High dimensional profiling identifies specific immune types along the recovery trajectories of critically ill COVID19 patients.

The COVID-19 pandemic poses a major burden on healthcare and economic systems across the globe. Even though a majority of the population develops only minor symptoms upon SARS-CoV-2 infection, a significant number are hospitalized at intensive care units (ICU) requiring critical care. While insights into the early stages of the disease are rapidly expanding, the dynamic immunological processes occurring in critically ill patients throughout their recovery at ICU are far less understood. Here, we have analysed whole blood samples serially collected from 40 surviving COVID-19 patients throughout their recovery in ICU using high-dimensional cytometry by time-of-flight (CyTOF) and cytokine multiplexing. Based on the neutrophil-to-lymphocyte ratio (NLR), we defined four sequential immunotypes during recovery that correlated to various clinical parameters, including the level of respiratory support at concomitant sampling times. We identified classical monocytes as the first immune cell type to recover by restoration of HLA-DR-positivity and the reduction of immunosuppressive CD163 + monocytes, followed by the recovery of CD8 + and CD4 + T cell and non-classical monocyte populations. The identified immunotypes also correlated to aberrant cytokine and acute-phase reactant levels. Finally, integrative analysis of cytokines and immune cell profiles showed a shift from an initially dysregulated immune response to a more coordinated immunogenic interplay, highlighting the importance of longitudinal sampling to understand the pathophysiology underlying recovery from severe COVID-19.

Lymphocyte-independent pathways underlie the pathogenesis of murine cytomegalovirus-associated secondary haemophagocytic lymphohistiocytosis.

Haemophagocytic lymphohistiocytosis (HLH) constitutes a spectrum of immunological disorders characterized by uncontrolled immune activation and key symptoms such as fever, splenomegaly, pancytopenia, haemophagocytosis, hyperferritinaemia and hepatitis. In genetic or primary HLH, hyperactivated CD8+ T cells are the main drivers of pathology. However, in acquired secondary HLH, the role of lymphocytes remains vague. In the present study the involvement of lymphocytes in the pathogenesis of a cytomegalovirus-induced model of secondary HLH was explored. We have previously reported CD8+ T cells to be redundant in this model, and therefore focused on CD4+ helper and regulatory T cells. CD4+ T cells were activated markedly and skewed towards a proinflammatory T helper type 1 transcription profile in mice displaying a severe and complete HLH phenotype. Counter to expectations, regulatory T cells were not reduced in numbers and were, in fact, more activated. Therapeutic strategies targeting CD25high hyperactivated T cells were ineffective to alleviate disease, indicating that T cell hyperactivation is not a pathogenic factor in cytomegalovirus-induced murine HLH. Moreover, even though T cells were essential in controlling viral proliferation, CD4+ T cells, in addition to CD8+ T cells, were dispensable in the development of the HLH-like syndrome. In fact, no T or B cells were required for induction and propagation of HLH disease, as evidenced by the occurrence of cytomegalovirus-associated HLH in severe combined immunodeficient (SCID) mice. These data suggest that lymphocyte-independent mechanisms can underlie virus-associated secondary HLH, accentuating a clear distinction with primary HLH.

Understanding the dosimetric powder EPR spectrum of sucrose by identification of the stable radiation-induced radicals.

Sucrose, the main component of table sugar, present in nearly every household and quite radiation sensitive, is considered as an interesting emergency dosemeter. Another application of radiation-induced radicals in sugars is the detection of irradiation in sugar-containing foodstuffs. The complexity of electron paramagnetic resonance (EPR) spectra of radicals in these materials, as a result of many hyperfine interactions and the multi-compositeness of the spectra of individual sugars, complicate dose assessment and the improvement of protocols for control and identification of irradiated sugar-containing foodstuffs using EPR. A thorough understanding of the EPR spectrum of individual irradiated sugars is desirable when one wants to reliably use them in a wide variety of dosimetric applications. Recently, the dominant room temperature stable radicals in irradiated sucrose have been thoroughly characterised using EPR, electron nuclear double resonance (ENDOR) and ENDOR-induced EPR. These radicals were structurally identified by comparing their proton hyperfine and g-tensors with the results of Density Functional Theory calculations for test radical structures. In this paper, the authors use the spin Hamiltonian parameters determined in these studies to simulate powder EPR spectra at the standard X-band (9.5 GHz), commonly used in applications, and at higher frequencies, up to J-band (285 GHz), rendering spectra with higher resolution. A few pitfalls in the simulation process are highlighted. The results indicate that the major part of the dosimetric spectrum can be understood in terms of three dominant radicals, but as-yet unidentified radicals also contribute in a non-negligible way.

