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Graphical abstract, Highlights • D-CATH-2 has strong antimicrobial activities towards multiple S.suis strains. • D-CATH-2 ameliorates macrophage function. • DCATH-2 binds LTA. • DCATH-2 has prophylactic effect against S. suis infection in vivo., Introduction Due to the increase of antibiotic resistant bacterial strains, there is an urgent need for development of alternatives to antibiotics. Cathelicidins can be such an alternative to antibiotics having both a direct antimicrobial capacity as well as an immunomodulatory function. Previously, the full d-enantiomer of chicken cathelicidin-2 (d-CATH-2) has shown to prophylactically protect chickens against infection 7 days post hatch when administered in ovo three days before hatch. Objectives To further evaluate d-CATH-2 in mammals as a candidate for an alternative to antibiotics. In this study, the prophylactic capacity of d-CATH-2 and two truncated derivatives, d-C(1–21) and d-C(4–21), was determined in mammalian cells. Methods Antibacterial assays; immune cell differentiation and modulation; cytotoxicity, isothermal titration calorimetry; in vivo prophylactic capacity of peptides in an S. suis infection model. Results d-CATH-2 and its derivatives were shown to have a strong direct antibacterial capacity against four different S. suis serotype 2 strains (P1/7, S735, D282, and OV625) in bacterial medium and even stronger in cell culture medium. In addition, d-CATH-2 and its derivatives ameliorated the efficiency of mouse bone marrow-derived macrophages (BMDM) and skewed mouse bone marrow-derived dendritic cells (BMDC) towards cells with a more macrophage-like phenotype. The peptides directly bind lipoteichoic acid (LTA) and inhibit LTA-induced activation of macrophages. In addition, S. suis killed by the peptide was unable to further activate mouse macrophages, which indicates that S. suis was eliminated by the previously reported silent killing mechanism. Administration of d-C(1–21) at 24 h or 7 days before infection resulted in a small prophylactic protection with reduced disease severity and reduced mortality of the treated mice. Conclusion d-enantiomers of CATH-2 show promise as anti-infectives against pathogenic S. suis for application in mammals.

Epigenetic regulators are frequently mutated in hematological malignancies including acute myeloid leukemia (AML). Thus, the identification and characterization of novel epigenetic drivers affecting AML biology holds potential to improve our basic understanding of AML and to uncover novel options for therapeutic intervention. To identify novel tumor suppressive epigenetic regulators in AML, we performed an in vivo short hairpin RNA (shRNA) screen in the context of CEBPA mutant AML. This identified the Histone 3 Lysine 4 (H3K4) demethylase KDM5C as a tumor suppressor, and we show that reduced Kdm5c/KDM5C expression results in accelerated growth both in human and murine AML cell lines, as well as in vivo in Cebpa mutant and inv(16) AML mouse models. Mechanistically, we show that KDM5C act as a transcriptional repressor through its demethylase activity at promoters. Specifically, KDM5C knockdown results in globally increased H3K4me3 levels associated with up-regulation of bivalently marked immature genes. This is accompanied by a de-differentiation phenotype that could be reversed by modulating levels of several direct and indirect downstream mediators. Finally, the association of KDM5C levels with long-term disease-free survival of female AML patients emphasizes the clinical relevance of our findings and identifies KDM5C as a novel female-biased tumor suppressor in AML.

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Arginine residues of the antimicrobial peptide LL-37 can be citrullinated by peptidyl arginine deiminases, which reduce the positive charge of the peptide. Notably, citrullinated LL-37 has not yet been detected in human samples. In addition, functional and biophysical properties of citrullinated LL-37 are not fully explored. The aim of this study was to detect citrullinated LL-37 in human bronchoalveolar lavage (BAL) fluid and to determine antibacterial and biophysical properties of citrullinated LL-37. BAL fluid was obtained from healthy human volunteers after intra-bronchial exposure to lipopolysaccharide. Synthetic peptides were used for bacterial killing assays, transmission electron microscopy, isothermal titration calorimetry, mass-spectrometry and circular dichroism. Using targeted proteomics, we were able to detect both native and citrullinated LL-37 in BAL fluid. The citrullinated peptide did not kill Escherichia coli nor lysed human red blood cells. Both peptides had similar α-helical secondary structures but citrullinated LL-37 was more stable at higher temperatures, as shown by circular dichroism. In conclusion, citrullinated LL-37 is present in the human airways and citrullination impaired bacterial killing, indicating that a net positive charge is important for antibacterial and membrane lysing effects. It is possible that citrullination serves as a homeostatic regulator of AMP-function by alteration of key functions.

The bone marrow microenvironment provides indispensable factors to sustain blood production throughout life. It is also a hotspot for the progression of hematologic disorders and the most frequent site of solid tumor metastasis. Preclinical research relies on xenograft mouse models, but these models preclude the human-specific functional interactions of stem cells with their bone marrow microenvironment. Instead, human mesenchymal cells can be exploited for the in vivo engineering of humanized niches, which confer robust engraftment of human healthy and malignant blood samples. However, mesenchymal cells are associated with major reproducibility issues in tissue formation. Here, we report the fast and standardized generation of human mini-bones by a custom-designed human mesenchymal cell line. These resulting humanized ossicles (hOss) consist of fully mature bone and bone marrow structures hosting a human mesenchymal niche with retained stem cell properties. As compared to mouse bones, we demonstrate superior engraftment of human cord blood hematopoietic cells and primary acute myeloid leukemia samples and also validate hOss as a metastatic site for breast cancer cells. We further report the engraftment of neuroblastoma patient-derived xenograft cells in a humanized model, recapitulating clinically described osteolytic lesions. Collectively, our human mini-bones constitute a powerful preclinical platform to model bone-developing tumors using patient-derived materials.

Highlights • Sub-lethal PMAP-36 treatment of bacteria increases outer membrane vesicle release. • Lipidomic analysis revealed the OMV lipidome upon PMAP-36 or heat treatment. • Supplementation with PMAP-36 attenuated undesirable OMV-induced immune responses., Host defense peptides (HDPs), such as cathelicidins, are small, cationic, amphipathic peptides and represent an important part of the innate immune system. Most cathelicidins, including the porcine PMAP-36, are membrane active and disrupt the bacterial membrane. For example, a chicken cathelicidin, CATH-2, has been previously shown to disrupt both Escherichia coli membranes and to release, at sub-lethal concentrations, outer membrane vesicles (OMVs). Since OMVs are considered promising vaccine candidates, we sought to investigate the effect of sub-bactericidal concentrations of PMAP-36 on both OMV release by a porcine strain of Bordetella bronchiseptica and on the modulation of immune responses to OMVs. PMAP-36 treatment of bacteria resulted in a slight increase in OMV release. The characteristics of PMAP-36-induced OMVs were compared with those of spontaneously released OMVs and OMVs induced by heat treatment. The stability of both PMAP-36- and heat-induced OMVs was decreased compared to spontaneous OMVs, as shown by dynamic light scattering. Furthermore, treatment of bacteria with PMAP-36 or heat resulted in an increase in negatively charged phospholipids in the resulting OMVs. A large increase in lysophospholipid content was observed in heat-induced OMVs, which was at least partially due to the activity of the outer-membrane phospholipase A (OMPLA). Although PMAP-36 was detected in OMVs isolated from PMAP-36-treated bacteria, the immune response of porcine bone-marrow-derived macrophages to these OMVs was similar as those against spontaneous or heat-induced OMVs. Therefore, the effect of PMAP-36 addition after OMV isolation was investigated. This did decrease cytokine expression of OMV-stimulated macrophages. These results indicate that PMAP-36 is a promising molecule to attenuate undesirable immune responses, for instance in vaccines., Graphical abstract Image, graphical abstract

