Etiketter

onsdag 10 oktober 2018

Legionellan effektoriproteiini AnkB vaatii isäntäsolulta FIH/ asparaginyylihydroksylaation

https://www.karger.com/Article/Pdf/235770


LÄHDE:
 Front Cell Infect Microbiol. 2017 Mar 6;7:54. doi: 10.3389/fcimb.2017.00054. eCollection 2017.
Host FIH-Mediated Asparaginyl Hydroxylation of Translocated Legionella pneumophila Effectors.
Abstraktin suomennos.
FIH-välitteinen posttranslationaalinen modifikaatio Asn--hydroxylaatiolla   merkitsee eukaryoottisille proteiiniella  proteiini-proteiini-interaktiossa olennaista seikkaa. 
Yhdestätoista Legionella pneumophilasta (siis  sen translokoituneista effektoreista)  on identifioitu  FIH-tunnistusmotiivi , yersiniasta YopM, Shigellasta IpaH4.5 ja Ricketssiasta  ankyriiniproteiini.
Massapsketromeriset analyysit L. opneumophilan AnkB ja AnkH effektoriproteiinista vahvastiaa  , että niisä on tapahtunut asparainyylihydroksylaatio. 
AnkB.effektoria  lokalisoituu  Lpn -bakteeria sisältävään LCV  vakuoliin ja  se osoittautuu FIH-modifiaation saaneeksi.  Isäntäsolun proteiineista sen kanssa interaktion tekevät  Mint2 ja MT1-MMP, joita  legionellaa sisältävä vakuoli (LCV) vaatii  Dot/Icm tyyppi IV-sekreetiosta riippuvalla tavalla. 
Jos estetään  FHI kemiallisesti  tai  RNAi-välitteisellä FHI poistogeenisyydellä , legionella pneumophilan  intravakuolaarinen replikaatio kumoutuu.  Nämä tiedot osoittavat, että   patogeenia sisältävä vakuoli hankkii isäntäkehosta FIH ja että  asparaginyylihydroksylaatio on  välttämätön  translokoituneille efektoriproteiineille , jota ne voisivat  olla funktionaalisia.

  • Abstract
  • FIH-mediated post-translational modification through asparaginyl hydroxylation of eukaryotic proteins impacts regulation of protein-protein interaction.   We have identified the FIH recognition motif in 11 Legionella pneumophila translocated effectors, YopM of Yersinia, IpaH4.5 of Shigella and an ankyrin protein of Rickettsia. Mass spectrometry analyses of the AnkB and AnkH effectors of L. pneumophila confirm their asparaginyl hydroxylation. Consistent with localization of the AnkB effector to the Legionella-containing vacuole (LCV) membrane and its modification by FIH, our data show that FIH and its two interacting proteins, Mint3 and MT1-MMP are acquired by the LCV in a Dot/Icm type IV secretion-dependent manner. 
    Chemical inhibition or RNAi-mediated knockdown of FIH promotes LCV-lysosomes fusion, diminishes decoration of the LCV with polyubiquitinated proteins, and abolishes intra-vacuolar replication of L. pneumophila. These data show acquisition of the host FIH by a pathogen-containing vacuole and that asparaginyl-hydroxylation of translocated effectors is indispensable for their function.KEYWORDS: AnkB; Dot/Icm; FIH; Legionella; ankyrin; asparagine hydroxylation; bacterial pathogenesis; hypoxia-inducible factor (HIF).


    Mikä on FIH-välitteinen posttranslationaalinen modifikaatio asn-hydroksylaatiolla?

