Efficiency and risk factors for CMV transmission in seronegative hematopoietic stem cell recipients

Cytomegalovirus (CMV) transmission via stem cells or marrow in CMV donor seropositive/recipient seronegative (D+/R-) hematopoietic cell transplantation (HCT) is surprisingly inefficient, and factors associated with transmission in these high-risk HCT recipients are unknown. In a retrospective cohort of D+/R- HCT recipients, cumulative incidence curve estimates were used to determine posttransplantation rates of CMV and multivariable Cox proportional models to assess risk factors associated with transmission. A total of 447 patients from 1995 to 2007 were eligible for enrollment. Overall, 85 of 447 (19.0%) acquired CMV at a median of 49 days (IQR 41-60) posttransplantation. CMV disease before day 100 occurred in 6 of 447 (1.3%) patients and in 7 of 447 (1.6%) after day 100. The donor graft, specifically the total nucleated cell count (adjusted hazard ratio [HR] 2.7; 95% confidence interval [CI], 1.4-4.7, P = .0002), was the only factor associated with CMV transmission in multivariable analyses. Notably, the source stem cells (marrow versus peripheral blood stem cell [PBSC]), screening method, and graft-versus-host disease (GVHD) were not associated with transmission. Thus, a highly cellular graft was the only identifiable risk factor associated with CMV transmission, suggesting that viral genomic content of the donor graft determines transmission efficiency in D+/R- HCT recipients.     

Effects of manidipine and delapril in hypertensive patients with type 2 diabetes mellitus: the delapril and manidipine for nephroprotection in diabetes (DEMAND) randomized clinical trial

To assess whether angiotensin-converting enzyme inhibitors and third-generation dihydropyridine calcium channel blockers ameliorate diabetic complications, we compared glomerular filtration rate (GFR; primary outcome), cardiovascular events, retinopathy, and neuropathy in 380 hypertensive type 2 diabetics with albuminuria <200 mg/min included in a multicenter, double-blind, placebo-controlled trial (DEMAND [Delapril and Manidipine for Nephroprotection in Diabetes]) and randomized to 3-year treatment with manidipine/delapril combination (10/30 mg/d; n=126), delapril (30 mg/d; n=127), or placebo (n=127). GFR was centrally measured by iohexol plasma clearance. Median monthly GFR decline (interquartile range [IQR]) was 0.32 mL/min per 1.73 m(2) (IQR: 0.16-0.50 mL/min per 1.73 m(2)) on combined therapy, 0.36 mL/min per 1.73 m(2) (IQR: 0.18-0.53 mL/min per 1.73 m(2)) on delapril, and 0.30 mL/min per 1.73 m(2) (IQR: 0.12-0.50 mL/min per 1.73 m(2)) on placebo (P=0.87 and P=0.53 versus combined therapy or delapril, respectively). Similar findings were observed when baseline GFR values were not considered for slope analyses. Albuminuria was stable in the 3 treatment groups. The hazard ratio (95% CI) for major cardiovascular events between combined therapy and placebo was 0.17 (0.04-0.78; P=0.023). Among 192 subjects without retinopathy at inclusion, the hazard ratio for developing retinopathy between combined therapy and placebo was 0.27 (0.07-0.99; P=0.048). Among 200 subjects with centralized neurological evaluation, the odds ratios for peripheral neuropathy at 3 years between combined therapy or delapril and placebo were 0.45 (0.24-0.87; P=0.017) and 0.52 (0.27-0.99; P=0.048), respectively. Glucose disposal rate decreased from 5.8±2.4 to 5.3±1.9 mg/kg per min on placebo (P=0.03) but did not change on combined or delapril therapy. Treatment was well tolerated. In hypertensive type 2 diabetic patients, combined manidipine and delapril therapy failed to slow GFR decline but safely ameliorated cardiovascular disease, retinopathy, and neuropathy and stabilized insulin sensitivity.     

