A New Type of Dual Atrioventricular Nodal Nonreentrant Tachycardia

Dual atrioventricular nodal nonreentrant tachycardia (DAVNNT) is very rarely observed clinically. The first review of this arrhythmia was published in 2011 by Wang, where four types of DAVNNT were described. Our case report presents a phenomenon that has never been published before. We revealed a very specific sequence of double fire phenomenon, 1:1 atrioventricular (AV) conduction and AV block.     

AT2 Receptor and Tissue Injury: Therapeutic Implications

The converging clinical effectiveness of mineralocorticoid receptor antagonists (MRAs) Spironolactone and Eplerenone has made their safety profiles/cost-effectiveness key determinants of “agents of choice” across a broad range of clinical indications. The clinical biology of the aldosterone molecule and its range of effects in varied organ systems have been well elucidated from recent mechanistic and systematic studies. Clinical experience with Spironolactone is well established, as is its adverse effects profile. The range of adverse effects experienced with Spironolactone subsequently led to its modification and synthesis of Eplerenone. Recent published reports have confirmed lower prevalence rates of sex-related adverse effects attributable to Eplerenone compared to Spironolactone. There is, however, not much to choose between these agents in regards to other adverse effects including hyperkalemia and kidney failure. As was the experience with Spironolactone, as more robust observational data on Eplerenone accrues, it is possible that the real-life experience of its adverse profile may be discordant with that reported by randomized controlled clinical trials (RCTs). In addition, its metabolism by the vulnerable and highly polymorphic cytochrome dependent pathway also makes it susceptible to various drug interactions. The potential implication of the latter (including morbidity and mortality) may take years to evolve.     

Methamphetamine Increases the Proportion of SIV-Infected Microglia/Macrophages,Alters Metabolic Pathways,and Elevates Cell Death Pathways: A Single-Cell Analysis

Both substance use disorder and HIV infection continue to affect many individuals. Both have untoward effects on the brain, and the two conditions often co-exist. In the brain, macrophages and microglia are infectable by HIV, and these cells are also targets for the effects of drugs of abuse, such as the psychostimulant methamphetamine. To determine the interaction of HIV and methamphetamine, we isolated microglia and brain macrophages from SIV-infected rhesus monkeys that were treated with or without methamphetamine. Cells were subjected to single-cell RNA sequencing and results were analyzed by statistical and bioinformatic analysis. In the animals treated with methamphetamine, a significantly increased proportion of the microglia and/or macrophages were infected by SIV. In addition, gene encoding functions in cell death pathways were increased, and the brain-derived neurotropic factor pathway was inhibited. The gene expression patterns in infected cells did not cluster separately from uninfected cells, but clusters comprised of microglia and/or macrophages from methamphetamine-treated animals differed in neuroinflammatory and metabolic pathways from those comprised of cells from untreated animals. Methamphetamine increases CNS infection by SIV and has adverse effects on both infected and uninfected microglia and brain macrophages, highlighting the dual and interacting harms of HIV infection and drug abuse on the brain.     

An identification key for the five most common species of Metastrongylus

Species of the Metastrongylus genus, the lung nematodes of pigs that require an intermediate host (earthworm) to complete their cycle, pose a potential risk to both livestock and humans. This parasite which can result in lung pathology and mixed infections with other pathogens (e.g. viruses) can be fatal to pigs. Although this genus is distributed worldwide, there are no classification keys for identifying this common parasite species. In this work, we take advantage of parasitological surveys of wild boar (Sus scrofa) in northern and central Spain and southern Poland to develop a morphological identification key for the five most common Metastrongylus species (Metastrongylus apri, Metastrongylus pudendotectus, Metastrongylus salmi, Metastrongylus confusus and Metastrongylus asymetricus). In addition, we provide the first record of M. confusus in Spain, probably unidentified until now due to the lack of appropriate identification keys. We hope that this user-friendly identification key will enable parasitologists and veterinary practitioners to avoid further misclassifications of Metastrongylus species.     

