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Background Autoantibodies against the paranodal protein contactin-1 have recently been described in patients with severe acute-onset autoimmune neuropathies and mainly belong to the IgG4 subclass that does not activate complement. IgG3 anti-contactin-1 autoantibodies are rare, but have been detected during the acute onset of disease in some cases. There is evidence that anti-contactin-1 prevents adhesive interaction, and chronic exposure to anti-contactin-1 IgG4 leads to structural changes at the nodes accompanied by neuropathic symptoms. However, the pathomechanism of acute onset of disease and the pathogenic role of IgG3 anti-contactin-1 is largely unknown. Methods In the present study, we aimed to model acute autoantibody exposure by intraneural injection of IgG of patients with anti-contacin-1 autoantibodies to Lewis rats. Patient IgG obtained during acute onset of disease (IgG3 predominant) and IgG from the chronic phase of disease (IgG4 predominant) were studied in comparison. Results Conduction blocks were measured in rats injected with the “acute” IgG more often than after injection of “chronic” IgG (83.3% versus 35%) and proved to be reversible within a week after injection. Impaired nerve conduction was accompanied by motor deficits in rats after injection of the “acute” IgG but only minor structural changes of the nodes. Paranodal complement deposition was detected after injection of the “acute IgG”. We did not detect any inflammatory infiltrates, arguing against an inflammatory cascade as cause of damage to the nerve. We also did not observe dispersion of paranodal proteins or sodium channels to the juxtaparanodes as seen in patients after chronic exposure to anti-contactin-1. Conclusions Our data suggest that anti-contactin-1 IgG3 induces an acute conduction block that is most probably mediated by autoantibody binding and subsequent complement deposition and may account for acute onset of disease in these patients. This supports the notion of anti-contactin-1-associated neuropathy as a paranodopathy with the nodes of Ranvier as the site of pathogenesis.

Emergency general surgery (EGS) involves care of a patient's often previously unknown disease in the setting of an unplanned interaction with the healthcare system. This leads to challenges collecting and interpreting patient reported outcome measures (PROMs). We performed a qualitative and mixed methods study using semi-structured interviews during the index hospitalization and at 6–12 months to capture peri-operative patient experiences. We compared interview findings to clinical characteristics. Among 30 patients, two-thirds reported feeling no choice but to pursue emergency surgery with many reporting exclusion from decision-making. Females reported these themes more commonly. Patients with minor complications less frequently reported trust in their team and discussed communication issues and delays in care (all p ​< ​0.05). Patients with major complications more frequently reported confidence in their team and gratefulness, but also communication limitations (all p ​< ​0.05). Patients not admitted to the ICU more frequently discussed good communication and expeditious treatment. PROMs developed for EGS patients should consider patient outcomes and reflections that they felt excluded from decision-making. Severity of complications may also differentially impact PROMs. [Display omitted] •The most common theme identified was communication with the care team.•Two thirds reported feeling that they had no choice but to pursue emergency surgery.•Many subgroups reported exclusion from decision-making.•Patients with complications focused on timing of their treatment and communication.

The phosphorylation of photosystem II (PSII) and its antenna (LHCII) proteins has been extensively studied and its involvement in state transitions and PSII repair is well known. Yet, very little is known about the extent and functions of phosphorylation of photosystem I (PSI) and its antenna (LHCI) proteins. Here, two proteomics methods were applied to generate a detailed map of the phosphorylation sites of the PSI-LHCI proteins in Chlorella ohadii cells that were grown under low- or extreme high-light intensities (LL and HL). Furthermore, we analyzed the content of oxidized tryptophans in these cell types to estimate light-induced oxidative damage to PSI-LHCI. Our work revealed the phosphorylation of 11 out of 22 PSI-LHCI subunits. The analyses detected extensive phosphorylation of the LHCI subunits lhca6 and lhca7. Other PSI-LHCI subunits were phosphorylated to a lesser extent. Additionally, we show the accumulation of oxidatively damaged tryptophans in the psaD subunit of PSI of HL-grown C. ohadii. The significant phosphorylation of lhca6 and lhca7 suggests a physiological role during photosynthesis, possibly by altering light-harvesting characteristics and binding of other LHCI subunits. Moreover, we show that psaD is susceptible to photodamage while LHCI is protected from ROS under HL.

Non-photochemical quenching (NPQ) mechanisms are crucial for protecting photosynthesis from photoinhibition in plants, algae, and cyanobacteria, and their modulation is a long-standing goal for improving photosynthesis and crop yields. The current work demonstrates that Chlorella ohadii, a green micro-alga that thrives in the desert under high light intensities which are fatal to many photosynthetic organisms, does not perform nor require NPQ to protect photosynthesis under constant high light. Instead of dissipating excess energy, it minimizes its uptake by eliminating the photosynthetic antenna of photosystem II. In addition it accumulates antioxidants that neutralize harmful reactive oxygen species (ROS) and ramps up cyclic electron flow around PSI. These NPQ-independent responses proved efficient in preventing ROS accumulation and reducing oxidative damage to proteins in high-light-grown cells.

While light is the driving force of photosynthesis, excessive light can be harmful. Photoinhibition, or light-induced photo-damage, is one of the key processes limiting photosynthesis. When the absorbed light exceeds the amount that can be dissipated by photosynthetic electron flow and other processes, damaging radicals are formed that mostly inactivate photosystem II (PSII). A well-defined mechanism that protects the photosynthetic apparatus from photoinhibition has been described in the model green alga Chlamydomonas reinhardtii and plants. Chlorella oha-dii is a green micro-alga, isolated from biological desert soil crusts, that thrives under extreme high light (HL) in which other organisms do not survive. Here, we show that this alga evolved unique protection mechanisms distinct from those of C. reinhardtii and plants. When grown under extreme HL, significant structural changes were noted in the C. ohadii thylakoids, including a drastic reduction in the antennae and the formation of stripped core PSII, lacking its outer and inner antennae. This is accompanied by a massive accumulation of protective carotenoids and proteins that scavenge harmful radicals. At the same time, several elements central to photoinhibition protection in C. reinhardtii, such as psbS, the stress-related light harvesting complex, PSII protein phosphorylation and state-transitions are entirely absent or were barely detected in C. ohadii. Taken together, a unique photoinhibition protection mechanism evolved in C. ohadii, enabling the species to thrive under extreme-light intensities where other photo-synthetic organisms fail to survive.