Anti-interferon auto-antibodies in autoimmune polyendocrinopathy syndrome type 1.
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Adolescent↗
Biomedical subjects
Michael Levin
Publications and source records attributed to Michael Levin.
Characterization of innexin gene expression and functional roles of gap-junctional communication in planarian regeneration.
Planaria possess remarkable powers of regeneration. After bisection, one blastema regenerates a head, while the other forms a tail. The ability of previously-adjacent cells to adopt radically different fates could be due to long-range signaling allowing determination of position relative to, and the identity of, remaining tissue. However, this process is not understood at the molecular level. Following the hypothesis that gap-junctional communication (GJC) may underlie this signaling, we cloned and characterized the expression of the Innexin gene family during planarian regeneration. Planarian innexins fall into 3 groups according to both sequence and expression. The concordance between expression-based and phylogenetic grouping suggests diversification of 3 ancestral innexin genes into the large family of planarian innexins. Innexin expression was detected throughout the animal, as well as specifically in regeneration blastemas, consistent with a role in long-range signaling relevant to specification of blastema positional identity. Exposure to a GJC-blocking reagent which does not distinguish among gap junctions composed of different Innexin proteins (is not subject to compensation or redundancy) often resulted in bipolar (2-headed) animals. Taken together, the expression data and the respecification of the posterior blastema to an anteriorized fate by GJC loss-of-function suggest that innexin-based GJC mediates instructive signaling during regeneration.
Amino Acid Sequence↗
BMP-3 is a novel inhibitor of both activin and BMP-4 signaling in Xenopus embryos.
In Xenopus, the biological effects of BMP-3 oppose those of ventralizing BMPs, but the mechanism for this antagonism remains unclear. Here, we demonstrate that BMP-3 is a dorso-anteriorizing factor in Xenopus embryos that interferes with both activin and BMP signaling. BMP-3 acts by binding to ActRIIB, the common type II receptor for these proteins. Once BMP-3 binds to ActRIIB, it cannot be competed off by excess ligand making a receptor complex that is unable to activate R-Smads and transduce signal. Consistent with a model where BMP-3 interferes with activin and BMPs through a shared receptor, we show that overexpression of BMP-3 can only be rescued by co-injection of xActRIIB. Our results identify BMP-3 as a novel antagonist of both activin and BMPs and uncover how some of the diverse developmental processes that are regulated by both activin and BMP signaling can be modulated during embryogenesis.
Activin Receptors, Type II↗
Acquired predisposition to mycobacterial disease due to autoantibodies to IFN-gamma.
Genetic defects in the IFN-gamma response pathway cause unique susceptibility to intracellular pathogens, particularly mycobacteria, but are rare and do not explain mycobacterial disease in the majority of affected patients. We postulated that acquired defects in macrophage activation by IFN-gamma may cause a similar immunological phenotype and thus explain the occurrence of disseminated intracellular infections in some patients without identifiable immune deficiency. Macrophage activation in response to IFN-gamma and IFN-gamma production were studied in whole blood and PBMCs of 3 patients with severe, unexplained nontuberculous mycobacterial infection. In all 3 patients, IFN-gamma was undetectable following mitogen stimulation of whole blood, but significant quantities were detectable in the supernatants of PBMCs when stimulated in the absence of the patients' own plasma. The patients' plasma inhibited the ability of IFN-gamma to increase production of TNF-alpha by both autologous and normal donor PBMCs, and recovery of exogenous IFN-gamma from the patients' plasma was greatly reduced. Using affinity chromatography, surface-enhanced laser desorption/ionization mass spectrometry, and sequencing, we isolated an IFN-gamma-neutralizing factor from the patients' plasma and showed it to be an autoantibody against IFN-gamma. The purified anti-IFN-gamma antibody was shown to be functional first in blocking the upregulation of TNF-alpha production in response to endotoxin; second in blocking induction of IFN-gamma-inducible genes (according to results of high-density cDNA microarrays); and third in inhibiting upregulation of HLA class II expression on PBMCs. Acquired defects in the IFN-gamma pathway may explain unusual susceptibility to intracellular pathogens in other patients without underlying, genetically determined immunological defects.