    https://www.frontiersin.org/articles/10.3389/fcimb.2017.00054/full
    ---Citate:
    Although intracellular bacterial pathogens have been shown to exploit various host post-translational machineries, their exploitation of the host asparaginyl hydroxylation post-translational modification has never been described. The 2-oxoglutarate dioxygenase, designated as factor inhibiting HIF1 (FIH), is a key eukaryotic enzyme, which selectively hydroxylates an asparagine residue within the L(X)5[D/E]φNφ motif (φ represents aliphatic amino acids) in eukaryotic proteins (Hewitson et al., 2002; Lando et al., 2002a,b; Cockman et al., 2009). The addition of the strongly electronegative oxygen atom increases both polarity of a protein and can act as a hydrogen bond donor and acceptor. Therefore, hydroxylation can function as a “molecular switch” for protein-protein interactions (Loenarz and Schofield, 2011). FIH plays a key role in various cellular processes and in particular, it regulates the activity of hypoxia-inducible factor (HIF1), which is the master transcriptional regulator of hypoxia (Webb et al., 2009). During normoxia, HIF1 is hydroxylated by FIH on an asparagine residue and this modification acts as a molecular switch to prevent interaction with its co-activator p300/CBP, blocking transcription of hundreds of HIF1-regulated genes involved in oxygen  homeostasis, energy production and immune responses (Hewitson et al., 2002; Lando et al., 2002a,b). In addition, FIH catalyzes asparaginyl hydroxylation of approximately 20 ankyrin repeat domain-containing (ARD) proteins such as p105 and IκBα (Cockman et al., 2009). FIH-dependent hydroxylation of the ARD protein, ASPP2, is required for binding of this protein to its target Par-3 (Janke et al., 2013). Therefore, asparaginyl hydroxylation acts as a molecular switch to promote or reduce protein-protein interactions between HIF1-p300/CBP and ASPP2-Par3 (Hewitson et al., 2002; Lando et al., 2002a,b; Janke et al., 2013). Additionally, FIH hydroxylates the deubiquitinase OTUB, which appears to regulate cellular metabolism (Scholz et al., 2016). A recent study has revealed a complex FIH interactome with many proteins that may serve as substrates for FIH enzyme activity, thus greatly expanding the number of eukaryotic proteins modified by asparaginyl hydroxylation (Rodriguez et al., 2016). However, the biological consequence of asparaginyl hydroxylation of eukaryotic proteins largely remains unclear.

    When L. pneumophila invades amoebae or human macrophages, it evades the default endosomal-lysosomal degradation pathway and remodels its phagosome into a specialized ER-derived vacuole via intercepting ER-to-golgi vesicular traffic (Isberg et al., 2009; Al-Quadan et al., 2012; Price et al., 2014). This is achieved by the translocation of ~300 effector proteins via the Dot/Icm type IVB secretion system T4SS (de Felipe et al., 2008; Isberg et al., 2009; Zhu et al., 2011). These effectors modulate a myriad of eukaryotic processes including host signaling, vesicular trafficking, protein synthesis, apoptosis, prenylation, ubiquitination, and proteasomal degradation (Al-Quadan et al., 2012; Price et al., 2014). Surprisingly, very few of these effectors are essential for intracellular replication of L. pneumophila, suggesting specific requirements for different effectors in different environmental hosts.

    The AnkB translocated effector is essential for proliferation of L. pneumophila within the two evolutionarily-distant hosts, mammalian and protozoan cells, and for intrapulmonary bacterial proliferation and manifestation of pulmonary disease in the mouse model (Al-Khodor et al., 2008; Price et al., 2009, 2010a,b, 2011; Lomma et al., 2010). Recent characterization of the crystal structure of AnkB has confirmed that it is a non-canonical F-box protein with three ankyrins repeats domain (Price et al., 2009; Lomma et al., 2010; Wong et al., 2017). The crystal structure has also confirmed that the F-box domain of AnkB interacts with the host SCF1 ubiquitin ligase, which explains show AnkB functions as a platform for the docking of polyubiquitinated proteins to the Legionella-containing vacuolar (LCV) membrane within macrophages and amoebae (Price et al., 2009; Lomma et al., 2010; Wong et al., 2017). The AnkB-assembled polyubiquitinated proteins are predominately Lys48-linked that are ultimately degraded by the host proteasome machinery, which generates higher levels of cellular amino acids that are the main sources of carbon and energy to power replication of L. pneumophila (Price et al., 2011). This enables intracellular bacteria to overcome host limitation of essential nutrients and favorable sources of carbon and energy, such as amino acids (Price et al., 2011; Abu Kwaik and Bumann, 2013).

    • ( Tässä johdetaan solussa  hajoitettavaksi tuomitut eli K48 polyubikitinoidut jäteproteiinit LCV vakuoliin, jossa  Legionella käyttää niiden aineksen  replikaatioon tarvittavana ravintona- asiaa ei  solu varmaan pysty "huomaamaan").

    Here we show that 11 L. pneumophila type IVB-translocated effectors including, AnkB and AnkH, harbor the recognition motif for FIH-dependent asparaginyl-hydroxylation. Furthermore, the FIH recognition motif is found in translocated effectors from other intracellular microbial pathogens including YopM from Yersinia pestis, IpaH4.5 of Shigella flexneri and a putative translocated ARD-protein of Rickettsia felis. We show that the AnkH and AnkB effectors are modified by asparaginyl hydroxylation. The LCV recruits FIH, which is indispensable for intra-vacuolar proliferation of L. pneumophila and plays a partial role in the ability of the LCV to evade lysosomal fusion and is needed for AnkB-dependent assembly of polyubiquitinated proteins on the LCV. This is the first example of an injected microbial effectors post-translationally modified by asparaginyl hydroxylation.

