Alternative Pathway Research Articles

The prognostic role of activation of the complement pathways in the progression of advanced IgA nephropathy to end-stage renal disease

IntroductionThe role of complement system in late stage of IgA nephropathy (IgAN) remains unknown. We therefore investigated the effects of complement system on worsening kidney function in advanced (stage 4 CKD) IgAN.MethodsRenal specimens of 69 IgAN patients who underwent renal biopsy during stage 4 CKD between 2010 and 2021, were stained using immunofluorescence (IF) and immunohistochemistry (IHC) for glomerular complement components. The primary outcome was progression to end-stage renal disease (ESRD). Associations of complement components with baseline clinicopathological characteristics and outcomes were assessed using multivariable Cox regression and Spearman analyses.ResultsDuring a median follow-up of 18.0 months, 26 (37.7%) patients progressed to ESRD and none died. C1q and C3 deposition were detected in 12 and 66 patients, respectively. Higher eGFR [hazards ratio (HR), 0.852, 95% confidence interval (CI), 0.756–0.959; P = 0.008], higher C3 intensity (HR, 2.955, 95%CI, 1.063–8.220; P = 0.038) and T1-2 score (HR, 2.576, 95%CI, 1.205–5.576, P = 0.015) were predictive of time to ESRD in CKD 4 stage IgAN. Significant expressions of C1q (P = 0.005), C4d (P < 0.001), factor B (P < 0.001), C3 (P = 0.042) and C5b-9 (P = 0.004) were identified in ESRD group than in non-ESRD group by IHC, while MBL expression was low. Although they were not associated with baseline 24 h-UP, higher factor B and C1q expressions were both correlated with a lower baseline eGFR (P < 0.001 and = 0.04, respectively) and the deterioration of kidney function during follow-up (P = 0.046 and 0.015, respectively).ConclusionComplement deposition in IgAN patients with stage 4 CKD portends a faster deterioration of kidney function. Activation of classical and alternative complement pathways plays a major role in this stage.

Safety and Efficacy of Avacopan in Patients with C3 Glomerulopathy: Randomized, Double-Blind Clinical Trial.

Complement 3 (C3) glomerulopathy is a rare autoimmune disorder characterized by activation of the alternative complement pathway with isolated or dominant C3 deposition in glomeruli. Patients with C3 glomerulopathy may develop progressive deterioration in kidney function and kidney failure. We studied the safety and efficacy of avacopan 30 mg twice daily in patients with C3 glomerulopathy (N=57) with elevated (> 244 ng/mL) and normal (≤ 244 ng/mL) levels of C5b-9 in a randomized, double-blind, placebo-controlled, phase 2 trial, with kidney biopsies performed pre-randomization and at 26 and 52 weeks. The primary outcome was the percent change from baseline to week 26 in C3 glomerulopathy histologic index for disease activity. The study was conducted in patients with C3 glomerulopathy, including C3 glomerulonephritis and DDD. The median study duration was 60.0 weeks (interquartile range 59.9 to 61.0). There were no significant differences in the primary outcome between the avacopan and the placebo group; least square mean treatment difference (95% CI) = -0.0 (-1.9 to 1.8). The secondary measures of efficacy including C3 Glomerulopathy Histological Index for disease chronicity, urine protein:creatinine ratio (UPCR), and estimated glomerular filtration rate (eGFR) were not different between treatment groups. The overall incidence and type of adverse events for both treatment groups were comparable. No deaths were reported during the study, and no new safety signals were detected. The primary end point for the study was not met; other clinical effects of avacopan to improve certain key kidney function parameters and slow disease progression were variable and require further evaluation.

Exploring the Dual Benefits of Fermented and Non-Fermented Garlic Powder on Growth, Antioxidative Capacity, Immune Responses, and Histology in Gray Mullet (Liza ramada)

