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Background/Aims: Interleukin-17A (IL-17A) is a T cell-derived inflammatory cytokine that is upregulated during renal allograft rejection. The present study sought to further describe the IL-17A-mediated proinflammatory/profibrotic activity of proximal tubule epithelium that may contribute to allograft rejection. Methods: Immortalized (HK-2) and primary (HRPTEpiC) human proximal tubule epithelial cells were utilized for this study. Profibrotic gene alterations were examined by real-time quantitative PCR. Inflammatory mediator secretion was examined by multiplex bead-based detection of secreted proteins. Immunofluorescence microscopy and immunoblotting were utilized to examine alterations in junctional protein expression and cell morphology. Results: In HK-2 cells IL-17A significantly downregulated the expression of the proepithelial gene CDH1 (E-cadherin) while the proinflammatory/profibrotic genes CTGF, CD44 and TGFBR1 were significantly increased. IL-17A also increased the secretion of fractalkine, G-CSF, GM-CSF, VEGF, IL-6 and IL-8. In HRPTEpiC 100 ng/ml IL-17A upregulated the proinflammatory/profibrotic genes ACTA2, CCL2, CHMP1A, CTGF, FN1, IL6, FSP1, SMAD1, SMAD5, TGFB1 and TGFBR2 while treatment with a reduced concentration of IL-17A (0.1 ng/ml) decreased SMAD5, TGFB1 and PDGFRB expression. Changes in ZO-1 and E-cadherin protein expression and cell morphology were examined following IL-17A treatment as indicators of epithelial-to-mesenchymal transition. IL-17A decreased ZO-1 expression in HK-2 and HRPTEpiC; however, E-cadherin was only reduced in HK-2 cells. Neither HK-2 nor HRPTEpiC assumed an elongated, fibroblast-like morphology following IL-17A treatment. Conclusions: IL-17A directly mediates proximal tubule epithelial cell proinflammatory/profibrotic activity as demonstrated by the alteration in genes associated with extracellular matrix remodeling and cell-cell interaction, and stimulation of inflammatory mediator and immune cell chemoattractant secretion. Additionally, IL-17A may have a negative impact on barrier integrity as indicated by ZO-1 downregulation. Copyright © 2010 S. Karger AG, Basel [PUBLICATION ABSTRACT]

Natural killer (NK) cells can express high levels of CD44, and signaling through CD44 has been shown to enhance NK cell cytotoxic activity. However, little is known about the factors that regulate CD44-mediated activation of NK cells. The studies reported here reveal that resting NK cells constitutively express CD44 that is in an inactive form that does not bind to hyaluronan (HA), the principal known ligand for CD44. After infection of mice with the intracellular parasite Toxoplasma gondii, however, a population of NK cells that expressed activated CD44 emerged. To determine how expression and activation of CD44 by resting NK cells were regulated, the role of cytokines in these events was assessed. These studies revealed that whereas stimulation of resting NK cells with interleukin-12 (IL-12) or IL-18 caused increased expression of CD44, only IL-2 or IL-15 led to the upregulation and activation of CD44. The cytokine-induced upregulation and activation of CD44 was independent of NK cell proliferation. To determine the functional consequences of CD44 activation, the effects of low molecular weight HA (LMWHA) on the production of interferon-γ (IFN-γ) by IL-2-activated NK cells were assessed. These studies showed that HA alone had little effect on the production of IFN-γ, but when used in combination with IL-2, IL-12, or IL-18, LMWHA was a potent enhancer of IFN-γ production. Together, these studies indicate an important role for proinflammatory cytokines in the activation of CD44 on NK cells and identify a novel pathway to enhance the ability of activated NK cells to produce IFN-γ.

Infliximab has been shown to induce clinical response and remission in ulcerative colitis (UC). To characterize the biological response of patients to infliximab, we analyzed the mRNA expression patterns of mucosal colonic biopsies taken from UC patients enrolled in the Active Ulcerative Colitis Trial 1 (ACT1) study. Biopsies were obtained from 48 UC patients before treatment with 5 or 10 mg/kg infliximab, and at 8 and 30 weeks after treatment (n = 113 biopsies). Global gene expression profiling was performed using Affimetrix GeneChip Human Genome U133 Plus 2.0 arrays. Expression profiling results for selected genes were confirmed using qPCR. Infliximab had a significant effect on mRNA expression in treatment responders, with both infliximab dose and duration of treatment having an effect. Genes affected are primarily involved with inflammatory response, cell-mediated immune responses, and cell-to-cell signaling. Unlike responders, non-responders do not effectively modulate T(H₁), T(H₂), and T(H₁₇) pathways. Gene expression can differentiate placebo and infliximab responders. Analysis of mRNA expression in mucosal biopsies following infliximab treatment provided insight into the response to therapy and molecular mechanisms of non-response.