    Acquisition of FIH, Mint3, and MT1-MMP by the LCV

    The AnkB effector is localized to the LCV membrane through host-mediated farnesylation (Price et al., 2010b). In addition, the effectors LepB, SdeC, and SdcA which are potential candidates for FIH-mediated asparaginyl hydroxylation are also LCV-localized (Chen et al., 2004, 2007; Luo and Isberg, 2004; Bardill et al., 2005; Ingmundson et al., 2007; Tan et al., 2011). Since FIH is a cytosolic enzyme that can be sequestered to membranous structures such as the Golgi apparatus through interaction with Mint3 and MT1-MMP in macrophages (Sakamoto and Seiki, 2009, 2010) and the LCV intercepts ER-Golgi vesicular traffic (Isberg et al., 2009; Al-Quadan et al., 2012; Price et al., 2014), we determined if FIH and its two interacting partners (Mint3 and MT1-MMP) were recruited to the LCV within hMDMs. 
    The data showed that by 2 h of infection, 75, 65, and 56% of the LCVs harboring wild type bacteria co-localized with FIH, Mint3, and MT1-MMP, respectively (Figures 2A–D). In contrast, only 27, 18.2, and 0% of the LCVs harboring the dotA translocation-deficient mutant co-localized with FIH, Mint3, and MT1-MMP, respectively (Figures 2A–D) and this was significantly reduced relative to co-localization observed for wild type LCVs (unpaired t-test, p < 0.01). This indicates recruitment of these proteins to the LCV is dependent on the Dot/Icm T4SS apparatus.

    •  Jotta tämä F1H funktio saataisiin pyydystettyä LCV vakuoleihin,   legionella  T5SS systeemin on rekrytoitava myös Mint3 ja MT1-MMP, koska F1H on sytosolinen  entsyymi ja  näiden toisten tekijöiden avulla se saadaan saostumaan kalvoihin kuten ER-Golgi, jolloin  se on legionellan tarpeisiin saatavissa ja sijoitettavissa LCV vakuoleihin.

    ---- Some citates from the article : 
    AnkB plays a central role for L. pneumophila by promoting the degradation of polyubiquitinated proteins which allows this organism to access essential amino acids that are used for both energy and a carbon source (Price et al., 2009, 2011). Substitution of the three hydroxylated asparagine residues significantly impacts the ability of AnkB to recruit polyubiquitinated proteins to the LCV and concomitantly fails to restore intra-vacuolar replication of an ankB mutant strain of L. pneumophila.
    -----
    Furthermore, blocking host FIH activity results in a similar phenotype to the AnkB substitutions, and taken together suggests that asparaginyl hydroxylation of AnkB contributes to the function of this effector.
     Blocking FIH activity results in a dose-dependent inhibition of intra-vacuolar replication of L. pneumophila. Interestingly however, only ~55% of LCVs trafficked to a lysosomal compartment, indicating that the FIH-mediated block in intra-vacuolar replication of L. pneumophila has both lysosomal evasion-independent and -dependent mechanisms.
    -----
    Both AnkB and AnkH are needed for intra-vacuolar proliferation of L. pneumophila but neither impacts the normal trafficking and biogenesis of the LCV (Al-Khodor et al., 2008; Habyarimana et al., 2008, 2010; Price et al., 2009, 2010a,b, 2011; Lomma et al., 2010).
    ------
     The lysosomal evasion-dependent mechanism may involve both injected effectors, though no single injected effector to date has been shown to be required for the ability of the LCV to evade the lysosomes (de Felipe et al., 2008; Isberg et al., 2009; Zhu et al., 2011).
    -----
    Mint3
      In macrophages, membrane-associated FIH is inactive, at least in terms of HIF1 hydroxylation activity, but through its binding to Mint3 it enables HIF1 to promote transcription of glycolytic genes that are needed by the macrophage to generate ATP (Sakamoto and Seiki, 2009, 2010).
     ------
     L. pneumophila uses host amino acids as the primary source of carbon and energy by AnkB-dependent proteasomal degradation, but exogenous pyruvate alone can compensate for proteasomal degradation to enable intra-vacuolar replication of L. pneumophila (Price et al., 2011). This indicates that host pyruvate is an additional metabolite scavenged by intra-vacuolar L. pneumophila. Therefore, a consequence of FIH recruitment to the LCV may be increased HIF1 activity, which will ultimately increase availability of pyruvate that the bacteria can scavenge from the intracellular environment to use as an energy source and building block of macromolecules.
     ---