This study investigated the effects of dietary garlic powder and fermented garlic powder supplementation at 1% and 2% levels on growth performance, digestive tract efficacy, blood biochemistry, immunity, and antioxidant status of Liza ramada (n = 225 fish; 86.00 ± 0.42 g) over a 60-day period. Fish fed diets supplemented with both forms of garlic at both levels exhibited significantly improved final body weight, weight gain, specific growth rate, and feed conversion ratio compared to the control group. Digestive enzyme activities (amylase, lipase, and protease) were significantly enhanced in all supplemented groups. Blood biochemical analysis revealed reduced glucose levels and increased total protein in garlic-supplemented groups, with no adverse effects on liver or kidney function markers. Immune parameters, including lysozyme activity, bactericidal activity against Streptococcus agalactiae, alternative complement pathway (ACP), and respiratory burst (NBT), were significantly enhanced in garlic-supplemented groups, with fermented garlic showing more pronounced effects. Antioxidant enzyme activities (SOD, CAT, and GPx) were also significantly increased in all supplemented groups, particularly in those fed fermented garlic. No significant differences in survival rates were observed among treatments. The results suggest that both garlic powder and fermented garlic powder supplementation, especially at the 2% level, can effectively improve growth, feed utilization, immune function, and antioxidant status in L. ramada. Fermented garlic generally demonstrated superior effects, indicating its potential as a beneficial feed additive in aquaculture. Based on these findings, it is recommended to incorporate fermented garlic powder at a 2% level in L. ramada diets to optimize growth performance and health status. Further research is warranted to investigate the long-term effects and cost-effectiveness of this supplementation strategy in commercial aquaculture settings.

Effect of Dietary Moldavian Balm (Dracocephalum moldavica L.) on Growth Performance, Antioxidant Status, Immune Response, and Gene Expression of Common Carp (Cyprinus carpio)

Abstract Chemical compounds used to prevent and control fish disease often cause environmental hazards; thus, alternative approaches as new and effective strategies are needed. The current investigation was performed with the aim of exploring the effects of dietary Moldavian balm (MB, Dracocephalum moldavica L.) on the growth, immune parameters, and antioxidant status of common carp (Cyprinus carpio). Fish (n=300, w=3.80±0.02 g) in four groups in triplicates were supplemented with 0%, 0.5%, 1%, and 2% MB. After 42 days, it was found that feed supplements increased final weight (FW), weight gain (WG), and specific growth rate (SGR) and decreased the food conversion ratio (FCR) (P&lt;0.05). In addition, fish supplemented with 2% MB significantly showed higher serum total protein (TP), alternative complement pathway (ACH50), and glutathione peroxidase (GPx) (P&lt;0.05). The 0.5% MB-supplemented fish represented higher levels of LYZ, alkaline phosphatase (ALP), total Ig, and ACH50 in their skin mucus in comparison with the unsupplemented fish (P&lt;0.05). The results also indicated that 2% MB resulted in a significantly higher expression level of intestinal tumor necrosis factor (TNF- α) (P&lt;0.05); however, the level of LYZ, interleukin-1β (IL-1 β), and TLRs decreased in supplemented fish. CAT and SOD expressions were increased in 0.5% MB supplement. In conclusion, MB could be recommended as an efficient feed additive to boost common carp’s growth, immunity, and health status.

Interactive Effects of Dietary Probiotic and Succinic Acid on the Growth Performance, Digestive Enzyme Activities, Immunomodulation, Antioxidative Capacity, and Disease Resistance in Rainbow Trout (Oncorhynchus mykiss) Juveniles

