggesting the existence of a primed adaptation complex (PAC) containing the Cas1–Cas2 adaptation integrase and Cas3. To detect this complex in vivo, we here performed chromatin immunoprecipitation with Cas3-specific and Cas1-specific antibodies using cells undergoing primed adaptation. We found that prespacers are bound by both Cas1 (presumably, as part of the Cas1–Cas2 integrase) and Cas3, implying direct physical association of the interference and adaptation machineries as part of PAC.

CRISPR-Cas systems of adaptive immunity provide prokaryotes with resistance against bacteriophages and plasmids (1–4). They consist of CRISPR DNA arrays and cas genes. Functionally, CRISPR defense can be subdivided into the interference and adaptation steps. The interference step involves specific recognition of regions in foreign nucleic acids, named protospacers, based on their complementarity to CRISPR arrays spacers followed by their destruction (5). The CRISPR adaptation step leads to integration of new spacers into the array (6, 7), forming inheritable memory that allows the entire lineage of cells derived from a founder that acquired a particular spacer to do away with genetic invaders carrying matching protospacers (8).Both interference and adaptation can be subdivided into multiple steps. For interference to occur, the CRISPR array is transcribed from a promoter located in the upstream leader region. The resulting pre-CRISPR RNA (pre-crRNA) is processed into short CRISPR RNAs (crRNAs), each containing a spacer flanked by repeat fragments (9). Individual crRNAs are bound by Cas proteins forming the effector complex, which is capable of recognizing sequences complementary to the spacer part of crRNA (10). Upon protospacer recognition, the target is destroyed either by a protein component of the effector complex or by additional recruitable Cas nucleases (3, 11–14). In a well-studied Type I-E CRISPR-Cas system of Escherichia coli, the effector comprises a multisubunit Cascade protein complex bound to a crRNA (11, 12, 15). The complementary interaction of Cascade-bound crRNA with a target protospacer leads to localized protospacer DNA melting and formation of an R-loop complex, where the crRNA spacer is annealed to the protospacer “target” strand, while the opposing “nontarget” strand is displaced and is present in a single-stranded form (16, 17). To avoid potentially suicidal recognition of CRISPR array spacers from which crRNAs originate, target recognition and R-loop complex formation require, in addition to complementarity with the crRNA spacer, the presence of a three-nucleotide long PAM (protospacer adjacent motif) preceding the protospacer (15, 18, 19). For E. coli type I-E system, the consensus PAM sequence is 5′-AAG-3′ on the nontarget strand. Some other trinucleotides also allow target recognition, though with decreased efficiency (15, 20). Below, we will refer to consensus PAM as “PAM^AAG.” The Cas3 nuclease-helicase is recruited to the R-loop complex and is responsible for target destruction (21–24). Cas3 first introduces a single-stranded break in the nontarget protospacer strand 11 to 15 nucleotides downstream of the PAM on the nontarget strand (25). Next, Cas3 unwinds and cleaves DNA in the 3′-5′ direction from the PAM (26–29). In vitro, Cas3-dependent degradation of DNA at the other side of the protospacer was also detected (16). Bidirectional Cas3-dependent degradation of DNA was also detected in vivo (30). The details of Cas3 “molecular gymnastics” required for such bidirectional destruction of DNA around the R-loop complex are not known.The main proteins of CRISPR adaptation are Cas1 and Cas2. In vitro, these proteins interact with each other, and the resulting complex is capable of inserting spacer-sized fragments in substrate DNA molecules containing at least one CRISPR repeat and a repeat-proximal leader region (31, 32). In the course of spacer integration, the Cas1–Cas2 complex first catalyzes a direct nucleophilic attack by the 3′-OH end of the incoming spacer at a phosphodiester bond between the leader and the first repeat in the top CRISPR strand (32, 33). This reaction proceeds via concurrent cleavage of the leader-repeat junction and covalent joining of one spacer strand to the 5′ end of the repeat. Subsequently, the 3′-OH on the second spacer strand attacks the phosphodiester bond at the repeat-spacer junction in the bottom CRISPR strand leading to full integration (32, 33). As a result, an intermediate with the newly incorporated spacer flanked by single-stranded repeat sequences is formed (32, 34). The gaps are filled in by a DNA polymerase, possibly DNA polymerase I (35).When overexpressed, E. coli Cas1 and Cas2 can integrate new spacers into the array in the absence of other Cas proteins (7, 36). During such “naive” adaptation, ∼50% of newly acquired spacers are selected from sequences flanked by the 5′-AAG-3′ trinucleotide, that is, consensus interference-proficient PAM^AAG. It thus follows that at least 50% of spacers acquired by Cas1 and Cas2 alone will be defensive during the interference step. The adaptation process must be tightly