The SM protein Sly1 accelerates assembly of the ER–Golgi SNARE complex

Soluble N-ethylmaleimide–sensitive factor attachment protein receptor (SNARE) and Sec1/Munc18 (SM) proteins constitute the core of an ancient vesicle fusion machine that diversified into distinct sets that now function in different trafficking steps in eukaryotic cells. Deciphering their precise mode of action has proved challenging. SM proteins are thought to act primarily through one type of SNARE protein, the syntaxins. Despite high structural similarity, however, contrasting binding modes have been found for different SM proteins and syntaxins. Whereas the secretory SM protein Munc18 binds to the ‟closed conformation” of syntaxin 1, the ER–Golgi SM protein Sly1 interacts only with the N-peptide of Sed5. Recent findings, however, indicate that SM proteins might interact simultaneously with both syntaxin regions. In search for a common mechanism, we now reinvestigated the Sly1/Sed5 interaction. We found that individual Sed5 adopts a tight closed conformation. Sly1 binds to both the closed conformation and the N-peptide of Sed5, suggesting that this is the original binding mode of SM proteins and syntaxins. In contrast to Munc18, however, Sly1 facilitates SNARE complex formation by loosening the closed conformation of Sed5.In eukaryotic cells, material is transported in vesicles that pinch off of one set of membranes and move along microtubule tracks to the next compartment, where they specifically fuse. Key players in the fusion of a vesicle with its acceptor membrane are the soluble N-ethylmaleimide–sensitive factor attachment protein receptor (SNARE) proteins. Heterologous sets of SNARE proteins drive the fusion of two membranes by zippering into a tight four-helix bundle structure. Distinct sets of SNARE proteins carry out different vesicle fusion steps in the cell. An essential SNARE protein for transport into and across the Golgi is Sed5/syntaxin 5 (1). Besides SNARE complexes, Sed5 exists also in a 1:1 complex with the Sec1/Munc18 (SM) protein Sly1 that is essential for ER–Golgi and intra-Golgi trafficking (2). Distinct types of SM proteins are thought to function together with the respective SNARE complex, specifically its syntaxin (reviewed in refs. 3–8).The very N-terminal region, the so-called N-peptide, of Sed5 binds with nanomolar affinity to the outer surface of Sly1 (9–12). This mode of interaction is consistent with the notion that Sly1 can stay bound during SNARE complex formation and that it might even be actively involved in this reaction (13). This idea was strengthened by the observation that Sec1, the SM protein essential for secretion in yeast, interacts with the assembled SNARE complex but not with its isolated syntaxin (14). Unfortunately, for the interaction of Sec1 with its SNARE unit, no definitive structural foundation exists so far, and it remains uncertain whether Sec1 can be considered as a model for SM protein function. Fortunately, the animal counterpart of Sec1, Munc18-1, has been studied in more detail. However, the results of numerous biochemical studies on Munc18-1 appear not to fit into the concept of SM proteins being factors that promote SNARE assembly. On the contrary, initial studies found that Munc18-1 strongly interferes with the ability of its cognate syntaxin 1 to form a SNARE complex (15, 16). This inhibition is difficult to reconcile with an essential role of Munc18-1 during neurotransmitter release (17). The structure of the Munc18-1/syntaxin 1a complex revealed that the central cavity of Munc18-1 wraps around syntaxin in the so-called “closed conformation” (18). In this conformation, the three-helix bundle formed by syntaxin’s N-terminal Habc domain folds back onto its SNARE motif (19), restricting the availability of syntaxin for its SNARE partners. Thus, although they share a similar structure, Munc18-1 and Sly1 appear to bind to their cognate syntaxins in different modes.New light on this discrepancy was shed when it was discovered that Munc18-1 is able to bind simultaneously to a second, spatially separated binding site on syntaxin 1 (15). This second site involves the N-peptide region of syntaxin 1 that, similar to the Sed5 N-peptide (12), binds to the outer surface of Munc18-1. Interestingly, both binding sites are also present in the Munc18/syxtaxin 1 complex of the choanoflagellate Monosiga brevicollis (20). This suggests that the binding mode involving two different sites is evolutionarily conserved. A comparable binding mode was also described for the SM protein Vps45, which regulates trans-Golgi network trafficking. Vps45 binds tightly to the N-peptide of its cognate syntaxin Tlg2/syntaxin 16 (21). It was shown later that Vps45 is also able to interact with the remainder of its Qa-SNARE, possibly in a closed conformation (15, 22).Not all SM proteins are known to bind to the N-peptide of their cognate syntaxin. For example, in the SM protein Vps33, which plays an essential role in the degradation pathway, the N-peptide binding pocket is blocked (23, 24). Vps33 is part of a multisubunit tethering complex known as the homotypic fusion and protein sorting complex (25). Nevertheless, the structure of Vps33 is very similar to other SM protein types despite having low sequence similarity (23, 24). It would be surprising if such structures were not preserved to maintain similar molecular functions. This raises the question of whether there are missing pieces to our understanding of the molecular role of SM proteins.With the idea of a conserved molecular role of SM proteins in mind, we aimed here at a more thorough comparison of Sly1 and Munc18, which are still thought to represent two examples of SM proteins with contrasting syntaxin binding modes. So far nothing is known about a second binding site in the Sly1/Sed5 complex, but the presence of a homologous N-peptide binding site in Munc18 and Sly1 reveals a certain similarity of the two SM protein types. It is debated whether binding of Sly1 to the N-peptide of Sed5 is essential for Golgi trafficking while biochemically less is known (11, 26–28). Neither the effect of Sly1 on SNARE complex assembly has been determined rigorously, nor is it clear whether Sed5 can adopt a closed conformation that interferes with its ability to form a SNARE complex. We therefore sought to determine whether Sly1, in addition to its tight interaction with the N-peptide of Sed5, interacts with the remaining part of Sed5 and, if so, whether this interaction would have an impact on the ability of Sed5 to form a SNARE complex. We found that Sed5 adopts a closed conformation. Comparable to Munc18-1, Sly1 binds simultaneously to both the closed conformation and the N-peptide region of Sed5, although the latter is the major contributor to its affinity to the complex. Remarkably, in contrast to Munc18-1, which blocks SNARE complex assembly, Sly1 was found to assist Sed5 in forming a SNARE complex.     

