Immunity, Inflammation and Disease

Incidence of ventilator-associated pneumonia (VAP) is increased in patients admitted for brain injury. Staphylococcus aureus appears to be a particularly common pathogen in these respiratory infections. Our aim was to confirm the extent of S. aureus involvement in VAP among patients with neurological injuries. We conducted a retrospective, multicenter study including patients with and without neurological injuries who developed VAP during their ICU stay. Among 15 702 patients admitted in the participant centers during the study period. 407 were finally included in the study. S. aureus was involved in 122 (61.6%) VAP in brain-injured patients and 63 (30.1%) of non-brain-injured patients. In brain-injured patients, multivariate analysis identified age (0.97 [0.95; 0.98]), antibioprophylaxis (0.31 [0.18; 0.53]; p < 0.0001), subarachnoid hemorrhage (2.18 [1.01; 4.68]; p=0.0461), lower Glasgow coma score (0.92 [0.87; 0.97]; p= 0.004) and SAPS II (0.98 [0.97; 1]; p=0.0174) as critical factors associated with the risk of S. aureus in VAP. In the non-brain-injured population, multivariate analysis identified antibioprophylaxis (0.38 [0.22; 0.65]; p=0.0006), age (0.96 [0.95; 0.98]; p<0.0001), SAPS II (0.98 [0.97; 1]; p=0.0265), thoracic surgery (0.21 [0.09; 0.48]; p=0.0002) and peripheral neurosurgery (1.95 [1.2; 3.19]; p=0.0076) as critical factors. A total of 172 patients (42.3%) died during their ICU stay and 90-days mortality was 194 (47.7%). No difference of mortality was noticed function of VAP-associated pathogen.

Background: Gastric carcinoma remains a major cause of cancer related mortality worldwide, with tumor progression increasingly recognized as a consequence of complex interactions within the tumor microenvironment. Hypoxia induced signaling, cancer associated fibroblast (CAF) heterogeneity, and immune checkpoint activation play critical roles in tumor progression and immune evasion. However, their integrated relationship in gastric carcinoma remains insufficiently characterized. Objectives: To evaluate the expression of Hypoxia inducible factor 1 alpha and its association with cancer-associated fibroblast subtypes and Programmed death-ligand 1 expression in gastric carcinoma. Methods: This cross sectional analytical study included 100 histologically confirmed gastric carcinoma cases from Satkhira Medical College. Immunohistochemistry was performed for HIF 1 alpha, smooth muscle actin (SMA), fibroblast activation protein (FAP), and PD L1. CAFs were subclassified into myofibroblastic CAFs (myCAFs) and inflammatory CAFs (iCAFs). Associations between biomarkers and clinicopathological variables were analyzed using chi square test, Spearman correlation, and multivariate logistic regression. Receiver operating characteristic (ROC) curve analysis was used to assess model performance. Result: High HIF 1 alpha expression was observed in 55% of cases and demonstrated significant association with poor differentiation (p = 0.001), advanced tumor stage (p = 0.002), and lymph node metastasis (p = 0.001). iCAF predominance was significantly associated with poor differentiation (p = 0.003), advanced stage (p = 0.004), and nodal metastasis (p = 0.004). High PD L1 expression was significantly associated with poor differentiation (p = 0.03), advanced stage (p = 0.001), and lymph node metastasis (p = 0.002). Multivariate logistic regression identified high HIF 1 alpha expression (OR = 3.8, p = 0.001), iCAF dominance (OR = 4.5, p < 0.001), and advanced tumor stage (OR = 2.9, p = 0.004) as independent predictors of high PD L1 expression. Combined high HIF 1 alpha expression and CAF activation demonstrated the highest rate of PD L1 positivity (76.7%, p < 0.001). ROC curve analysis demonstrated good predictive performance of the model with an area under the curve of 0.81. Conclusion: The present study demonstrates a significant interaction between hypoxia, stromal remodeling, and immune checkpoint activation in gastric carcinoma. High HIF 1 alpha expression and inflammatory CAF predominance are strongly associated with aggressive clinicopathological features and increased PD L1 expression, supporting the existence of a coordinated hypoxia stroma immune axis in gastric carcinoma progression. These findings may have potential implications for prognostic stratification and combined targeted therapeutic strategies.