Gene expression profiling reveals clear differences between EBV-positive and EBV-negative posttransplant lymphoproliferative disorders.

Posttransplant patients are at risk of developing a potentially life-threatening posttransplantation lymphoproliferative disorder (PTLD), most often of diffuse large B cell lymphoma (DLBCL) morphology and associated with Epstein-Barr Virus (EBV) infection. The aim of this study was to characterize the clinicopathological and molecular-genetic characteristics of posttransplant DLBCL and to elucidate whether EBV(+) and EBV(-) posttransplant DLBCL are biologically different. We performed gene expression profiling studies on 48 DLBCL of which 33 arose posttransplantation (PT-DLBCL; 72% EBV+) and 15 in immunocompetent hosts (IC-DLBCL; none EBV+). Unsupervised hierarchical analysis showed clustering of samples related to EBV-status rather than immune status. Except for decreased T cell signaling these cases were inseparable from EBV(-) IC-DLBCL. In contrast, a viral response signature clearly segregated EBV(+) PT-DLBCL from EBV(-) PT-DLBCL and IC-DLBCL cases that were intermixed. The broad EBV latency profile (LMP1+/EBNA2+) was expressed in 59% of EBV(+) PT-DLBCL and associated with a more elaborate inflammatory response compared to intermediate latency (LMP1+/EBNA2-). Inference analysis revealed a role for innate and tolerogenic immune responses (including VSIG4 and IDO1) in EBV(+) PT-DLBCL. In conclusion we can state that the EBV signature is the most determining factor in the pathogenesis of EBV(+) PT-DLBCL.

Excavated mass and doubletracking in the sigmoid colon due to colocolic fistula complicating diverticulitis.

We report on a patient admitted for work up of prostatic carcinoma in which CT study showed an excavated mass involving the sigmoid colon and the bladder dome. Barium enema showed a double track pattern associated with diverticular disease. By surgery the mass was separated from the urinary bladder and the sigmoid resected. On pathological exam diverticulitis was evident as well as an organised colocolic fistula in the thickened fibrotic subserosal fat.The usefulness of opacifying the colon is highlighted.

Activated CD4+CD25+ regulatory T cells inhibit osteoclastogenesis and collagen-induced arthritis.

OBJECTIVES: Patients with rheumatoid arthritis (RA) have defective CD4(+)CD25(+) regulatory T (T(reg)) cells and increased osteoclastogenesis. A similar situation has been described in collagen-induced arthritis (CIA). In this study, it was investigated whether a single transfer of polyclonally activated T(reg) cells inhibits CIA and osteoclastogenesis. METHODS: Purified T(reg) cells were expanded in vitro with anti-CD3 and anti-CD28 antibody-coated beads and injected into DBA/1 mice. Mice were immunised with collagen type II (CII) in complete Freund adjuvant (CFA) and scores of arthritis were recorded. In vitro osteoclastogenesis assays were performed on splenocytes by stimulation with macrophage colony-stimulating factor (M-CSF) and receptor activator of nuclear factor (NF)kappaB ligand (RANKL). Levels of anti-CII antibody and cytokines were determined in the supernatant using ELISA and Bio-Plex protein array system. RESULTS: It was found that 10(6) activated T(reg) cells significantly counteracted the development of CIA, which was accompanied by decreased serum levels of TNFalpha and IL6, but not by inhibition of autoimmune antibody responses. The differentiation of osteoclasts in splenocyte cultures was significantly reduced in the presence of prestimulated T(reg) cells. Expression of cytokines that are described to inhibit osteoclastogenesis, including granulocyte macrophage colony-stimulating factor (GM-CSF), interferon (IFN)gamma, interleukin (IL)5 and IL10, were dramatically increased upon addition of T(reg) cells. Furthermore, splenocytes from mice that had been treated with T(reg) cells displayed an impaired capacity to develop into mature osteoclasts, suggesting that T(reg) cells abrogated osteoclastogenesis in vivo. CONCLUSIONS: Activated CD4(+)CD25(+) T(reg) cells improve clinical symptoms of CIA, regulate cytokine production and inhibit osteoclastogenesis in vitro and in vivo.

Recovery of humoral immunity is critical for successful antiviral therapy in disseminated mouse adenovirus type 1 infection.