The scope of this thesis is the interplay between Host Defense Peptides (HDPs) and Outer Membrane Vesicles (OMVs). HDPs have both antimicrobial and immunomodulatory properties. OMVs contain multiple antigens in their native environment and are therefore promising for vaccine development. It was also thought that OMVs could protect bacteria against killing by HDPs, but additionally it was investigated whether OMV release could be a response of bacteria upon HDPs in the environment. This increase in OMV yield could also be used for vaccine production, if OMV properties are not significantly altered. HDPs are known to have membrane-active properties, but the role of LPS-binding in killing of Gram-negative bacteria is not yet evident. Therefore, LPS-binding was correlated with HDP antibacterial effectivity, to distinguish between LPS acting as anchor and facilitating HDP functions or LPS acting as a sink and inhibiting HDP functions. Furthermore, immunomodulatory capabilities of HDPs were investigated, since this neutralization has not yet been described for OMV-induced activation. If HDPs could balance OMV-induced immune responses, the combination could be promising for vaccine development. In chapter 3, it was shown that OMVs can indeed act as a bacterial defense against HDPs. Not only were OMV quantities increased after stimulation with sub-lethal concentrations of HDPs, but also could addition of isolated OMVs to bacterial cultures protect against HDP killing. However, this was not true for all HDPs tested. The differences in the mechanisms of action of HDPs were further elucidated in chapter 4. CATH-2 and PMAP-36 were shown to be membrane active, but their effectivity did not correlate with LPS-binding. PMAP-23 showed an interaction with LPS and probably acts via a carpet model, but antibacterial effectivity was not correlated with LPS affinity. PR-39 was shown to be purely intracellularly active and to not affect bacterial membranes at all but did show binding to LPS. Stronger LPS-binding even correlated with enhanced bacterial killing for PR-39. Not only HDPs were shown to affect bacterial membranes, but also heat was shown to affect bacteria and enhance OMV release. In chapter 5, PMAP-36 was studied in more detail with respect to OMV induction and also to the immunomodulation of OMVs. Induction with PMAP-36 resulted in the presence of the peptide in isolated OMVs but this presence did not affect immunomodulation. When PMAP-36 was added to spontaneously formed OMVs (sOMVs) after isolation, it did show a neutralizing effect. Therefore, a large array of HDPs was investigated for their immunomodulatory capabilities in combination with OMVs (chapter 6). Four out of the eight HDPs tested showed immunomodulatory effects, being LL-37, CATH-2, PMAP-36 and K9CATH. They were further investigated for their specific TLR neutralizing capabilities. This revealed that OMVs were not only able to stimulate TLR4 and TLR2, but also TLR5 and TLR9. TLR neutralization was HDP specific, but TLR5 was consistently not neutralized by any peptide tested. Concluding, OMVs indeed play a role in defense against HDPs and HDPs are able to modulate OMV-induced immune responses. However, LPS-binding did not seem to correlate with HDP antibacterial activity.

The bone marrow microenvironment provides indispensable factors to sustain blood production throughout life. It is also a hotspot for the progression of hematologic disorders and the most frequent site of solid tumor metastasis. Pre-clinical research relies on xenograft mouse models, precluding the human-specific functional interactions of stem cells with their bone marrow microenvironment. Human mesenchymal cells can be exploited for the in vivo engineering of humanized ossicles (hOss). Those mini-bones provide a human niche conferring engraftment of human healthy and malignant blood samples, yet suffering from major reproducibility issue. Here, we report the standardized generation of hOss by developmental priming of a custom-designed human mesenchymal cell line. We demonstrate superior engraftment of cord blood hematopoietic cells and primary acute myeloid leukemia samples, but also validate our hOss as metastatic site for breast cancer cells. Finally, we report the first engraftment of neuroblastoma patient-derived xenograft cells in a humanized model, recapitulating clinically reported osteolytic lesions. Collectively, our hOss constitute a powerful standardized and malleable platform to model normal hematopoiesis, leukemia and solid tumor metastasis.

Host defense peptides (HDPs) are part of the innate immune system and constitute a first line of defense against invading pathogens. They possess antimicrobial activity against a broad spectrum of pathogens. However, pathogens have been known to adapt to hostile environments. Therefore, the bacterial response to treatment with HDPs was investigated. Previous observations suggested that sublethal concentrations of HDPs increase the release of outer membrane vesicles (OMVs) in Escherichia coli. First, the effects of sublethal treatment with HDPs CATH-2, PMAP-36, and LL-37 on OMV release of several Gram-negative bacteria were analyzed. Treatment with PMAP-36 and CATH-2 induced release of OMVs, but treatment with LL-37 did not. The OMVs were further characterized with respect to morphological properties. The HDP-induced OMVs often had disc-like shapes. The beneficial effect of bacterial OMV release was studied by determining the susceptibility of E. coli toward HDPs in the presence of OMVs. The minimal bactericidal concentration was increased in the presence of OMVs. It is concluded that OMV release is a means of bacteria to dispose of HDP-affected membrane. Furthermore, OMVs act as a decoy for HDPs and thereby protect the bacterium. IMPORTANCE Antibiotic resistance is a pressing problem and estimated to be a leading cause of mortality by 2050. Antimicrobial peptides, also known as host defense peptides (HDPs), and HDP-derived antimicrobials have potent antimicrobial activity and high potential as alternatives to antibiotics due to low resistance development. Some resistance mechanisms have developed in bacteria, and complete understanding of bacterial defense against HDPs will aid their use in the clinic. This study provides insight into outer membrane vesicles (OMVs) as potential defense mechanisms against HDPs, which will allow anticipation of unforeseen resistance to HDPs in clinical use and possibly prevention of bacterial resistance by the means of OMVs.

