The rockefeller university

BackgroundAdvanced practice nursing (APN) and advanced practice midwifery (APM) in Kenya are critical in healthcare system strengthening by expanding access to quality care, particularly in underserved regions. Globally, the International Council of Nurses (ICN) defines APN as a level of nursing practice that requires a minimum of a master's degree, along with advanced clinical training and competency. Similarly, APM involves midwives with advanced training to provide specialized maternal and neonatal care. In Kenya, the APN and APM concepts were launched in 2020 and are still nascent, and their practice is determined by the context as provided by the country credentialing the practice. Despite the strides made in developing the advanced roles, there is an eminent gap in understanding stakeholders' perceptions of the roles, scope of practice, and regulation.AimTo explore stakeholders' perceptions of the roles and regulations of APN and APM in Kenya.DesignAn exploratory qualitative study was undertaken as part of a larger formative research conducted between January 2022 and November 2023, utilizing a multimethod design that included a gap analysis of the scopes of practice for APN and APM in Kenya. Data collection was conducted among purposively sampled participants using a total of 7 focus group discussions (FGDs), with three of them conducted among 14 APN and APM students and 4 FGDs among 16 members of the Kenyan-based nursing and midwifery associations. Seven key informant interviews (KIIs) were also held with 2 medical doctors (OBGYN), two faculty, and 3 students (practicing APN). A thematic analysis approach was employed, and reporting was done according to the Standards for Reporting Qualitative Research.FindingsParticipant's perspectives were reflected in 5 themes: definition of APN/APM and scope; entry qualifications into APN/APM practice; roles of APN/APM; barriers to enacting APN/APM roles; the national policy and regulatory landscape for advanced practice roles.ConclusionThere were varied viewpoints on how APNs/APMs are defined in the Kenyan context. Similarly, views on the entry level qualifications into APN/APM were diverse. Many participants emphasized the importance of licensure, autonomy of practice, ability to manage patients independently, training, and competency. Well-defined policies and regulations can create an enabling environment for practice.

The thrombolytic protease tissue plasminogen activator (tPA) is expressed in the CNS, where it regulates diverse functions including neuronal plasticity, neuroinflammation, and blood-brain-barrier integrity. However, its role in different brain regions such as the substantia nigra (SN) is largely unexplored. In this study, we characterize tPA expression, activity, and localization in the SN using a combination of retrograde tracing and beta-galactosidase tPA reporter mice. We further investigate tPA's potential role in SN pathology in an alpha-synuclein mouse model of Parkinson's disease (PD). To characterize the mechanism of tPA action in alpha-synuclein-mediated pathology in the SN and to identify possible therapeutic pathways, we performed RNA-seq analysis of the SN and used multiple transgenic mouse models. These included tPA deficient mice and two newly developed transgenic mice, a knock-in model expressing endogenous levels of proteolytically inactive tPA (tPA Ala-KI) and a second model overexpressing proteolytically inactive tPA (tPA Ala-BAC). Our findings show that striatal GABAergic neurons send tPA+ projections to dopaminergic (DA)-neurons in the SN and that tPA is released from SN-derived synaptosomes upon stimulation. We also found that tPA levels in the SN increased following alpha-synuclein overexpression. Importantly, tPA deficiency protects DA-neurons from degeneration, prevents behavioral deficits, and reduces microglia activation and T-cell infiltration induced by alpha-synuclein overexpression. RNA-seq analysis indicates that tPA in the SN is required for the upregulation of genes involved in the innate and adaptive immune responses induced by alpha-synuclein overexpression. Overexpression of alpha-synuclein in tPA Ala-KI mice, expressing only proteolytically inactive tPA, confirms that tPA-mediated neuroinflammation and neurodegeneration is independent of its proteolytic activity. Moreover, overexpression of proteolytically inactive tPA in tPA Ala-BAC mice leads to increased neuroinflammation and neurodegeneration compared to mice expressing normal levels of tPA, suggesting a tPA dose response. Finally, treatment of mice with glunomab, a neutralizing antibody that selectively blocks tPA binding to the N-methyl-D-aspartate receptor-1 (NMDAR1) without affecting NMDAR1 ion channel function, identifies the tPA interaction with NMDAR1 as necessary for tPA-mediated neuroinflammation and neurodegeneration in response to alpha-synuclein-mediated neurotoxicity. Thus, our data identifies a novel pathway that promotes DA-neuron degeneration and suggests a potential therapeutic intervention for PD targeting the tPA-NMDAR1 interaction.