Air-liquid interface (ALI) cultures consisting of well-differentiated primary respiratory epithelial cells (PRECs) provide a versatile in vitro model for pharmacological studies and to investigate host-pathogen interactions. Proliferation and differentiation of PRECs require complex media containing several growth factors, hormones, and nutrients. Usually, some of these essential components are provided by the addition of fetal calf serum (FCS). However, several disadvantages of FCS and, most importantly, ethical concerns regarding the method of serum collection have encouraged researchers to find alternatives. Human platelet lysate (hPL) has emerged as a promising alternative to FCS for supporting cell expansion in vitro. In the present study, we investigated the effects of different concentrations of hPL on the proliferation of porcine PRECs and their subsequent differentiation under ALI conditions. Cell morphology was assessed by phase-contrast microscopy, while cell proliferation was evaluated using the ClickTech EdU Cell Proliferation Kit and visualization of proliferating cells by fluorescence microscopy. Differentiation under ALI conditions was monitored by immunofluorescence staining of ciliated cells and the establishment of an intact epithelial barrier was confirmed by measuring transepithelial electrical resistance (TEER). We found that 5% hPL supported efficient cell growth and the subsequent formation of a functional, well-differentiated airway epithelium comparable to or even better than 10% FCS. Thus, hPL offers a reproducible, ethically sound, and scalable alternative to FCS for complex cell culture models in respiratory research, drug development, and host-pathogen interaction studies. LO_SCPLOWAYC_SCPLOW SO_SCPLOWUMMARYC_SCPLOWRespiratory epithelial cells from the lungs of slaughtered animals, such as pigs, can be used for cell culture models to study respiratory diseases and drug development. Air-liquid interface (ALI) cultures closely mimic the natural environment of the airways by exposing the cells to air, making them a valuable alternative to animal experiments. To grow and mature properly, these cells require nutrients and growth factors that are commonly supplied by serum from unborn calves (FCS). However, for ethical and scientific reasons, the use of FCS should be avoided. Therefore, we evaluated whether human platelet lysate (hPL) derived from expired blood donations could replace FCS in ALI cultures. We found that adding 5% hPL to the medium supported efficient cell growth and the development of a well-differentiated airway epithelium. This approach enables the use of an improved and ethically superior model of the (porcine) respiratory tract in accordance with the 3Rs principle.

Fuchs Endothelial Corneal Dystrophy (FECD) is characterized by progressive corneal endothelial cell loss and the formation of corneal guttae. Currently, there is a global shortage of donor corneas and new strategies are needed to reduce the need for corneal transplantation. While adeno-associated viruses (AAVs) have the capacity to deliver anti-apoptotic genes to human corneal endothelial cells (CECs), this has not been fully explored as a therapeutic strategy for FECD. In this study, we evaluated the transduction efficiency of self-complementary (sc-) and single-stranded (ss-) AAV2 serotypes in human CECs and ex vivo tissues and assessed whether AAV-mediated expression of Bcl-xL could attenuate apoptosis in FECD. Seventeen scAAV2 serotypes were screened for transduction efficiency in normal human CECs via green fluorescent protein (GFP) expression. The top 4 AAV2 serotypes were further evaluated in FECD cell lines, healthy cadaveric donor specimens, and FECD patient specimens. FECD cell lines were transduced with anti-apoptotic ssAAV2/5-Bcl-xL (AAV2/5-CAG-eGFP-P2A-BCLXL) and treated with etoposide to induce apoptosis. We found that scAAV2/5 demonstrated high transduction efficiency across all normal and FECD cell lines and tissues. We observed that ssAAV2/5-mediated expression of Bcl-xL provided significant protection against etoposide-induced apoptosis in FECD CECs (71.68%{+/-}0.69 vs 23.96%{+/-}8.88%, p=0.018). Our findings show that AAVs have the potential for therapeutic gene delivery to the human corneal endothelium, and that targeting the Bcl-xL mediated apoptotic pathway can be further explored as a therapeutic for FECD.

Background: Subepithelial connective tissue grafting remains a reference treatment for predictable root coverage. Although short- and medium-term outcomes of tunnel-based procedures are well documented, evidence regarding stability beyond 10 years remains limited. This study evaluated the long-term clinical performance of a minimally invasive tunnel technique combined with subepithelial connective tissue grafting (SCTG) under routine clinical conditions. Methods: This retrospective longitudinal cohort study included 74 patients (57 women and 17 men) contributing 710 gingival recession sites treated between 2009 and 2025. All sites were treated with a tunnel approach and SCTG, with enamel matrix derivative (EMD) used in selected cases. The mean follow-up was 6.0 for 4.0 years, with a maximum observation period of 16 years. The primary outcome was recession depth reduction. Secondary outcomes included complete root coverage (CRC), mean root coverage, and long-term marginal stability. Clinically relevant relapse was defined as a 1 mm increase in recession after initial healing. Results: Mean recession reduction was 2.72 mm. Complete root coverage was achieved at 83.4% of treated sites. At the final available follow-up, no treated site showed a clinically relevant relapse of 1 mm after initial healing, and no site deteriorated beyond its baseline recession level. Treatment effects were observed across anterior and posterior regions. Conclusions: Within the limitations of a retrospective cohort design, tunnel surgery combined with SCTG was associated with high root-coverage predictability and durable marginal soft-tissue stability for observation periods extending to 16 years. These real-world data support phenotype-enhancing, minimally invasive soft-tissue augmentation as a durable therapeutic strategy for localized and multiple gingival recessions. Keywords: gingival recession; tunnel technique; subepithelial connective tissue graft; root coverage; periodontal plastic surgery; long-term stability