Objectives: Our group recently developed a new group of antimicrobial peptides termed PepBiotics, of which peptides CR-163 and CR-172 showed optimized antibacterial activity against Pseudomonas aeruginosa and Staphylococcus aureus without inducing antimicrobial resistance. In this study, the antibacterial mechanism of action and the immunomodulatory activity of these two PepBiotics was explored. Methods: RAW264.7 cells were used to determine the ability of PepBiotics to neutralize Lipopolysaccharide (LPS)-and Lipoteichoic acid (LTA)-induced activation of macrophages. Isothermal titration calorimetry and competition assays with dansyl-labeled polymyxin B determined binding characteristics to LPS and LTA. Combined bacterial killing with subsequent macrophage activation assays was performed to determine so-called ‘silent killing’. Finally, flow cytometry of peptide-treated genetically engineered Escherichia coli expressing Green Fluorescent Protein (GFP) and mCherry in the cytoplasm and periplasm, respectively, further established the antimicrobial mechanism of PepBiotics. Results: Both CR-163 and CR-172 were shown to have broad-spectrum activity against ESKAPE pathogens and E. coli using a membranolytic mechanism of action. PepBiotics could exothermically bind LPS/LTA and were able to replace polymyxin B. Finally, it was demonstrated that bacteria killed by PepBiotics were less prone to stimulate immune cells, contrary to gentamicin and heat-killed bacteria that still elicited a strong immune response. Conclusions: These studies highlight the multifunctional nature of the two peptide antibiotics as both broad-spectrum antimicrobial and immunomodulator. Their ability to kill bacteria and reduce unwanted subsequent immune activation is a major advantage and highlights their potential for future therapeutic use.

Gram-negative bacteria release vesicular structures from their outer membrane, so called outer membrane vesicles (OMVs). OMVs have a variety of functions such as waste disposal, communication, and antigen or toxin delivery. These vesicles are the promising structures for vaccine development since OMVs carry many surface antigens that are identical to the bacterial surface. However, isolation is often difficult and results in low yields. Several methods to enhance OMV yield exist, but these do affect the resulting OMVs. In this review, our current knowledge about OMVs will be presented. Different methods to induce OMVs will be reviewed and their advantages and disadvantages will be discussed. The effects of the induction and isolation methods used in several immunological studies on OMVs will be compared. Finally, the challenges for OMV-based vaccine development will be examined and one example of a successful OMV-based vaccine will be presented.

Current vaccines against Bordetella pertussis do not prevent colonization and transmission of the bacteria, and vaccine-induced immunity wanes rapidly. Besides, efficacy of vaccines for Bordetella bronchiseptica remains unclear. Novel vaccines could be based on outer-membrane vesicles (OMVs), but vesiculation of bordetellae needs to be increased for cost-effective vaccine production. Here, we focused on increasing OMV production by reducing the anchoring of the outer membrane to the peptidoglycan layer. Inactivation of rmpM, tolR, and pal failed, presumably because their products are essential in bordetellae. Conditional pal mutants were constructed, which were hypervesiculating under Pal-depletion conditions. SDS-PAGE and Western blot analyses showed that the protein composition of OMVs produced under Pal-depletion conditions resembled that of the outer membrane but differed from that of OMVs released by the wild type. Pal depletion affected the cell morphology and appeared to increase the amounts of cell-surface-exposed phospholipids, possibly reflecting a role for the Tol-Pal system in retrograde phospholipid transport. We also identified additional lipoproteins in bordetellae with a putative peptidoglycan-anchoring domain. However, their inactivation did not influence OMV production. We conclude that the conditional pal mutants could be valuable for the development of OMV-based vaccines.

Antibiotic resistance is increasing and one strategy to prevent resistance development is the use of bacterial vaccines. For Gram-negative bacteria, natural outer membrane vesicles (OMVs) could be used for vaccine development. These vesicular structures are naturally produced by all Gram-negative bacteria and contain several antigens in their native environment. However, despite that the presence of lipopolysaccharide (LPS) may aid as intrinsic adjuvant, there is a risk that it may also cause undesired immune responses. Therefore, molecules to dampen LPS-induced toll-like receptor (TLR) 4 activation may be needed. Here host defense peptides (HDPs), like cathelicidins, can play an important role. They have been shown to interact with LPS and thereby neutralize LPS-induced TLR4 activation. However, there is currently no knowledge about neutralization in an OMV-based setting. Therefore, in this paper the immune modulating capacity of HDPs was investigated after macrophage stimulation with either spontaneous or heat-induced B. bronchiseptica OMVs. This revealed that the cathelicidins LL-37, CATH-2, PMAP-36 and K9CATH were able to modulate immune responses. Interestingly, immune modulation by these cathelicidins was different for spontaneous compared to heat-induced OMVs. Interaction studies revealed that the mode of binding of cathelicidins to OMVs slightly differed between OMV classes. Furthermore, TLR screening revealed that TLR2, 4, 5 and 9 were involved in stimulation of macrophages by OMVs, with TLR4-mediated activation being the most important pathway. Uptake of OMVs did not play a major role in macrophage activation. Taken together, this study shows how OMVs can activate macrophages and how cathelicidins may modulate these immune responses.

Highlights • Heat inactivation of Bordetella stimulates outer membrane vesicle (hOMVs) release. • hOMVs are released without extensive cell lysis. • Protein composition of hOMVs is similar to that of spontaneous OMVs (sOMVs). • Protein composition of hOMVs and sOMVs is deviant from that of the outer membrane. • hOMVs are a promising tool for the development of novel Bordetella vaccines., Pertussis, also known as whooping cough, is caused by the Gram-negative bacterium Bordetella pertussis, an obligate human pathogen. Despite high vaccination rates in high-income countries, resurgence of pertussis cases is an occurring problem that urges the necessity of developing an improved vaccine. Likewise, the efficacy of vaccines for Bordetella bronchiseptica, which causes similar disease in pigs and companion animals, is debatable. A promising approach for novel vaccines is the use of outer membrane vesicles (OMVs). However, spontaneous OMV (sOMV) release by Bordetella spp. is too low for cost-effective vaccine production. Therefore, we investigated the influence of growth in various media commonly used for culturing Bordetella in the Bvg+, i.e. virulent, phase and of a heat shock applied to inactivate the cells on OMV production. Inactivation of the bacterial cells at 56 °C before OMV isolation greatly enhanced OMV release in both Bordetella spp. without causing significant cell lysis. The growth medium used barely affected the efficiency of OMV release but did affect the protein pattern of the OMVs. Differences were found to be related, at least in part, to different availability of the nutrient metals iron and zinc in the media and include expression of potentially relevant vaccine antigens, such as the receptors FauA and ZnuD. The protein content of OMVs released by heat shock was comparable to that of sOMVs as determined by SDS-PAGE and Western blot analysis, and their heat-modifiable electrophoretic mobility suggests that also protein conformation is unaffected. However, significant differences were noticed between the protein content of OMVs and that of a purified outer membrane fraction, with two major outer membrane proteins, porin OmpP and the peptidoglycan-associated RmpM, being underrepresented in the OMVs. Altogether, these results indicate that the application of a heat shock is potentially an important step in the development of cost-effective, OMV-based vaccines for both Bordetella spp., Graphical abstract Image, graphical abstract