Adult↗
Xenopus TRPN1 (NOMPC) localizes to microtubule-based cilia in epithelial cells, including inner-ear hair cells.
In vertebrates, the senses of hearing and balance depend on hair cells, which transduce sounds with their hair bundles, containing actin-based stereocilia and microtubule-based kinocilia. A longstanding question in auditory science is the identity of the mechanically sensitive transduction channel of hair cells, thought to be localized at the tips of their stereocilia. Experiments in zebrafish implicated the transient receptor potential (TRP) channel NOMPC (drTRPN1) in this role; TRPN1 is absent from the genomes of higher vertebrates, however, and has not been localized in hair cells. Another candidate for the transduction channel, TRPA1, apparently is required for transduction in mammalian and nonmammalian vertebrates. This discrepancy raises the question of the relative contribution of TRPN1 and TRPA1 to transduction in nonmammalian vertebrates. To address this question, we cloned the TRPN1 ortholog from the amphibian Xenopus laevis, generated an antibody against the protein, and determined the protein's cellular and subcellular localization. We found that TRPN1 is prominently located in lateral-line hair cells, auditory hair cells, and ciliated epidermal cells of developing Xenopus embryos. In ciliated epidermal cells TRPN1 staining was enriched at the tips and bases of the cilia. In saccular hair cells, TRPN1 was located prominently in the kinocilial bulb, a component of the mechanosensory hair bundles. Moreover, we observed redistribution of TRPN1 upon treatment of hair cells with calcium chelators, which disrupts the transduction apparatus. This result suggests that although TRPN1 is unlikely to be the transduction channel of stereocilia, it plays an essential role, functionally related to transduction, in the kinocilium.
Animals↗
Management of severe malaria in children: proposed guidelines for the United Kingdom.
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Antimalarials↗
The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases.
OBJECTIVE: To determine whether suboptimal management in hospital could contribute to poor outcome in children admitted with meningococcal disease. DESIGN: Case-control study of childhood deaths from meningococcal disease, comparing hospital care in fatal and non-fatal cases. SETTING: National statistics and hospital records. SUBJECTS: All children under 17 years who died from meningococcal disease (cases) matched by age with three survivors (controls) from the same region of the country. MAIN OUTCOME MEASURES: Predefined criteria defined optimal management. A panel of paediatricians blinded to the outcome assessed case records using a standardised form and scored patients for suboptimal management. RESULTS: We identified 143 cases and 355 controls. Departures from optimal (per protocol) management occurred more frequently in the fatal cases than in the survivors. Multivariate analysis identified three factors independently associated with an increased risk of death: failure to be looked after by a paediatrician, failure of sufficient supervision of junior staff, and failure of staff to administer adequate inotropes. Failure to recognise complications of the disease was a significant risk factor for death, although not independently of absence of paediatric care (P = 0.002). The odds ratio for death was 8.7 (95% confidence interval 2.3 to 33) with two failures, increasing with multiple failures. CONCLUSIONS: Suboptimal healthcare delivery significantly reduces the likelihood of survival in children with meningococcal disease. Improved training of medical and nursing staff, adherence to published protocols, and increased supervision by consultants may improve the outcome for these children and also those with other life threatening illnesses.
Adolescent↗
Enhancement of a 24.77-nm line emitted by the plasma of a boron nitride capillary discharge irradiated by a high-intensity ultrashort laser pulse.
Investigations of plasma produced by a boron nitride capillary discharge irradiated with a guided 20-TW Ti: sapphire laser pulse at a peak intensity of 4 x 10(18) W/cm2 are presented. The guided laser radiation in the plasma channel generated He-like ions that, subject to suitable plasma temperature, recombined into Li-like nitrogen ions. Intense radiation at a wavelength of 24.77 nm was observed, indicating possible lasing at the 3d(5/2) - 2p(3/2) transition in Li-like nitrogen.
Journal Article↗
Serotonin signaling is a very early step in patterning of the left-right axis in chick and frog embryos.