    Original Research ARTICLE

    Front. Cell. Infect. Microbiol., 06 March 2017 | https://doi.org/10.3389/fcimb.2017.00054

tisdag 4 september 2018

Ruotsin Kolmården Tropicarium esittää myös mamboja

http://www.tropicarium.se/visa_djur/?id=189
Jos mamboja on eläintarhasas, lie lähistössä (Tukholmasssa)  aina saatavilla  vastaseerumia mahdollisille  käärmeenpuremille, joita voi työtapaturmana tulla, arvelen.  

Katsauksia mamban pureman biologiasta ja hoidosta

 1996
https://www.wemjournal.org/article/S1080-6032(96)71002-5/pdf

2017 Sveitsi,  A case report
https://www.hindawi.com/journals/cricc/2017/5021924/
 Abstract

Mambas (genus Dendroaspis) are among the most feared venomous African snakes. Without medical treatment, mamba bites are frequently fatal. First-aid treatment includes lymphatic retardation with the pressure immobilization technique. Medical management comprises continuous monitoring, securing patency of the airway, ensuring adequate ventilation, symptomatic measures, and administration of specific antivenin. We report an unusual case of a snake breeder bitten by a black mamba in Switzerland, report the clinical course, and review the lifesaving emergency management of mamba bites. This case highlights the importance of early antivenin administration and suggests that emergency and critical care physicians as well as first responders all around the world should be familiar with clinical toxinology of exotic snake bites as well as with the logistics to most rapidly make the specific antivenin available.

“The snake bites the tamer first.”
Romanian Proverb.
 1. Introduction

Dendroaspis polylepis (black mamba) is one of the most dangerous snakes worldwide. Without medical treatment, mamba bites are frequently fatal [1]. As mamba bites are rare in Europe [2–5] treatment can be challenging, particularly if rapid administration of antivenin fails [6]. We report the case of a Swiss snake breeder who was bitten by a black mamba, report the typical clinical course, and review the management of neurotoxic snake bites.
2. Case Presentation

Written informed consent for publication was obtained from the patient.

While feeding a 5-year-old male black mamba, a 34-year-old snake breeder suddenly noticed a tiny bloody mark on his forearm and, at the same time, a slight tingling of his lips. He immediately realized that he had been bitten and called a befriended snake expert to seek advice. The patient was thus able to provide the first responders with detailed information about the snake and on where to obtain the corresponding antivenin. He instructed his wife to apply a pressure bandage to the forearm. Within the next five minutes, chest tightness, generalized paresthesia, and fasciculation occurred. Upon arrival of the ambulance, the patient was unable to walk, was tachypneic, and had prominent dysarthria. Assuming a concomitant allergic reaction, the paramedics administered methylprednisolone, clemastine, and adrenaline before transferring the patient to the nearest hospital. In the meantime, the Swiss helicopter ambulance collected the antivenin from one of the 8 national antivenin depots.

Forty minutes after the bite, the patient arrived in the emergency department, complaining of worsening fasciculations and paresthesia affecting the extremities and the face. On physical examination, he was fully conscious with a heart rate of 105/min and a blood pressure of 165/80 mmHg. He was tachypneic at 30/min. Pulse oximetry revealed an oxygen saturation of 95% on room air. There were two tiny puncture wounds with local swelling and redness on the left forearm. Motor function was normal, except for mild ptosis. Seventy minutes after the bite, the patient was given 2 vials (20 ml) of “SAMIR Polyvalent Snake Antivenin” together with 2.5 mg of IV midazolam for ongoing hyperventilation. Thereafter, the patient was transferred to our tertiary intensive care unit for further treatment.

