Juan Antonio Giménez-Scherer

Malformations in acardiac twins are consistent with reversed blood flow: liver as a clue to their pathogenesis.

Because of the uncertainty concerning the origin of the malformations in the acardiac twin, its structure was studied to see if the malformations were random or with a pattern related to the twinning process. Included were 18 cases of dysmorphic twins in which an autopsy demonstrated a rudimentary or absent heart, and in which some polarity was evident. The organs and long bones with alterations were tabulated according to the embryonal–fetal circulation of blood from and to the placenta. Malformations were more often encountered in the superior limbs and organs; the number of altered organs decreased in a cranio–caudal direction. The liver was the exception being affected in 89% of the cases vs. an average of 54% for the other abdominal organs. As the liver lies first in the circulatory path from the placenta to the fetus, the pattern of the malformations was in accordance with the “twin reversed arterial perfusion sequence” (TRAP). The more frequent absence of distal bones (P = 0.0007) is compatible with reduced perfusion in each limb. The malformations found in the acardiac twins involved brain, esophagus and trachea, liver, other abdominal organs, diaphragm, vertebrae, limbs, anus, and omphalocele; vascular disruption may be the common pathogenesis for the acardiac twins as well as other dysmorphic infants with similar anomalies.

Effect of the monocyte locomotion inhibitory factor (MLIF) produced by Entamoeba histolytica on the expression of cell adhesion molecules (CAMs) in the skin of guinea pigs.

Entamoeba histolytica synthesizes a heat-stable pentapeptide, originally identified by one of its effects on mononuclear phagocytes (MP) as a monocyte locomotion inhibitory factor (MLIF). In addition to several other in vitro measurable antiinflammatory actions, MLIF was also found in vivo to delay the arrival of the late mononuclear leukocyte component in Rebuck human skin windows (1), and to inhibit the 1-chloro-2-4-dinitrobenzene (DNCB) contact hypersensitivity skin reaction in guinea pigs, a predominantly late mononuclear leukocyte inflammatory animal model (2). To explore whether MLIF also affects the regulation of cell-adhesion molecules (CAMs), we chose to measure the monocyte integrin VLA-4 and its corresponding endothelial ligand, the Ig superfamily VCAM-1, an interaction couple essential for the rolling, adhesion, and eventual extravasation of monocytes (3,4) in the course of a DNCB contact hypersensitivity skin reaction in guinea pigs.

Immunization with a tetramer derivative of an anti‐inflammatory pentapeptide produced by Entamoeba histolytica protects gerbils (Meriones unguiculatus) against experimental amoebic abscess of the liver

Axenically grown Entamoeba histolytica produces a pentapeptide (Met‐Gln‐Cys‐Asn‐Ser) with several anti‐inflammatory properties, including the inhibition of human monocyte locomotion (Monocyte Locomotion Inhibitory Factor (MLIF)). A construct displays the same effects as the native material. It remains to be seen if MLIF is used, or even produced in vivo by the tissue‐invading parasite. If MLIF were to be relevant in invasive amoebiasis, immunizing against it could diminish this parasite advantage and prevent lesions. KLH‐linked MLIF mixed with Freunds adjuvant was too aggressive an immunizing material to answer this question. However, immunization with a tetramer of MLIF (but not a scrambled version of MLIF) around a lysine core (MLIF–MAPS), that displays increased antigenicity, yet lacks excessive innate immunity activation, completely protects gerbils against amoebic abscess of the liver caused by the intraportal injection of virulent E. histolytica. Liver abscesses caused by Listeria monocytogenes were not prevented. Invasive E. histolytica may produce the parent protein of MLIF in vivo, and if appropriately cleaved, it may play a role in invasive amoebiasis. MLIF may join new vaccination strategies against amoebiasis.

