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(KUTV) - The John A. Moran Eye Center at the University of Utah reported Saturday that it will be notifying 607 patients of a potential disclosure of some of their information following a theft of electronic equipment.

A laptop computer and external storage device (used to take and store retinal images) were stolen from a locked storage unite at 65 Mario Capecchi Drive in Salt Lake City. The eye center learned about this theft on April 3, 2018.

The devices contained retinal images, full or partial name and dates of birth for patients and medical reference numbers for 602 infants and 5 adults, all of whom had images taken by Moran specialists conducting evaluations at the University of Utah Hospital and Primary Children's Hospital between July 1, 2014 and March 30, 2018.

No social security numbers or financials records were stored on either device. This investigation is still ongoing.

"As part of University of Utah Health, the John A. Moran Eye Center is fully committed to protecting the privacy of our patients," Randall J. Olson, CEO of the John A. Moran Eye Center, said in a statement. "I sincerely regret that personal information about any of our patients is ever exposed and especially so for children. While no financial information was disclosed, I understand the concerns that impacted patients and parents may have. For peace of mind, we are offering free credit monitoring for any child or adult whose data may have been compromised."

The Moran Eye Center is working to improve its policy and procedures and enhance security measures to reduce the risk of an event like this from happening again.

"Patient trust is fundamental to everything we do at the Moran Eye Center, and our team is conducting a comprehensive review of our policies, procedures, and security measures to ensure patient information is always protected," Olson said.

Impacted patients and parents or guardians will receive letters by U.S. mail. If you are an impacted individuals and you would like to ask a question about this situation, please call 855-349-6456 between 7 a.m. and 7 p.m. MDT Monday through Friday.




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New guidelines released Wednesday recommend American adults start getting colon cancer screenings earlier -- at age 45 instead of 50.

The American Cancer Society said it decided to urge earlier screenings because a study last year found rising rates of colon cancer deaths in people younger than 50.

The new guidelines are for men and women ages 45 to 75 with average risk for colon cancer. The recommendations may differ for people with certain conditions, like Crohn's disease, or a family history of colon cancer.

The American Cancer Society endorses six kinds of screening exams, ranging from inexpensive take-home stool tests performed annually to colonoscopies done every 10 years.

"All of these tests are good tests, and the choice should be offered to patients," said the ACS's Dr. Rich Wender. "The best test is the test that gets done."

Dr. Harsha Polavarapu of Blessing Physician Services in Quincy, who specializes in colorectal surgery, said he thinks the earlier screening recommendation is a good idea based on the studies showing colon cancer is striking "a younger and younger population."

Polavarapu said it makes sense to start the screening process earlier "and catch those marginal patients who are between 40 and 50."

He said early detection is the key to helping someone diagnosed with colon cancer, which is typically confirmed through a colonoscopy -- an examination of the colon using a flexible tube inserted through the rectum. If the exam uncovers the presence of a polyp, a tissue sample from the polyp will be taken to determine if cancer cells are present.

If cancer is not present or if no polyps are found, the patient can usually wait 10 years before having another colonoscopy.

"Our goal is to catch these cancers at the polyp stage where we can take it out completely without any major surgery," he said.

Polavarapu said any type colon cancer screening is helpful, including stool tests that look for microscopic traces of cancer or even CT scans that look for abnormalities in the colon.

"But the colonoscopy is still the gold standard test for screening for colorectal cancer," he said.

"Colon cancer screening is extremely important, and it's something that everybody needs to seriously consider and talk to their primary care doctor about."

The ACS's new guideline is out of sync with guidelines from the U.S. Preventive Services Task Force, an influential government advisory group that kept the initial screening age at 50 in an update two years ago.

The panel reviews evidence and issues advice for a variety of screenings and treatments. It updated its colon cancer guidelines in 2016 and its next review isn't expected until around 2021.

The panel's recommendations drive what screening is covered by insurance under the Affordable Care Act, although 20 states have laws that link coverage to the cancer society's guidelines. It's not uncommon for groups to have slightly different guidelines, although those for colon cancer have been about the same for decades.

Cancer society officials acknowledge the shift to 45 could cause confusion for doctors and patients, but they felt they needed to act now because of the rising number of younger cases.

Polavarapu agreed that the change in guidelines could lead to some confusion, but he feels it's "something that can easily be disseminated in the medical community" through an educational campaign.

Statistics show most colon cancer occurs in adults 55 and older, and the good news is rates of cases and deaths have been falling for decades. Colon cancer, combined with rectal cancer, is the second leading cause of cancer death in the U.S. This year, more than 140,000 Americans are expected to be diagnosed with it, and about 50,000 will die from it.

Doctors will probably look to specialty medical societies to sort out the different guidelines, said Dr. Marcus Plescia, of the Association of State and Territorial Health Officials. But it may take a little while before they offer clear advice.