Background. Glucagon-like peptide 2 (GLP-2) is an intestinal specific trophic hormone, with therapeutic potential; the effects on intestinal healing are unknown. We used a rat model of colonic healing, under normoxic, and stress (hypoxic) conditions to examine the effect of GLP-2 on intestinal healing. Methods. Following colonic transection and reanastomosis, animals were randomized to one of six groups (n=8/group): controls, native GLP-2, long-acting GLP-2 (GLP-2- MIMETIBODY, GLP-2-MMB), animals were housed under normoxic or hypoxic (11%  O2) conditions. Animals were studied five days post-operation for anastomotic strength and wound characteristics. Results. Anastomotic bursting pressure was unchanged by GLP-2 or GLP-2-MMB in normoxic or hypoxic animals; both treatments increased crypt cell proliferation. Wound IL-1β increased with GLP-2; IFNγ with GLP-2 and GLP-2-MMB. IL-10 and TGF-β were decreased; Type I collagen mRNA expression increased in hypoxic animals while Type III collagen was reduced with both GLP-2 agonists. GLP-2 MMB, but not native GLP-2 increased TIMP 1-3 mRNA levels in hypoxia. Conclusions. The effects on CCP, cytokines and wound healing were similar for both GLP-2 agonists under normoxic and hypoxic conditions; anastomotic strength was not affected. This suggests that GLP-2 (or agonists) could be safely used peri-operatively; direct studies will be required.

Alterations in intestinal permeability have been implicated in ulcerative colitis (UC). Infliximab, a monoclonal anti-tumor necrosis factor alpha (TNFα) antibody, can induce clinical response in UC. Gene expression in colonic biopsies taken from responders and nonresponders to infliximab can provide insight into the mechanisms of the altered intestinal permeability at a molecular level.MethodsColonic biopsies (n = 18 anti-TNFα naïve UC patients; n = 8 normal controls; n = 80 Active Ulcerative Colitis Trial [ACT] 1 patients) were analyzed for mRNA expression using gene expression microarrays. Computational reverse causal reasoning was applied to build causal network models of UC and response and nonresponse of UC to treatment. Quantitative reverse-transcription polymerase chain reaction (qPCR) was used to confirm differentially expressed genes.ResultsReverse causal reasoning on mRNA expression data from anti-TNFα-naïve UC and normal samples provided a mechanistic disease model of the biology of gene expression observed in UC. mRNA expression data from the ACT 1 study enabled construction of a mechanistic model describing the biology of nonresponders to infliximab, including evidence for increased intestinal permeability compared with normal and responder samples. Gene expression changes identified as central to intestinal permeability dysregulation were confirmed in normal, UC, and infliximab-treated patients by qPCR analysis. Gene expression returned toward normal levels in infliximab responders, but not in nonresponders.Conclusion:Gene expression analysis and causal network modeling in combination showed that aberrant mRNA expression of genes involved in intestinal epithelial permeability for infliximab responders was restored toward levels observed in normal samples. Infliximab nonresponders showed no equivalent restoration in the expression of these genes. (Inflamm Bowel Dis 2012)

Parasitic infections remain an important cause of disease worldwide, and it is important to understand how the immune system protects against these organisms. In addition, the study of how the immune system deals with different types of pathogens provides the opportunity to discern how innate and adaptive arms of the immune system interact to provide an integrated protective response. Costimulatory signals are an important element involved in the control of lymphocyte response, and this laboratory studies the role of the costimulatory molecules CD28 and ICOS in the events that lead to resistance to the opportunistic pathogen Toxoplasma gondii as well as the development of immune pathology associated with this infection.

CD44 is a glycoprotein, which is ubiquitously expressed on the surface of many different cell types and its levels of expression vary between cell types and their activation state. In addition, CD44 can exist in an inactive or active state, which is defined by the ability of CD44 to bind to its primary ligand, low molecular weight Hyaluronan (HA). HA is a component of the extracellular matrix and is ubiquitously expressed in a high molecular weight form. In contrast, low molecular weight HA accumulates at sites of inflammation as a consequence of cleavage of high molecular weight HA or de novo synthesis. It was originally thought that the accumulation of low molecular weight HA helps to direct the trafficking of lymphocytes to these sites. However, more recent studies have shown that CD44/HA interactions have additional effects on cells of the immune system. Signaling through CD44 induces T cell proliferation and IL-2 production, NK cell cytotoxicity, and macrophage production of cytokines and chemokines. Over the last few years, CD44 has been implicated in the pathogenesis of various diseases, but very little is known about the role of CD44 during infection. Although expression of CD44 has been used as a marker for T cell activation in different infection models, there have been no reports of how infection affects the activation status of CD44 on T cells during infection. The studies presented here characterize the activation status of CD44 on CD4 + T cells during both acute and chronic stages of toxoplasmosis, as well as on NK cells during the acute phase of infection. These studies have identified: (1) the emergence of population of HA binding cells following infection, (2) a novel pathway for CD44 in the production of IFN-γ, and (3) a novel role for CD44 in the development of infection-induced immunopathology. In addition, we investigated the factors that regulate CD44 expression and activation status of NK cells and antigen-specific CD4 + T cells. These later studies demonstrate that expression of activated CD44 may be useful as a marker to distinguish activated antigen-specific CD4 + T cells, and demonstrate differential requirements for the activation of CD44 by CD4+ T cells and NK cells. Thus, it appears that CD44 is differentially regulated and activated by cells of the adaptive and innate arms of the immune system.

In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999–2008 and 12/302 (4.0%) in 2009–2011 (P<.001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003–2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed.