Analytical Sensitivity of Six SARS-CoV-2 Rapid Antigen Tests for Omicron versus Delta Variant

Rapid antigen detection (RAD) tests are commonly used for the diagnosis of SARS-CoV-2 infections. However, with the continuous emergence of new variants of concern (VOC), presenting various mutations potentially affecting the nucleocapsid protein, the analytical performances of these assays should be frequently reevaluated. One hundred and twenty samples were selected and tested with both RT-qPCR and six commercial RAD tests that are commonly sold in Belgian pharmacies. Of these, direct whole-genome sequencing identified the strains present in 116 samples, of which 70 were Delta and 46 were Omicron (BA.1 and BA.1.1 sub-lineages, respectively). The sensitivity across a wide range of Ct values (13.5 to 35.7; median = 21.3) ranged from 70.0% to 92.9% for Delta strains and from 69.6% to 78.3% for Omicron strains. When taking swabs with a low viral load (Ct > 25, corresponding to <4.9 log₁₀ copies/mL), only the Roche RAD test showed acceptable performances for the Delta strains (80.0%), while poor performances were observed for the other RAD tests (20.0% to 40.0%). All the tested devices had poor performances for the Omicron samples with a low viral load (0.0% to 23.1%). The poor performances observed with low viral loads, particularly for the Omicron strain, is an important limitation of RAD tests, which is not sufficiently highlighted in the instructions for use of these devices.     

Ghrelin receptor conformational dynamics regulate the transition from a preassembled to an active receptor:Gq complex

How G protein-coupled receptor conformational dynamics control G protein coupling to trigger signaling is a key but still open question. We addressed this question with a model system composed of the purified ghrelin receptor assembled into lipid discs. Combining receptor labeling through genetic incorporation of unnatural amino acids, lanthanide resonance energy transfer, and normal mode analyses, we directly demonstrate the occurrence of two distinct receptor:Gq assemblies with different geometries whose relative populations parallel the activation state of the receptor. The first of these assemblies is a preassembled complex with the receptor in its basal conformation. This complex is specific of Gq and is not observed with Gi. The second one is an active assembly in which the receptor in its active conformation triggers G protein activation. The active complex is present even in the absence of agonist, in a direct relationship with the high constitutive activity of the ghrelin receptor. These data provide direct evidence of a mechanism for ghrelin receptor-mediated Gq signaling in which transition of the receptor from an inactive to an active conformation is accompanied by a rearrangement of a preassembled receptor:G protein complex, ultimately leading to G protein activation and signaling.G protein-coupled receptors (GPCRs), one of the largest cell surface receptor families, are involved in many cellular signaling processes (1). Based on this property, as well as their importance as drug targets, the molecular aspects of GPCR functioning have been extensively investigated. In particular, coupling to heterotrimeric G proteins has been the focus of numerous studies. Indeed, delineating the molecular mechanisms responsible for receptor:G protein interaction is absolutely required to better understand how signaling is controlled. Recent years have seen spectacular advances that have culminated in elucidation of the 3D structure of the β₂-adrenergic receptor:Gs complex (2). Nevertheless, the need for further progress remains, in particular to fully understand the dynamics of this interaction. This is a crucial question, given that how the receptor interacts with its G protein partner governs signaling, and thus biological and pathophysiological responses.To date, two different models for GPCR:G protein interaction have been proposed: collision coupling and preassembly. Originally, it was proposed that receptors and G proteins couple by collision (3, 4). One of the main features of this model is that only activated receptors interact with G proteins. Since then, alternative models of signaling have been developed. One of these, the preassembly model, proposes that the receptor and the G protein make a complex even in the absence of agonist (5–8). Discriminating between the two models is crucial. Indeed, signaling outputs, such as the kinetics of G protein activation, will be significantly different depending on whether the ligand-free receptor is always in complex with its G protein or must first be activated by the agonist to recruit the G protein and trigger signaling. Moreover, it has been shown that GPCR conformational dynamics (9–11) and signaling in the absence of ligand are key features of GPCR functioning (12). How receptor constitutive activity and conformational dynamics relate to their coupling to the G protein remains an open question.Here we used the purified ghrelin receptor GHS-R1a to analyze the way in which this GPCR interacts with its G protein partners. Ghrelin is a neuroendocrine peptide hormone that acts through its cognate GPCR to control important biological processes, such as growth hormone secretion, food intake, and reward-seeking behaviors (13). Among the GPCRs, GHS-R1a has been shown to have one of the highest basal Gq activation levels both in vitro (10, 14) and in vivo (15, 16). The physiological relevance of GHS-R1a basal activity is substantiated by the occurrence of a natural human mutation in the GHS-R1a gene (A²⁰⁴E substitution in the second extracellular loop of the receptor) that dramatically decreases constitutive activity and is associated with a short-stature phenotype (17). Along with its importance in drug design, GHS-R1a is a prototype for peptide-activated class A GPCRs.To delineate the way in which the ghrelin receptor interacts with G proteins, we used monomeric GHS-R1a reconstituted in a membrane-mimicking environment, lipid discs, and a combination of innovative biochemical [labeling with unnatural amino acid (UAA)] and biophysical [lanthanide resonance energy transfer (LRET) and normal mode (NM) analyses] approaches. By doing so, we provide the first direct evidence that ghrelin-mediated signaling involves a complex dialogue between the conformational dynamics of the receptor and its ability to interact with the different G protein subtypes to which it is coupled.     