BackgroundReactive oxygen species (ROS) overproduction, inflammatory cytokines, and plasma mediators disrupt alveolar tight junction integrity and perpetuate oxidative injury in acute respiratory distress syndrome (ARDS). Biological heterogeneity of ARDS, reflected by hyper- and hypoinflammatory subphenotypes with distinct plasma mediator profiles, may contribute to heterogeneity of treatment effect. Stem cell-derived EVs have been shown to exert regenerative and immunomodulatory effects by horizontal transfer of proteins, lipids and genetic material to injured target cells. This study investigated whether extracellular vesicles derived from bone marrow (MSC-EVs) and adipose tissue (ASC-EVs) mesenchymal stem cells restore barrier integrity and redox homeostasis, and whether efficacy differs across subphenotypes. MethodsBronchial epithelial cells (BEAS-2B), microvascular endothelial cells (HMEC-1), and small airway epithelial cells (SAEC) were challenged with plasma from patients with hyperinflammatory or hypoinflammatory ARDS subphenotypes, including those treated with venovenous ECMO. MSC-EVs or ASC-EVs were added concomitantly with plasma exposure or six hours later, at a dose of 5,000 particles/cell. After 24 h, the expression of actin and tight junction proteins, zonula occludens (ZO)-1, occludin, and vascular endothelial (VE)-cadherin, was evaluated by immunofluorescence. Oxidative stress parameters, antioxidant defenses, and antioxidant enzyme activities, were measured. ResultsPlasma from patients with the hyperinflammatory ARDS subphenotype induced marked disruption of ZO-1, occludin, and VE-cadherin expression, together with actin cytoskeletal rearrangement, across BEAS-2B, HMEC-1, and SAEC cells. Barrier disruption was accompanied by increased oxidative stress markers and altered antioxidant enzyme activity. Both MSC-EVs and ASC-EVs restored tight junction protein expression and cytoskeletal organization when administered either concurrently with ARDS plasma or 6 hours after exposure, and both effectively modulated redox parameters. Delayed administration 6 hours after injury produced greater effects for several oxidative stress endpoints, particularly in cells challenged with hypoinflammatory plasma. ConclusionARDS-associated plasma mediators induce subphenotype-dependent impairment of epithelial-endothelial barrier integrity through oxidative mechanisms. Both MSC-EVs and ASC-EVs mitigate this injury, with efficacy that varies according to ARDS subphenotype and timing of administration.

Sepsis is a global health problem. Patients in the Intensive Care Unit (ICU) are at risk of having sepsis because of their vulnerability and use of invasive medical devices. Emerging antimicrobial-resistance complicates treatment. Understanding bacterial profiles and antibiotic sensitivity patterns in the ICU plays an important role in managing sepsis, optimizing antimicrobial use, and improving patient outcomes. The aim of this study was to show bacterial profiles and antibiotic sensitivity patterns among patients who were admitted to the ICU at Mbeya Zonal Referral Hospital for 12 months. This was a prospective cross-sectional study among 187 sepsis-suspected patients. Data analysis was performed using SPSS Version 27. Categorical data were summarized by frequency and percentage. Fishers exact test, chi-square test, and modified Poisson regression were used to show the association between patients clinical variables and culture positivity at a 95% CI. Statistical significance was set at a p-value < 0.05. Out of 187 samples, 41.7% were culture positive. Gram-negative bacteria were commonly isolated (65.4%, with Klebsiella pneumoniae and Escherichia coli being commonly isolated. Commonly isolated Gram-positive bacteria were Coagulase-negative Staphylococcus species (19%). 100% of gram-positive bacteria and 96% of gram-negative bacteria were Multi-Drug Resistant (MDR), respectively. In multivariable analysis, patients who were intubated and mechanically ventilated (aPR = 2.208, 95% CI: 1.133-4.305, p = 0.020) and post-laparotomy patients (aPR = 3.241,95% CI: 1.320-7.958, p = 0.010) independently had a higher proportion of Gram-negative bacteria. The study reveals a high level of resistance to commonly used antimicrobials in our setting, necessitating strengthening of the antimicrobial stewardship program and routine surveillance of antimicrobial resistance patterns.

Background: Oral dysbiosis has been associated with oral squamous cell carcinoma (OSCC); however, most microbiome studies rely on 16S ribosomal RNA (rRNA) gene sequencing, limiting species-level taxonomic resolution. Methods: Dental plaque, saliva, and tumor tissue samples from 10 patients with OSCC and dental plaque and saliva samples from 10 healthy controls were analyzed in this exploratory cross-sectional study. DNA was extracted and subjected to shotgun metagenomic sequencing using the Illumina MiSeq platform. Sequence reads were quality filtered with fastp, taxonomically classified using Kraken2 v2.1.3, and species-level abundances were re-estimated with Bracken v2.9 following the removal of human reads and low abundance taxa. Relative abundances were compared using the Mann Whitney U test with the Benjamini Hochberg false discovery rate correction, while the Bray Curtis principal coordinate analysis was used as an exploratory approach to visualize microbial community patterns. Results: Shotgun metagenomic sequencing revealed distinct bacterial community profiles across the oral microenvironment. Dental plaque exhibited the highest taxonomic diversity and relative abundance. The control plaque was enriched in Streptococcus koreensis, Capnocytophaga sp. oral taxon 878, Treponema sp. Marseille Q4132, and Leptotrichia sp. oral taxon 498, whereas the plaque from patients with OSCC showed a higher relative abundance of Pyramidobacter piscolens, Parvimonas parva, and Gemella sanguinis. Salivary samples displayed lower diversity and a more homogeneous composition, predominantly comprising Capnocytophaga endodontalis, Prevotella jejuni, Aggregatibacter aphrophilus, and Gemella sanguinis. The tumor tissue showed relatively higher abundance of Sellimonas catena, Escherichia coli, Solobacterium moorei, and Lacrimispora sp. HJ 01. Conclusions: This exploratory study provides species-level characterization of the oral microbiome across multiple oral microenvironments in OSCC and generates hypotheses for future integrative metagenomic and functional studies investigating the potential contribution of oral bacterial communities to OSCC pathogenesis.

The human host defence peptide LL-37 mediates pleiotropic immunomodulatory functions that can be both pro- and anti-inflammatory. Under inflammatory conditions in the lungs, LL-37 is susceptible to the post-translational modification (PTM) citrullination. The impact of this PTM on LL-37's immunomodulatory functions is not fully understood. Therefore, we characterized the transcriptome and cytokine profile in response to LL-37 and citrullinated-LL-37 (citLL-37), in human bronchial epithelial cells (HBEC). Cells were stimulated with either LL-37 or citLL-37 (0.5 M), or a scrambled peptide (sLL-37). RNA after 4 hours (h) was analyzed with NanoString nCounter Host Response Panel, and 96 cytokines were examined (after 24 h) in tissue culture supernatants (Luminex platform). Genes and cytokines with a Log2 fold-change [&ge;]0.5 with p<0.05 compared to unstimulated cells were considered differentially expressed (DE). These studies revealed overlapping and distinct biosignatures. There were 118 DE genes with LL-37 and 71 with citLL-37, of which magnitude of change was significantly different for 32 genes. 16 out of 17 DE genes altered by both peptides were directly related to inflammation, and these were significantly less (by ~45%) with citLL-37 compared to LL-37. Similarly, inflammatory cytokines enhanced in response to LL-37 were significantly less (by 37-94%) with citLL-37. Overall, our findings indicate that citrullination of LL-37 does not abrogate cellular response in HBEC, instead dampens the inflammatory biosignature induced by LL-37.

Purpose: To investigate the incidence, clinical features, and risk factors for SARS-CoV-2 nucleic acid re-positivity in recovered COVID-19 patients. Methods: We enrolled 441 convalescent COVID-19 patients from the rehabilitation ward of the Fifth Hospital of Shijiazhuang between January and April 2021. Based on nucleic acid test results, patients were categorized into repositive (n = 69) and non-repositive (n = 372) groups. Demographic, clinical, laboratory, and imaging data were compared between groups. Logistic regression was used to identify factors associated with re-positivity. Results: The overall re-positivity rate was 15.65%. Compared with the non-repositive group, the repositive group presented with a significantly higher proportion of moderate disease severity (72.46% vs. 50.54%) and a lower proportion of patients under 14 years old (7.25% vs. 23.66%). Additionally, multi-lobar involvement ([&ge;] 3 lobes) during the acute phase was more common in the repositive group (43.48% vs. 26.61%), with all differences being statistically significant (P < 0.001). Laboratory analysis revealed that repositive patients had significantly lower lymphocyte and eosinophil counts, as well as reduced albumin (ALB), aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, and albumin/globulin (A/G) ratio. Furthermore, circulating CD3+, CD4+, and CD8+ T-cell counts were markedly decreased. In contrast, the neutrophil-to-lymphocyte ratio (NLR), immunoglobulin M (IgM), immunoglobulin A (IgA), and neutralizing antibody (NAb) levels were significantly elevated in re-positive patients (all P < 0.05). Multivariate logistic regression analysis identified the CD8+ as independent risk factors for re-positivity. Conclusion: In convalescent patients, SARS-CoV-2 RNA re-positivity correlates with distinct clinical and immunological characteristics. The CD8+ T-cell level is an independent predictor, highlighting that dysregulated immune and inflammatory responses contribute to delayed viral clearance.