Fetal Amniotic Adhesions. Their Topographic Concordance with Regionally Clustered Malformations

BACKGROUND The amniotic band disruption complex (ABDC) has been segregated recently into various phenotypes. In view of the pathogenic mechanisms that have been proposed, this study was designed to assess if it is one variable process or is composed of several distinct complexes. METHODS The 48 cases of fetuses with bands or placenta attached to fetal parts cited in this paper included nine new cases and 39 from the literature. They were organized first according to the embryonal topography of the malformations, then according to the position of the adhesions, and finally by the assessment of distances between the cases and between the malformations using the squared Euclidean distances for binary variables and cluster analysis. RESULTS In all three analyses, three groups were identified: 1) fetuses with cephalo-thoracic anomalies; 2) fetuses with caudal anomalies, and 3) fetuses with mixed anomalies. Nonetheless, overlap among the three groups was apparent. Thus, while fetuses with amniotic bands form three clusters, it appears that these are part of a spectrum and should be considered as variable manifestations of a single entity resulting from a single pathogenetic mechanism. An association was established between the localization of the adhesions and the malformations in various axes. Abdominoschisis, however, was not particularly related to adhesions at one or the other end of the fetus; a short umbilical cord was an almost universal finding. Single umbilical artery (SUA) was especially related to caudal adhesions and malformations (p = 0.004 and 0.001), as well as abdominoschisis (p = 0.002) and agenesis of the abdominal organs (p = 0.008). CONCLUSIONS The association between amniotic adhesions to the fetus and multiple malformations occurring predominantly in the same area suggest that the former are the cause of the latter. The association of abdominoschisis, as well as a short umbilical cord, with malformations and adhesions in all areas, suggests that these are secondary phenomena to generalized embryonal and fetal tension. SUA, however, with a specifically regional association, is more likely to be due to disruption from exposure in cases with abdominoschisis, often accompanying the loss of abdominal organs.

The Cys-Asn-Ser carboxyl-terminal end group is the pharmacophore of the amebic anti-inflammatory monocyte locomotion inhibitory factor (MLIF)

The monocyte locomotion inhibitory factor (MLIF) is an anti-inflammatory oligopeptide produced by Entamoeba histolytica. Among its different effects, it inhibits locomotion of human monocytes, hence its original name. Previous experimental studies have shown that the anti-inflammatory properties of MLIF (Met-Gln-Cys-Asn-Ser) remained when aminoacid glutamine was substituted by a proline in the second position (pMLIF: Met-Pro-Cys-Asn-Ser). By changing the order of MLIF amino acids, the resulting scrambled oligopeptide (sMLIF: Gln-Cys-Met-Ser-Asn) has failed activity. By means of ab initio study at the Hartree-Fock and Density Functional Theory levels, it was found that MLIF and pMLIF peptides maintain a great structural similarity among the last three amino acids (...Cys-Asn-Ser) predicting a pharmacophore. The objective of this work was to experimentally verify in vivo and in vitro the existence of the pharmacophore group in MLIF. We assayed three tripeptides by respiratory burst and delayed hypersensitivity skin reactions. The tripeptide Cys-Asn-Ser carboxyl-terminal end group maintained 100% of its biological properties, as well as the anti-inflammatory activity of MLIF, while the other tripeptides tested did not do that.

Effect of the monocyte locomotion inhibitory factor (MLIF) produced by E. histolityca on cytokines and chemokine receptors in T CD4+ lymphocytes.

Entamoeba histolytica produces Monocyte Locomotion Inhibitory Factor (MLIF), which may contribute to the delayed inflammation observed in amoebic hepatic abscesses. Leukocytes are affected through the modulation of cytokine expression and/or production. We evaluated the effects of MLIF on the activation and production of intracellular cytokines in human CD4+ T lymphocytes by flow cytometry. Cells were stimulated for 24 h with PMA, MLIF, or PMA+MLIF. Cellular activation was measured using anti-CD69. Th1/Th2 production was studied by the expression of intracellular cytokines and cytokine/chemokine receptors. MLIF increased CD69 and induced the over-expression of the IL-lss, IFN-gamma, IL-2, IL-4, and IL-10 intracellular cytokines; PMA+MLIF inhibited Th1 cytokine (IFN-gamma) and increased Th2 cytokines (IL-4 and IL-10). The co-expression of the cytokine and chemokine receptors IFN-gamma/CCR5 and IL-1ss/CCR5 was inhibited by PMA+MLIF and Th2 co-expression was increased. MLIF effects varied depending on the conditions. MLIF alone activated the Th1 and Th2 cytokines and cytokine/receptor expression; however, PMA+MLIF increased the expression of Th2 but inhibited it in Th1.

Abdominal wall defects: autopsy findings of distinct groups suggest different pathogenetic mechanisms.