BACKGROUND: Consistent left-right (LR) asymmetry is a fascinating problem in developmental and evolutionary biology. Conservation of early LR patterning steps among vertebrates as well as involvement of nonprotein small-molecule messengers are very poorly understood. Serotonin (5-HT) is a key neurotransmitter with crucial roles in physiology and cognition. We tested the hypothesis that LR patterning required prenervous serotonin signaling and characterized the 5-HT pathway in chick and frog embryos. RESULTS: A pharmacological screen implicated endogenous signaling through receptors R3 and R4 and the activity of monoamine oxidase (MAO) in the establishment of correct sidedness of asymmetric gene expression and of the viscera in Xenopus embryos. HPLC and immunohistochemistry analysis indicates that Xenopus eggs contain a maternal supply of serotonin that is progressively degraded during cleavage stages. Serotonin's dynamic localization in frog embryos requires gap junctional communication and H,K-ATPase function. Microinjection of loss- and gain-of-function constructs into the right ventral blastomere randomizes asymmetry. In chick embryos, R3 and R4 activity is upstream of the asymmetry of Sonic hedgehog expression. MAO is asymmetrically expressed in the node. CONCLUSIONS: Serotonin is present in very early chick and frog embryos. 5-HT pathway function is required for normal asymmetry and is upstream of asymmetric gene expression. The microinjection data reveal asymmetry existing in frog embryos by the 4-cell stage and suggest novel intracellular 5-HT mechanisms. These functional and localization data identify a novel role for the neurotransmitter serotonin and implicate prenervous serotonergic signaling as an obligate aspect of very early left-right patterning conserved to two vertebrate species.
Animals↗
Genomewide analysis of the host response to malaria in Kenyan children.
Malaria is a global problem, and there is a critical need for further understanding of the disease process. When malarial parasites invade and develop within the bloodstream, they stimulate a profound host response whose main clinical sign is fever. To explore this response, we measured host gene expression in whole blood from Kenyan children hospitalized with either acute malaria or other febrile illnesses. Genomewide analysis of expression identified 2 principal gene-expression profiles related to neutrophil and erythroid activity. In addition to these general acute responses, a third gene-expression profile was associated with host parasitemia; mediators of erythrophagocytosis and cellular stress were notable components of this response. The delineation of subjects on the basis of patterns of gene expression provides a molecular perspective of the host response to malaria and further functional insight into the underlying processes of pathogenesis.
Child↗
Randomized trial of volume expansion with albumin or saline in children with severe malaria: preliminary evidence of albumin benefit.
BACKGROUND: Metabolic acidosis is the best predictor of death in children with severe falciparum malaria; however, its treatment presents a therapeutic dilemma, because acidosis and hypovolemia may coexist with coma, which can be associated with elevated intracranial pressure. We postulated that volume resuscitation with albumin might correct acidosis and hypovolemia with a lower risk of precipitating cerebral edema than crystalloid. In an open-label, randomized, controlled trial, we compared the safety of resuscitation with albumin to saline in Kenyan children with severe malaria. METHODS: We randomly assigned children with severe malaria and metabolic acidosis (base deficit, >8 mmol/L) to receive fluid resuscitation with either 4.5% albumin or normal saline. A control (maintenance only) group was only included for patients with a base deficit of <15 mmol/L. The primary outcome measure was the percentage reduction in base deficit at 8 h. Secondary end points included death, the requirement for rescue therapies, and neurological sequelae in survivors. RESULTS: Of 150 children recruited for the trial, 61 received saline, 56 received albumin, and 33 served as control subjects. There was no significant difference in the resolution of acidosis between the groups; however, the mortality rate was significantly lower among patients who received albumin (3.6% [2 of 56 patients]) than among those who received saline (18% [11 of 61]; relative risk, 5.5; 95% confidence interval, 1.2-24.8; P=.013). CONCLUSIONS: In high-risk children with severe malaria and acidosis, fluid resuscitation with albumin may reduce mortality. Our study design did not enable us to determine whether saline administration is preferable to fluid restriction or whether saline administration is actually hazardous. Further studies are needed to confirm our findings before definitive treatment recommendations can be made.
