Generation of four iPSC lines from four patients with Leigh syndrome carrying homoplasmic mutations m.8993T > G or m.8993T > C in the mitochondrial gene MT-ATP6.

We report the generation of four human iPSC lines (8993-A12, 8993-B12, 8993-C11, and 8993-D7) from fibroblasts of four patients affected by maternally inherited Leigh syndrome (MILS) carrying homoplasmic mutations m.8993T > G or m.8993T > C in the mitochondrial gene MT-ATP6. We used Sendai viruses to deliver reprogramming factors OCT4, SOX2, KLF4, and c-MYC. The established iPSC lines expressed pluripotency markers, exhibited a normal karyotype, were capable to form cells of the three germ layers in vitro, and retained the MT-ATP6 mutations at the same homoplasmic level of the parental fibroblasts.

Mitochondrial metabolism in early neural fate and its relevance for neuronal disease modeling.

Modulation of energy metabolism is emerging as a key aspect associated with cell fate transition. The establishment of a correct metabolic program is particularly relevant for neural cells given their high bioenergetic requirements. Accordingly, diseases of the nervous system commonly involve mitochondrial impairment. Recent studies in animals and in neural derivatives of human pluripotent stem cells (PSCs) highlighted the importance of mitochondrial metabolism for neural fate decisions in health and disease. The mitochondria-based metabolic program of early neurogenesis suggests that PSC-derived neural stem cells (NSCs) may be used for modeling neurological disorders. Understanding how metabolic programming is orchestrated during neural commitment may provide important information for the development of therapies against conditions affecting neural functions, including aging and mitochondrial disorders.

Good Manufacturing Practice-Compliant Production and Lot-Release of Ex Vivo Expanded Regulatory T Cells As Basis for Treatment of Patients with Autoimmune and Inflammatory Disorders.

In recent years, the exploration of regulatory T cell (Treg)-based cellular therapy has become an attractive strategy to ameliorate inflammation and autoimmunity in various clinical settings. The main obstacle to the clinical application of Treg in human is their low number circulating in peripheral blood. Therefore, ex vivo expansion is inevitable. Moreover, isolation of Treg bears the risk of concurrent isolation of unwanted effector cells, which may trigger or deteriorate inflammation upon adoptive Treg transfer. Here, we present a protocol for the GMP-compliant production, lot-release and validation of ex vivo expanded Tregs for treatment of patients with autoimmune and inflammatory disorders. In the presented production protocol, large numbers of Treg, previously enriched from a leukapheresis product by using the CliniMACS® system, are ex vivo expanded in the presence of anti-CD3/anti-CD28 expander beads, exogenous IL-2 and rapamycin during 21 days. The expanded Treg drug product passed predefined lot-release criteria. These criteria include (i) sterility testing, (ii) assessment of Treg phenotype, (iii) assessment of non-Treg cellular impurities, (iv) confirmation of successful anti-CD3/anti-CD28 expander bead removal after expansion, and (v) confirmation of the biological function of the Treg product. Furthermore, the Treg drug product was shown to retain its stability and suppressive function for at least 1 year after freezing and thawing. Also, dilution of the Treg drug product in 0.9% physiological saline did not affect Treg phenotype and Treg function for up to 90 min. These data indicate that these cells are ready to use in a clinical setting in which a cell infusion time of up to 90 min can be expected. The presented production process has recently undergone on site GMP-conform evaluation and received GMP certification from the Bavarian authorities in Germany. This protocol can now be used for Treg-based therapy of various inflammatory and autoimmune disorders.

Characterization and Expansion of Autologous GMP-ready Regulatory T Cells for TREG-based Cell Therapy in Patients with Ulcerative Colitis.