Some experts have worried about pre-50 risks of colon cancer in some racial and ethnic groups, and at least one specialty society for gastroenterologists has urged screening of black adults starting at age 45.

Others argue that instead of lowering the age for routine screening, more effort should be put into getting more people tested. Only about two-thirds of people 50 and older have been following screening guidelines.

"It's hard enough to get people to do it at all," Plescia noted.

The Associated Press contributed to this report.

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Discussion

PARP1 utilizes NAD+ as substrate and attaches ADP-ribose units to amino acids on various acceptor proteins. The nuclear PARP1/PAR was discovered more than fifty years [26]. In the nucleus, PARP1 activity is mainly targeted towards PARylation of lysine, arginine, and cysteine residues, and it participates in nuclear DNA repair through PARylation of histone proteins [17]. Recent studies show that major histone proteins, H2A and H2B involved in nuclear DNA repair, are also present in the inner mitochondrial membranes [27], and intra-mitochondrial localization of PARP1 and PARP1 activity were increased in cultured cells exposed to genotoxic stimuli (e.g. ROS) [28]. However, investigators have largely ignored studying the role of mtPARP1/PAR in health and disease. In this study, we have found that the expression, activity, and intra-mitochondrial localization of PARP1/PAR were increased in cardiac biopsies of chagasic mice and in human cardiomyocytes infected by Tc. While the expression of a majority of the components of the mtDNA replisome machinery was not significantly altered in chagasic (vs. control) mice, PARP1 binding to POLG and mtDNA was increased and associated with a loss in mtDNA content, mtDNA-encoded gene expression, and OXPHOS capacity, and an increase in mitochondrial ROS production in chronically infected murine myocardium. Importantly, Inhibition of PARP1 by genetic deletion or treatment with a chemical antagonist had protective effects against cardiac hypertrophy and LV dysfunction in chagasic heart. The beneficial effects of PARP1 inhibition were not delivered via its direct effect on parasite persistence that is suggested to be the major cause for the development of chronic cardiomyopathy (reviewed in [29,30]). Instead, PARP1 depletion preserved the POLG-dependent mtDNA content, mitochondrial function, and antioxidant/oxidant balance in chagasic myocardium and human cardiomyocytes infected by T. cruzi. Taken together, we have demonstrated that the mitochondrial transport of PARP1/PAR adversely impacts the mtDNA maintenance by POLG replisome, and exacerbates the mitochondrial dysfunction, oxidative stress and cardiac remodeling in Chagas disease. We propose that PARP1 inhibitors will be beneficial in preserving the mitochondrial health and LV function in chronic cardiomyopathy of chagasic (and potentially other) etiologies.

It is logical to expect that mitochondrial PARP1, via its capacity to carry out PARylation, can modulate mitochondrial function. A proteomic study has indeed reported an increase in PARylation of a variety of mitochondrial proteins in response to traumatic brain injury in rodents [31], and Modis et al [32] have found mitochondrial respiratory deficiency in A549 human epithelial cells overexpressing mitochondria targeted PARP1. In our in vivo model of Chagas disease, cytosolic, nuclear, as well as mitochondrial PARP/PAR were increased in the myocardium of infected mice. The organelle-specific deletion or overexpression of PARP1 in vivo is not yet feasible, and thus it is difficult to dissect the role of nuclear (vs. mitochondrial) PARP1/PAR in health and disease. Nevertheless, we noted that the nuclear-DNA encoded proteins of the respiratory complexes as well as majority of the proteins of POLG replisome were not altered in expression in chagasic (vs. control) heart. This observation suggests that nuclear PARP1/PAR is either beneficial or not detrimental in Chagas disease. Instead, the increase in intra-mitochondrial PARP1/PAR was associated with mitochondrial electron transport chain dysfunction, and decreased the CII-complex supported ATP synthesis. Further, the dysregulation of mitochondrial electron transport chain resulted in mitochondrial uncoupling, and produced a secondary increase in ROS by mitochondria. PARP1/PAR inhibition, in a dose dependent manner, was beneficial in rescuing the mitochondrial electron transport chain activity and OXPHOS capacity in chagasic heart. Sirtuin 1 is a highly conserved member of the family of NAD+-dependent Sir2 histone deacetylases [33], and it competes with PARP1 for NAD+ substrate. Bai et al showed that PARP1 or PARP2 deficiency enhanced the mitochondrial oxidative metabolism, energy expenditure, and protection against diet-induced obesity, and this outcome was achieved, at least partially, via increased availability of NAD+ for SIRT1 activation [34,35]. However, we did not observe the beneficial effects of treatment with a SIRT1 agonist (SRT1720) in improving the mitochondrial function in chagasic mice [36]. Thus, it is unlikely that benefits of PARP1 inhibition in rescuing mitochondrial oxidative metabolism in chagasic mice were delivered via increase in SIRT1 activity. Our finding of increased PARP1/PAR suggest that mitochondrial PARP1 may have had a direct effect on OXPHOS capacity through PARylation of various complexes of the electron transport chain in chagasic WT mice, as was observed in ovarian epithelial cancer cells [37].