Severe adenovirus infections in transplant recipients undergoing immunosuppressive therapy are of increasing concern. Controversy exists on the contribution of antiviral therapy and the host immune response to recovery from these infections. Here, we established a systemic mouse adenovirus type 1 (MAV-1) infection in cyclophosphamide (CyP)-treated BALB/c mice. CyP was administered at 100 mg per kg of body weight every other day for 2, 3, or 4 weeks, thereby inducing general but reversible leukopenia, with a major suppression of the B-cell numbers and functionality that was more pronounced than that seen with T cells. The outcome of MAV-1 infection was dependent on the duration of CyP therapy, as the mice with the most severe immunosuppression were the most vulnerable to MAV-1-induced hemorrhagic enteritis and mortality. The protective effect of concomitant antiviral therapy with cidofovir depended on the level of immunosuppression. The combination of cidofovir treatment with the withdrawal of immunosuppression was the most successful regimen for increasing survival rates. Survival was clearly correlated with the clearance of virus and increased titers of MAV-1-specific antibodies in sera. In addition, the passive transfer of MAV-1-specific immunoglobulin G into MAV-1-infected SCID BALB/c mice caused a marked delay in mortality, the extent of the delay being dependent on the titer of MAV-1-specific antibodies. Based on the critical role of the humoral immune response in the early defense against disseminated adenovirus infection, the concomitant use of adenovirus-specific immunoglobulins and antiviral therapy should be considered for transplant patients at risk for severe adenovirus infections.

Electron paramagnetic resonance study of a Eu2+ related defect in CsBr:Eu needle image plates for computed radiography.

The electron paramagnetic resonance (EPR) spectrum of needle image plates of CsBr doped with Eu(2+), which are proposed as new X-ray storage phosphors for computed radiography, is studied at room temperature and Q-band microwave frequencies (34 GHz). X-ray diffraction analysis demonstrates that the CsBr:Eu(2+) needles have an 001 out of plane (perpendicular to the plate) orientation, and contrary to expectation that the in plane orientation is not random. The room temperature EPR spectrum is attributed to a single centre which is related to Eu(2+) with axial 001 symmetry. Using the spin Hamiltonian parameters extracted from the spectrum recorded with the magnetic field parallel to the needles' axes, we convincingly simulate both the spectrum of a powdered image plate and the single crystal like angular dependence of intact pieces of image plate. The knowledge of the symmetry of this centre, which appears to be related with the radiation sensitivity of the plate, presents a first step in finding its model and role in the X-ray storage process.

[The effect of interferon-gamma in collagen-induced arthritis in mice shows a mechanism of expanding Mac-1+ blood cells during its pathogenesis]. / Onderzoek naar de werking van interferon-gamma in collageen-geïnduceerde artritis in muizen legt een mechanisme van expanderende Mac-1+ cellen bloot in de pathogenese.

Collagen-induced arthritis (CIA) is an animal model for human rheumatoid arthritis. CIA is induced in the mouse by immunization with collagen type II in complete Freund's adjuvant (CFA). As a result of this immunization, mice will develop an autoimmune disease that is characterized by an inflammatory and destructive affection of the joints. IFN-gammaR KO mice have an increased susceptibility to CIA as compared to wild-type control animals: they developed arthritis with a significant earlier disease onset and a higher disease incidence and score. The results indicate that IFN-gamma acts as a disease-protective factor in CIA. The disease-protective effect of IFN-gamma in CIA appeared to be due to CFA that was used for the induction of CIA, and more precisely to the presence of killed mycobacteria in this adjuvant. The killed mycobacteria in CFA elicited in mice an extramedullar myelopoiesis and an expansion of Mac-1+ cells that was strongly inhibited by endogenous IFN-gamma. Parts of the expanded Mac-1+ splenocytes were precursor cells for osteoclasts, they migrated to the joints after challenge with SDF-1, where they found to differentiate into mature osteoclasts who are responsible for bone destruction. The mechanism of expansion, migration and osteoclast activation occurred in IFN-gammaR KO as well as in wild-type mice, but was much more pronounced in the mutant mice. Thus, the use of IFN-gammaR KO mice has exposed a new mechanism in the pathogenesis of autoimmune arthritis in mice. These findings may have important clinical perspectives.

Ankylosing enthesitis, dactylitis, and onychoperiostitis in male DBA/1 mice: a model of psoriatic arthritis.

OBJECTIVES: To further characterise spontaneous arthritis in aging male DBA/1 mice as a model of spondyloarthropathy and psoriatic arthritis with particular attention to signs of inflammation and nail involvement. MATERIALS AND METHODS: Aging male DBA/1 mice from different litters were caged together (4-6 mice per cage) at the age of 12 weeks, checked twice a week for signs of arthritis, and killed at different times. Hind paws were dissected and processed for histology. RESULTS: Disease incidence varied between 50% and 100% in four different experiments. Besides clinical signs of arthritis, nail abnormalities were noticed. Pathological examination showed the occurrence of dactylitis characterised by diffuse neutrophil infiltration in 6 of 50 paws examined. Onycho-periostitis with progressive destruction of the nail bed and the underlying distal phalanx was seen in 5 of 50 paws examined. CONCLUSIONS: Although dactylitis and onychoperiostitis are rare manifestations of the disease process, these data strongly suggest that spontaneous arthritis in aging male DBA/1 mice shares important features with human psoriatic arthritis. This model may therefore be an important tool to study links between stress, sex, inflammation, and new bone formation with particular relevance to human psoriatic arthritis.