Follicular dendritic cell tumor of the mediastinum: expression of fractalkine and SDF-1α as mast cell chemoattractants

Follicular dendritic cell tumor (FDCT) is a rare tumor mainly located in laterocervical lymph nodes. We report one case of mediastinal FDCT associated with a history of bullous skin disease and clinically obvious immunosuppression. This tumor was characterized by heavy mast cell infiltration. Mast cells were in close relationship with tumor cells as demonstrated by ultrastructural examination and their presence are probably related with the strong expression of mast cell chemoattractants as fraktalkine and stromal cell-derived factor-1α by tumor cells. The long follow-up period of more than 17 years allowed to us assess the relatively indolent evolution of this tumor characterized by three slowly growing local recurrences without metastasis.     

Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion

Objective To assess whether hyponatremia in acute neurological patients is associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or with the cerebral salt-wasting syndrome (CSWS). Design Clinical, controlled, prospective study. Setting Department of intensive care of a tertiary care academic hospital. Patients Forty acute neurological patients with hyponatremia suggesting SIADH or CSWS (20) or with normonatremia (20). Interventions None. Measurements and main results Measurement of clinical and biological variables. Measurement of blood, plasma, and red blood cell volumes to discriminate SIADH and CSWS. Renal, adrenal and thyroid functions were normal in all patients. Average blood, plasma, and red blood cell volumes were 54, 37 and 17 ml/kg in control patients and 54, 37 and 18 ml/kg in hyponatremic patients, respectively. Conclusions The adequate blood volumes in hyponatremic patients confirm the diagnosis of SIADH and do not support the concept of CSWS. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Late ear sequelae in cleft palate patients

This retrospective study looks at the incidence and nature of ear disease in 50 adolescent patients who had cleft palates repaired in infancy. Half of these patients had a history of grommet insertion. We found that most patients had normal hearing (81%) and middle-ear pressures (86%), although about half had tympanic membrane abnormalities. Grommet insertion did not result in better long-term hearing in this study but was strongly associated with tympanosclerosis. Cleft type did not influence the degree of ear disease although more patients with complete clefts had a history of repeated grommet insertion. Otitis media with effusion is almost universal in cleft palate infants and may influence later language, speech and educational development. At the time of palatal repair grommets should be inserted to improve hearing in these infants.     

Systemic oxygen extraction can be improved during repeated episodes of cardiac tamponade

We used a tamponade model to study the relationship between oxygen uptake (VO₂) and oxygen delivery (Do₂) during successive, reversible decreases in blood flow. In 7 pentobarbital-anesthetized and mechanically ventilated dogs, a catheter was introduced via a left thoracotomy into the pericardium to inject and to withdraw saline. Each experiment consisted of three steps. First, cardiac output was reduced by successive pericardial fluid injections until 4 to 6 data points were obtained in the dependent region of the o₂/ o₂ plot (step 1). Second, cardiac output was restored by progressive withdrawal of pericardial fluid (step 2). Third, cardiac output was lowered again by reinjection of fluid into the pericardium until death (step 3). Expired gases were collected for determination of ₂. In each animal, critical o₂ ( o₂crit), below which ₂ became o₂ dependent, was determined from a plot of ₂ versus o₂. When releasing tamponade, ₂ was restored to baseline. For the 3 steps, o₂crit were 10.5 ±- 2.2 mL/kg/min in step 1, 9.8 ±- 1.8 mL/kg/min in step 2, and 8.3 ±- 1.9 mL/kg/min in step 3 (P < .01 v step 1; P < .05 v step 2, respectively). There was no significant difference in o₂2 at o₂crit for the three steps. Hence, critical oxygen extraction ratio (ERo₂crit) increased from 60% ±- 12% in step 1 to 64% ± 11 % in step 2 (not significant) and to 73% ±- 12% in step 3 (P < .01). The ₂/ o₂ dependency slope was also steeper in step 3 than in step 1 (0.77 ± 0.31 v 0.54 ±- 0.20, P < .05). A progressive decrease in arterial and in mixed venous pH was observed during the experiment. We conclude that a decrease in ₂ associated with an acute reduction in blood flow can be readily reversible. When the procedure is repeated, a progressive increase in oxygen extraction capabilities is observed. This reversible tamponade model is potentially suitable to induce several hypoxic episodes in the same animal.     