BackgroundHuman T-lymphotropic virus type 1 (HTLV-1) is an oncogenic retrovirus which is transmitted via cell-containing blood fluids or from mother to child via breastfeeding, leading to severe diseases such as adult T-cell leukemia/lymphoma (ATL) and neuroinflammation. Most studies focus on virus detection in peripheral blood due to limited access of tissue material, especially in infants. Thus, our understanding of viral distribution in organs, in particular along the oral route of transmission, is still a critical gap in HTLV-1 research. Methodology/Principal FindingsHere, we present an analysis of tissues from a non-human primate (NHP) colony (olive baboon: Papio anubis) naturally infected with the closely related counterpart of HTLV-1, simian T-lymphotropic virus type 1 (STLV-1). Various organs and tissues of the oropharyngeal and gastrointestinal tract including tonsils, stomach, small intestine and colon were analyzed for the presence or absence of STLV-1. Beside TaqMan qPCR measuring relative copy numbers, we established a highly sensitive and precise droplet digital (dd) PCR protocol to measure absolute copy numbers of viral Tax DNA. Tax DNA was detectable in the tonsils in two NHPs, but to a greater extent in stomach in four NHPs. We also found Tax in parts of the small intestine, i.e. duodenum and Peyers patches, in a NHP with high blood proviral load. Conclusion/SignificanceThese data provide a quantitative analysis of STLV-1 Tax in the gastrointestinal tract and are, to our knowledge, the first indication of STLV-1 detection in stomach tissue of naturally STLV-1-infected asymptomatic NHPs. Although it is unclear how infection occurred - from mother-to-child, sexual or via animal bites - our study suggests that these parts of the gastrointestinal tract might either serve as site of virus transmission or as viral reservoir. Author summaryHuman T-lymphotropic virus type 1 (HTLV-1) is a human oncogenic retrovirus being transmitted via cell-containing body fluids such as breast milk, blood, or semen. The estimated number of infected people is around 10 to 20 million. To study the viral distribution and persistence of HTLV-1 in different organs in the oropharyngeal and gastrointestinal tract, a suitable in vivo model is essential. In this study, tissues of non-human primates (NHPs, baboon: Papio anubis) naturally infected with the closely related simian counterpart of HTLV-1, simian T-lymphotropic virus type 1 (STLV-1), were analyzed for the presence or absence of the viral gene Tax. We identified the presence of STLV-1 Tax in the stomach, duodenum and Peyers patches by using two different detection methods: TaqMan-based qPCR and the more sensitive droplet digital PCR (ddPCR). Tax could be detected in tonsils in two NHPs only, but in stomach in four NHPs. Together, this is the first time that STLV-1 Tax was detected in stomach tissue of STLV-1-infected asymptomatic NHPs, highlighting the importance of investigating viral persistence and/or viral reservoirs of primate T-lymphotropic viruses independently of the entry route.

BackgroundStrategies to define human monocytes by flow cytometry vary considerably across studies. Recently, toll-like receptor 2 (TLR2) has been proposed as a marker to identify "all monocytes" in human peripheral blood. However, the TLR2-defined monocytes also contained a previously ignored TLR2posCD14dim/negCD16neg population, which we termed the unclassified subset (UCS). MethodsPeripheral blood mononuclear cells (PBMCs) from healthy donors and patients with multiple myeloma (MM) or monoclonal gammopathy of undetermined significance (MGUS) were analyzed by multiparameter flow cytometry using TLR2pos gating. PBMCs from additional healthy donors were analyzed to characterize the UCS population, including the impact of using either TLR2pos or a negative selection-based gating strategy. ResultsThe TLR2pos CD14dim/neg CD16neg UCS population was present in healthy controls, MGUS, and MM patients. The UCS expressed the monocyte-macrophage scavenger receptor CD163 and was significantly reduced in MM patients compared to healthy donors (P<0.002). Further phenotypic characterization in healthy blood donors revealed that approximately 80% of UCS cells expressed CD163 at levels comparable to classical monocytes, yet phenotypically resembled CD163pos dendritic cells (DCs). Importantly, gating strategies influenced the composition of the UCS: negative selection-based gating captured all DC subsets, whereas TLR2pos gating primarily included CD1cpos DCs that were highly CD163pos. ConclusionsThese findings demonstrate that circulating CD163pos CD1cpos DCs are included in the TLR2pos cell population previously described as exclusively monocytes, highlighting the impact of gating strategy on monocyte subset identification. Further, the lower level of TLR2pos CD14dim/neg CD16neg CD163pos cells in MM patients may represent decreased levels of circulating DCs that may contribute to the immune dysregulation in this disease.

Background: Chimeric Antigen Receptor (CAR) T-cell therapy has transformed the treatment of hematologic malignancies, yet, its broader clinical application often faces major challenges, including slow expansion rates, variable transduction efficiency, exhaustion, and functional heterogeneity. Recent studies have demonstrated that a Synthetic Immune Niche (SIN) composed of immobilized CCL21 and ICAM1 promotes the proliferation of murine and human T-cells while preserving their cytotoxic potency. In this study, we explored the capacity of immobilized CCL21 and ICAM1 to enhance the production of highly potent CAR T-cells by facilitating both their expansion and cytotoxic capacity. Methods: CD19-directed CAR T-cells were generated from PBMCs of healthy donors using a clinical-grade protocol. Following retroviral transduction, the cells were expanded on CCL21 and ICAM1 coated plates, or on uncoated control plates. The effects of the SIN treatment on CAR T-cell expansion, morphology, physical properties, phenotypic markers, and potency were systematically evaluated. Results: SIN exposure significantly enhanced CAR T-cell expansion, achieving a 9.3-fold higher total cell yield by day 13, compared with control cultures. This proliferative advantage persisted even after withdrawal of the cells from the synthetic niche on day 10. SIN stimulation preferentially expanded the CAR-transduced population, increasing CAR T-cell frequencies from 45.4% to 77.6%, resulting in a 14.6-fold increase in the absolute number of CAR T-cells compared with untreated cultures. Morphological and phenotypic analyses revealed distinct activated cell morphology, manifested by increased cell size, polarity and granularity, and elevated expression of the activation markers CD137 and CD69. Importantly, CAR T-cells transiently exposed to the SIN retained cytokine secretion and cytotoxic activity comparable to that of continuously SIN-treated cells, indicating that the SIN effect is persistent. Overall, SIN-conditioned CAR T-cells displayed robust antigen-dependent IFN-{gamma} secretion and cytotoxicity against CD19-expressing target cells. Conclusion: Stimulation of CAR T-cells with a synthetic immune niche consisting of immobilized CCL21 and ICAM1 enhances overall expansion while selectively enriching the CAR-transduced population, thereby substantially increasing both the number and prominence of therapeutically relevant CAR T-cells. This effect is accompanied by a persistent activation phenotype and high functional potency. We propose that incorporating SIN stimulation into CAR T-cell manufacturing represents a simple and scalable strategy for improving CAR T-cell yield while maintaining high cytotoxic efficacy.