BACKGROUND: A local imbalance between regulatory (Treg) and effector T cells is believed to play a major role in gut-specific inflammation, including ulcerative colitis (UC). Restoration of this balance through an adoptive Treg transfer is an attractive new treatment approach in patients who are refractory to current standard therapies. It was our goal to develop a Good Manufacturing Practices (GMP)-conform protocol for expansion of UC Treg cells as a rational backbone for future studies on Treg therapy in UC. METHODS: CD25 blood T cells derived from patients with UC were ex vivo expanded in the presence of IL-2, rapamycin, and anti-CD3/anti-CD28 expander beads using a GMP-conform protocol. Cells were subsequently assessed for stability and function. RESULTS: Patient-derived ex vivo rapamycin-expanded GMP-ready CD25 cells were polyclonal, hypomethylated at intron 1 of the FoxP3 locus, and suppressive in carboxyfluorescein succinimidyl ester-dilution assays against autologous peripheral blood-derived and allogeneic colon-derived responder cells. Function was mediated by soluble factors, including toxic granules. In addition to CD4 T cells, suppressive hypermethylated CD8 T-cell subsets were also induced during the expansion process. CONCLUSIONS: Patient-derived rapamycin-expanded CD25 cells are stable and functional, and as such, ready to serve in a phase I dose-escalation safety study in UC.

Concise Review: Induced Pluripotent Stem Cell-Based Drug Discovery for Mitochondrial Disease.

High attrition rates and loss of capital plague the drug discovery process. This is particularly evident for mitochondrial disease that typically involves neurological manifestations and is caused by nuclear or mitochondrial DNA defects. This group of heterogeneous disorders is difficult to target because of the variability of the symptoms among individual patients and the lack of viable modeling systems. The use of induced pluripotent stem cells (iPSCs) might significantly improve the search for effective therapies for mitochondrial disease. iPSCs can be used to generate patient-specific neural cell models in which innovative compounds can be identified or validated. Here we discuss the promises and challenges of iPSC-based drug discovery for mitochondrial disease with a specific focus on neurological conditions. We anticipate that a proper use of the potent iPSC technology will provide critical support for the development of innovative therapies against these untreatable and detrimental disorders. Stem Cells 2017;35:1655-1662.

Human iPSC-Derived Neural Progenitors Are an Effective Drug Discovery Model for Neurological mtDNA Disorders.

Mitochondrial DNA (mtDNA) mutations frequently cause neurological diseases. Modeling of these defects has been difficult because of the challenges associated with engineering mtDNA. We show here that neural progenitor cells (NPCs) derived from human induced pluripotent stem cells (iPSCs) retain the parental mtDNA profile and exhibit a metabolic switch toward oxidative phosphorylation. NPCs derived in this way from patients carrying a deleterious homoplasmic mutation in the mitochondrial gene MT-ATP6 (m.9185T>C) showed defective ATP production and abnormally high mitochondrial membrane potential (MMP), plus altered calcium homeostasis, which represents a potential cause of neural impairment. High-content screening of FDA-approved drugs using the MMP phenotype highlighted avanafil, which we found was able to partially rescue the calcium defect in patient NPCs and differentiated neurons. Overall, our results show that iPSC-derived NPCs provide an effective model for drug screening to target mtDNA disorders that affect the nervous system.

Utilidad de la ecografía en la evaluación de los nódulos tiroideos / Usefulness of ultrasonography is the evaluation of thyroid nodules

