Purpose: Disparities in rates of heart transplantation (HT) and implantation of durable left ventricular assist devices (LVAD) among racial/ethnic minorities and persons of increased socioeconomic risk remain common in the United States. We aim to report the characteristics and outcomes of these therapies among recipients referred from a public safety net hospital in Dallas, Texas.

Glucagon-like peptide-1 agonists are effective weight loss treatments, yet few data are available regarding their use in patients with durable left ventricular assist devices. We report our single-center experience with glucagon-like peptide-1 agonist use in 21 patients with World Health Organization class I-III obesity on durable left ventricular assist device support. During therapy, patients experienced a median weight change of -12.4 (-20.0 to -2.9) kgs and a -7.4% (-16.3 to -2.1) change in body weight with a median time on glucagon-like peptide-1 agonist therapy of 12 (6-22) months. Of these, 17/21 patients lost weight (median change -14.0 kg [-21.8 to -5.3], -9.5% [-18.0 to -4.0] body weight) and 9 of 21 had a speed reduction. No major adverse events were attributed to glucagon-like peptide-1 agonist therapy. At our center, glucagon-like peptide-1 agonists use was well-tolerated, safe and was associated with weight loss in patients with durable left ventricular assist devices.

While increased heart failure (HF) severity and poor quality of life (QOL) have been associated with the decision to receive a left ventricular assist device (LVAD), we examined if socioeconomic factors were associated with patient willingness to accept an LVAD.

African Americans (AA) with heart failure (HF) suffer disproportionately poor outcomes compared to white counterparts. Whether delays of care influence this is unclear. We aimed to assess whether AA patients assessed in advanced HF clinics were more symptomatic or higher risk compared to white patients.

The outlook for ambulatory patients on optimal oral medical therapy for advanced heart failure (HF) and the appropriate timing of transplant or ventricular assist device (VAD) implant remain uncertain. The goal of the Medical Arm of Mechanically Assisted Circulatory Support (MedaMACS) Registry was to identify and study a multi-center cohort of these patients to better understand and address their disease trajectory.

Slow gait speed (increased time to walk 5m) is a commonly employed measure of frailty linked to adverse outcomes particularly in elderly patients undergoing cardiac surgery. We sought to evaluate the relationship between frailty, quality of life, and predicted mortality in ambulatory patients with advanced heart failure (HF).

Milk lipids contain several bioactive factors exhibiting antimicrobial activity against bacteria, viruses, and fungi. In the present study, we demonstrate that free fatty acids (FFA) derived from the saponification of bovine whey cream lipids are active in vitro at inhibiting the germination of Candida albicans, a morphological transition associated with pathogenicity. This activity was found to be significantly increased when bovine FFA were enriched in non-straight-chain FFA. At low cell density, this non-straight-chain FFA-enriched fraction was also found to inhibit in a dose-dependant manner the growth of both developmental forms of C. albicans as well as the growth of Aspergillus fumigatus. Using an assay-guided fractionation, the main components responsible for these activities were isolated. On the basis of mass spectroscopic and gas chromatographic analysis, antifungal compounds were identified as capric acid (C10:0), lauroleic acid (C12:1), 11-methyldodecanoic acid (iso-C13:0), myristoleic acid (C14:1n-5), and gamma-linolenic acid (C18:3n-6). The most potent compound was gamma-linolenic acid, with minimal inhibitory concentration values of 5.4 mg/L for C. albicans and 1.3 mg/L for A. fumigatus, in standardized conditions. The results of this study indicate that bovine whey contains bioactive fatty acids exhibiting antifungal activity in vitro against 2 important human fungal pathogens.