Abstract The current study was carried out to explore the effects of lactofeed (LA) as a multi-strain probiotic and succinic acid (SA) on growth variables, gut lactic acid bacteria count, digestive enzymes, innate immune responses, antioxidant capacity, and resistance against yersinia ruckeri in rainbow trout juveniles (Oncorhynchus mykiss). Three hundred sixty healthy rainbow trout juveniles (13.21±0.41 g) were randomly divided into twelve tanks (300 L) as four experimental groups. They were fed with basal diet (Control; BD), FT1: BD + 1 g/kg LA, FT2: BD + 5 g/kg SA, and FT3: BD + 1 g/kg LA + 5 g/kg SA for eight weeks. According to the results, final weight (FW), weight gain (WG), protein efficiency rate (PER), and feed conversion rate (FCR) revealed a remarkable discrepancy compared to the control group. In addition, dietary inclusion of LA (FT1 and FT3) significantly increased the specific growth rate (SGR). Dietary supplementation of LA+SA (FT3) remarkably improved total bacteria count (TBC) and amylase activity compared to the unsupplemented group. Gut lactic acid bacteria (LAB) count and digestive protease activity in all supplemented fish were remarkably higher than in unsupplemented group. Blood immunological factors including white blood cell (WBC) count, total immunoglobulin content (Ig), and the activity of lysozyme (LYZ), alternative complement pathway (ACH50), and acid phosphatase (ACP) were significantly enhanced in the supplemented groups. Neutrophil (NEU) count, skin mucus Ig and hepatic glutathione peroxidase (GPX) increased in SA (FT2 and FT3) treatments. In addition, monocyte (MON) count and skin mucus LYZ activity were significantly elevated following feeding with the FT3 diet. Other immunological parameters of skin mucus including protease activity, alkaline phosphatase (ALP) activity, and ACH50 activity, as well as hepatic superoxide dismutase (SOD) and catalase (CAT) activities increased in fish fed with diets containing LA and/or SA. Malondialdehyde (MDA) value was remarkably decreased in all supplemented rainbow trout compared to the fish fed with BD. Disease resistance against Y. ruckeri in fish fed with supplemented diets significantly improved with respect to the results obtained in the control specimens. Overall, dietary LA+SA supplementation was beneficial to improve growth performance, gut LAB count, digestive enzyme activities, innate immune responses, antioxidant capacity, and disease resistance in rainbow trout. According to these findings, 1 g/kg LA + 5 g/kg SA is suggested for adding to rainbow trout diet.

Synergistic Benefits of Dietary Silymarin and Selenium on Growth, Immune Functions, Antioxidants, and Gut/Liver Health of Thinlip Mullet (Liza ramada) Juveniles

Abstract This study investigates the synergistic impact of silymarin (SI) levels combined with inorganic selenium (sodium selenite: Se) on growth, feed utilization, biochemical parameters, antioxidants, innate immunity, intestinal and liver histology, and gene expression of thinlip mullet (Liza ramada) juveniles. The experimental design involved thinlip mullets initially weighing 3.5±0.13 g, distributed in a completely randomized design with 30 fish per hapa (0.5 × 0.5 × 1 m), and conducted in triplicate over 60 days. Seven experimental diets were employed, including a control (without SI and Se supplementation), a negative control (with only Se supplementation), and four treatments with varying levels of silymarin (250, 450, 650, 850 mg/kg) alongside selenium (0.5 mg/kg diet). The growth performance results highlighted significant enhancements in final body weight, weight gain, and specific growth rate, particularly in the SI 850 mg/kg + Se treatment. Survival rates, feed intake, and feed conversion ratios showed positive trends across the SI-Se supplemented groups. Biochemical profiles of serum exhibited that the control diet induced elevated concentrations of glucose, cholesterol, alanine aminotransferase, aspartate aminotransferase, and urea, while Se or SI supplementation significantly mitigated these levels, with the lowest concentrations observed in the SI-Se supplemented groups. Moreover, SI supplementation increased serum protein content. Antioxidant enzyme activities, represented by superoxide dismutase (SOD), catalase (CAT), and catalase (GPx), demonstrated notable improvements in the SI-Se fortified groups, with significantly elevated GPx activity compared to the Se-supplemented and control groups. Immune system responses, including lysozyme, bactericidal, nitro-blue tetrazolium (NBT%), and serum alternative complement pathway (ACH50) activities, were highest in the SI-Se augmented groups. SI and Se in L. ramada reduce liver pro-inflammatory gene expression (IL-1 β, hepcidin) vs. control group. Histological examinations of the intestine and liver depicted structural enhancements, especially at moderate and high levels of SI with Se supplementation. The results indicate improved intestinal villi morphology and hepatic architecture, supporting the positive influence of dietary treatments on the health of thinlip mullet juveniles. In conclusion, the combined supplementation of SI at 850 mg/kg diet and Se at 0.5 mg/kg diet positively influenced the growth, biochemical profiles, antioxidant status, immune responses, gene expression, and histological integrity of thinlip mullet juveniles, providing valuable insights for optimizing aquafeed formulations.

PI3K/PTEN/mTOR pathway dynamic tracking and prognostic value in HR+/HER2− BC patients with residual disease after neoadjuvant chemotherapy: a cohort study

AimsHormone receptor-positive (HR)+/HER2− breast cancer (BC) is highly heterogeneous, with PI3K/PTEN/mTOR pathway alterations emerging as possible players within this complexity. We longitudinally tracked PI3K/PTEN/mTOR pathway dynamics from baseline biopsy to...

