Impact of an E-Learning Histology Course on the Satisfaction and Performance of Medical, Nursing and Midwifery Students / Impacto de un Curso E-Learning de Histología en la Satisfacción y Desempeño de Estudiantes de Medicina, Enfermería y Obstetricia

SUMMARY: The importance and relevance of e-learning courses in medicine and health sciences has increased significantly in the last decade. Despite this, there are few published teaching experiences of e-learning histology courses in the literature worldwide. The histology course we designed was structured on the Moodle platform as a learning management system, and the content was proposed in a synchronous (zoom) and asynchronous (recordings) format. We also included the use of free virtual microscopy tools. This study aimed to investigate the impact of an e-learning histology course on the satisfaction and performance of medical, nursing and midwifery students. The sample included 424 Chilean medical, nursing, and midwifery students from two cohorts. A Likert-type survey was administered at the end of the course. We performed exploratory analysis and ordinary least squares regression. In this study, we present a positive experience of an e-learning histology course. Exploratory factor analysis revealed three main factors related to "e- learning satisfaction", "in-person class activities", and "course design and teaching quality". We also found that there was a positive and significant relationship between students' perceptions of the adaptation of the traditional (face-to-face) histology course into an e-learning format and their academic performance. Our study shows that e-learning histology courses that integrate lectures and practical sessions can be a valuable teaching method for learning histology. Curriculum developers and teachers need to consider the limitations and advantages of this type of teaching and incorporate these three factors into the design and assessment of e-learning histology courses.

La importancia y relevancia de los cursos e-learning en medicina y ciencias de la salud ha aumentado significativamente en la última década. A pesar de ello, existen pocas experiencias docentes publicadas de cursos de histología e-learning en la literatura a nivel mundial. El curso de histología que diseñamos se estructuró en la plataforma Moodle, y los contenidos se propusieron en formato síncrono (zoom) y asíncrono (grabaciones). También incluimos el uso de herramientas gratuitas de microscopía virtual. Este estudio tuvo como objetivo investigar el impacto de un curso de histología e-learning en la satisfacción y el rendimiento de los estudiantes de medicina, enfermería y obstetricia. La muestra incluyó 424 estudiantes chilenos de medicina, enfermería y obstetricia de dos cohortes. Se aplicó una encuesta tipo Likert al final del curso. Se realizó un análisis exploratorio y una regresión por mínimos cuadrados ordinarios. En este estudio, presentamos una experiencia positiva de un curso de e-learning de histología. El análisis factorial exploratorio reveló tres factores principales relacionados con la "satisfacción sobre el aprendizaje e-learning", "clases presenciales versus clases virtuales" y el "diseño del curso y la calidad de la enseñanza". También encontramos que existía una relación positiva y significativa entre las percepciones de los estudiantes sobre la adaptación del curso de histología tradicional (presencial) a un formato e-learning y su rendimiento académico. Nuestro estudio muestra que los cursos de histología e-learning que integran clases teóricas y sesiones prácticas pueden ser una valiosa herramienta de enseñanza. Los responsables de la elaboración de planes de estudios y los profesores de histología deben tener en cuenta las limitaciones y ventajas de este tipo de enseñanza y sugerimos incorporar estos tres factores al diseño y la evaluación de los cursos de histología en línea.

Kidney-resident innate-like memory γδ T cells control chronic Staphylococcus aureus infection of mice.

γδ T cells are involved in the control of Staphylococcus aureus infection, but their importance in protection compared to other T cells is unclear. We used a mouse model of systemic S. aureus infection associated with high bacterial load and persistence in the kidney. Infection caused fulminant accumulation of γδ T cells in the kidney. Renal γδ T cells acquired tissue residency and were maintained in high numbers during chronic infection. At day 7, up to 50% of renal γδ T cells produced IL-17A in situ and a large fraction of renal γδ T cells remained IL-17A+ during chronic infection. Controlled depletion revealed that γδ T cells restricted renal S. aureus replication in the acute infection and provided protection during chronic renal infection and upon reinfection. Our results demonstrate that kidney-resident γδ T cells are nonredundant in limiting local S. aureus growth during chronic infection and provide enhanced protection against reinfection.

Ecto-5'-Nucleotidase (CD73) Regulates the Survival of CD8+ T Cells.

Ecto-5'-nucleotidase (CD73) is an enzyme present on the surface of tumor cells whose primary described function is the production of extracellular adenosine. Due to the immunosuppressive properties of adenosine, CD73 is being investigated as a target for new antitumor therapies. We and others have described that CD73 is present at the surface of different CD8+ T cell subsets. Nonetheless, there is limited information as to whether CD73 affects CD8+ T cell proliferation and survival. In this study, we assessed the impact of CD73 deficiency on CD8+ T cells by analyzing their proliferation and survival in antigenic and homeostatic conditions. Results obtained from adoptive transfer experiments demonstrate a paradoxical role of CD73. On one side, it favors the expression of interleukin-7 receptor α chain on CD8+ T cells and their homeostatic survival; on the other side, it reduces the survival of activated CD8+ T cells under antigenic stimulation. Also, upon in vitro antigenic stimulation, CD73 decreases the expression of interleukin-2 receptor α chain and the anti-apoptotic molecule Bcl-2, findings that may explain the reduced CD8+ T cell survival observed in this condition. These results indicate that CD73 has a dual effect on CD8+ T cells depending on whether they are subject to an antigenic or homeostatic stimulus, and thus, special attention should be given to these aspects when considering CD73 blockade in the design of novel antitumor therapies.