Activation of T lymphocytes by mouse mammary tumor virus superantigen (vSAg) requires binding to MHC class II molecules. The subcellular location where functional interactions occur between MHC class II molecules and vSAgs is still a matter of debate. To gain further insight into this issue, we have used human epithelial HeLa cells expressing HLA-DR1. Surprisingly, the human cells were unable to present transfected vSAg7 or vSAg9 to a series of murine T cell hybridomas. The defect is not related to a lack of vSAg processing, because these cells can indirectly activate T cells after coculture in the presence of B lymphocytes. However, after IFN-gamma treatment, the HeLa DR1(+) cells became apt at directly presenting the vSAg. Furthermore, transfection of CIITA was sufficient to restore presentation. Reconstitution experiments demonstrated the necessity of coexpressing HLA-DM and invariant chain (Ii) for efficient vSAg presentation. Interestingly, inclusion of a dileucine motif in the DR beta cytoplasmic tail bypassed the need for HLA-DM expression and allowed the efficient presentation of vSAg7 in the presence of Ii. A similar trafficking signal was included in vSAg7 by replacing its cytoplasmic tail with the one of Ii. However, sorting of this chimeric Ii/vSAg molecule to the endocytic pathway completely abolished both its indirect and direct presentation. Together, our results suggest that functional vSAgs-DR complexes form after the very late stages of class II maturation, most probably at the cell surface.

Through the regulation of human leukocyte antigen (HLA)-DM (DM) in B cells, HLA-DO (DO) modulates positively or negatively the presentation of specific peptides. Transduction of DO into human blood monocyte-derived dendritic cells (MoDC) has been proposed as a mean of modifying the peptide repertoire of major histocompatibility complex class II molecules. However, maturation of DC induced by inflammatory stimuli or possibly the adenoviral vector itself triggers acidification of vesicles and shuts down transcription of the class II transactivator gene as well as de novo biosynthesis of class II-related molecules and DM activity. In these conditions, it is unclear that transduced DO could alter the peptide repertoire. Our Western blot and reverse trancriptase-polymerase chain reaction analyses revealed that human DC derived from blood monocytes express small amounts of DO alpha. Transduction of DO beta alone resulted in the accumulation of a small pool of DO in DM+ CD63(+) vesicles and at the plasma membrane of mature DC. The cell-surface increase in class II-associated invariant chain peptide (CLIP)/class II complexes is in line with an inhibitory role of DO on DM. Cotransduction of DO alpha and DO beta only slightly increased CLIP and DO levels at the cell surface. Together with the fact that a large fraction of transduced DO remains in the endoplasmic reticulum, this suggests that DM is limiting in these conditions. DO expression did not affect a mixed lymphocyte reaction but reduced presentation of the exogenous gp100 antigen to a specific T cell clone. These results show that transduced DO modulates antigen presentation in human mature MoDC, evoking the possible use of this chaperone for immunotherapy.

HLA-DR is a host-derived protein present at the surface of HIV-1. To clarify the mechanism through which this molecule is inserted within viruses, we monitored whether the incorporation process might be influenced by the level of virus-encoded envelope (Env) glycoproteins. Wild-type virions and viruses either lacking or bearing lower levels of Env were produced in different cell types. Results from a virus capture test indicate that HLA-DR is efficiently incorporated and at comparable levels in the tested virus preparations. Therefore, Env does not play an active role in the acquisition of host HLA-DR by emerging HIV-1 particles.

The p35 isoform of the human invariant chain (Iip35) contains an N-terminal RXR endoplasmic-reticulum (ER) retention signal that becomes nonfunctional only after assembly with MHC-class-II molecules. We have previously shown that the MHC-class-II β-chain cytoplasmic tail is crucial for the maturation of class-II/Iip35 complexes. In order to shed some light on the molecular determinants involved in shielding the RXR motif, we performed site-directed mutagenesis of the DRβ chain and Ii cytoplasmic domains. Chimeric β chains with irrelevant cytoplasmic tails allowed the efficient transport of Iip35 out of the ER in transiently transfected HEK 293T cells. An alanine scan of the cytoplasmic tail of HLA-DRβ confirmed that no specific motif is required to overcome ER retention. Surprisingly, a β chain with a three-amino-acid-long cytoplasmic tail (Tyr-Phe-Arg) was sufficient to overcome the Iip35 RXR motif. Moreover, replacement of residues F231 and R232 with alanines created a cytoplasmic tail (Tyr-Ala-Ala) that allowed ER egress. Given the limited length of this tail, steric hindrance would only be possible if the Ii ER retention motif was close to the membrane in the first place. However, this is not likely because an Ii molecule with an internal cytoplasmic deletion bringing the RXR motif closer to the membrane is not retained in the ER, even in the absence of class-II molecules. These results suggest that MHC-class-II molecules overcome ER retention and prevent COPI binding to the Iip35 RXR motif through a mechanism distinct from steric hindrance by its β chain.