Background: Transplant arterial injury is an underlying feature of acute organ transplant rejection and is a main cause of late heart transplant failure. The role of the gut microbiota, and especially specific microbial components of this community, in controlling immune responses that cause this aspect of rejection is poorly understood. Methods: We utilized a murine aortic interposition model of transplant arterial injury to investigate the role of the gut commensal bacteria, Akkermansia muciniphila, in controlling immune responses in transplant arteries. Results: Early life treatment of female mice with broad spectrum antibiotics, which delayed colonization of the intestinal tract with bacteria until after weaning, led to the development of dysbiosis in adults that was characterized by the absence of A. muciniphila. This was related to an elevation in systemic levels of CCL2 and a reduction in the immunomodulatory short-chain fatty acid, propionate. When transplant arterial injury was examined, there was more arterial injury indicative of acute rejection and increased intimal thickening reflective of transplant arteriosclerosis in grafts from dysbiotic mice compared to controls. Dysbiosis also increased macrophage accumulation early after transplantation in dysbiotic mice. Notably, restoring A. muciniphila in the gut microbiota of dysbiotic mice through voluntary oral administration in infants ameliorated macrophage-mediated transplant arterial injury. Conclusions: A. muciniphila is an immunomodulatory component of the gut microbiota that protects against vascular injury and pathology in organ transplantation.

Background: Recurrent ocular herpetic disease is a leading infectious cause of corneal blindness and is associated with psychological distress, anxiety, and social withdrawal. No ocular herpes vaccine or immunotherapy currently exists. Hypothesis: A prime/pull/keep (PPK) T-cell immunotherapy, built on HSV-1 epitopes preferentially recognized by CD8+/CD4+ T cells from naturally protected asymptomatic (ASYMP) individuals, would reduce viral reactivation, shedding, recurrent corneal disease, and associated neurobehavioral deficits. Methods: Immunodominant HLA-restricted CD8+/CD4+ epitopes from HSV-1 gD/gB, tegument proteins VP11/12/VP13/14, and helicase UL9 were delivered via topical ocular AAV8 vector (prime) to latently infected HLA-A*0201/DRB1 mice, combined with chemokine CXCL11 (pull) and IL-2/IL-15 cytokines to sustain TRM cells (keep), then UVB-exposed to trigger reactivation and recurrent corneal disease. Results: PPK immunotherapy conferred robust, near-complete protection against recurrent HSV-1 disease and improved survival after UVB-induced reactivation, unlike its individual components. This protection was associated with site-specific accumulation of HSV-1-specific CD8+/CD4+ TRM cells in the cornea and trigeminal ganglia (TG), but not in the spleen, with peak retention from combined IL-2/IL-15, alongside durable central/effector memory populations. PPK-induced T cells showed enhanced polyfunctionality (cytokine production, cytotoxicity, proliferation), reduced exhaustion markers, and a TCF-1+ self-renewing phenotype. PPK also elicited robust, Th1-biased HSV-1-specific IgG responses complementing mucosal immunity, and restored spatial memory, reduced depression-like behavior, and reversed social withdrawal in mice with recurrent ocular herpes. Conclusion: PPK immunotherapy induces potent, durable antiviral TRM cells at primary sites of HSV-1 latency and reactivation, protecting against recurrent ocular herpetic disease and alleviating associated neurobehavioral deficits, supporting its translational potential in humans.