Objetivo. Evaluar la capacidad diagnóstica de la ecografía para diferenciar nódulos tiroideos benignos y malignos, y su utilidad para evitar procedimientos invasivos innecesarios. Pacientes y métodos. De enero de 2012 a diciembre de 2014 se realizaron 321 procedimientos de punción-aspiración con aguja fina (PAAF) a 302 pacientes remitidos por el Servicio de Endocrinología del Centro Medico de Especialidades, seleccionados bajo los criterios de la Guía de la Asociación Americana de Endocrinología Clínica y de la Guía de la Asociación Americana del Tiroides. Se analizaron las siguientes características ecográficas: localización, tamaño, morfología, contorno, consistencia, ecoestructura, ecogenicidad, calcificaciones y vascularización. Se realizó un análisis univariante y multivariante para investigar la relación entre los hallazgos ecográficos y el cáncer de tiroides. Resultados. La prevalencia de malignidad en nuestra población de estudio es del 5,92%. Los hallazgos ecográficos que son estadísticamente significativos y están asociados a una mayor probabilidad de malignidad son la presencia de microcalcificaciones, la vascularización central y la hipoecogenicidad. Los hallazgos asociados a un menor riesgo son la presencia de halo, la existencia de áreas de degeneración coloide y la heterogeneidad de los nódulos. Conclusión. Según nuestro estudio, la indicación de realizar PAAF no debería basarse en el tamaño del nódulo, sino en la presencia de hallazgos ecográficos sospechosos de malignidad de acuerdo con las estimaciones de nuestro modelo estadístico. De esta forma sugerimos evitar realizar PAAF innecesarias en nódulos que no presenten dichas características (AU)

Objective. To evaluate the diagnostic capacity of ultrasonography (US) for differentiating between malignant and benign thyroid nodules and its usefulness in obviating unnecessary invasive procedures. Patients and methods. From January 2012 through December 2014, a total of 321 fine-needle aspiration biopsy (FNAB) procedures were done in 302 patients selected according to the criteria recommended by the American Association of Clinical Endocrinology guidelines and the American Thyroid Association guidelines. We analyzed the following characteristics on US: location, size, morphology, contour, consistency, echostructure, echogenicity, calcifications, and vascularization. We used univariate and multivariate analyses to investigate the relationship between the US findings and thyroid cancer. Results. The prevalence of malignancy in our study population was 5.92%. The US findings that were significantly associated with a greater probability of malignancy were microcalcifications, central vascularization, and hypoechogenicity. The US findings that were associated with a lower risk of malignancy were areas of colloid degeneration and nodule heterogeneity. Conclusion. Our results suggest that decisions about whether to perform FNAB should be based on the presence of suspicious US findings found with our statistic model rather than on the size of the nodule. Thus, unnecessary FNAB procedures on nodules without suspicious US characteristics can be avoided (AU)

Usefulness of ultrasonography is the evaluation of thyroid nodules. / Utilidad de la ecografía en la evaluación de los nódulos tiroideos.

OBJECTIVE: To evaluate the diagnostic capacity of ultrasonography (US) for differentiating between malignant and benign thyroid nodules and its usefulness in obviating unnecessary invasive procedures. PATIENTS AND METHODS: From January 2012 through December 2014, a total of 321 fine-needle aspiration biopsy (FNAB) procedures were done in 302 patients selected according to the criteria recommended by the American Association of Clinical Endocrinology guidelines and the American Thyroid Association guidelines. We analyzed the following characteristics on US: location, size, morphology, contour, consistency, echostructure, echogenicity, calcifications, and vascularization. We used univariate and multivariate analyses to investigate the relationship between the US findings and thyroid cancer. RESULTS: The prevalence of malignancy in our study population was 5.92%. The US findings that were significantly associated with a greater probability of malignancy were microcalcifications, central vascularization, and hypoechogenicity. The US findings that were associated with a lower risk of malignancy were areas of colloid degeneration and nodule heterogeneity. CONCLUSION: Our results suggest that decisions about whether to perform FNAB should be based on the presence of suspicious US findings found with our statistic model rather than on the size of the nodule. Thus, unnecessary FNAB procedures on nodules without suspicious US characteristics can be avoided.

A movement disorder with dystonia and ataxia caused by a mutation in the HIBCH gene.

