The molecular crosstalk between the interkeukin-7 receptor (IL-7R) and pre-BCR in B lymphopoiesis has been enigmatic. We demonstrate that in pre-B cells, the IL-7R, but not the pre-BCR, was coupled to the phosphatidylinositol-3-OH kinase (PI(3)K)–Akt module, signaling by which prevents Rag expression. Attenuation of IL-7 signaling resulted in up-regulation of Foxo1 and Pax5, which co-activated many pre-B cell genes, including Rag1,2 and Blnk. Induction of the latter gene enabled pre-BCR signaling via the Syk-BLNK module and promoted immunoglobulin light chain rearrangement. BLNK signaling also antagonized Akt activation, thereby augmenting Foxo1 and Pax5 accumulation. This self-reinforcing molecular circuit appears to sense limiting concentrations of IL-7 and functions to control the expansion and differentiation of pre-B cells.

ObjectiveAlthough gastric per-oral endoscopic myotomy (G-POEM) is considered a promising technique for the management of refractory gastroparesis, high-quality evidence is limited. We prospectively investigated the efficacy and safety of G-POEM in unselected patients with refractory gastroparesis.DesignIn five tertiary centres, patients with symptomatic gastroparesis refractory to standard medical therapy and confirmed by impaired gastric emptying were included. The primary endpoint was clinical success, defined as at least one score decrease in Gastroparesis Cardinal Symptom Index (GCSI) with ≥25% decrease in two subscales, at 12 months. GCSI Score and subscales, adverse events (AEs) and 36-Item Short Form questionnaire of quality of life were evaluated at baseline and 1, 3, 6 and 12 months after G-POEM. Gastric emptying study was performed before and 3 months after the procedure.ResultsOf 80 enrolled patients, 75 patients (94%) completed 12-month follow-up. Clinical success at 12 months was 56% (95% CI, 44.8 to 66.7). GCSI Score (including subscales) improved moderately after G-POEM (p<0.05). In a regression model, a baseline GCSI Score >2.6 (OR=3.23, p=0.04) and baseline gastric retention >20% at 4 hours (OR=3.65, p=0.03) were independent predictors of clinical success at 12 months, as was early response to G-POEM at 1 month after therapy (OR 8.75, p<0.001). Mild procedure-related AEs occurred in 5 (6%) patients.ConclusionG-POEM is a safe procedure, but showed only modest overall effectiveness in the treatment of refractory gastroparesis. Further studies are required to identify the best candidates for G-POEM; unselective use of this procedure should be discouraged.Trial registration numberClinicalTrials.gov Registry NCT02732821.

No abstract

No abstract

No abstract