Acidosis↗
Localization and loss-of-function implicates ciliary proteins in early, cytoplasmic roles in left-right asymmetry.
Left-right asymmetry is a crucial feature of the vertebrate body plan. While much molecular detail of this patterning pathway has been uncovered, the embryonic mechanisms of the initiation of asymmetry, and their evolutionary conservation among species, are still not understood. A popular recent model based on data from mouse embryos suggests extracellular movement of determinants by ciliary motion at the gastrulating node as the initial step. An alternative model, driven by findings in the frog and chick embryo, focuses instead on cytoplasmic roles of motor proteins. To begin to test the latter hypothesis, we analyzed the very early embryonic localization of ciliary targets implicated in mouse LR asymmetry. Immunohistochemistry was performed on frog and chick embryos using antibodies that have (KIF3B, Polaris, Polycystin-2, acetylated alpha-tubulin) or have not (LRD, INV, detyrosinated alpha-tubulin) been shown to detect in frog embryos only the target that they detect in mammalian tissue. Immunohistochemistry revealed localization signals for all targets in the cytoplasm of cleavage-stage Xenopus embryos, and in the base of the primitive streak in chick embryos at streak initiation. Importantly, several left-right asymmetries were detected in both species, and the localization signals were dependent on microtubule and actin cytoskeletal organization. Moreover, loss-of-function experiments implicated very early intracellular microtubule-dependent motor protein function as an obligate aspect of oriented LR asymmetry in Xenopus embryos. These data are consistent with cytoplasmic roles for motor proteins in patterning the left-right axis that do not involve ciliary motion.
Animals↗
Left-right asymmetry in embryonic development: a comprehensive review.
Embryonic morphogenesis occurs along three orthogonal axes. While the patterning of the anterior-posterior and dorsal-ventral axes has been increasingly well characterized, the left-right (LR) axis has only recently begun to be understood at the molecular level. The mechanisms which ensure invariant LR asymmetry of the heart, viscera, and brain represent a thread connecting biomolecular chirality to human cognition, along the way involving fundamental aspects of cell biology, biophysics, and evolutionary biology. An understanding of LR asymmetry is important not only for basic science, but also for the biomedicine of a wide range of birth defects and human genetic syndromes. This review summarizes the current knowledge regarding LR patterning in a number of vertebrate and invertebrate species, discusses several poorly understood but important phenomena, and highlights some important open questions about the evolutionary origin and conservation of mechanisms underlying embryonic asymmetry.
Amphibians↗
Asymmetric expression of Syndecan-2 in early chick embryogenesis.
Chicken Syndecan-2 (cSyndecan-2) is the homologue of Xenopus Syndecan-2, a member of the heparan sulfate proteoglycan family with an important role in left-right patterning in frog embryos. A relationship to LR asymmetry in other species has not been reported. We show that cSyndecan-2 is expressed throughout the primitive streak between st. 1 and 3 in the chick embryo, and is restricted to the rostral and caudal tips of the primitive streak at st. 4. It displays distinct left-right asymmetry, being expressed in the right side of Hensen's node at st. 5. The asymmetric expression of cSyndecan-2 is maintained around the node between st. 5 and 7. At early somite stages, somites and neural folds express cSyndecan-2. The somite expression disappears by st. 11, but strong expression in the neural tube continues. Our data reveal a new asymmetric transcript in the chick embryo and indicate that in contrast to protein-level asymmetries, which underlie syndecan-2 function in Xenopus, chick syndecan-2 exhibits asymmetry at the mRNA level.
Animals↗
Eye regeneration assay reveals an invariant functional left-right asymmetry in the early bilaterian, Dugesia japonica.