Cathelicidins (CATHs) are host defense peptides (HDPs) that play an important role in the innate immune response against infections. Although multiple functions of cathelicidins have been described, including direct antimicrobial activity and several immunomodulatory effects on the host, relatively little is known about their antiviral activity. Therefore, in vitro antiviral activity of chicken cathelicidins and the underlying mechanism was investigated in this study against different influenza A virus (IAV) strains. Our results show that chicken CATH-B1 has broad anti-IAV activity compared to other cathelicidins (CATH-1, -2, -3, LL-37, PMAP-23, and K9CATH) with an inhibition of viral infection up to 80% against three tested IAV strains (H1N1, H3N1, and H5N1). In agreement herewith, CATH-B1 affected virus-induced inflammatory cytokines expression (IFN-β, IL-1β, IL-6, and IL-8). Incubation of cells with CATH-B1 prior to or after their inoculation with virus did not reduce viral infection indicating that direct interaction of virus with the peptide was required for CATH-B1's antiviral activity. Experiments using combined size exclusion and affinity-based separation of virus and peptide also indicated that CATH-B1 bound to viral particles. In addition, using electron microscopy, no morphological change of the virus itself was seen upon incubation with CATH-B1 but large aggregates of CATH-B1 and viral particles were observed, indicating that aggregation might be the mechanism of action reducing IAV infectivity. Neuraminidase (NA) activity assays using monovalent or multivalent substrates, indicated that CATH-B1 did not affect NA activity per se, but negatively affected the ability of virus particles to interact with multivalent receptors, presumably by interfering with hemagglutinin activity. In conclusion, our results show CATH-B1 has good antiviral activity against IAV by binding to the viral particle and thereby blocking viral entry.

Pertussis, also known as whooping cough, is caused by the Gram-negative bacterium Bordetella pertussis, an obligate human pathogen. Despite high vaccination rates in high-income countries, resurgence of pertussis cases is an occurring problem that urges the necessity of developing an improved vaccine. Likewise, the efficacy of vaccines for Bordetella bronchiseptica, which causes similar disease in pigs and companion animals, is debatable. A promising approach for novel vaccines is the use of outer membrane vesicles (OMVs). However, spontaneous OMV (sOMV) release by Bordetella spp. is too low for cost-effective vaccine production. Therefore, we investigated the influence of growth in various media commonly used for culturing Bordetella in the Bvg+, i.e. virulent, phase and of a heat shock applied to inactivate the cells on OMV production. Inactivation of the bacterial cells at 56 °C before OMV isolation greatly enhanced OMV release in both Bordetella spp. without causing significant cell lysis. The growth medium used barely affected the efficiency of OMV release but did affect the protein pattern of the OMVs. Differences were found to be related, at least in part, to different availability of the nutrient metals iron and zinc in the media and include expression of potentially relevant vaccine antigens, such as the receptors FauA and ZnuD. The protein content of OMVs released by heat shock was comparable to that of sOMVs as determined by SDS-PAGE and Western blot analysis, and their heat-modifiable electrophoretic mobility suggests that also protein conformation is unaffected. However, significant differences were noticed between the protein content of OMVs and that of a purified outer membrane fraction, with two major outer membrane proteins, porin OmpP and the peptidoglycan-associated RmpM, being underrepresented in the OMVs. Altogether, these results indicate that the application of a heat shock is potentially an important step in the development of cost-effective, OMV-based vaccines for both Bordetella spp.

The Gq-coupled 5-hydroxytryptamine 2B (5-HT2B) receptor is known to regulate the proliferation of islet beta cells during pregnancy. However, the role of serotonin in the control of insulin release is still controversial. The aim of the present study was to explore the role of the 5-HT2B receptor in the regulation of insulin secretion in mouse and human islets, as well as in clonal INS-1(832/13) cells.Expression of HTR2B mRNA and 5-HT2B protein was examined with quantitative real-time PCR, RNA sequencing and immunohistochemistry. α-Methyl serotonin maleate salt (AMS), a serotonin receptor agonist, was employed for robust 5-HT2B receptor activation. Htr2b was silenced with small interfering RNA in INS-1(832/13) cells. Insulin secretion, Ca(2+) response and oxygen consumption rate were determined.Immunohistochemistry revealed that 5-HT2B is expressed in human and mouse islet beta cells. Activation of 5-HT2B receptors by AMS enhanced glucose-stimulated insulin secretion (GSIS) in human and mouse islets as well as in INS-1(832/13) cells. Silencing Htr2b in INS-1(832/13) cells led to a 30% reduction in GSIS. 5-HT2B receptor activation produced robust, regular and sustained Ca(2+) oscillations in mouse islets with an increase in both peak distance (period) and time in the active phase as compared with control. Enhanced insulin secretion and Ca(2+) changes induced by AMS coincided with an increase in oxygen consumption in INS-1(832/13) cells.Activation of 5-HT2B receptors stimulates GSIS in beta cells by triggering downstream changes in cellular Ca(2+) flux that enhance mitochondrial metabolism. Our findings suggest that serotonin and the 5-HT2B receptor stimulate insulin release.

Aims/hypothesis Genetic studies show coupling of genes affecting beta cell function to type 1 diabetes, but hitherto no studies on whether beta cell dysfunction could precede insulitis and clinical onset of type 1 diabetes are available. Methods We used 40-day-old BioBreeding (BB) DRLyp/Lyp rats (a model of spontaneous autoimmune type 1 diabetes) and diabetes-resistant DRLyp/+ and DR+/+ littermates (controls) to investigate beta cell function in vivo, and insulin and glucagon secretion in vitro. Beta cell mass was assessed by optical projection tomography (OPT) and morphometry. Additionally, measurements of intra-islet blood flow were performed using microsphere injections. We also assessed immune cell infiltration, cytokine expression in islets (by immunohistochemistry and qPCR), as well as islet Glut2 expression and ATP/ADP ratio to determine effects on glucose uptake and metabolism in beta cells. Results DRLyp/Lyp rats were normoglycaemic and without traces of immune cell infiltrates. However, IVGTTs revealed a significant decrease in the acute insulin response to glucose compared with control rats (1685.3 ± 121.3 vs 633.3 ± 148.7; p

Non-invasive imaging and quantification of human beta cell mass remains a major challenge. We performed pre-clinical in vivo validation of a peptide previously discovered by our group, namely, P88 that targets a beta cell specific biomarker, FXYD2&gamma, a. We conjugated P88 with DOTA and then complexed it with GdCl3 to obtain the MRI (magnetic resonance imaging) contrast agent (CA) Gd-DOTA-P88. A scrambled peptide was used as a negative control CA, namely Gd-DOTA-Scramble. The CAs were injected in immunodeficient mice implanted with EndoC-&beta, H1 cells, a human beta cell line that expresses FXYD2&gamma, a similarly to primary human beta cells. The xenograft-bearing mice were analyzed by MRI. At the end, the mice were euthanized and the CA biodistribution was evaluated on the excised tissues by measuring the Gd concentration with inductively coupled plasma mass spectrometry (ICP-MS). The MRI and biodistribution studies indicated that Gd-DOTA-P88 accumulates in EndoC-&beta, H1 xenografts above the level observed in the background tissue, and that its uptake is significantly higher than that observed for Gd-DOTA-Scramble. In addition, the Gd-DOTA-P88 showed good xenograft-to-muscle and xenograft-to-liver uptake ratios, two potential sites of human islets transplantation. The CA shows good potential for future use to non-invasively image implanted human beta cells.