137 Possible mechanisms underlying enhanced intramuscular adipogenesis in Wagyu cattle

Abstract The quality of beef hinges significantly on the abundance of intramuscular fat and tenderness. Intramuscular fat accumulation results directly from intramuscular adipogenesis, while tenderness is adversely affected by collagenous intramuscular connective tissue. Both intramuscular fat and connective tissue originate from fibro/adipogenic progenitors (FAPs), a group of bipotent progenitors. Wagyu cattle are renowned for their tender beef with rich intramuscular fat, likely owing to the distinctive features of Wagyu FAPs. Our study has identified fewer myogenic cells but more FAPs with greater adipogenic potential in Wagyu compared with Angus muscle. Furthermore, single-cell transcriptomic analysis identified that Wagyu FAPs exhibit greater adipogenic and decreased fibrogenic characteristics compared with FAPs in Brahman cattle, which generally produce low-quality beef with limited intramuscular fat and tenderness. Interestingly, Wagyu muscle also contains more abundant vascular cells, crucial for supporting adipogenesis. Mechanistic studies have unveiled several signaling pathways, including the bone morphogenetic protein signaling and the alternative complement pathway of the complement system, which likely contributes to the heightened adipogenic programming of Wagyu FAPs and is subject to epigenetic regulation.

Utility of factor D and other alternative complement factors as biomarkers in systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH)

BackgroundActivation of the complement cascade is thought to play a role in scleroderma vasculopathy. We previously showed that complement factor D was elevated in patients with limited cutaneous SSc and pulmonary arterial hypertension (PAH). In this study, we sought to assess multiple relevant components of the complement cascade to determine if they are altered in SSc-PAH, as well as their potential utility as biomarkers of disease severity and progression. MethodsComplement components (n = 14) were measured using multiplex assays in 156 patients with SSc-PAH from a multi-site repository and were compared to 33 patients with SSc without PAH, and 40 healthy controls. Data were evaluated for correlations between complement levels, right heart catheterization measures, and clinical endpoints including 6-minute walk distance. To assess complement longitudinally, serum complement levels were assayed at 0, 4, 12, 24, 36 and 48 weeks in 52 SSc-PAH patients who participated in a prior clinical trial. ResultsWe found that factor D was significantly elevated in SSc-PAH compared to SSc without PAH (p < 0.0001) and was highly sensitive and specific for SSc-PAH (AUC=0.82, p < 0.001). In SSc-PAH patients, alterations in factor H, C4, and factor D were associated with measures of PAH disease severity including right heart catheterization measurements (cardiac output, right atrial pressure, and VO2 max), survival, and 6-minute walk distance. No significant changes in complement levels or clinical associations were seen over time or associated with treatment in the longitudinal clinical trial study. ConclusionOur work confirms prior studies demonstrating a role for complement activation in SSc vascular disease and elevations of factor D in a large SSc-PAH population. Further, factor H and other complement factors are associated with severity of PAH including mortality. Taken together, these findings suggest that the alternative complement pathway plays a role in SSc-PAH pathogenesis and may serve as a biomarker to inform diagnosis and prognosis.

Adipose tissue–derived adipsin marks human aging in non-type 2 diabetes population

IntroductionAdipsin or complement factor D is an adipokine that augments insulin secretion, is altered in various degrees of obesity, and is involved in alternative complement pathway. However, whether adipsin has...

Enhancement of Candida albicans phagocytosis and inhibitory potency of Alternative Complement Pathway by an arabinoxylan extracted from Plantago ciliata Desf. Seeds and its oligosaccharides

