Motivation for and adherence to growth hormone replacement therapy in adults with hypopituitarism: the patients‘ perspective

Pituitary - While reasons for non-adherence in children requiring growth hormone (GH) replacement (GH-Rx) are well researched, few studies have investigated adherence in adult GH deficient...     

Regulation of the tolerogenic function of steady‐state DCs

Dendritic cells (DCs) are master regulators of T‐cell responses. After sensing pathogen‐derived molecular patterns (PAMPs), or signals of inflammation and cellular stress, DCs differentiate into potent activators of naïve CD4⁺ and CD8⁺ T cells through a process that is termed DC maturation. By contrast, DCs induce and maintain peripheral T‐cell tolerance in the steady state, that is in the absence of overt infection or inflammation. However, the immunological steady state is not devoid of DC‐activating stimuli, such as commensal microorganisms, subclinical infections, or basal levels of proinflammatory mediators. In the presence of these activating stimuli, DC maturation must be calibrated to ensure self‐tolerance yet allow for adequate T‐cell responses to infections. Here, we review the factors that are known to control DC maturation in the steady state and discuss their effect on the tolerogenic function of steady‐state DCs.     

Online and post-trial feedback differentially affect implicit adaptation to a visuomotor rotation

Multiple motor learning processes can be discriminated in visuomotor rotation paradigms. At least four processes have been proposed: Implicit adaptation updates an internal model based on prediction errors. Model-free reinforcement reinforces actions that achieve task success. Use-dependent learning favors repetition of prior movements, and strategic learning uses explicit knowledge about the task. The current experiment tested whether the processes involved in motor learning differ when visual feedback is altered. Specifically, we hypothesized that online and post-trial feedback would cause different amounts of implicit adaptation. Twenty subjects performed drawing movements to targets under a 45° counterclockwise visuomotor rotation while aiming at a clockwise adjacent target. Subjects received visual feedback via a cursor on a screen. One group saw the cursor throughout the movement (online feedback), while the other only saw the final position after movement execution (post-trial feedback). Both groups initially hit the target by applying the strategy. After 80 trials, subjects with online feedback had drifted in clockwise direction [mean direction error: 15.1° (SD 11.2°)], thus overcompensating the rotation. Subjects with post-trial feedback remained accurate [mean: 0.7° (SD 2.0°), TIME × GROUP: F = 3.926, p = 0.003]. We interpret this overcompensation to reflect implicit adaptation isolated from other mechanisms, because it is driven by prediction error rather than task success (model-free reinforcement) or repetition (use-dependent learning). The current findings extend previous work (e.g., Mazzoni and Krakauer in J Neurosci 26:3642–3645, 2006; Hinder et al. in Exp Brain Res 201:191–207, 2010) and suggest that online feedback promotes more implicit adaptation than does post-trial feedback.     

Gut Commensal Bacteria and Regional Wnt Gene Expression in the Proximal Versus Distal Colon

Regional expression of Wingless/Int (Wnt) genes plays a central role in regulating intestinal development and homeostasis. However, our knowledge of such regional Wnt proteins in the colon remains limited. To understand further the effect of Wnt signaling components in controlling intestinal epithelial homeostasis, we investigated whether the physiological heterogeneity of the proximal and distal colon can be explained by differential Wnt signaling. With the use of a Wnt signaling-specific PCR array, expression of 84 Wnt-mediated signal transduction genes was analyzed, and a differential signature of Wnt-related genes in the proximal versus distal murine colon was identified. Several Wnt agonists (Wnt5a, Wnt8b, and Wnt11), the Wnt receptor frizzled family receptor 3, and the Wnt inhibitory factor 1 were differentially expressed along the colon length. These Wnt signatures were associated with differential epithelial cell proliferation and migration in the proximal versus distal colon. Furthermore, reduced Wnt/β-catenin activity and decreased Wnt5a and Wnt11 expression were observed in mice lacking commensal bacteria, an effect that was reversed by conventionalization of germ-free mice. Interestingly, myeloid differentiation primary response gene 88 knockout mice showed decreased Wnt5a levels, indicating a role for Toll-like receptor signaling in regulating Wnt5a expression. Our results suggest that the morphological and physiological heterogeneity within the colon is in part facilitated by the differential expression of Wnt signaling components and influenced by colonization with bacteria.One of the fundamental aspects in the development of the gastrointestinal tract is the spatiotemporal expression of signaling molecules that regulate cell fate and differentiation. Previous studies have highlighted a central role of the evolutionarily conserved Wingless/Int (Wnt) signaling pathways as key regulators of embryonic development and epithelial homeostasis in the gut.^1–3 In development, local expression patterns of Wnt signaling components play an important role in organogenesis.^4,5 Wnt signals control important biological processes required for cell proliferation, differentiation, polarity, and movement, depending on the target cell and the cellular environment.Recent reports have highlighted the importance of understanding the role of Wnt signaling in the intestinal tract. The intestinal epithelium is highly dynamic and, depending on the species and location, is actively turned over in <1 week.⁶ Wnt/β-catenin signaling regulates intestinal epithelial cell (IEC) homeostasis and proliferation by increasing β-catenin stability in crypt epithelial cells, whereas IEC migration and differentiation are believed to be in part facilitated through noncanonical (Wnt) signaling pathways independent of β-catenin.^6,7 The renewal of intestinal epithelia requires a delicate balance of signaling proteins to control epithelial cell proliferation and migration that in turn is vital for maintaining mucosal homeostasis. Interestingly, regional differences in Wnt gene expression in small versus large intestine are observed in adult mice, suggesting the importance of differential local Wnt expression in regulation of intestinal mucosal homeostasis.⁷Although the entire colon exhibits considerable morphological and physiological heterogeneity along its length,^8–11 the expression pattern of Wnt signaling components in the different regions of the adult colon remains poorly understood. Embryologically, the cecum, ascending colon, and the proximal two-thirds of the transverse colon are derived from the midgut, whereas the distal colon originates from the hindgut. Such distinct origins of the colonic segment support specific biological characteristics and suggest that distinct regulatory factors are likely to control epithelial homeostasis in the proximal versus distal colon. In addition, important contributing factors that influence Wnt/β-catenin signaling and intestinal epithelial proliferation might be microbial communities that localize in the intestine in distinct regions.^6,12 Such a delicate physiological balance of Wnt signaling and intestinal epithelial homeostasis is further perturbed in mucosal inflammatory and neoplastic diseases,^3,13 which also indicate regional differences in the proximal versus distal colonic segments.^14–17In the present study, we investigate the regional heterogeneity of Wnt genes in the proximal versus distal colon. Given the importance of luminal microbiota in influencing intestinal epithelial homeostasis¹⁸ and to determine whether the Wnt signatures are influenced by microflora colonization, we examined expression of Wnt proteins in the colonic segments of mice raised under germ-free (GF) conditions.