In late 2016, Bas Smit, CEO of WeCare, a large Dutch regional care organisation providing home care, intramural nursing home care and extramural social care, had just returned from a high-level funding session organised by the Dutch Healthcare Authority. In addition to people from the care sector, the meeting included representatives from insurance companies, government agencies and healthcare providers—all there on a rainy afternoon to assess recent attempts by care providers to improve the quality and personalization of home care while cutting costs. Although all agreed on the move towards more local embedding with increased responsibility for nurses in neighbourhood-based, self-organising teams, there had been debate on precisely how to embed the teams in the organisation and their neighbourhoods. While some had argued for self-managing teams, following Dutch care organisation Buurtzorg’s very successful approach (ref) with completely autonomous teams, Smit believed that WeCare’s embedded self-organising teams featuring district nurses improved possibilities for local coordination. This case explores WeCare’s model of self-organisation and addresses key challenges in dealing with issues of innovation, costs and efficiency, quality of care and the job quality of care workers. This case shows the complex regulatory and financial environment in which an existing home care organisation aims to develop and adapt by introducing self-organising teams.

Islet produced 5-hydroxy tryptamine (5-HT) is suggested to regulate islet hormone secretion in a paracrine and autocrine manner in rodents. Hitherto, no studies demonstrate a role for this amine in human islet function, nor is it known if 5-HT signaling is involved in the development of beta cell dysfunction in type 2 diabetes (T2D). To clarify this, we performed a complete transcriptional mapping of 5-HT receptors and processing enzymes in human islets and investigated differential expression of these genes in non-diabetic and T2D human islet donors. We show the expression of fourteen 5-HT receptors as well as processing enzymes involved in the biosynthesis of 5-HT at the mRNA level in human islets. Two 5-HT receptors (HTR1D and HTR2A) were over-expressed in T2D islet donors. Both receptors (5-HT1d and 5-HT2a) were localized to human alpha, beta and delta cells. 5-HT inhibited both insulin and glucagon secretion in non-diabetic islet donors. In islets isolated from T2D donors the amine significantly increased release of insulin in response to glucose. Our results suggest that 5-HT signaling participates in regulation of overall islet hormone secretion in non- diabetic individuals and over-expression of HTR1D and HTR2A may either contribute to islet dysfunction in T2D or arise as a consequence of an already dysfunctional islet.

There are presently no reliable ways to quantify endocrine cell mass (ECM) in vivo, which prevents an accurate understanding of the progressive beta cell loss in diabetes or following islet transplantation. To address this unmet need, we coupled RNA sequencing of human pancreatic islets to a systems biology approach to identify new biomarkers of the endocrine pancreas. Dipeptidyl-Peptidase 6 (DPP6) was identified as a target whose mRNA expression is at least 25-fold higher in human pancreatic islets as compared to surrounding tissues and is not changed by proinflammatory cytokines. At the protein level, DPP6 localizes only in beta and alpha cells within the pancreas. We next generated a high-affinity camelid single-domain antibody (nanobody) targeting human DPP6. The nanobody was radiolabelled and in vivo SPECT/CT imaging and biodistribution studies were performed in immunodeficient mice that were either transplanted with DPP6-expressing Kelly neuroblastoma cells or insulin-producing human EndoC-βH1 cells. The human DPP6-expressing cells were clearly visualized in both models. In conclusion, we have identified a novel beta and alpha cell biomarker and developed a tracer for in vivo imaging of human insulin secreting cells. This provides a useful tool to non-invasively follow up intramuscularly implanted insulin secreting cells., SCOPUS: ar.j, info:eu-repo/semantics/published

Pro-inflammatory cytokines contribute to pancreatic beta cell apoptosis in type 1 diabetes at least in part by inducing endoplasmic reticulum (ER) stress and the consequent unfolded protein response (UPR). It remains to be determined what causes the transition from "physiological" to "apoptotic" UPR, but accumulating evidence indicates that signaling by the ER transmembrane protein IRE1α is critical for this transition. IRE1α activation is regulated by both intra-ER and cytosolic cues. We evaluated the role for the presently discovered cytokine-induced and IRE1α-interacting protein ubiquitin D (UBD) on the regulation of IRE1α and its downstream targets. UBD was identified by use of a MAPPIT (mammalian protein-protein interaction trap)-based IRE1α interactome screen followed by comparison against functional genomic analysis of human and rodent beta cells exposed to pro-inflammatory cytokines. Knockdown of UBD in human and rodent beta cells and detailed signal transduction studies indicated that UBD modulates cytokine-induced UPR/IRE1α activation and apoptosis. UBD expression is induced by the pro-inflammatory cytokines interleukin (IL)-1β and interferon (IFN)-γ in rat and human pancreatic beta cells, and it is also up-regulated in beta cells of inflamed islets from non-obese diabetic mice. UBD interacts with IRE1α in human and rodent beta cells, modulating IRE1α-dependent activation of JNK and cytokine-induced apoptosis. Our data suggest that UBD provides a negative feedback on cytokine-induced activation of the IRE1α/JNK pro-apoptotic pathway in cytokine-exposed beta cells., info:eu-repo/semantics/published

Insulin is a major autoantigen in islet autoimmunity and progression to type 1 diabetes. It has been suggested that the insulin B-chain may be critical to insulin autoimmunity in type 1 diabetes. INS-IGF2 consists of the preproinsulin signal peptide, the insulin B-chain, and eight amino acids of the C-peptide in addition to 138 amino acids from the IGF2 gene. We aimed to determine the expression of INS-IGF2 in human pancreatic islets and autoantibodies in newly diagnosed children with type 1 diabetes and controls. INS-IGF2, expressed primarily in beta cells, showed higher levels of expression in islets from normal compared with donors with either type 2 diabetes (p = 0.006) or high HbA1c levels (p < 0.001). INS-IGF2 autoantibody levels were increased in newly diagnosed patients with type 1 diabetes (n = 304) compared with healthy controls (n = 355; p < 0.001). Displacement with cold insulin and INS-IGF2 revealed that more patients than controls had doubly reactive insulin-INS-IGF2 autoantibodies. These data suggest that INS-IGF2, which contains the preproinsulin signal peptide, the B-chain, and eight amino acids of the C-peptide may be an autoantigen in type 1 diabetes. INS-IGF2 and insulin may share autoantibody-binding sites, thus complicating the notion that insulin is the primary autoantigen in type 1 diabetes.