Consistent visceral asymmetry in vertebrates raises fascinating questions about the developmental mechanisms and evolutionary origin of fixed chirality of the left-right axis. One persistent controversy is whether consistently biased asymmetry is a later innovation imposed on a bilaterally symmetrical primitive body-plan, or whether asymmetry is a fundamental property predating the bilateria. The morphology of planaria suggests proximity to the origin of the bilateral body-plan, and they are commonly thought to be left-right symmetrical, as no consistent anatomical asymmetries have been described despite over a century of study of regeneration. Here, we show that D. japonica possess a consistent functional asymmetry in eye patterning defects caused by inhibition of H+/K+-ATPase activity (an ion flux mechanism recently shown to be an important early step in the asymmetry of several vertebrate embryos). Moreover, an endogenous transcript of the non-gastric H+/K+-ATPase subunit alpha is expressed in the head blastema shortly after amputation. Taken together, these data suggest that (1) left-right asymmetry is at least as old as planaria, (2) subtle functional asymmetries should be sought in other more primitive model systems that are believed to be symmetrical, and (3) symmetrical paired structures may in fact contain information about their position on the L or R side.
Animals↗
Changes in the interleukin-6/soluble interleukin-6 receptor axis in meningococcal septic shock.
OBJECTIVE: Interleukin-6 is strongly associated with disease severity and outcome in meningococcal septicemia. It is known that interleukin-6 exerts many of its effects via the soluble interleukin-6 receptor. By facilitating the activity of interleukin-6, it is likely that alterations in the levels of soluble interleukin-6 receptor in septic shock could affect the severity of disease. We aimed to investigate changes in the levels of interleukin-6 and soluble interleukin-6 receptor in acute meningococcal septicemia and the relationship with disease severity. DESIGN: Laboratory investigation of interleukin-6 and soluble interleukin-6 receptor levels in children with meningococcal disease. SETTING: University hospital and laboratories. SUBJECTS: Children with severe meningococcal disease requiring intensive care. INTERVENTIONS: Blood samples obtained on admission to the intensive care unit were analyzed for interleukin-6 and soluble interleukin-6 receptor levels. Levels were also serially measured for up to 48 hrs in a subset of patients. MEASUREMENTS AND MAIN RESULTS: Cytokine levels were measured by enzyme-linked immunosorbent assay using mouse monoclonal antihuman antibodies. Acute meningococcemia is associated with a reduction in soluble interleukin-6 receptor levels in proportion to disease severity and is inversely related to interleukin-6 levels. Soluble interleukin-6 receptor returns to levels seen in normal donors following recovery from meningococcal septicemia. CONCLUSIONS: Changes in the levels of interleukin-6 and soluble interleukin-6 receptor in acute meningococcemia may affect the severity and progression of multiple organ failure. Interventions to modulate this axis may improve outcome from meningococcal septic shock.
Adolescent↗
Pre-transfusion management of children with severe malarial anaemia: a randomised controlled trial of intravascular volume expansion.
Symptomatic severe malarial anaemia (SMA) has a high fatality rate of 30-40%; most deaths occur in children awaiting blood transfusion. Blood transfusion services in most of Africa are not capable of delivering adequate supplies of safe blood in a timely manner to critically ill children with SMA. Contrary to widely held belief, hypovolaemia, rather than heart failure, has emerged as a common complication in such children. We examined the safety of pre-transfusion management (PTM) by volume expansion, aimed at stabilizing children and obviating the urgency for blood transfusion. Kenyan children with severe falciparum anaemia (haemoglobin <5 g/dl) and respiratory distress were randomly assigned to 20 ml/kg of 4.5% albumin or 0.9% saline or maintenance only (control) while awaiting blood transfusion. PTM was apparently safe since it did not lead to the development of pulmonary oedema or other adverse events. There was no significant difference in the primary outcome [mean percentage reduction in base excess between admission and 8 h (95% confidence interval)] between the control group 42% (19-66%) albumin group 44% (32-57%) and saline group 36% (16-57%); adjusted analysis of variance F=0.31, P=0.7. However, the number of children requiring emergency interventions was significantly greater in the control group, four of 18 (22%) than the saline group 0 of 20 (P=0.03). We have established the safety of this PTM in children with SMA whilst awaiting blood transfusion at a hospital with an adequate blood-banking program. The impact on mortality should be assessed where blood transfusion services are unable to supply emergency transfusions.
Anemia↗