CD73 Ectonucleotidase Restrains CD8+ T Cell Metabolic Fitness and Anti-tumoral Activity.

CD39 and CD73 are ectoenzymes that dephosphorylate ATP into its metabolites; ADP, AMP, and adenosine, and thus are considered instrumental in the development of immunosuppressive microenvironments. We have previously shown that within the CD8+ T cell population, naïve and memory cells express the CD73 ectonucleotidase, while terminally differentiated effector cells are devoid of this enzyme. This evidence suggests that adenosine might exert an autocrine effect on CD8+ T cells during T cell differentiation. To study the possible role of CD73 and adenosine during this process, we compared the expression of the adenosinergic signaling components, the phenotype, and the functional properties between CD73-deficient and WT CD8+ T cells. Upon activation, we observed an upregulation of CD73 expression in CD8+ T cells along with an upregulation of the adenosine A2A receptor. Interestingly, when we differentiated CD8+ T cells to Tc1 cells in vitro, we observed that these cells produce adenosine and that CD73-deficient cells present a higher cytotoxic potential evidenced by an increase in IFN-γ, TNF-α, and granzyme B production. Moreover, CD73-deficient cells presented a increased glucose uptake and higher mitochondrial respiration, indicating that this ectonucleotidase restrict the mitochondrial capacity in CD8+ T cells. In agreement, when adoptively transferred, antigen-specific CD73-deficient CD8+ T cells were more effective in reducing the tumor burden in B16.OVA melanoma-bearing mice and presented lower levels of exhaustion markers than wild type cells. All these data suggest an autocrine effect of CD73-mediated adenosine production, limiting differentiation and cytotoxic T cells' metabolic fitness.

Pathogen-induced tissue-resident memory TH17 (TRM17) cells amplify autoimmune kidney disease.

Although it is well established that microbial infections predispose to autoimmune diseases, the underlying mechanisms remain poorly understood. After infection, tissue-resident memory T (TRM) cells persist in peripheral organs and provide immune protection against reinfection. However, whether TRM cells participate in responses unrelated to the primary infection, such as autoimmune inflammation, is unknown. By using high-dimensional single-cell analysis, we identified CD4+ TRM cells with a TH17 signature (termed TRM17 cells) in kidneys of patients with ANCA-associated glomerulonephritis. Experimental models demonstrated that renal TRM17 cells were induced by pathogens infecting the kidney, such as Staphylococcus aureus, Candida albicans, and uropathogenic Escherichia coli, and persisted after the clearance of infections. Upon induction of experimental glomerulonephritis, these kidney TRM17 cells rapidly responded to local proinflammatory cytokines by producing IL-17A and thereby exacerbate renal pathology. Thus, our data show that pathogen-induced TRM17 cells have a previously unrecognized function in aggravating autoimmune disease.

P2X7 Receptor at the Crossroads of T Cell Fate.

The P2X7 receptor is a ligand-gated, cation-selective channel whose main physiological ligand is ATP. P2X7 receptor activation may also be triggered by ARTC2.2-dependent ADP ribosylation in the presence of extracellular NAD. Upon activation, this receptor induces several responses, including the influx of calcium and sodium ions, phosphatidylserine externalization, the formation of a non-selective membrane pore, and ultimately cell death. P2X7 receptor activation depends on the availability of extracellular nucleotides, whose concentrations are regulated by the action of extracellular nucleotidases such as CD39 and CD38. The P2X7 receptor has been extensively studied in the context of the immune response, and it has been reported to be involved in inflammasome activation, cytokine production, and the migration of different innate immune cells in response to ATP. In adaptive immune responses, the P2X7 receptor has been linked to T cell activation, differentiation, and apoptosis induction. In this review, we will discuss the evidence of the role of the P2X7 receptor on T cell differentiation and in the control of T cell responses in inflammatory conditions.

In Vitro-Generated Tc17 Cells Present a Memory Phenotype and Serve As a Reservoir of Tc1 Cells In Vivo.

Memory CD8+ T cells are ideal candidates for cancer immunotherapy because they can mediate long-term protection against tumors. However, the therapeutic potential of different in vitro-generated CD8+ T cell effector subsets to persist and become memory cells has not been fully characterized. Type 1 CD8+ T (Tc1) cells produce interferon-γ and are endowed with high cytotoxic capacity, whereas IL-17-producing CD8+ T (Tc17) cells are less cytotoxic but display enhanced self-renewal capacity. We sought to evaluate the functional properties of in vitro-generated Tc17 cells and elucidate their potential to become long lasting memory cells. Our results show that in vitro-generated Tc17 cells display a greater in vivo persistence and expansion in response to secondary antigen stimulation compared to Tc1 cells. When transferred into recipient mice, Tc17 cells persist in secondary lymphoid organs, present a recirculation behavior consistent with central memory T cells, and can shift to a Tc1 phenotype. Accordingly, Tc17 cells are endowed with a higher mitochondrial spare respiratory capacity than Tc1 cells and express higher levels of memory-related molecules than Tc1 cells. Together, these results demonstrate that in vitro-generated Tc17 cells acquire a central memory program and provide a lasting reservoir of Tc1 cells in vivo, thus supporting the use of Tc17 lymphocytes in the design of novel and more effective therapies.