Insulin is a major autoantigen in islet autoimmunity and progression to type 1 diabetes. It has been suggested that the insulin B-chain may be critical to insulin autoimmunity in type 1 diabetes. INS-IGF2 consists of the preproinsulin signal peptide, the insulin B-chain and eight amino acids of the C-peptide in addition to 138 amino acids from the IGF2 gene. We aimed to determine 1) expression of INS-IGF2 in human pancreatic islets and 2) autoantibodies in newly diagnosed type 1 diabetes children and controls. INS-IGF2, expressed primarily in beta cells, showed higher levels of expression in islets from normal compared to donors with either type 2 diabetes (p=0.006) or high HbA1c levels (p

Islet hormone secretion is tightly regulated by metabolic status as well as local and circulating factors. These factors can activate different receptors on the pancreatic islet cells, for instance G-protein coupled receptors (GPCRs). When activated, these receptors are able to fine-tune islet hormone secretion and regulate overall β-cell function. Estrogen and serotonin are circulating factors that bind to GPCRs. First, we studied the activation of GPER-1 in pancreatic islets using two agonists G-1 and Estrogen (E2). Both G-1 and E2 displayed a similar response in mouse and human islets even in the presence of estrogen receptor blockers, ICI 182, 720 and EM652. G-1 and E2 potentiated insulin secretion and inhibited glucagon and somatostatin secretion. G-1 induced cAMP generation, suggesting positive coupling to adenylate cyclase and a subsequent rise in insulin release. Furthermore both agonists protected pancreatic islets from cytokine-induced apoptosis via activation of anti-apoptotic signals, CREB, ERK1/2 and AKT and reduced phosphorylation of the pro-apoptotic signals SAPK/JNK and p38. Second, we studied serotonin (5-HT) receptors in human islets and INS (832/13) cells. We detected 15 different 5-HT receptors and the 5-HT producing enzymes, TPH1 and TPH2 as well as DDC. Cellular localization for 5-HT1A, 5-HT1D and 5-HT2A were observed in both β- and α-cells; while 5-HT2B was only present in β-cells. Agonists targeting these four receptors were able to either inhibit or stimulate insulin secretion from human islets and INS (832/13) cells. In addition, 5-HT was quantified using GC/MS in INS (832/13) cells, rat islets and detected in human α and β-cells with immunohistochemistry. Third, we investigated the peripheral role of a 5-HT2 receptor agonist, α-methyl serotonin maleate salt (AMS) in insulin resistance and β cell function. Long-term treatment with AMS in a high fat diet fed mouse model resulted in increased insulin sensitivity in vivo in high fat fed AMS treated mice. Moreover, insulin secretion from AMS treated control fed mice in vitro was decreased while plasma glucose levels were similar in vivo between AMS treated and untreated controls. In addition, AMS mediated protection from lipotoxicity in INS-1(832/13) cells. In conclusion, this thesis contributes to increased understanding of how estrogen and peripheral 5-HT mediate their effects on islet function and overall glucose homeostasis. Internationella diabetesförbundet räknar med att en tiondel av världens befolkning kommer att ha någon form av diabetes om 50 år. Diabetes är en sjukdom med global spridning som innebär att kroppen inte kan ta hand om all den näring man intar, framförallt inte sockret. Detta medför att sockerhalten i blodet höjs. Insulin produceras efter en måltid och signalerar till kroppens muskel-, fett- och leverceller att ta upp och använda sockret i blodet. Cellerna som producerar hormonet insulin finns i bukspottskörteln. Om blodsockret förblir högt under en längre tid tröttas de insulinproducerande cellerna ut och blodsockret skjuter ytterligare i höjden, kroppens celler börjar förstöras och andra följdsjukdomar kan uppstå, såsom hjärt- kärl-, ögon-, njur- och nervsjukdomar. I vår forskning visar vi att östrogen har en skyddande effekt på de insulinproducerande cellerna samt att insulinproduktionen ökar. Östrogen, som framförallt är ett kvinnligt hormon, finns också i lägre koncentrationer hos män. Östrogen fungerar som ett signalhormon i kroppen och aktiverar sina mottagare (receptorer). I kroppens celler finns det två typer av östrogenreceptorer, de som verkar inuti cellkärnan och de som finns i cellens membran. Vi har i möss studerat den membranbundna, ”yttre” receptorn, som kallas GPER-1. När denna receptor signalerar ser vi positiva effekter av östrogen. Här har vi använt en specifik substans, G-1, som endast aktiverar GPER-1. Vi kan konstatera att östrogenreceptorerna finns i de hormonproducerande cellerna i bukspottskörteln. G-1:s effekt följde östrogenets effekt på bukspottskörtelceller från både möss och människor. Insulinproduktionen ökade och glukagonproduktionen minskade. Vid behandling med G-1 och östrogen, överlevde tre gånger så många celler då vi utsatte dem för ämnen som är involverade i inflammation. Vi har även studerat serotoninets (5-HT) effekt på bukspottskörtelcellerna. Serotonin har man tidigare studerat som en signalsubstans i nervbanor, där serotonin fungerar som stämningsreglerare och finns cirkulerande i blodomloppet där det kan påverka bland annat blodtrycket. Serotonin signalerar genom flera olika sorters serotoninreceptorer. Vi har funnit femton olika receptorer för 5-HT i bukspottskörtelns hormonproducerande celler från människa och att dessa olika receptorer kan antingen påverka frisättningen positivt eller negativt. Vidare visar vi också att ett specifikt läkemedel som aktiverar en 5-HT2B receptor (AMS) har en positiv effekt på insulinutsöndring, samt att det kan motverka något som kallas för insulinresistens. Insulinresistens gör att kroppens celler har svårt att ta upp socker, vilket bidrar till ökade blodsocker nivåer och slutligen typ 2 diabetes. Resultaten i denna avhandling bidrar till att öka den allmänna kunskapen om östrogen och hur förändrade östrogennivåer kan leda till diabetes, till exempel vid graviditet och efter övergångsåldern. Vår forskning bidrar även till ökad kunskap om vilka receptorer för 5-HT som är involverade i reglering av insulinfrisättning och att stämningsreglerande läkemedel, till exempel antidepressiva läkemedel, som primärt verkar genom att öka mängden serotonin i hjärnan, kan ha oönskade effekter på energiomsättningen och ge upphov till diabetes och övervikt. Vi visar också att systemet för 5-HT i bukspottskörteln kan ha positiva effekter beroende på vilka receptorer man väljer att aktivera. Systemen för östrogen och 5-HT är komplexa, men vidare studier av dessa system kan bidra till utvecklingen av nya, mer effektiva läkemedel för typ 2 diabetes.