Upon arrival in our ICU, the patient was hemodynamically stable but still tachycardic and tachypneic. Fasciculations, dysarthria, and ptosis had slightly improved. ECG showed a grade 1 atrioventricular block without any other abnormalities. Initial laboratory tests were unremarkable, apart from moderate respiratory alkalosis. Over the next few hours, sweating, chills, and difficulty with swallowing as well as nausea occurred. However, the airway was never compromised, coughing reflex was intact, and respiratory failure did not occur. Therefore, and because of initial concerns about a possible allergic reaction, we decided against further antivenin administration. On the next day, symptoms of envenomation had improved, but the patient developed cellulitis of the bitten forearm and rhabdomyolysis, with a peak serum creatine kinase level of 16,049 U/L. Upon treatment with intravenous fluids and amoxicillin/sulbactam, his condition gradually improved. After four days in the hospital, he was discharged home with muscular pain as the only residual symptom. A few weeks later, the patient had fully recovered.
3. Discussion

Snake bites by Dendroaspis are rare in Europe. In 1987 Markwalder and Koller [2] described two cases of bites by Dendroaspis viridis (the green mamba). In France, one victim survived a green mamba bite although administration of antivenin failed [6]. Bites by black mambas have been reported in Germany [3] and in the Czech Republic [4]. To our knowledge, our case is the third registered black mamba bite in Switzerland and the first to be published.

The venom of black mambas is highly neurotoxic and contains a combination of α-neurotoxins, which induce postsynaptic blockade of the neuromuscular junctions, and dendrotoxins, which inhibit the voltage-dependent potassium channels, enhancing the release of acetylcholine at the neuromuscular junction, thus producing a neuromuscular block similar to a depolarizing block [7, 8]. In contrast, fasciculins act as acetylcholinesterase inhibitors, thus increasing the availability of acetylcholine at the neuromuscular junction and producing generalized, long-lasting fasciculations [9]. Calciseptine, another venom component, inhibits smooth muscle contraction and cardiac function by blocking L-type calcium channels [10]. The venom does not usually cause tissue destruction and necrosis [11, 12] as it lacks significant protease activity [13], although it does contain low percentages of other proteins, such as metalloproteinases (MMPs) , hyaluronidase, prokineticin, nerve growth factor (NGF), vascular endothelial growth factor (VEGF), phospholipase A2 (PLA2) , 5′-nucleotidase, and phosphodiesterase (PDE) [7].

After a mamba bite, symptoms can occur as quickly as within 10 minutes [13]. A tingling sensation at the site of the bite may be the only initial sign of envenomation [14]. Other neurological symptoms include miosis, ptosis, blurred vision, bulbar symptoms, paresthesia, fasciculations, ataxia, and loss of consciousness. General signs of envenomation may include local pain, nausea, cough, and profuse sweating from asympthetic overstimulation. In severe cases, intubation, mechanical ventilation, and circulatory support may be necessary [4].

First-aid management includes reassuring the patient, removing constricting jewelry, and lymphatic retardation with pressure immobilization technique. Multiple bites are common, as mambas can strike repeatedly. A bandage is wrapped starting proximal to the bite site, just above the fingers or toes, and should cover the entire limb. Subsequent immobilization by a splint is recommended [15]. The bandage is not removed until administration of antivenin [16]. A tourniquet is not recommended.

The cornerstone of medical management is ensuring patent airway and adequate ventilation, providing circulatory support when necessary, and intravenous administration of specific antivenin [17]. Antivenin treatment should be considered whenever mamba envenomation is diagnosed by the presence of the systemic or neurological signs described above. Absence of fang marks does not preclude envenomation. On the other hand, presence of fang (myrkkyhammas) marks does not confirm it, since dry bites may occur. The recommended initial dose of SAIMR polyvalent antiserum is 20 ml (2 vials) [18]. Additional antivenin (up to five times the initial dose) should be titrated against the signs and symptoms of envenomation. Antivenin treatment is effective even when neurotoxic effects have become quite pronounced [19]. Therefore, there is no upper time limit for antivenin administration [20].

Antivenin therapy is not without risks. IgE-mediated allergic reactions including frank anaphylaxis can occur either to the antivenin or to the venom itself [21]. Delayed reactions (within 6–21 days after exposure) do occur, such as urticaria and serum sickness disease [22]. However, given the poor prognosis of an untreated mamba bite, even an anaphylactic response does not represent a contraindication to antivenin administration. In such cases, antivenin infusion should be temporarily discontinued and the patient should be stabilized before the antivenin infusion is resumed at a slower rate. An intravenous test dose of 1 ml diluted in 9 ml normal saline may be used in patients at high risk of allergic reactions. Limited evidence supports the use of prophylactic epinephrine prior to the administration of antivenins [23, 24]. There is no evidence for pretreatment with either antihistamines or corticosteroids [25, 26].