Enterococcus faecium is a gram-positive bacterium that is resident to the intestines of animals including humans. E. faecium is also an opportunistic pathogen that causes multidrug-resistant (MDR) infections. Bacteriophages (phages) have been proposed as therapeutics for the treatment of MDR infections; however, an obstacle for phage therapy is the emergence of phage resistance. Despite this, the development of phage resistance can impact bacterial fitness. Thus, understanding the molecular basis of fitness costs associated with phage resistance can likely be leveraged as an antimicrobial strategy. We discovered that phage-resistant E. faecium harbor mutations in the cell wall hydrolase gene sagA. SagA cleaves crosslinked peptidoglycan (PG) involved in PG remodeling. We show that mutations in sagA compromised E. faecium PG hydrolysis. One sagA mutant, with a defect in cell envelope integrity, increased cellular permeability, and aberrant distribution of penicillin-binding proteins, was also more sensitive to beta-lactam antibiotics. These changes correspond to a growth defect where cells have abnormal division septa, membrane blebbing, and aberrant cell shape. The dysregulation of the cell envelope caused by the sagA mutation alters the binding of phages to the E. faecium cell surface, where phage infection of E. faecium requires phages to localize to sites of peptidoglycan remodeling. Our findings show that by altering the function of a single PG hydrolase, E. faecium loses intrinsic beta-lactam resistance. This indicates that phage therapy could help revive certain antibiotics when used in combination.IMPORTANCEEnterococcus faecium causes hospital-acquired infections and is frequently resistant to frontline antibiotics, including those that target the cell wall. Bacteriophages represent a promising alternative to combat such infections. However, bacterial adaptation to phage predation often results in resistance. Such resistance is frequently accompanied by fitness trade-offs, most notably altered antibiotic susceptibility. This study provides mechanistic insights into phage resistance-associated antibiotic sensitivity in E. faecium. We show that phage-resistant E. faecium carrying a mutation in the peptidoglycan hydrolase SagA has compromised cell envelope integrity, mislocalized penicillin-binding proteins, and become sensitized to beta-lactam antibiotics. These findings highlight the potential of reviving antibiotics when used in combination with phages in the clinical setting.

Microglia, the innate immune cells of the brain, play a defining role in the progression of Alzheimer's disease (AD)1. The microglial response to amyloid plaques in AD can range from neuroprotective to neurotoxic2. Here we show that the protective function of microglia is governed by the transcription factor PU.1, which becomes downregulated following microglial contact with plaques. Lowering PU.1 expression in microglia reduces the severity of amyloid disease pathology in mice and is linked to the expression of immunoregulatory lymphoid receptor proteins, particularly CD28, a surface receptor that is critical for T cell activation3,4. Microglia-specific deficiency in CD28, which is expressed by a small subset of plaque-associated PU.1low microglia, promotes a broad inflammatory microglial state that is associated with increased amyloid plaque load. Our findings indicate that PU.1low CD28-expressing microglia may operate as suppressive microglia that mitigate the progression of AD by reducing the severity of neuroinflammation. This role of CD28 and potentially other lymphoid co-stimulatory and co-inhibitory receptor proteins in governing microglial responses in AD points to possible immunotherapy approaches for treating the disease by promoting protective microglial functions.

BACKGROUND & AIMS: The role of goblet cells in small intestinal inflammation in Crohn's disease (CD) is unknown. Polymorphisms of NOD2 confer risk for CD and associate with small intestinal disease location. We previously showed in mice that Nod2 deficiency leads to overexpansion of Phocaeicola vulgatus in the gut and downstream goblet cell defects, which preceded small intestinal inflammation. In this study, we ask whether goblet cell defects occur in patients with CD with NOD2 polymorphisms and investigate in mice how P vulgatus signals through the intestinal epithelium. METHODS: We performed a retrospective study of patients with CD to assess clinical outcomes and goblet cell histology by NOD2 status. We evaluated the contribution of microbiota and MyD88 signaling in the intestinal epithelium to goblet cell defects in the setting of Nod2 deficiency using genetic mouse models and germ-free mice. RESULTS: In patients with CD who have undergone ileocolic resection, NOD2 risk alleles confer a risk for reoperation (odds ratio, 8.12; P 1/4 .047) and for increased phosphorylated extra-cellular signal-regulated kinase and goblet cell defects in uninflamed ileal tissue. We show that patients with CD with ileal involvement harbor P vulgatus regardless of NOD2 risk allele status. We show that intestinal epithelial MyD88 and TLR4 are required for goblet cell defects in Nod2-/-mice harboring P vulgatus. Finally, we show that P vulgatus requires complex microbiota to exert its effects in Nod2-deficient mice. CONCLUSIONS: Goblet cell defects may be a harbinger of small intestinal inflammation in patients with CD, particularly in the postoperative setting. Our findings in mice show that small intestinal goblet cell loss associated with Nod2 mutation is induced by microbiome dysbiosis and epithelial MyD88, in part due to TLR4 signaling. (Cell Mol Gastroenterol Hepatol 2025; 19:101533; https://doi.org/10.1016/j.jcmgh.2025.101533)