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OBJECTIVE The incretin hormone GIP (glucose-dependent insulinotropic polypeptide) promotes pancreatic β-cell function by potentiating insulin secretion and β-cell proliferation. Recently, a combined analysis of several genome-wide association studies (Meta-analysis of Glucose and Insulin-Related Traits Consortium [MAGIC]) showed association to postprandial insulin at the GIP receptor (GIPR) locus. Here we explored mechanisms that could explain the protective effects of GIP on islet function. RESEARCH DESIGN AND METHODS Associations of GIPR rs10423928 with metabolic and anthropometric phenotypes in both nondiabetic (N = 53,730) and type 2 diabetic individuals (N = 2,731) were explored by combining data from 11 studies. Insulin secretion was measured both in vivo in nondiabetic subjects and in vitro in islets from cadaver donors. Insulin secretion was also measured in response to exogenous GIP. The in vitro measurements included protein and gene expression as well as measurements of β-cell viability and proliferation. RESULTS The A allele of GIPR rs10423928 was associated with impaired glucose- and GIP-stimulated insulin secretion and a decrease in BMI, lean body mass, and waist circumference. The decrease in BMI almost completely neutralized the effect of impaired insulin secretion on risk of type 2 diabetes. Expression of GIPR mRNA was decreased in human islets from carriers of the A allele or patients with type 2 diabetes. GIP stimulated osteopontin (OPN) mRNA and protein expression. OPN expression was lower in carriers of the A allele. Both GIP and OPN prevented cytokine-induced reduction in cell viability (apoptosis). In addition, OPN stimulated cell proliferation in insulin-secreting cells. CONCLUSIONS These findings support β-cell proliferative and antiapoptotic roles for GIP in addition to its action as an incretin hormone. Identification of a link between GIP and OPN may shed new light on the role of GIP in preservation of functional β-cell mass in humans.

How to reach consensus? Methods to reach consensus about recommendations Clinical guideline development is an important first step in delivering good (quality of) care. Quality indicators are more and more used to monitor compliance of recommendations in these clinical guidelines. This paper describes two ways to reach consensus about the most relevant recommendations for delivering good quality of care. The first method (IQ consensustool) is based on individual rounds of scoring the recommendations followed by discussion meetings. The other method (Synmind) is a digital communication platform where recommendations can be scored and discussed online. These tools have been used in different research settings and based on this we concluded that both methods are valuable tools in getting consensus about the most relevant recommendations, in this particular case, for delivering good surgical care.

The role of the newly discovered estrogen receptor GPR30 in islet physiology and pathophysiology is unclear. We examined GPR30 expression in relation to hormone secretion and possible anti-apoptotic effects in isolated mouse islets using the synthetic GPR30 ligand G-1. The mRNA and protein expression of GPR30 was analyzed by qPCR, Western blot and confocal microscopy. Hormone secretion and cAMP content were determined with RIA and apoptosis in islet cells with the Annexin-V method. GPR30 mRNA and protein expression was markedly higher in islets from females compared to male. This gender difference was not found for the genomic estrogen receptors ER alpha and ER beta, the ER alpha expression being 10-fold higher than ER beta in both genders. Confocal microscopy revealed abounden GPR30 expression in insulin, glucagon and somatostatin cells. Dose-response studies of G-1 vs 17beta-estradiol in isolated islets at 1 or 12 mM glucose showed an almost identical pattern in that both compounds increased insulin and inhibited glucagon and somatostatin secretion. ICI-182,780 and EM-652, potent antagonists of the 17beta-estradiol receptors (ER alpha and ER beta) did not influence the amplifying effect of G-1 or 17beta-estradiol on cAMP content or insulin secretion from isolated islets. Cytokine-induced (IL-1 beta+TNFalpha+INF gamma) apoptosis in islets, cultured for 24h at 5mM glucose, was almost abolished by G-1 or 17beta-estradiol treatment. Addition of ICI-182,780 or EM-652 did not affect this beneficial effect of G-1 or 17beta-estradiol. Taken together, our findings show that GPR30 is expressed in most islet endocrine cells. The synthetic GPR30 ligand G-1 mimics the non-genomic effects of 17beta-estradiol on islet hormone secretion, cAMP content in islets and its anti-apoptotic effects. G-1 or analogs thereof might be new potential candidates in the therapeutic strategy for type 2 diabetes in women.

Verslag van een themabijeenkomst welke als doel had om de sector concrete handvatten aan te reiken voor het aanvragen én realiseren van een gezondheidsclaim.

SummaryType 2 diabetes (T2D) evolves when insulin secretion fails. Insulin release from the pancreatic β cell is controlled by mitochondrial metabolism, which translates fluctuations in blood glucose into metabolic coupling signals. We identified a common variant (rs950994) in the human transcription factor B1 mitochondrial (TFB1M) gene associated with reduced insulin secretion, elevated postprandial glucose levels, and future risk of T2D. Because islet TFB1M mRNA levels were lower in carriers of the risk allele and correlated with insulin secretion, we examined mice heterozygous for Tfb1m deficiency. These mice displayed lower expression of TFB1M in islets and impaired mitochondrial function and released less insulin in response to glucose in vivo and in vitro. Reducing TFB1M mRNA and protein in clonal β cells by RNA interference impaired complexes of the mitochondrial oxidative phosphorylation system. Consequently, nutrient-stimulated ATP generation was reduced, leading to perturbed insulin secretion. We conclude that a deficiency in TFB1M and impaired mitochondrial function contribute to the pathogenesis of T2D.

Malmö högskolaLärarutbildningen Skolutveckling och ledarskapSpecialpedagogisk påbyggnadsutbildningHöstterminen 2007AbstraktIngeborg Balhuizen. (2007). Vuxna med läs- och skrivsvårigheter. Strategi-er – hinder och möjligheter. Skolutveckling och ledarskap, Specialpedago-gisk påbyggnadsutbildning, Lärarutbildningen, Malmö högskola.SyfteSyftet med följande arbete har varit att undersöka om vuxna med läs- och skrivsvårigheter upplever förändringar av strategierna de använder vid läs- och skrivuppgifter och läs- och skrivkrav efter tolv veckors studier på en läs- och skrivkurs. Vilka strategier har använts under tidigare skolgång och arbetsliv? Kan en ökad språklig medvetenhet påvisas med analysverktyg som mäter läshastighet, läsförståelse och stavning?MetodFör att uppnå mitt syfte har jag intervjuat sex vuxenelever om deras skol-gång och yrkesliv och huruvida läs- och skrivsvårigheter har påverkat stu-dier och arbete. Vilka strategier har använts? Har läs- och skrivuppgifter och läs- och skrivkrav undvikits? Hur har situationer lösts? Genom test-ning, med för- och eftertest av läshastighet, läsförståelse och stavning har jag undersökt om en resultatförändring kan påvisas. Kan resultaten från tes-terna visa på en ökad språklig medvetenhet efter en intensiv språkträning på tolv veckor?ResultatSammanfattningsvis tyder resultaten av undersökningarna på att eleverna har förändrat sina strategier vid uppgifter som ställer läs- och skrivkrav och vid lösning av läs- och skrivuppgifter, från att hanterat situationer undvi-kande till ett mera medvetet bearbetningssätt. Däremot visar testresultaten ingen större förändring. Nyckelord: bearbetande strategier, dyslexi, läsförståelse, läshastighet, läs- och skrivkrav, läs- och skrivuppgifter, rättstavning, självkänsla, språklig medvetenhet, undvikande strategier.Ingeborg Balhuizen Handledare: Birgitta LansheimGrindögatan 130257 32 Rydebäck042- 22 26 95