In our patient, fasciculation, muscle contractions, bulbar paralysis, and rhabdomyolysis were the main clinical symptoms. Respiratory failure did not occur for three possible reasons. First reason is the patient’s immediate recognition of the bite and exemplary first-aid response, including pressure bandage and physical rest. Second, although the venom metering hypothesis is controversial [27] the amount of venom injected was probably submaximal as the bite was most likely defensive. Third, the rapid availability of antivenin prevented further deterioration, especially respiratory failure. However, the clinical course probably would have been more severe, if the patient himself had not reacted so swiftly. Our report highlights the importance of early antivenin administration. Emergency and critical care physicians as well as first responders around the world should, therefore, be familiar with clinical toxinology of snake bites and with the logistics to most rapidly make the specific antivenin available.
Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.
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Vihreä tai musta mamba purrut Landvetterissä miestä

Vastamyrkkyä ei Sahlgrensskassa juuri tätä kärmelajia kothaan, joten  sitä kiikutettiin Tukholmasta.
Green mamba venom
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Vanzolini KL, Ainsworth S, Bruyneel B, Herzig V, Seraus MGL, Somsen GW, Casewell NR, Cass QB, Kool J.
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torsdag 9 augusti 2018

9 vuotiaan tytön kyynpurematapaus Suomessa 13.7.18.

https://www.facebook.com/notes/tyks-medisiininen-toimialue/kyyn-purema-potilasohje/364523417388557/?fref=mentions

Kyykäärmeen tunnistaa selän tummasta sahalaitakuviosta ja se on ainut myrkyllinen käärmelaji Suomessa. Yleensä kyy pakenee ihmistä, mutta uhattuna saattaa myös purra. Pistojälki on tyypillisesti kaksi 3-4mm:n etäisyydellä toisistaan olevaa pientä reikää. Kyyn puremasta aiheutuu paikallisia oireita noin kolmelle neljästä ja vakavampia oireita yhdelle neljästä. Kaikki kyyn puremat vaativat lääkärin arvion. Sairaalahoitoa vaativia riskiryhmiä ovat lapset, iäkkäät, ja raskaana olevat.
Puremasta aiheutuvia oireita ovat: -punoitus ja turvotus purema-alueella -hengenahdistus ja kurkunpään turvotus -hikoilu ja ripuli -päänsärky sekä tajunnan häiriöt - myöhäisoireina voi ilmaantua raajojen tuntohäiriöitä, paikallisia rakkuloita ja pidempään kestäviä ihon värimuutoksia 
 Kyyn purressa muista seuraavat ohjeet: - rauhoittele pureman uhria - älä koske tai käsittele purema-aluetta - jos pisto raajassa, laita kohoasentoon turvotuksen estämiseksi - piston uhrin ei tule käyttää raajaa ja lihastyötä on vältettävä, joten lastoita raaja ja mahdollisuuksien mukaan kanna piston uhri pois paikalta - jos hoitoon pitkämatka (tunteja), lievän puristussiteen käyttö voi hidastaa myrkyn etenemistä, avaa kuitenkin sidettä tunnin välein 5 minuutiksi - kyytabletin voi ottaa kyypakkauksen ohjeen mukaan, kyypakkauksesta (hydrokortisoni) antamisesta ei ole todistettavasti hyötyä, muttei haittaakaan - älä anna tulehduskipulääkettä Sairaalahoito käsittää tarpeen mukaan nestehoitoa, suuria kortisoniannoksia, antibioottihoitoa ja jäykkäkouristusrokotussuojasta huolehtimisen. Vakavissa myrkytyksissä sairaaloissa voidaan antaa kyyn pureman vastamyrkkyä oireiden hillitsemiseksi.
Teksti: LK Jemina Noutia ja Sisätautien ja kliinisen hematologian erikoislääkäri Marko Vesanen
Kuvat: Pixabay ja Wenche Nyhus"



TAPAUSSELOSTUS Yle uutisissa 
Paikka Kemiön saari
Hoitopaikka TYKS
Artikkeliin liittyy myös kuva , joka on pedagoginen, mutta  EU:n nykysääntöjen mukaan ei saa  kopioida  kuvaa ellei saa  siihen lupaa kirjoittajalta. . Asetan kuitenkin linkin ylle
ja muutaman olennaisen sanan siteeraan:

"Kyy iski hampaansa yhdeksänvuotiaan tytön nilkkoihin – kesälomaviikko vierähti jalat pystyssä sairaalassa

Neljä nopeaa iskua, yksi varpaiden väliin ja kolme nilkkoihin. Kohtaaminen kyyn kanssa ei ollut leikin asia.





torsdag 12 juli 2018

Käärmeenpureman vaaroista. Käärmeseerumin valmistuksesta.