RationaleNeurogenic inflammation is recognised as an important contributor to the pathophysiology of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). Substance P (Sub P), a neuropeptide released from sensory nerves, is a potent inducer of mast cell degranulation through the Mas-related G protein-coupled receptor member X2 (MRGPRX2), resulting in the release of pro-inflammatory mediators that perpetuate chronic bladder inflammation. Medihoney, a medical-grade M[a]nuka honey, possesses well-established antimicrobial and anti-inflammatory properties, and we have recently demonstrated its ability to stabilise mast cells through inhibition of histamine release. However, its effects on Sub P-induced mast cell activation and MRGPRX2-mediated neurogenic inflammation have not previously been investigated. Aim of the studyWe aimed to investigate the inhibitory effects of Medihoney and a sugar-free M[a]nuka honey extract on Substance P-induced mast cell degranulation and MRGPRX2 activation as potential therapeutic approaches for chronic neurogenic inflammation associated with IC/BPS. In addition, we examined the expression of MRGPRX2 in bladder biopsies from patients with IC/BPS. Materials and methodsHuman LAD2 mast cells were stimulated with Substance P (1 M) for 40 minutes following 20-minute pre-incubation with Medihoney or a sugar-free M[a]nuka honey extract. Mast cell degranulation was quantified by measuring {beta}-hexosaminidase release. MRGPRX2 activation was assessed by intracellular calcium imaging using Fluo-4 in MRGPRX2-expressing HEK-293 cells. Bladder biopsies obtained from patients with IC/BPS and healthy controls were immunostained for mast cell tryptase, chymase and MRGPRX2. ResultsMedihoney at 2% and 4% markedly inhibited Substance P-induced mast cell degranulation in LAD2 cells by approximately 90%, an effect that was similarly observed with the sugar-free M[a]nuka honey extract. Both preparations produced a dose-dependent inhibition of Substance P-induced intracellular signalling in MRGPRX2-expressing HEK-293 cells, demonstrating suppression of MRGPRX2 activation. Furthermore, immunohistochemical analysis of bladder biopsies revealed that approximately 66% of tryptase-positive mast cells expressed MRGPRX2 in patients with IC/BPS, which was significantly higher than that observed in healthy control tissues (25%). ConclusionThe present study demonstrates that mast cells within IC/BPS bladder tissue express increased levels of MRGPRX2, suggesting enhanced responsiveness to Substance P and supporting a role for neurogenic inflammation in the pathophysiology of IC/BPS. Medihoney and the sugar-free M[a]nuka honey extract significantly inhibit Substance P-induced mast cell degranulation through modulation of MRGPRX2-mediated intracellular signalling, highlighting their potential as novel therapeutic agents for reducing neurogenic bladder inflammation associated with IC/BPS. ImpactThis study provides evidence that MRGPRX2-mediated neurogenic mast cell activation is enhanced in IC/BPS and demonstrates, for the first time, that Medihoney and a sugar-free M[a]nuka honey extract effectively inhibit Substance P-induced mast cell degranulation through modulation of MRGPRX2 signalling. These findings provide new mechanistic insight into the anti-inflammatory actions of M[a]nuka honey-derived preparations and identify MRGPRX2 as a potential therapeutic target in IC/BPS. The observed inhibition of neurogenic mast cell activation suggests that these naturally derived preparations may offer a novel strategy for limiting chronic bladder inflammation. Overall, this work provides a foundation for future preclinical and clinical studies evaluating the safety and therapeutic efficacy of Medihoney and M[a]nuka honey-derived compounds in patients with IC/BPS.

RationaleMast degranulation is a driver of several pathologies. Several endogenous peptides have been established as stimulators of mast cell degranulation. Compounds that stabilise mast cells have in part demonstrated inhibitory effect on the inflammatory cascade. Manuka honey has been widely used for the treatments of various inflammatory diseases. However, its effect on A23187 (Calcium ionophore) stimulated mast cell degranulation, cytokine release and cellular signalling pathways has not yet been investigated. Aim of the studyWe aim to investigate the effect of Medical Grade Manuka Honey (MGMH) on A23187 induced mast cell degranulation, cytokine release and downstream signalling pathways in a human mast cell lines LAD2 model. Materials and methodsThe cytotoxic effect of MGMH on LAD2 cells was assessed using LDH assay. LAD2 cells were pre-incubated with MGMH and challenged with A23187.Mast cell degranulation was measured by {beta}-hexosaminidase release whilst histamine and cytokines released were measured by ELISA. The effect of MGMH on downstream signalling of Mitogen Activated Protein Kinase (MAPK) pathways was determined and quantified by SDS-PAGE western blotting. ResultsMGMH at 2% and 4% was well tolerated by LAD2 cells. MGMH at all concentrations tested significantly inhibited the A23187 triggered release of {beta}-hexosaminidase but failed to inhibit the release of histamine. MGMH 4% significantly inhibited the release of GM-CSF and IL-8. MGMH (2% and 4%) significantly down regulated the expression of both ERK I and ERK II. However, MGMH at all the doses tested had no effect on the expressions of JNK and p38. On the contrary, an increase expression of these p38 and JNK were noted with MGMH pre-incubation. ConclusionOur present study provides evidence that MGMH inhibition of A23187 stimulated degranulation of mast cells and cytokine release through down regulation of ERK I and II signalling. The results suggest potential use as a mast cell stabiliser and effective treatments of mast cell mediated inflammatory diseases. ImpactThis study provides the first evidence that Medical Grade Manuka Honey (MGMH) can attenuate A23187-induced mast cell activation and pro-inflammatory cytokine release in human LAD2 mast cells through modulation of ERK1/2 signalling pathways. The findings advance our understanding of the cellular and molecular mechanisms underlying the anti-inflammatory properties of Manuka honey. The demonstration that MGMH inhibits {beta}-hexosaminidase release suggests a mast cell-stabilising effect, highlighting its potential as a novel natural therapeutic agent for mast cell-mediated disorders, including allergic diseases, interstitial cystitis, asthma, chronic inflammatory skin conditions, and mast cell activation syndromes. The observed reduction in GM-CSF and IL-8 production further indicates that MGMH may help limit the amplification and persistence of inflammatory responses. Mechanistically, the selective downregulation of ERK1/2 signalling provides new insight into how MGMH exerts its biological effects and identifies a potential molecular target through which its anti-inflammatory activity is mediated. These findings contribute to the growing evidence base supporting the therapeutic value of Manuka honey beyond its established antimicrobial and wound-healing properties. Overall, this work lays the foundation for future preclinical and clinical studies investigating MGMH as a safe, naturally derived mast cell stabiliser and anti-inflammatory intervention, with potential applications across a broad spectrum of allergic and inflammatory diseases.