Total body irradiation–high-dose cytosine arabinoside and melphalan followed by allogeneic bone marrow transplantation from HLA-identical siblings in the treatment of children with acute lymphoblastic leukaemia after relapse while receiving chemotherapy: a Société Française de Greffe de Moelle study

We investigated the use of a new conditioning regimen followed by allogeneic bone marrow transplantation (BMT) for treating children with acute lymphoblastic leukaemia (ALL) after relapse within 6 months of the completion of therapy. One hundred and sixteen children with acute lymphoblastic leukaemia in second or subsequent complete remission (CR) underwent allogeneic bone marrow transplantation from HLA-identical siblings after a preparative regimen comprising total body irradiation (TBI), high-dose cytosine arabinoside and melphalan (TAM regimen). The Kaplan-Meier product-limit estimate (mean ± SE) of disease-free survival (DFS) at 7 years was 59.5 ± 9% (95% confidence interval). The estimated chance of relapse was 22.5 ± 15% with a median follow-up of 88.5 months (range 51–132). 26 patients (22.4%) died with no evidence of recurrent leukaemia, mainly from interstitial pneumonitis, veno-occlusive disease or acute graft-versus-host disease (GVHD). Three factors significantly affected DFS: acute GVHD, site of relapse and, for children in second remission after a marrow relapse, the disease status at the time of transplantation. The DFS were 59.02 ± 12.6%, 37.5 ± 19.8% and 77.4 ± 15% among patients in CR2 after a marrow relapse, in CR3 or in untreated partial marrow relapse, and in CR2 after an isolated CNS relapse, respectively. The lowest DFS was seen in children with acute GVHD grades 3–4. Two significant factors were associated with relapse: the marrow status at the time of transplantation and chronic GVHD. The relapse rate was lower among children in CR2 or with chronic GVHD. We conclude that transplantation after the TAM regimen is an effective therapy for this population with acceptable toxicity, particularly for children in second remission after a very early marrow relapse, or those with early isolated CNS involvement.     

Enhanced removal of cholesterol from macrophage foam cells to serum from type IV hypertriglyceridemic subjects

Hypertriglyceridemia being an independent cardiovascular risk factor, we have compared the potential of sera from asymptomatic hypertriglyceridemic (HTG) type IIb, type IV or normolipidemic (NLP) subjects to promote both fractional cholesterol efflux and cellular cholesterol mass changes using macrophage foam cells. The J774 cells loaded with cholesterol by incubation with acetylated LDL were incubated in the absence or presence of cAMP to upregulate ABCA1 (ATP binding cassette transporter A1) and then incubated for 24 h with 1% serum. Compared with NLP, type IV sera exhibited a major increase in ABCA1-dependent efflux while type IIb sera exhibited a moderate but not significant increased ABCA1-mediated efflux. Moreover, positive correlations were established between ABCA1-dependent efflux and the serum preβ-HDL or TG concentrations. The major finding was that the sera from type IV induced higher total cholesterol and cholesteryl ester mass depletions from ABCA1-expressing cells compared with other groups. Moreover, negative correlations were obtained between total cholesterol or cholesteryl ester mass changes and serum preβ-HDL levels. In conclusion, we demonstrated for the first time that the serum preβ-HDL present in high proportions in type IV HTG subjects are not only responsible for higher cholesterol efflux potential but also for increased abilities to promote net removal of cholesterol from macrophage foam cells.     

Are home ventilators able to guarantee a minimal tidal volume?

Objective  

The aim of the study was to evaluate the ability of home ventilators to maintain a minimal tidal volume during different conditions associated with alveolar hypoventilation.     

Effect on blood lipids of two daily servings of Camembert cheese. An intervention trial in mildly hypercholesterolemic subjects

As a concentrated source of saturated fat, cheese consumption is considered to be associated with increased cholesterolemia and generally forbidden in dietary guidelines for adults with hypercholesterolemia. The aim of this study was to evaluate the impact of saturated fatty acids on lipid parameters and blood pressure with regards to different types of dairy products: Camembert and full-fat yoghurt. One-hundred and fifty-nine moderate hypercholesterolemic subjects without treatment were instructed to consume two full-fat yoghurts (2?×?125?g) per day for 3 weeks (run-in period) and then for a further period of 5 weeks, either two full-fat yoghurts or two 30?g servings of Camembert cheese per day. We observed that over the 5-week daily consumption of two servings of Camembert cheese, blood pressure and serum lipids did not change in moderate hypercholesterolemic subjects. These results suggest that fermented cheese such as Camembert could be consumed daily without affecting serum lipids or blood pressure.