Seniora Läkare lehdessä nr 2, 2018 on artikkeli Dödliga ombett.(Kuolettavat käärmeenpuremat)

Aihe on varsin aktuelli siksikin, kun Pohjoismaihin, ainakin Ruotsiin näyttää salakuljetetun paljon eteläisiä myrkkykäärmeitä ja liskoja, ja ilmasto alkaa osoittaa lämpiämisen merkkejä vuodesta toiseen, joten kaikenlaiset tuodut trooppiset ja subtrooppiset käärmeet, liskot ja muut elukat ja niveljalkaiset voivat ainakin osan vuotta pysyä elossa täkäläisessä miljöössä ihan luonnossa. Tosin viranomaisyhteistyön avulla on paljon maahankuljettajien myrkkykäärmetiloja löydettykin ja asianmukaisia sääntöjä sillekin keräilyhobbylle on kyllä valmiina olemassa.

Kirjoitan muistiin ruotsalaisen tekstin ja suomennan sitä.
Seniora Läkare, sivu 7,2/2018.

”Robin Östberg otti meidät Afrikan matkalle Saharan eteläpuoliseen monien myrkkykäärmeiden maahan. Hän oli aiemmin zoologi ja on nykyään lääkäri. Hän on sitä mieltä, että myrkkykäärmeiden purema on trooppisessa lääketieteessä suurelta osalta unohdettu ongelma.

  • ”Robin Östberg tog oss med på en resa till Afrika söder om Sahara och de många giftormarnas land. Robin, tidigare zoolog, nu läkare menade att bett av giftiga ormar är ett i stort sett bortglömt tropikmedicinskt problem.
Länsimailla käärmeenpuremia saa 1,8- 2,5 miljoonaa ihmistä vuosittain ja yli 90 000 kuolee käärmeenpuremaan. Altistuneinta on maanviljelysseutujen varaton väestö, varsinkin heidän lapsensa.

  • 1,8-2,5 miljoner människor i västvärlden blir ormbitna varje år, över 90 000 avlider av betten. De fattiga från jordbruksbygderna och deras barn är mest utsatta.

Myrkyt voivat olla hermomyrkkyjä neurotoksiineja, joista aiheutuu halvauksia, verimyrkkyjä hemotoksiineja, joista tulee verenhyytymishäitiöitä ja verenvuotoja, solumyrkkyjä sytotoksiineja , jotka tuhoavat pehmytosakudoksia, tai lihasmyrkkyjä myotoksiineja, jotka aiheuttavat lihaksen särkymistä ja verisuonen pinnan vauriota.

  • Gifterna kan vara neurotoxiner (som orsakar paralyser), hemotoxiner( koagulopatier, blödningar), cytotoxiner (mjukdelsnekroser) eller myotoxiner (muskelsönderfall, endotelskador).
Afrikassa on kaupan joukko valmisteita, jotka ovat lähinnä vaikutuksettomia.
Myrkkyä puristetaan käsin ulos käärmeistä. Tarvitaan 700- 1400 tällaista käärmelypsyä, jotta on koossa tarpeeksi myrkkyä yhdeksi ampulliksi, joka sitten ruiskutetaan hevoseen, ja hevosessa alkaa muodostua vasta-aineita, jotka otetaan talteen.

  • I Afrika saluförs en mängd preparat som är i stort sett verkningslösa. Giftet extraheras manuellt från ormar. Det krävs 700- 1400 ”mjölkningar” av ormar för att få ihop till en ampull gift som sedan injiceras i en häst som bildar antikropparna.
Vasta-aineista tehdään immunoglobuliini IgG- kuivavalmiste, jota voidaan säilyttää ja tarvittaessa liuottaa keittosuolalla (NaCl) injektioksi potilaalle, jota käärme on purrut.

  • En torr beredning av immunoglobulin IgG framställs som kan förvaras och vid behov lösas med NaCl för injektion av den bitne.

Tämä on hyvin kallista, sillä hevonen otetaan hengiltä sen jälkeen, kun vasta-aineet on saatu. Sen takia Euroopassa on paljon enemmän ampulleja kuin koko Afrikassa.