Induction of IL-15 by TCR/CD3 aggregation depends on IFN-gamma and protects against apoptosis of immature thymocytes in vivo.

TCR/CD3 aggregation by injection of anti-CD3 Ab produces T cell activation, release of cytokines such as IFN-gamma, and apoptosis in the cortical region of the thymus. We show that anti-CD3 Ab induces IL-15 mRNA in spleens of wild-type but not IFN-gamma receptor-knock-out (IFN-gammaR KO) mice. The loss of IL-15 mRNA induction in IFN-gammaR KO mice was associated with increased thymocyte apoptosis. Pretreatment of wild-type mice with neutralizing anti-IL-15 Ab increased the anti-CD3-triggered thymocyte apoptosis, thus mimicking the sensitive phenotype of IFN-gammaR KO mice. Inversely, anti-CD3-induced apoptosis in IFN-gammaR KO mice was suppressed by administration of recombinant IL-15. In IFN-gammaR KO mice and in wild-type mice that were treated with anti-IL-15, augmented apoptosis affected mainly CD4+CD8+ immature thymocytes. IL-15 as well as IL-15Ralpha mRNA expression in thymocytes was not increased by anti-CD3. These data demonstrate that systemic IL-15 exerts anti-apoptotic activity on immature T cells and establish a regulatory mechanism whereby TCR/CD3 engagement induces IL-15 expression via an IFN-gamma-dependent pathway. The self-amplifying nature of this IFN-gamma/IL-15 connection may constitute a regulatory pathway in central tolerance to self.

Some recent multi-frequency electron paramagnetic resonance results on systems relevant for dosimetry and dating.

Electron Paramagnetic Resonance (EPR) applications like e.g. EPR dosimetry and dating, are usually performed at X-band frequencies because of practical reasons (cost, sample size, etc.). However, it is increasingly recognized that the radiation-induced EPR signals are strongly composite, what might affect dose/age estimates. A few recent examples from both the dosimetry and dating field, illustrating the problems, will be presented. The involved spectra are mainly due to carbonate-derived radicals (CO2-, CO3(3-), etc.). Measurements at higher microwave frequencies are often recommended to improve the insight into the spectra and/or the practical signal quantification. Recent results at Q- and W-band frequencies will show that a multi-frequency approach indeed opens many interesting perspectives in this field but also that each frequency may have specific (dis)advantages depending on the EPR probe and application involved. The discussion will concern carbonate-containing apatite single crystals, shells, modern and fossil tooth enamel.

Modes of action of Freund's adjuvants in experimental models of autoimmune diseases.

Freund's adjuvants are irreplaceable components of induction protocols of many experimental animal models of autoimmune disease. Apart from the early studies done in the 1950s and 1960s, no further direct investigation on the mode of action of these adjuvants has been undertaken. It is generally assumed that incomplete (IFA) and complete Freund's adjuvant (CFA) act by prolonging the lifetime of injected autoantigen, by stimulating its effective delivery to the immune system and by providing a complex set of signals to the innate compartment of the immune system, resulting in altered leukocyte proliferation and differentiation. Here, we review evidence collected from various types of studies that provide more insight in the specific alterations of the immune response caused by IFA and CFA. Early events include rapid uptake of adjuvant components by dendritic cells, enhanced phagocytosis, secretion of cytokines by mononuclear phagocytes, and transient activation and proliferation of CD4+ lymphocytes. The mycobacterial components within CFA signal T lymphocytes to assume a Th1 profile so that strong delayed-type hypersensitivity against autoantigens develops. In the absence of mycobacteria, T-lymphocyte differentiation tends to assume a Th2 profile with strong antibody production only. The mycobacterial component also accounts for a morphologic and functional remodeling of the haemopoietic system that develops over a period of several weeks and that is characterized by a drastic expansion of Mac-1+ immature myeloid cells. These cells have been found to be associated with enhanced disease in some models but with reduced disease in others. Thus, in experimental autoimmune diseases, CFA-mediated activation of the innate immune compartment is important not only by regulating the early induction phase but also by providing a surplus of effector and regulator cells in the late phase.