Background: Molecular markers and mediators of adverse post-hospital outcomes following critical illness remain incompletely characterized. Anemia and red blood cell (RBC) indices integrate inflammation, nutritional status, and hematopoietic function, and may represent biological processes that influence long-term outcomes. We therefore examined whether pre-discharge anemia and hematologic clusters derived from correlated RBC indices were associated with one-year mortality among critical illness survivors. Methods: We conducted an exploratory, retrospective cohort study of adult ICU patients discharged alive using MIMICIV. Pre-hospital discharge RBC indices (hemoglobin, red cell distribution width (RDW), mean corpuscular volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), and RBC count) were analyzed. Hemoglobin and anemia were first evaluated, followed by Gaussian mixture modeling of standardized RBC indices to identify patient clusters in a derivation cohort (70%) and validated findings in a held-out cohort (30%). Associations with one-year mortality were assessed using multivariable-adjusted Cox models. Results: Among 20,233 ICU survivors with available pre-discharge hemoglobin (median age, 67 years), based on the WHO definition of anemia, 17,247 (85.2%) critical illness survivors were anemic at hospital discharge. Anemia was associated with higher one-year mortality (adjusted HR 1.42, p<0.001). Mortality was 20% overall and decreased across increasing hemoglobin quartiles, from 28.8% to 12.5% (log-rank P<0.005); lower hemoglobin was associated with progressively higher adjusted one-year mortality risk. Six hematologic clusters derived from RBC indices were identified with one-year mortality ranging from 10.1% to 31.4% (log-rank p<0.005). Compared with the lowest-risk group, the cluster characterized by elevated RDW and MCV had a twofold higher adjusted mortality risk (HR 2.14; 95% CI, 1.81-2.53). Conclusion: Both anemia and hematologic clusters derived from standard RBC indices at hospital discharge are associated with one-year mortality following critical illness. These hypothesis-generating findings support further investigation of RBC indices as potential biomarkers for post-discharge risk stratification and of the underlying biological pathways as possible therapeutic targets.

Severe dengue can damage the liver through unestablished mechanisms. We investigated the role of myeloperoxidase (MPO), a neutrophil enzyme, in dengue through patients, fatal liver samples, and mouse infection models. Observations from two independent clinical cohorts revealed elevated plasma MPO levels in dengue and, in one cohort, MPO was further linked to liver injury markers during the critical phase of disease, whereas livers from dengue fatal cases revealed MPO build-up in the vicinity of CD177+ activated neutrophils. In mice, dengue led to MPO overexpression, oxidative damage, and broad activation of innate and systemic inflammatory pathways in livers. Blocking MPO activity alleviated these and improved survival in one model and delayed disease progression without preventing death in another. These findings establish MPO as a functional mediator of severe dengue-associated liver injury and inflammation, which warrants further preclinical investigation into its hepatic pathogenic mechanism and its validity as target for therapeutic intervention.

Adipose-derived mesenchymal stem cells (gAD-MSCs) are promising candidates for veterinary regenerative medicine, yet the characterization of gAD-MSCs from locally adapted Indonesian goat breeds remains limited. This study aimed to isolate and characterize gAD-MSCs from Peranakan Ettawa (PE) goats using tissue explant culture. Subcutaneous adipose tissue was collected from the base of the tail of healthy PE goats (n=3). Primary cell outgrowth from explants was observed by Day 5, displaying characteristic fibroblast-like, spindle-shaped morphology and strong plastic adherence. Serial passaging to Passage 3 (P3) yielded a morphologically stable, homogeneous cell population. Assessment of cellular metabolic activity via the resazurin assay demonstrated sustained cell viability and a statistically significant increase in metabolic activity between Day 3 and Day 5 (p < 0.05). Furthermore, functional clonogenic capacity, evaluated using the colony-forming unit (CFU) assay, showed continuous temporal expansion of colonies over 14 days, yielding an average of 52.0 + - 4.1 colonies per dish. These findings confirm that expanded gAD-MSCs P3from PE goats maintain characteristic mesenchymal morphology, sustained metabolic activity, and clonogenic capacity. This work provides a baseline cellular profile of PE goat gAD-MSCs, supporting their potential use in veterinary regenerative medicine and tissue engineering.