Leveraging bioactive compounds with immunomodulatory effects to boost immune functions represents a promising strategy for therapeutic intervention. The main objective of this work was to investigate the influence of the partial acid hydrolysis of an arabinoxylan extracted from Plantago ciliata Desf. seeds into oligosaccharides on its immunomodulatory effect. The resulting oligosaccharides and their polymer were evaluated for their potential to improve the phagocytic capacity (PC) and the phagocytic activity (PA) of polymorphonuclear neutrophils (PMNs) through the uptake of Candida albicans and to moderate alternative complement pathway (ACP) activation. As a result, the arabinoxylan derived from P. ciliata seeds (AXPCs) and its oligosaccharides (AXOPCs) significantly enhanced the PC of PMN cells, with EC50 values of 0.14 ± 0.23 and 0.12 ± 0.10 mg/mL, respectively. Zymosan used as a reference exhibited the highest PC with an EC50 0.07 ± 0.08 mg/mL. However, for PA, zymosan still demonstrated the highest activity with an EC50 of 0.22 ± 0.46 mg/mL compared to 0.33 ± 1.36 and 0.30 ± 0.74 mg/mL for AXPCs and AXOPCs, respectively. Moreover, AXPCs and AXOPCs were tested as moderator inhibitors of the complement system, showing maximum inhibition percentages of 40.11 ± 8.38% and 50.57 ± 10.45% at 1 mg/mL, with IC50 values of 1.49 ± 0.40 and 1.02 ± 0.20 mg/mL, respectively, compared to 61.52 ± 7.17% and 70.89 ± 5.78% for heparin used as a reference. These results suggest that AXPCs and AXOPCs can serve as relevant therapeutic immunomodulatory factors.

Complement Factor B (CFB) inhibits the malignant progression of lung adenocarcinoma by downregulating the Ras/MAPK signaling pathway

Lung adenocarcinoma (LUAC) as the most common lung cancer, and its incidence is increasing. Complement factor B (CFB) is an important factor in the alternative complement pathway. CFB has been reported to be involved in the progression of many cancers, including in pancreatic cancer, cutaneous squamous cell carcinoma, and nasopharyngeal carcinoma, but the function and molecular mechanism of CFB in LUAC remains unclear. The present study aimed to explore the role of CFB in LUAC malignant progression. In our previous study, we found that CFB was downregulated expression in LUAC clinical samples. Here, we firstly detected the cell function in vitro. Cell proliferation and migration were increased, while cell apoptosis and cell cycle arrest were suppressed after CFB knockdown. Overexpression of CFB repressed the malignant progression of LUAC in vitro. Besides, in vivo experiments revealed that upregulation of CFB inhibited tumor growth and Ki67 expression. Additionally, our data indicated that CFB negatively regulated Ras/mitogen-activated protein kinase (MAPK) signaling pathway. Furthermore, upregulation of CFB inhibited the progression of LUAC was reversed by Ras/MAPK pathway activators (ML-098 or C16-PAF). Our study uncovered that CFB acts as a tumor suppressor repressed tumorigenesis of LUAC through inhibiting the Ras/MAPK pathway, suggesting that CFB may be a potential biomarker and therapeutic target for LUAC.

Choosing Vocational Courses: Why twelve British Pakistani males selected vocational courses at the age of 16

ABSTRACT The higher participation of England’s ethnic minority students on vocational courses at the age of 16 initiates them onto the ‘lower tier’ pathway in tertiary education. Lower tier implies participating in certain vocational courses and entering lower status universities. Consequently, ethnic minority students in England have a weaker labour market position upon graduation. Using semi-structured interviews, this article explores the decision-making process of 12 British Pakistani students, as they are initiated on this lower tier pathway. The findings suggest that decision-making is a negotiation of student biography with ethnic capital and ‘racial warehousing’. This interplay funnels many ethnic minority students towards the lower tier pathway, where selecting certain vocational courses is deemed as the only pathway feasible for progression. This study sheds light on the need to promote alternative vocational pathways to England’s ethnic minority students.

Impact of Weak Organic Acids as Coagulants on Tailoring the Properties of Cellulose Aerogel Beads.

Tailoring the properties of cellulose aerogel beads was investigated in the present study by using weak organic acids as coagulants. Three different weak acids were specifically chosen, acetic acid, lactic acid and citric acid. For comparative studies, a strong acid, hydrochloric acid was examined. The production of aerogel beads by conventional dropping technique was controlled and optimized for weak acids. Aerogels were characterized by density analyses, scanning electron microscopy, nitrogen adsorption-desorption analysis, X-ray powder diffractometry and IR spectroscopy. In common, all the aerogel beads showed interconnected nanofibrillar network, high specific surface area, high pore volume, high porosity and meso- and macroporous structure. In particular, when the weakest acid (acetic acid) was used as coagulant in the regeneration bath, the lowest shrinkage was observed. As a result, the cellulose aerogel beads produced from acetic acid showed the highest values of specific surface area (423 m2 g-1) and pore volume (3.6 cm3 g-1). The porous structure can be tuned by the choice of regeneration bath, which has either strong acid or a high concentration of weak acid. The aerogel beads were pure and showed cellulose II crystallinity. Hence this study paves an alternative path way to tailor the properties of cellulose aerogel beads.