BACKGROUND: Recessive mutations in the 3-hydroxyisobutyryl-CoA hydrolase gene (HIBCH) are associated with a rare neurodegenerative disease that affects the basal ganglia. Most patients die during infancy or early childhood. Here we describe 5 adolescent and adult patients from 2 unrelated families, who presented with a movement disorder and MRI features suggestive of Leigh syndrome. METHODS: Clinical and metabolic assessment was followed by autozygosity mapping and whole exome and Sanger sequencing. HIBCH enzyme activity and the bioenergetic profile were determined in patient fibroblasts. RESULTS: The movement disorder was dominated by ataxia in one family and by dystonia in the other. All affected family members carried the identical homozygous c.913A>G (p.T305A) HIBCH mutation. Enzyme activity was reduced, and a valine challenge reduced the oxygen consumption rate. CONCLUSIONS: We report the first adult patients with HIBCH deficiency and a disease course much milder than previously reported, thereby expanding the HIBCH-associated phenotypic spectrum. © 2016 International Parkinson and Movement Disorder Society.

Energy metabolism in neuronal/glial induction and in iPSC models of brain disorders.

The metabolic switch associated with the reprogramming of somatic cells to pluripotency has received increasing attention in recent years. However, the impact of mitochondrial and metabolic modulation on stem cell differentiation into neuronal/glial cells and related brain disease modeling still remains to be fully addressed. Here, we seek to focus on this aspect by first addressing brain energy metabolism and its inter-cellular metabolic compartmentalization. We then review the findings related to the mitochondrial and metabolic reconfiguration occurring upon neuronal/glial specification from pluripotent stem cells (PSCs). Finally, we provide an update of the PSC-based models of mitochondria-related brain disorders and discuss the challenges and opportunities that may exist on the road to develop a new era of brain disease modeling and therapy.

Multi-host expression system for recombinant production of challenging proteins.

Recombinant production of complex eukaryotic proteins for structural analyses typically requires a profound screening process to identify suitable constructs for the expression of ample amounts of properly folded protein. Furthermore, the evaluation of an optimal expression host has a major impact on protein yield and quality as well as on actual cost of the production process. Here we present a novel fast expression system for multiple hosts based on a single donor vector termed pFlp-Bac-to-Mam. The range of applications of pFlp-Bac-to-Mam comprises highly efficient transient transfection of HEK293-6E in serum-free suspension culture and subsequent large-scale production of challenging proteins expressing in mg per Liter level using either the baculoviral expression vector system or stable CHO production cell lines generated by Flp-mediated cassette exchange. The success of the multi-host expression vector to identify the optimal expression strategy for efficient production of high quality protein is demonstrated in a comparative expression study of three model proteins representing different protein classes: intracellular expression using a fluorescent protein, secretion of a single-chain-Fv-hIgG1Fc fusion construct and production of a large amount of highly homogeneous protein sample of the extracellular domain of a Toll-like receptor. The evaluation of the production efficiency shows that the pFlp-Bac-to-Mam system allows a fast and individual optimization of the expression strategy for each protein class.

Hallazgos radiológicos en la filariasis mamaria / Radiological findings in filariasis of the breast

Presentamos 2 casos de filariasis linfática de localización mamaria, con el propósito de describir los distintos hallazgos radiológicos de una enfermedad inusual en los países occidentales. Sin embargo, debido al incremento de la inmigración desde áreas endémicas, progresivamente veremos a más pacientes con esta enfermedad en nuestro medio. En el primer caso, la paciente presentaba un nódulo mamario sólido que precisó de punción aspirativa con aguja fina para llegar al diagnóstico. Se trataba de un ganglio linfático con microfilarias. En el segundo caso, en una mamografía rutinaria se observan unas calcificaciones serpinginosas y tubulares, sin masa acompañante, compatibles con tejido parasitario necrosado y calcificado. Estas calcificaciones son características de la filariasis(AU)

We report two cases of lymphatic filariasis of the breast, presenting the various imaging findings of an unusual disease in western countries. However, due to increased immigration from endemic areas, more patients with this disease will gradually be seen in this country. In the first case, the patient had a solid breast lump, which required fine needle aspiration cytology to be diagnosed. It was a lymph node with microfilariae. In the second case, a routine mammogram showed serpiginous and tubular calcifications without an accompanying mass compatible with necrotic tissue and calcified parasite. These calcifications are typical of filariasis(AU)