Histopathological spectrum of paediatric diffuse intrinsic pontine glioma: diagnostic and therapeutic implications

Diffuse intrinsic pontine glioma (DIPG) is the main cause of brain tumour-related death in children. In the majority of cases diagnosis is based on clinical and MRI findings, resulting in the scarcity of pre-treatment specimens available to study. Our group has developed an autopsy-based protocol to investigate the histologic and biologic spectrum of DIPG. This has also allowed us to investigate the terminal pattern of disease and gain a better understanding of what challenges we are facing in treating DIPG. Here, we review 72 DIPG cases with well documented clinical history and molecular data and describe the pathological features of this disease in relation to clinical and genetic features. Fifty-three of the samples were autopsy material (7 pre-treatment) and 19 were pre-treatment biopsy/surgical specimens. Upon histological review, 62 patients had high-grade astrocytomas (18 WHO grade III and 44 WHO grade IV patients), 8 had WHO grade II astrocytomas, and 2 had features of primitive neuroectodermal tumour (PNET). K27M-H3 mutations were exclusively found in tumours with WHO grade II–IV astrocytoma histology. K27M-H3.1 and ACVR1 mutations as well as ALT phenotype were only found in WHO grade III–IV astrocytomas, while PIK3CA mutations and PDGFRA gains/amplifications were found in WHO grade II–IV astrocytomas. Approximately 1/3 of DIPG patients had leptomeningeal spread of their tumour. Further, diffuse invasion of the brainstem, spinal cord and thalamus was common with some cases showing spread as distant as the frontal lobes. These findings suggest that focal radiation may be inadequate for some of these patients. Importantly, we show that clinically classic DIPGs represent a diverse histologic spectrum, including multiple cases which would fit WHO criteria of grade II astrocytoma which nevertheless behave clinically as high-grade astrocytomas and harbour the histone K27M-H3.3 mutation. This suggests that the current WHO astrocytoma grading scheme may not appropriately predict outcome for paediatric brainstem gliomas.