Sensory neurons regulate stimulus-dependent humoral immunity.

Sensory neurons sense pathogenic infiltration, serving to inform immune coordination of host defense. However, sensory neuron-immune interactions have been predominantly shown to drive innate immune responses. Humoral memory, whether protective or destructive, is acquired early in life - as demonstrated by both early exposure to streptococci and allergic disease onset. Our study further defines the role of sensory neuron influence on humoral immunity in the lung. Using a murine model of Streptococcus pneumonia pre-exposure and infection and a model of allergic asthma, we show that sensory neurons are required for B-cell and plasma cell recruitment and antibody production. In response to S. pneumoniae, sensory neuron depletion resulted in a larger bacterial burden, reduced B-cell populations, IgG release and neutrophil stimulation. Conversely, sensory neuron depletion reduced B-cell populations, IgE and asthmatic characteristics during allergen-induced airway inflammation. The sensory neuron neuropeptide released within each model differed. With bacterial infection, vasoactive intestinal polypeptide (VIP) was preferentially released, whereas substance P was released in response to asthma. Administration of VIP into sensory neuron-depleted mice suppressed bacterial burden and increased IgG levels, while VIP1R deficiency increased susceptibility to bacterial infection. Sensory neuron-depleted mice treated with substance P increased IgE and asthma, while substance P genetic ablation resulted in blunted IgE, similar to sensory neuron-depleted asthmatic mice. These data demonstrate that the immunogen differentially stimulates sensory neurons to release specific neuropeptides which specifically target B-cells. Targeting sensory neurons may provide an alternate treatment pathway for diseases involved with insufficient and/or aggravated humoral immunity.

Liposomes with Low Levels of Grafted Poly(ethylene glycol) Remain Susceptible to Destabilization by Anti-Poly(ethylene glycol) Antibodies.

Binding of anti-PEG antibodies to poly(ethylene glycol) (PEG) on the surface of PEGylated liposomal doxorubicin (PLD) in vitro and in rats can activate complement and cause the rapid release of doxorubicin from the liposome interior. Here, we find that irinotecan liposomes (IL) and L-PLD, which have 16-fold lower levels of 1,2-distearoyl-sn-glycero-3-phosphoethanolamine (DSPE)-PEG2000 in their liposome membrane as compared to PLD, generate less complement activation but remain sensitive to destabilization and drug release by anti-PEG antibodies. Complement activation and liposome destabilization correlated with the theoretically estimated number of antibody molecules bound per liposome. Drug release from liposomes proceeded through the alternative complement pathway but was accelerated by the classical complement pathway. In contrast to PLD destabilization by anti-PEG immunoglobulin G (IgG), which proceeded by the insertion of membrane attack complexes in the lipid bilayer of otherwise intact PLD, anti-PEG IgG promoted the fusion of L-PLD, and IL to form unilamellar and oligo-vesicular liposomes. Anti-PEG immunoglobulin M (IgM) induced drug release from all liposomes (PLD, L-PLD, and IL) via the formation of unilamellar and oligo-vesicular liposomes. Anti-PEG IgG destabilized both PLD and L-PLD in rats, indicating that the reduction of PEG levels on liposomes is not an effective approach to prevent liposome destabilization by anti-PEG antibodies.