controlled, activated in the presence of the infecting mobile genetic elements, and directed toward foreign DNA, for otherwise, spacers acquired from host DNA will lead to suicidal self-interference. The details of the activation of CRISPR adaptation upon the entry of foreign DNA into the cell remain elusive. Some data indicate that active replication and/or a small size of phage or plasmid DNA may be responsible for a preferential selection of spacers from these molecules compared to selection of self-targeting spacers from host chromosomes (19). In addition, DNA repair/recombination signals present in host DNA, but lacking in foreign DNA may also increase the bias of the adaptation machinery to the latter (37).The bias of spacer acquisition machinery toward foreign DNA does not have to be significant, for acquisition of a self-targeting spacer by an infected cell will lead to the demise of such a cell in an act of altruism that would help control the spread of the infectious agent through the population. In contrast, acquisition of interference-proficient spacers from foreign DNA may allow the infected cell to survive, clear the infection, and endow its progeny with inheritable resistance—clearly an advantageous trait.To overcome CRISPR resistance, viruses and plasmids accumulate “escaper” mutations in the targeted protospacer or its PAM (36, 38). Given that the acquisition of protective spacers in infected cells is likely to be a rare event and the ease with which escaper mutations accumulate, the complex multistage CRISPR defense could become costly and ineffective (39). To increase the efficiency of CRISPR defense and counter the spread of mobile genetic elements with escaper mutations, CRISPR-Cas systems have evolved a specialized mode of spacer acquisition referred to as “primed adaptation” or “priming” (36, 40–47). Unlike the naive adaptation, in Type I CRISPR-Cas systems, priming requires, in addition to Cas1 and Cas2, a Cascade charged with crRNA recognizing the foreign target and the Cas3 nuclease–helicase. Spacers acquired during priming originate almost exclusively from DNA located in cis with the protospacer initially recognized by the effector complex (referred to hereafter as the “priming protospacer” or “PPS”). Furthermore, 90% or more of spacers acquired during priming by the I-E system of E. coli originate from protospacers with PAM^AAG and are therefore capable of efficient interference. Another hallmark of primed adaptation is the following: spacers acquired from DNA located at different sides of the PPS map to opposite DNA strands. The mapping of spacers acquired during naive adaptation shows no strand bias (48). Thus, the strand bias of spacers acquired during priming is probably related to Cas3 nuclease activity; however, exact details are lacking.The overall yield of spacers acquired during priming is increased when the PPS is imperfectly matched with a Cascade-bound crRNA spacer or when the PAM of the PPS is suboptimal (49). Thus, escaper protospacers serve as PPS, and priming initiated by inefficient recognition of such protospacers allows cells to quickly update their immunological memory by specific and efficient acquisition of additional interference-proficient spacers from mobile genetic elements that accumulated escaper mutations to earlier acquired spacers.The exact molecular mechanism of primed adaptation is not fully understood. Clearly, it should involve tight coordination between suboptimal interference against escaper targets and the spacer acquisition process. The DNA fragments produced by Cas3, a nuclease responsible for target degradation during interference, may feed primed adaptation, directly or indirectly, providing a functional link between the interference and adaptation arms of the CRISPR-Cas response. Based on results of in vitro experiments, it has been proposed that Cas3-generated degradation products may be used as substrates for the generation of prespacers (50)—DNA fragments that can be incorporated by the Cas1–Cas2 complex into arrays. However, no Cas3-generated products were detected in cells undergoing interference only, suggesting that Cas3 may degrade DNA to very short, subspacer length products (30). On the other hand, mutations abolishing the Cas3 nuclease activity lead to very little primed adaptation, indicating that priming requires the Cas3 nuclease activity (51). A possible way out from this impasse would be the existence of a “priming complex” that includes both Cas1–Cas2 and Cas3 and is responsible for the generation of prespacers by the Cas1–Cas2 complex from DNA along which Cas3 moves. Single-molecule analysis supports the existence of such a complex and even suggests that PPS-bound Cascade may be part of the priming complex (52). Here, we show that both Cas1–Cas2 and Cas3 associate with the same set of prespacers in cells undergoing primed adaptation, functionally linking CRISPR interference and adaptation machineries during priming. We also investigate the phenomenon of strand bias of spacer acquisition during priming and show that this bias does not depend on the orientation of PPS.