Cell biology and genetic studies have demonstrated that DNA double-strand break (DSB) repair can be performed using an RNA transcript that spans the site of the DNA break as a template for repair. This type of DSB repair requires a reverse transcriptase to convert an RNA sequence into DNA to facilitate repair of the break, rather than copying from a DNA template as in canonical DSB repair. Translesion synthesis (TLS) DNA polymerases (Pol) are often more promiscuous than DNA Pols, raising the notion that reverse transcription could be performed by a TLS Pol. Indeed, several studies have demonstrated that human Pol h has reverse transcriptase activity, while others have suggested that the yeast TLS Polz is involved. Here, we purify all seven known nuclear DNA Pols of Saccharomyces cerevisiae and compare their reverse transcriptase activities. The comparison shows that Polz far surpasses Pol h and all other DNA Pols in reverse transcriptase activity. We fi nd that Polz reverse transcriptase activity is not affected by RPA or RFC/PCNA and acts distributively to make DNA complementary to an RNA template strand. Consistent with prior S. cerevisiae studies performed in vivo, we propose that Polz is the major DNA Pol that functions in the RNAtemplated DSB repair pathway.

Although the etiological relevance of the detection of microsporidia in human stool samples remains uncertain, the immunological status of patients has been posited as an important determinant of potential clinical impact of these parasites. To further assess the interplay between the epidemiology of microsporidia and immunological markers, we conducted a study utilizing real-time PCR targeting Enterocytozoon bieneusi, Encephalitozoon cuniculi, Encephalitozoon hellem, and Encephalitozoon intestinalis, combined in a single fluorescence channel. The study involved a cohort of 595 clinically and immunologically well-characterized Ghanaian HIV patients, alongside 82 HIV-negative control individuals from Ghana. While microsporidial DNA was absent in HIV-negative controls, among people living with HIV, its prevalence was inversely correlated with CD4+ lymphocyte counts: 6.0% in those with >500 cells/mu L, 9.5% in those with 200-499 cells/mu L, 13.8% in those with 50-199 cells/mu L, and 27.5% in those with <50 cells/L, respectively. Correspondingly, microsporidia were more frequently detected in HIV patients who were not receiving antiretroviral therapy. There were no associations with clinical symptoms including gastroenteritis with the exception of a non-significant trend towards weight loss. HLA-DR+CD38+ on CD4+ T lymphocytes, a marker of immune activation, as well as Ki67, a marker of cell proliferation, were increased on CD4+ T lymphocytes in HIV patients with microsporidia, suggesting an immune response may be triggered. In conclusion, our assessment indicates a higher prevalence of microsporidia in the stool of Ghanaian HIV patients, which varies with their immunological status. However, given the lack of clear associations with clinical symptoms, the detection of microsporidia in the stool of HIV patients needs to be cautiously interpreted in clinical settings.

Glioblastoma is incurable and in urgent need of improved therapeutics(1). Here we identify a small compound, gliocidin, that kills glioblastoma cells while sparing non-tumour replicative cells. Gliocidin activity targets a de novo purine synthesis vulnerability in glioblastoma through indirect inhibition of inosine monophosphate dehydrogenase 2 (IMPDH2). IMPDH2 blockade reduces intracellular guanine nucleotide levels, causing nucleotide imbalance, replication stress and tumour cell death(2). Gliocidin is a prodrug that is anabolized into its tumoricidal metabolite, gliocidin-adenine dinucleotide (GAD), by the enzyme nicotinamide nucleotide adenylyltransferase 1 (NMNAT1) of the NAD(+) salvage pathway. The cryo-electron microscopy structure of GAD together with IMPDH2 demonstrates its entry, deformation and blockade of the NAD(+) pocket(3). In vivo, gliocidin penetrates the blood-brain barrier and extends the survival of mice with orthotopic glioblastoma. The DNA alkylating agent temozolomide induces Nmnat1 expression, causing synergistic tumour cell killing and additional survival benefit in orthotopic patient-derived xenograft models. This study brings gliocidin to light as a prodrug with the potential to improve the survival of patients with glioblastoma.

In view of changing climatic conditions and disappearing natural resources such as fertile soil and water, exploring alternatives to today's industrial monocrop farming becomes essential. One promising farming practice is intercropping (IC), in which two or more crop species are grown together. Many experiments have shown that, under certain circumstances, IC can decrease soil erosion and fertilizer use, improve soil health and land management, while preserving crop production levels. However, there have been no quantitative approaches to predict, design, and control appropriate IC implementation for given particular environmental and farming conditions, and to assess its robustness. Here, we develop such an approach, based on methods and concepts developed in data science and systems biology. Our dataset groups the results of 2258 IC experiments, involving 274 pairs of 69 different plants. The data include 4 soil characteristics and 5 environmental and farming conditions, together with 8 traits for each of the two intercropped plants. We performed a dimensional reduction of the resulting 25-dimensional variable space and showed that, from a few quantities, one can predict IC yield relative to sole cultivation with good accuracy. For given environmental conditions, our computational approach can help to choose a companion plant and appropriate farming practices. It also indicates how to estimate the robustness of IC to external perturbations. This approach, together with its results, can be viewed as an initial step toward "systems agriculture," which would ultimately develop systems of multiple plant grown together in appropriately designed and controlled settings.