Генетически-фенотипический профиль детей с атипичным гемолитико-уремическим синдромом

Atypical hemolytic uremic syndrome (aHUS) is a life-threatening disease caused by dysregulation of the alternative complement pathway as a result of mutations in complement genes or the formation of antibodies (AB) to some of the complement factors. Identification of the gene mutations incidence and the corresponding phenotypic features in pediatric patients with aHUS in Russia is aimed at improving the diagnosis and prognosis of the disease as well as treatment tactics planning for patient management. The purpose of this research was to determine the patterns of progression, prognosis and outcomes of aHUS in children depending on their genetic profile. Materials and methods used: the Article represents data from a retro- and prospective analyses of the characteristics of the course of aHUS in 172 children depending on their genetic profile performed in Jan. 2012-Feb. 2022. The sporadic form of aHUS was diagnosed after exclusion of the other forms of thrombotic microangiopathy (TMA), the familial form (in cases with the familial records), the acquired (CFH-Ab HUS) in cases with AB increase to factor H. AutoAb against factor H was determined by enzyme-linked immunosorbent assay (ELISA-VIDITEST anti-complement factor H). The search for mutations (n=167) was carried out using Next-generation Sequencing (NGS) and Sanger sequencing methods. Results: the sporadic form of aHUS was diagnosed in 96.9% of cases, familial in 3.1% and CFH-Ab HUS in 23.8%. The genetic nature of aHUS was confirmed in 53.4% of cases. Pathogenic mutations were detected in 8.6% of cases, probably pathogenic in 42.8% and those with unclear clinical significance in 46.8%. The complement genes mutations were detected in 88.5% of cases and mutations of genes not related to the complement system (ADAMTS13, DGKE, INF2) in 11.5%. The most frequently identified mutations were in the CFH (17.1%), C3 (12.9%) and CD46 (12.9%) genes and less frequently in CFI (7.1%), THBD (5.7%), CFHR5 (5.7%) and CFB (1.4%). In children with CFH-Ab HUS, the CFHR1/CFHR3 deletion was detected in 87.8% of cases, including in 19.4% in combination with mutations of unknown clinical significance. Multiple organ failure syndrome had developed in 77.8% of cases in children with pathogenic/probably pathogenic mutations, in 85.3% in patients with mutations of unknown clinical significance, in 91.8% in patients without mutations and in 83.3% in patients with CFHR1/CFHR3 deletion. Chronic kidney disease (CKD) stages 3 to 5 in sporadic/familial aHUS, regardless of genetic profile, had counted for 14.5% and 16.7% in CFH-Ab HUS. Lethal outcome occurred in 4.3% of cases in the presence of mutations, in 4.9% in the absence of mutations and in 2.8% in cases of CFHR1/CFHR3 deletion. Relapses of aHUS prior to the Eculizumab treatment had developed more often in the presence of CFHR1/CFHR3 mutations and deletion in comparison with children without mutations (31.4% v. 13.1%, p=0.0313 and 44.4% v. 13.1%, p= 0.004). Relapse of aHUS after discontinuation of the Eculizumab therapy had developed in 16.4% of cases. Risk factors for the relapse of aHUS were as follows: patient’s age above 12 months old at the time of the development of aHUS, severe arterial hypertension in the acute period, the use of Eculizumab at the fourth week after the onset of the disease and/or later, recurrent course of aHUS and the presence of CKD prior to the start of the Eculizumab therapy. Conclusion: The genetic profile of patients does not determine the severity and outcome of aHUS though it does affect the relapse rate. The prognosis and survival of patients with aHUS are determined by the severity of the acute period and the timeliness of the complement blocking therapy management.

Responses of oscar (Astronotus ocellatus) to different temperatures and its interaction with early mild stress

Non-optimum temperature results in stress in fish through different biological and physiological processes. This study investigated how early mild stress (EMS) and temperature can influence growth, hematology, blood biochemistry, immunological response, antioxidant system, liver enzymes, and stress response of juvenile oscar (Astronotus ocellatus; 8.02 ± 0.81 g) before and after acute confinement stress (AC stress). Eight experimental treatments were 17D (farmed at 17 °C), 22D (farmed at 22 °C), 27D (farmed at 27 °C), 32D (farmed at 32 °C), 17DES (farmed at 17 °C and EMS), 22DES (farmed at 22 °C and EMS), 27DES (farmed at 27 °C and EMS), and 32DES (farmed at 32 °C and EMS). At the end of the experiment (nine weeks), there was no significant difference in survival rate, feed conversion ratio, body composition, and survival rate after the AC stress (ten weeks). The growth rates in the 17 and 32 °C groups were lower than others, showing the negative effect of temperature being too high or too low. After nine weeks, fish farmed at 32 °C had the highest hematological parameters (hematocrit, hemoglobin, red blood cells, and blood performance) and liver enzymes (lactate dehydrogenase, alanine transaminase, and aspartate transaminase). This group also has the lowest lysozyme, alternative complement pathway (ACH50), immunoglobulin, complement C3, complement C4, superoxide dismutase, and glutathione peroxidase. The EMS did not positively or negatively affect fish physiology in this study. In conclusion, the optimum temperature for oscar to achieve the best growth performance, immune response, and health status is 22–27 °C.