Central and lateral abdominal wall defects are probably distinct and likely arise from different pathogenetic mechanisms. An autopsy study was done using data from a total of 45 central and lateral abdominal wall defect cases to evaluate if they are indeed separate entities and to suggest possible mechanisms involved in their formation. Central defects were found to be statistically different from lateral defects; malformations that co-existed with central defects were mainly bilateral and internal and also involved “inferior” organs in relation to fetal-embryonal blood flow. Patients with lateral defects were more often female, and their coexistent defects were usually unilateral and external, with only 1 defect occurring in an “inferior” organ. These results indicate mechanisms of a vascular perfusion deficit for the majority of the central defects and of external disruption for the lateral defects.

Computational study of the electronic structure characterization of a novel anti-inflammatory tripeptide derived from monocyte locomotion inhibitory factor (MLIF)-pentapeptide

The structure and properties of molecules are determined by their charge-density distribution. Several works have shown that electron delocalization along the peptide backbone and side-chain modulates the physical and chemical features of peptides and protein properties. Research on Entamoeba histolytica-soluble factors led to the identification of the pentapeptide Met-Gln-Cys-Asn-Ser, with anti-inflammatory in vivo and in vitro effects. A synthetic pentapeptide, Met-Pro-Cys-Asn-Ser, maintained the same anti-inflammatory actions in experimental assays. A previous theoretical study allowed proposing the Cys-Asn-Ser tripeptide (CNS tripeptide) as the pharmacophore group of both molecules. This theoretical hypothesis was recently confirmed experimentally. The aim of this study was to characterize the electronic structure and physico-chemical properties of the CNS tripeptide through a theoretical study at the second-order Møller-Plesset perturbation theory (MP2) and density functional theory (DFT) theoretical levels. Our results in deprotonation energies show that the hydrogen atom (H2) of the serine-amide group possesses acidic characteristics. This result was confirmed by means of a study of bond order. Atomic charges, dipole moment, frontier molecular orbitals (Highest occupied molecular orbital [HOMO-1] and Lowest unoccupied molecular orbital [LUMO+1]), and electrostatic potential isosurface and its geometric parameters permitted to characterize its electronic structure and physico-chemical features and to identify some reactive sites that could be associated with this tripeptides anti-inflammatory activity.

COMPARISON OF THE AMNIOTIC BAND DISRUPTION COMPLEX WITH ACARDIAC TWINS DOES NOT SUPPORT ITS VASCULAR ORIGIN

The amniotic band disruption complex (ABDC) has been attributed to vascular disruption by some authors, not by others. Acardiac twins (ATs), however, have been generally accepted as a prime example of vascular disruption. In this study a comparison was made of these two entities to determine if they were similar or not, and thus we attempted to resolve the controversy of the mechanisms in the ABDC. A female tendency (2:1) was found in the ABDC in contrast to the “normal” sex distribution (0.88:1) in the ATs (p < 0.001). Most types of malformations (66%) were mutually exclusive, notably those of the cranium/brain, abdominal wall, and most internal organs; 83% were more significantly related to one or other of the entities. The ABDC malformations tended to occur unilaterally, but in the ATs they occurred bilaterally (p < 0.0001); the former tended to involve external organs and the latter internal organs (p < 0.0001). With so many differences, the two entities are unlikely due to the same mechanism: the ABDC is more likely to be due to external disruption.

Two Major Patterns of Nongenetic Malformations Are Found at Autopsy

Patterns of malformations seen in autopsies may contribute to the understanding of their pathogenetic mechanisms. Two entities, acardiac twins (ATs) and amniotic band disruption complex (ABDC), have distinct patterns, indicating different mechanisms, namely vascular perfusion deficit and external disruption. With ATs and ABDC as model groups, this study was undertaken to see if other dysmorphic infants with the characteristic defects of these models formed distinct and numerically important groups. A total of 192 autopsies with nongenetic malformations was divided into groups including (1) those with defects found in the ATs but not in the ABDC, (2) those with defects found only in the ABDC, and (3) those with a mixture of exclusive defects from each model group. The cases followed the characteristic defects of ATs or ABDC in 20% (group 1) and 28% (group 2), respectively, forming 2 large and distinct groups; only 4% had mixed malformations (group 3). Group 1 had different characteristics from group 2 as a result of the frequent multiple malformations, often with congenital heart defects (CHDs), internal and inferior malformations. These cases were probably related to a vascular perfusion deficit. Group 2 had a majority of females and single, external, and superior defects, but it lacked CHDs and inferior malformations. These cases were likely due to external disruption. Two large and distinct groups of autopsies with nongenetic malformations were thus identified, and their mechanisms are proposed to be similar to those of the model groups.