  • En oerhört dyr vara, hästen avlivas efter att man tagit hand om antikropparna. Därför finns det fler ampuller i europa än i hela Afrika.
Koetetaan pyrkiä tekemään polyvalentteja vasta-ainevalmisteita, jotka voivat vastavaikuttaa usean käärmelajin myrkkyyn. 
 Saharan eteläpuolella tapahtuu 11 500 käärmeenpuremaa ja 7 500 puremasta johtuvaa kuolemantapausta vuosittain. 
Joka vuosi tehdään 6000 - 15 000 myrkyttyneen raajan amputaatiota. 
Tällaista olisi voitu välttää, jos olisi ollut seerumia. Monet ovat vastukset Afrikassa ennen kuin asianmukainen hoito tavoittaa käärmeenpureman uhrin. On ongelmia seerumin varastoimisessa ja paikalletoimituksessa; on taloudellisia ongelmia; hevosten käyttö vasta-aineenvalmistukseen on kallista; tieteellinen tutkimus on riittämätöntä ja käytäntö puuteellista..
  • Man eftersträvar polyvalenta beredningar med antikroppar som kan motverka flera ormarters gift. Söder om Sahara sker 31 500 ormbett och 7 500 dödsfall efter bett per år.
  • Varje år görs 6000- 15 000 amputationer av den förgiftade lemmen. Dessa hade kunnat undvikas om serum funnits. Svårigheterna att nå den ormbitna med adekvat behandling i Afrika är många. Bl.a. lagrings- och distributionsproblem, svårigheter att ordna finansiering,dyrt med hästar för immunoglobulintillverkning, otillräcklig forskning och bristfällig praxis.
Miten toimitaan täkäläisissä (Ruotsalaisissa)  kyykäärmeenpuremissa kesällä?
Älä anna kortisonia. Kortisonista ei ole dokumentoitua tehoa.
Äläkä annan adrenaliinia, ellei ole selvää anafylaksiaa.
Kuljeta potilas sairaalaan tarkkailuun. Siellä annetaan seerumia kun oireet ovat selvät,
kuten kylmänhikisyys ja shokki.

  • Hur gör vi då med våra giftiga huggormars bett i sommar? Ge inte kortison- kortison har ingen dokumenterad effekt. Ge inte heller adrenalin om det inte föreligger en klar anafylaxi. Transportera patienten till sjukhus för övervakning. Serum ges där endast vid klara symtom som kallsvett och chock.
(Kertomus Afrikan matkasta jatkuu lehden seuraavassa numerossa. )
Fortsättning nästa uppslag.
Musitiin 12.7. 2018

onsdag 20 juni 2018

CEBP ja MMP9

 https://www.ncbi.nlm.nih.gov/pubmed/26411364

Oncogene. 2016 Jun 2;35(22):2893-901. doi: 10.1038/onc.2015.350. Epub 2015 Sep 28.

CPEB1 mediates epithelial-to-mesenchyme transition and breast cancer metastasis.

Abstract

In mouse mammary epithelial cells, cytoplasmic polyadenylation element binding protein 1 (CPEB1) mediates the apical localization of ZO-1 mRNA, which encodes a critical tight junction component. In mice lacking CPEB1 and in cultured cells from which CPEB has been depleted, randomly distributed ZO-1 mRNA leads to the loss of cell polarity.

We have investigated whether this diminution of polarity results in an epithelial-to-mesenchyme (EMT) transition and possible increased metastatic potential. Here, we show that CPEB1-depleted mammary epithelial cells alter their gene expression profile in a manner consistent with an EMT and also become motile, which are made particularly robust when cells are treated with transforming growth factor-β, an enhancer of EMT.

CPEB1-depleted mammary cells become metastatic to the lung following injection into mouse fat pads while ectopically expressed CPEB1 prevents metastasis. Surprisingly, CPEB1 depletion causes some EMT/metastasis-related mRNAs to have shorter poly(A) tails while other mRNAs to have longer poly(A) tails.

Matrix metalloproteinase 9 (MMP9) mRNA, which encodes a metastasis-promoting factor, undergoes poly(A) lengthening and enhanced translation upon CPEB reduction.

Moreover, in human breast cancer cells that become progressively more metastatic, CPEB1 is reduced while MMP9 becomes more abundant.

These data suggest that at least in part, CPEB1 regulation of MMP9 mRNA expression mediates metastasis of breast cancer cells.
PMID:
26411364
PMCID:
PMC4809797
DOI:
10.1038/onc.2015.350
[Indexed for MEDLINE]
Free PMC Article