Ribonucleotide reductases (RNRs) catalyze the reduction of ribonucleotides to deoxyribonucleotides, the building blocks for DNA synthesis, and are found in all but a few organisms. RNRs use radical chemistry to catalyze the reduction reaction. Despite RNR having evolved several mechanisms for generation of different kinds of essential radicals across a large evolutionary time frame, this initial radical is normally always channelled to a strictly conserved cysteine residue directly adjacent to the substrate for initiation of substrate reduction, and this cysteine has been found in the structures of all RNRs solved to date. We present the crystal structure of an anaerobic RNR from the extreme thermophile Thermotoga maritima (tmNrdD), alone and in several complexes, including with the allosteric effector dATP and its cognate substrate CTP. In the crystal structure of the enzyme as purified, tmNrdD lacks a cysteine for radical transfer to the substrate pre-positioned in the active site. Nevertheless activity assays using anaerobic cell extracts from T. maritima demonstrate that the class III RNR is enzymatically active. Other genetic and microbiological evidence is summarized indicating that the enzyme is important for T. maritima. Mutation of either of two cysteine residues in a disordered loop far from the active site results in inactive enzyme. We discuss the possible mechanisms for radical initiation of substrate reduction given the collected evidence from the crystal structure, our activity assays and other published work. Taken together, the results suggest either that initiation of substrate reduction may involve unprecedented conformational changes in the enzyme to bring one of these cysteine residues to the expected position, or that alternative routes for initiation of the RNR reduction reaction may exist. Finally, we present a phylogenetic analysis showing that the structure of tmNrdD is representative of a new RNR subclass IIIh, present in all Thermotoga species plus a wider group of bacteria from the distantly related phyla Firmicutes, Bacteroidetes and Proteobacteria., SCOPUS: ar.j, info:eu-repo/semantics/published

Ribonucleotide reductases (RNRs) catalyze the reduction of ribonucleotides to deoxyribonucleotides, the building blocks for DNA synthesis, and are found in all but a few organisms. RNRs use radical chemistry to catalyze the reduction reaction. Despite RNR having evolved several different mechanisms for generation of different kinds of essential radicals across a large evolutionary time frame, for over 30 years the paradigm has been that this initial radical is always channeled to a strictly conserved cysteine residue directly adjacent to the substrate for initiation of substrate reduction. Such a cysteine residue has been present in the structure of each of the many RNRs determined to date. We present the crystal structure of an anaerobic RNR from the extreme thermophile Thermotoga maritima (tmNrdD), both alone and in complex with allosteric effector dATP and substrate CTP. Remarkably, tmNrdD lacks a cysteine for radical transfer to the substrate, and is the first structurally or biochemically characterized RNR to do so. However in many other respects tmNrdD appears to be a normal anaerobic RNR, including gene structure, expression levels, metal cofactor and binding of allosteric effectors and substrates in the expected conformations. Furthermore, it is possible to generate a glycyl radical as expected. We present evidence that the structure of tmNrdD is representative for the new RNR subclass IIIh, present in all Thermotoga species plus a wider group of bacteria from the distantly related phyla Firmicutes, Bacteroidetes and Proteobacteria, all lacking the canonical cysteine residue. The wide distribution provides further evidence that the subclass IIIh is a functional RNR. Taken together, the results imply that an alternative initiation route for the RNR reduction reaction must exist that do not require channeling through a cysteine side chain.

Aim: We document for the first time the occurrence of a malignant myoepithelioma at a site other than within the major and minor salivary glands. Methods and results: A 67-year-old male presented with progressive symptoms and signs of a space-occupying lesion in the right maxillary sinus. An initial biopsy identified a malignant (myo)epithelial lesion and a radical maxillectomy was performed. Histology, supplemented by immunohistochemistry, confirmed the prescence of a malignant myoepithelioma. Conclusion: Malignant myoepithelioma is a very rare tumour composed almost exclusively of myoepithelial cells and, to date, has only been described arising in the the major and minor salivary glands. A variety of tumours of salivary tissue have been reported within the head and neck area at sites outside the major and minor salivary glands, probably arising within accessory salivary tissue. We report the first case of a malignant myoepithelioma occurring in the maxillary sinus, also presumably arising in accessory salivary tissue in this location.

A 57-year-old woman was admitted because of weakness, fatigue, abdominal discomfort, easy bruising and splenomegaly. A highly elevated leukocyte count with hairy-cell-like cells was found, the cells being positive for the monoclonal antibodies CD19, FMC7, CD11c and B-ly-7 and negative for CD24 and CD25. Blood and bone marrow were investigated not only in our own laboratory but also in several other laboratories resulting in a variety of possible diagnoses. Only after combining all data could a definitive diagnosis of variant hairy cell leukaemia be made. The patient was treated initially with a splenectomy and later on with interferon-alpha-2b, resulting in a steady decrease in the leukocyte count. After a follow-up of 2 years a nearly complete remission was obtained with a good quality of life. The differential diagnosis of this rare disorder is discussed with emphasis on the relative contribution of different diagnostic procedures.

✓ The authors present a retrospective analysis of the results of the cytological examinations of cerebrospinal fluid (CSF) samples and tumor-cyst aspirates deriving from 262 patients treated for malignant intracranial primary and secondary tumors, and vertebral and peridural metastastic processes. Positive preoperative CSF samples were found in 15.3% of all cases of primary cerebral malignancies (13.9% of all gliomas) and positive postoperative CSF samples were found in 40% (91% of the medulloblastoma cases). In all cases of single or multiple secondary cerebral tumors, positive preoperative CSF samples were found in 20%.

Noninvasive beta cell mass (BCM) quantification is a crucial tool to understand diabetes development and progression. [(111)In]exendin is a promising agent for in vivo beta cell imaging, but tracer testing has been hampered by the lack of well-defined rodent models., SCOPUS: ar.j, info:eu-repo/semantics/published

Histoplasmosis was considered a rare and always fatal disease for many years after it was first described by Darling in 1906. However, recent epidemiological studies in the United States have revealed that in some states in the endemic area 60% to 70% of males aged 17 through 21 years have been infected with Histoplasma capsulatum . 1 The respiratory tract is the usual portal of entry of the fungus with the primary lesion occurring in the lungs. 2 Cases of histoplasmosis having skin lesions have been reported, but the skin lesions were usually the result of dissemination of the infection. 3,4 The purpose of this paper is to report a case of primary cutaneous histoplasmosis which resulted from direct inoculation of the fungus through the skin. Report of Case On Jan 12, 1959, a 32-year-old white male who had recently moved into the endemic area for histoplasmosis assisted with an autopsy