The close proximity to the electron transport chain exposes the mtDNA to endogenous ROS, and thus, mtDNA may accumulate 20-100-fold higher level of oxidative adducts and DNA breaks than might be noted in nuclear DNA under similar conditions. Indeed, we have noted increased mtDNA damage in human cardiomyocytes in vitro infected with T. cruzi and in cardiac biopsies of chagasic patients [10]. Two mitochondrial enzymes, POLG and ExoG, carry out DNA base excision repair/single-strand breaks repair (BER/SSBR) of mtDNA [38]. POLG also assembles the mtDNA replisome, and carries the burden of mtDNA replication [38]. Whether PARP1 independently, or in conjunction with POLG and ExoG, is involved in mtDNA repair and replication in health or disease has not been studied so far. The first evidence that PARP1/PAR may exert a negative effect on mtDNA was provided by the observation of lower number of mtDNA mutagenic lesions in PARP1-/- (vs. PARP1+/+) cells [39]. Szabo and coworkers showed that PARP1 depletion by shRNAi led to faster recovery of mtDNA integrity after initial oxidative insult in A549 epithelial cells [40]. In this study, we provide the first in vivo evidence that overexpression of PARP1 was detrimental to mtDNA maintenance and contributed to increased severity of chagasic cardiomyopathy. The PARylation of POLG or other proteins of the POLG replisome was not increased in chagasic heart, as was speculated to be the cause for deficiency of mtDNA repair in A549 cells exposed to oxidative stress [40]. PARP1 binding to LIG3 or other proteins of the DNA repair machinery or change in the expression of the components of the mtDNA replication and transcription machinery was also not noted in chagasic myocardium. Instead, we noted that PARP1 direct binding to POLG and mtDNA was increased and the levels of POLG and intact mtDNA were decreased in cardiac mitochondria of chagasic WT mice. Treatment of chagasic mice with PJ34 (PARP1 chemical inhibitor) or genetic depletion of PARP1 restored the POLG level and intact mtDNA content in chagasic heart. Further studies will be required to delineate if the PARP1 depletion restored the mtDNA repair or mtDNA replication activities of the POLG complex. Yet, our studies allow us to surmise that chemical inhibition of PARP1 by PJ34 treatment or genetic depletion of PARP1 was beneficial in controlling the mtROS and cardiac remodeling and restoring the mitochondrial oxidative metabolism as well as LV function in chagasic heart.

The pathologic features of the chronic Chagas cardiomyopathy also include focal areas of inflammation constituted by T cells and macrophages with a few eosinophils, plasma cells, and mast cells (reviewed in [6]). Parasites are rarely observed by conventional microscopic analysis of cardiac biopsies or random sections of explants or autopsy specimens during chronic Chagas disease [41]. It is, therefore, imperative that research community pays attention to host-derived factors as modulators of inflammatory responses in chronic Chagas disease. In this context, it is important to note that PARP1/PAR have been implicated in driving inflammation induced by cytotoxic agents (e.g. arsenite [42]). PARP1 suppression by genetic deletion or pharmacological inhibitors have been shown to be beneficial in reducing LPS-induced lung inflammation [43] and gut inflammation [44] in mice and humans. We have shown PARP1-dependent post-translational modification of Rel A (p65)-interacting nuclear proteins facilitated the assembly of NF?B transcription complex and cytokine gene expression in cardiomyocytes infected by T. cruzi [19]. Further, Sirtuin 1 (SIRT1), a highly conserved member of the family of NAD+-dependent Sir2 histone deacetylases, is known to compete with PARP1 for NAD+ substrate, and integrate mitochondrial metabolism and inflammation [45,46,47]. Treatment of mice with the SIRT1 agonist SRT1720 suppressed NF?B-dependent transcription and inflammatory stress in T. cruzi-infected cells and chagasic mice [36]. Thus, it is feasible that the observed benefits of PARP1 depletion in improving cardiac outcomes are not only due to improvement of mitochondrial function but also due to control of chronic inflammation in chagasic mice. We propose that while mitochondrial PARP1 is detrimental to maintaining the mtDNA integrity as observed in this study, nuclear PARP1 contributes to chronic inflammation in Chagas disease. Further studies will be required to delineate the potential role of nuclear PARP1 in driving chronic inflammation in Chagas disease.

In summary, we have used in vitro and in vivo models of T. cruzi infection and Chagas disease, and demonstrated that mitochondrial PARP1/PAR disturbs the POLG-dependent mtDNA integrity, and contributes to loss in mitochondrial function. Inhibition of mitochondrial PARP1/PAR offers a novel therapy in preserving the mitochondrial and LV function in chronic Chagas disease.

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