Mitochondrial dysfunction and oxidative and endoplasmic reticulum stress in argyrophilic grain disease

Argyrophilic grain disease (AGD) is characterized by the accumulation of hyperphosphorylated 4R tau in dendritic varicosities (i.e."grains") in neurons and pretangles in certain areas of the cerebral cortex and other brain regions. We investigated oxidative and endoplasmic reticulum (ER) stress and dysregulation of mitochondrialbiogenesis as potential mechanisms involved in the AGD pathogenesis. Samples from AGD patients (n = 8) and nonpathologic, age-matched controls (n = 5) were compared using biochemical and immunohistochemical techniques with a panel of antibodies to markers of ER stress responses, stress chaperones, oxidative stress and associated cellular responses, respiratory chain complexes, mitochondrial regulators, and modulators of mitochondrial biogenesis. Because AGD is often associated with other tauopathies, mainly Alzheimer disease (AD), results were also compared with those of a group of similar Braak AD stage cases without grains (n = 5). In both AD and AGD cases, we found activation of key molecules that are involved in the unfolded protein response and lead to elevated ER chaperone levels, increased oxidative stress damage, mainly related to lipoxidation and targeting glycolytic enzymes. Altered expression of components of the respiratory chain markers modulating mitochondrial biogenesis were selectively affected in AGD. The findings suggest that, despite the common pathogenic trends in AD and AGD, there is molecular specificity for AGD.     

Occurrence of haemosporidian parasites in the paddyfield warbler, <Emphasis Type="Italic">Acrocephalus agricola</Emphasis> (Passeriformes,Sylviidae)

The blood parasite diversity was studied in paddyfield warblers (Acrocephalus agricola) breeding in NE Bulgaria, SW Russia and S. Kazakhstan. Nine cytochrome b gene lineages were recorded, 4 belonging to Haemoproteus spp. and 5 to Plasmodium spp. The overall prevalence of haemosporidians was 33.3%. The composition of parasites varied geographically, with six lineages recorded in Russia, five lineages in Bulgaria and two lineages in Kazakhstan. Two lineages are described for the first time, i.e. ACAGR1 (belonging to Plasmodium sp. and recorded from a single bird in Russia) and ACAGR2 (belonging to Haemoproteus sp., recorded from Bulgaria and Russia). The latter lineage is the most widespread parasite in the Bulgarian population, scarce in Russia and absent in Kazakhstan. It is supposed that ACAGR2 has originated from the widespread lineage ACDUM1 differing from it by a single nucleotide. One lineage only (ACDUM2) occurs in all the three populations studied and is a nonspecific parasite known from various passerines. Six of the registered lineages have been found in a single population of A. agricola and also represent non-specific parasites occurring in a wide range of passerine birds. Their records in A. agricola may indicate the high transmission rate of these parasites in the habitats where this host co-occurs with other passerines. The variation of the composition of the haemosporidian parasite communities through the breeding range of A. agricola makes up heterogeneous selection pressures that may drive intraspecific variation in important life-history traits.     

Increased ER stress during motor neuron degeneration in a transgenic mouse model of amyotrophic lateral sclerosis

The endoplasmic reticulum (ER), which plays important roles in apoptosis, is susceptible to oxidative stress. ER stress is also thought to be involved in the pathogenesis of neurodegenerative diseases. In this study, we investigated whether ER stress is involved in the pathogenesis of amyotrophic lateral sclerosis (ALS) using the anterior part of the lumbar spinal cord of transgenic mice carrying a mutation (G93A) in the superoxide dismutase 1 (SOD1) gene. Western blot and immunohistochemical analyses demonstrated that the expressions of p-PERK and p-eIF2alpha were increased in the microsome fraction (P3) of the lumbar spinal cord at the pre-symptomatic age of 12 weeks (12W), while the expression of activated caspase-12 was increased in the cytoplasmic fraction (S3) of the lumbar spinal cord at both the pre-symptomatic age of 12W and the late symptomatic age of 20W. In contrast, GRP78 did not show any increases in the microsome fraction (P3) of the lumbar spinal cord at either the pre-symptomatic or symptomatic ages. Thus, the present results strongly suggest that the balance between anti- and pro-apoptotic proteins related to ER stress is impaired from the pre-symptomatic stage in this ALS mouse model, and that this imbalance may be related to the pathogenesis of motor neuron degeneration in ALS.     

Human bone marrow granulocyte-macrophageal colonies (GM-Cs) in vitro: myeloid cells in health and in cases of myeloid leukemia

The morphological characteristics of granulocyte/macrophageal (GM-) colonies and clusters, obtained in vitro (in semi-solid agar cultures) from bone marrow hematopoietic myeloid progenitors pertain to leukocyte hemorheology of healthy persons and patients with myeloid leukemias. The morphological features of in vitro growing myeloid progenitors, granulocytes and macrophages of healthy persons differ in their cell size, shape and degree of differentiation from the cultivated marrow cells in cases of acute and chronic myeloid leukaemia. In this malignant disease, the rheological properties of leukocytes (granulocytes/macrophages) were found to provide diagnostic information. Further studies should be undertaken to examine whether the method could be useful in defining survival, prognosis and therapeutical approach in cases of myeloid leukemia.