Cryptococcus gattii genotype VGI infection in New England

Cryptococcus gattii is a known, emerging infectious disease pathogen predominantly in the Pacific Northwest, the United States, and British Columbia, Canada. We report a case of an immunocompetent adolescent from New England who had severe pulmonary and central nervous system infection caused by the VGI genotype of C. gattii.     

Immune activation and IL-12 production during acute/early HIV infection in the absence and presence of highly active, antiretroviral therapy

Suppressed IL-12 production and maladaptive immune activation, both of which are ameliorated by successful highly active antiretroviral therapy (HAART), are thought to play important roles in the immunopathogenesis of chronic HIV infection. Despite the important effects of the immunological and virological events of early HIV infection on subsequent disease progression, IL-12 production and immune activation in early infection remain under-defined. To quantify IL-12 production and immune activation during acute/early HIV infection, in the presence and absence of HAART, we performed a prospective, longitudinal study of participants in the Baltimore site of the Acute Infection and Early Disease Research Program, with cross-sectional comparison to healthy control subjects. PBMC cytokine productive capacity and plasma immune activation markers [soluble CD8 (sCD8), sCD4, granzyme B, neopterin, beta2-microglobulin, sIL-2R, sTNFRI, sTNFRII, and IL-12p70] were quantified by ELISA. Notably, PBMC from patients with acute/early HIV infection exhibited in vivo IL-12p70 production along with increased, maximal in vitro IL-12 production. Further, despite evidence from plasma markers of generalized immune activation, no elevation in plasma levels of sCD4 was observed, suggesting relative blunting of in vivo CD4+ T cell activation from the beginning of HIV infection. Finally, despite successful virological responses to HAART, heightened in vivo CD8+ T cell activation, IL-12 production, and IFN activity were sustained for at least 6 months during primary HIV infection. These data underscore the need for comparative mechanistic analysis of the immunobiology of early and chronic HIV infection.     

In silico analysis of missense substitutions using sequence-alignment based methods

Genetic testing for mutations in high-risk cancer susceptibility genes often reveals missense substitutions that are not easily classified as pathogenic or neutral. Among the methods that can help in their classification are computational analyses. Predictions of pathogenic vs. neutral, or the probability that a variant is pathogenic, can be made based on: 1) inferences from evolutionary conservation using protein multiple sequence alignments (PMSAs) of the gene of interest for almost any missense sequence variant; and 2) for many variants, structural features of wild-type and variant proteins. These in silico methods have improved considerably in recent years. In this work, we review and/or make suggestions with respect to: 1) the rationale for using in silico methods to help predict the consequences of missense variants; 2) important aspects of creating PMSAs that are informative for classification; 3) specific features of algorithms that have been used for classification of clinically-observed variants; 4) validation studies demonstrating that computational analyses can have predictive values (PVs) of approximately 75 to 95%; 5) current limitations of data sets and algorithms that need to be addressed to improve the computational classifiers; and 6) how in silico algorithms can be a part of the "integrated analysis" of multiple lines of evidence to help classify variants. We conclude that carefully validated computational algorithms, in the context of other evidence, can be an important tool for classification of missense variants.     

Rapid screening of toxic glycoalkaloids and micronutrients in edible nightshades (Solanum spp.)

African indigenous vegetables (AIVs) because of their nutrient density have the unique potential to reduce micronutrient deficiencies in sub-Saharan Africa, yet some may also contain anti-nutritive compounds. Vegetable nightshades from Solanum americanum, Solanum nigrum, Solanum scabrum and Solanum villosum are among the major AIVs used as a leafy vegetables and consumed regularly in many countries in sub-Sahara Africa. These under-recognized food crops have not been subjected to extensive studies for their nutritional and antinutritive factors. In this study, 15 entries of the vegetable nightshades were field-grown and the leaves which are the consumed product of commerce chemically profiled by LC/ESI-MS. Twenty-three flavones, eight saponins, and two glycoalkaloids along with a phenolic acid of chlorogenic acid were identified by MS and UV data. Anti-nutrient glycoalkaloids were quantified as total aglycones after acidic hydrolysis using MS detection and found to be within safe-consumption thresholds by comparison with the glycoalkaloid level in the globally consumed Solanum member eggplants. Edible nightshades were also found to be sources of β-carotene, vitamin E and total polyphenols and exhibited high antioxidant activity. Results of this study support that consumption of vegetable nightshades are safe from the presence of glycoalkaloids and thus, can contribute to the reduction of micronutrient deficiency in sub-Sahara Africa.     

Immune dysregulation caused by homozygous mutations in CBLB

CBL-B is an E3 ubiquitin ligase that ubiquitinates proteins downstream of immune receptors to downregulate positive signaling cascades. Distinct homozygous mutations in CBLB were identified in 3 unrelated children with early-onset autoimmunity, one of whom also had chronic urticaria. Patient T cells exhibited hyperproliferation in response to anti-CD3 cross-linking. One of the mutations, p.R496X, abolished CBL-B expression, and a second mutation, p.C464W, resulted in preserved CBL-B expression. The third mutation, p.H285L in the SH2 domain of CBL-B, was expressed at half the normal level in the patient’s cells. Mice homozygous for the CBL-B p.H257L mutation, which corresponds to the patient’s p.H285L mutation, had T and B cell hyperproliferation in response to antigen receptor cross-linking. Cblb^H257L mice had increased percentages of T regulatory cells (Tregs) that had normal in vitro suppressive function. However, T effector cells from the patient with the p.H285L mutation and Cblb^H257L mice were resistant to suppression by WT Tregs. Bone marrow–derived mast cells from Cblb^H257L mice were hyperactivated after FcεRI cross-linking, and Cblb^H257L mice demonstrated exaggerated IgE-mediated passive anaphylaxis. This study establishes CBL-B deficiency as a cause of immune dysregulation.     

A rare case of COVID-19 vaccine-induced myopericarditis in a young adult

Although extremely rare, the COVID-19 mRNA vaccine can induce myopericarditis without left ventricular dysfunction, and there have been rare reports of such incidents. However, these prior cases either did not have pericardial effusion without reduced left ventricular ejection fraction or had a more typical presentation of vaccine-induced myopericarditis such as shortness of breath or tactile temperature. We present a rare case of a 25-year-old man who developed myopericarditis following administration of the second dose of COVID-19 mRNA Vaccine. As vaccination plays a significant role in the fight against the COVID-19 pandemic, it is essential to highlight the physical manifestations of the vaccine''s potential adverse effects and risk factors to increase the general population''s awareness regarding the importance of emergent medical care.Kewyords: COVID-19, Myopericarditis, Pericardial effusion, Vaccine, Myocarditis, Pericarditis