Whereas the association of major histocompatibility complex (MHC) class II molecules with the cytoskeleton and their recruitment into lipid rafts play a critical role during cognate T/antigen-presenting cell interactions, MHC class II-induced signals, regions, and residues involved in their association and recruitment have not yet been fully deciphered. In this study, we show that oligomerization of HLA-DR molecules induces their association with the cytoskeleton and their recruitment into lipid rafts. The association of oligomerized HLA-DR molecules with the cytoskeleton and their recruitment into lipid rafts occur independently. Furthermore, the association with the cytoskeleton is HLA-DR-specific, since oligomerization of HLA-DP triggers its recruitment only into lipid rafts. HLA-DR molecules devoid of both alpha and beta cytoplasmic tails did not associate with the cytoskeleton, but their recruitment into lipid rafts was unimpeded. Deletion of either the alpha or beta cytoplasmic tail did not affect the association of HLA-DR with the cytoskeleton and/or recruitment into lipid rafts. HLA-DR molecules that were devoid of the alpha cytoplasmic chain and that had their beta cytoplasmic chain replaced with the HLA-DP beta chain or with a beta chain in which the residues at positions Gly(226)-His(227)-Ser(228) were substituted by alanine no longer associated with the cytoskeleton. They were, however, still recruited into lipid rafts. Together, these results support the involvement of different regions of the cytoplasmic tails in the association and the recruitment of HLA-DR into different compartments. The differential behavior of HLA-DP and -DR with respect to their association with the cytoskeleton may explain the previously described difference in their transduced signals.

CD40-activated B cells (CD40-B cells) have been demonstrated to expand memory and prime naive CD8+ T cells in healthy individuals and cancer patients [(1][1], [2][2], [3][3], [4][4], [5][5], [6)][6] . These findings are of particular interest to the cancer vaccine field because CD40-B cells are

Although they are considered as antigen-presenting cells, the role of antigen-unspecific B lymphocytes in antigen presentation and T-lymphocyte stimulation remains controversial. In this paper, we tested the capacity of normal human peripheral activated B cells to stimulate T cells using melanoma antigens or melanoma cell lysates. B lymphocytes activated through CD40 ligation and then pulsed with tumor antigens efficiently processed and presented MHC class II-restricted peptides to specific CD4 T-cell clones. This suggests that CD40-activated B cells have the functional and molecular competence to present MHC class II epitopes when pulsed with exogenous antigens, thereby making them a relevant source of antigen-presenting cells to generate T cells. To test this hypothesis, CD40-activated B cells were pulsed with a lysate prepared from melanoma cells and used to stimulate peripheral autologous T cells. Interestingly, T cells specific to melanoma antigens were generated. Additional analysis of these T-cell clones revealed that they recognized MHC class II-restricted epitopes from tyrosinase, a known melanoma tumor antigen. The efficient antigen presentation by antigen-unspecific activated B cells was correlated with a down-regulation in the expression of HLADO, a B cell-specific protein known to interfere with HLA-DM function. Because HLA-DM is important in MHC class II peptide loading, the observed decrease in HLA-DO may partially explain the enhanced antigen presentation after B-cell activation. Results globally suggest that when they are properly activated, antigen-unspecific B-lymphocytes can present exogenous antigens by MHC class II molecules and stimulate peripheral antigen-specific T cells. Antigen presentation by activated B cells could be exploited for immunotherapy by allowing the in vitro generation of T cells specific against antigens expressed by tumors or viruses.