Protein-losing enteropathy as a new phenotype in atypical hemolytic uremic syndrome caused by CD46 gene mutation.

Atypical hemolytic uremic syndrome (aHUS) is a life-threatening thrombotic microangiopathy. Genetic defects in the alternative complement (AP) pathway have been identified in 60-70% of individuals. Eculizumab is recommended as a first-line therapy. We collected the clinical data of a pediatric patient with aHUS accompanied by protein-losing enteropathy (PLE). Genetic testing was performed. Related literature on aHUS combined with PLE was reviewed. A 15-year-old Chinese girl was diagnosed with aHUS at 3.7years of age and experienced five episodes; her symptoms completely resolved with plasma treatment. Severe gastrointestinal symptoms and hypoalbuminemia presented after the first episode, and PLE was diagnosed. A novel homozygous CD46 variant was identified, and FACS revealed significantly decreased CD46 expression. She presented at a recent relapse with persistent GI symptoms and headache and progressed to chronic kidney failure; peritoneal dialysis was initiated. Eculizumab was given 8months after the last recurrence. Surprisingly, PLE was cured. Afterward, dialysis was discontinued, and eGFR recovered to 44.8ml/min/1.73 m2. A review of the literature indicated that PLE with thrombosis was caused by CD55 variants via hyperactivation of the AP system. We report an aHUS patient with PLE caused by CD46 variants. Symptoms of both PLE and aHUS were significantly alleviated in our patient and patients with CD55 variants treated with eculizumab, indicating that PLE was a new symptom of aHUS in our patient with a CD46 variant. Our case expands the phenotype of aHUS caused by a CD46 mutation and provides evidence of the efficacy of eculizumab after a long phase of chronic kidney failure.

A Patent Review of Human Dihydroorotate Dehydrogenase (hDHODH) Inhibitors as Anticancer Agents and their Other Therapeutic Applications (1999-2022).

Highly proliferating cells, such as cancer cells, are in high demand of pyrimidine nucleotides for their proliferation, accomplished by de novo pyrimidine biosynthesis. The human dihydroorotate dehydrogenase (hDHODH) enzyme plays a vital role in the rate-limiting step of de novo pyrimidine biosynthesis. As a recognised therapeutic target, hDHODH plays a significant role in cancer and other illness. In the past two decades, small molecules as inhibitors hDHODH enzyme have drawn much attention as anticancer agents, and their role in rheumatoid arthritis (RA), and multiple sclerosis (MS). In this patent review, we have compiled patented hDHODH inhibitors published between 1999 and 2022 and discussed the development of hDHODH inhibitors as anticancer agents. Therapeutic potential of small molecules as hDHODH inhibitors for the treatment of various diseases, such as cancer, is very well recognised. Human DHODH inhibitors can rapidly cause intracellular uridine monophosphate (UMP) depletion to produce starvation of pyrimidine bases. Normal cells can better endure a brief period of starvation without the side effects of conventional cytotoxic medication and resume synthesis of nucleic acid and other cellular functions after inhibition of de novo pathway using an alternative salvage pathway. Highly proliferative cells such as cancer cells do not endure starvation because they are in high demand of nucleotides for cell differentiation, which is fulfilled by de novo pyrimidine biosynthesis. In addition, hDHODH inhibitors produce their desired activity at lower doses rather than a cytotoxic dose of other anticancer agents. Thus, inhibition of de novo pyrimidine biosynthesis will create new prospects for the development of novel targeted anticancer agents, which ongoing preclinical and clinical experiments define. Our work brings together a comprehensive patent review of the role of hDHODH in cancer, as well as various patents related to the hDHODH inhibitors and their anticancer and other therapeutic potential. This compiled work on patented DHODH inhibitors will guide researchers in pursuing the most promising drug discovery strategies against the hDHODH enzyme as anticancer agents.