From Sanjivani to Grey’s Anatomy: Best medical dramas to watch on World Health Day 2020 – India TV News

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From Sanjivani to Grey's Anatomy: Best medical dramas to watch on World Health Day 2020

It's World Health Day on Tuesday, so let's salute doctors and nurses who are doing their best to help the victims of COVID-19. While you continue to help them by maintaining social distancing, indulge in catching up a few medical dramas that have been winning hearts for years.

These five shows suggested by IANS had originally aired on television, but now you can catch them at the comfort of your palms what with OTT platforms making these available.

Grey's Anatomy

One of the most popular American medical dramas, it revolves around the title character, Dr. Meredith Grey (Ellen Pompeo), who was first seen as an intern back in 2005. It told the stories of the personal and professional lives of five surgical interns and their supervisors. Over the years, many original cast members have bid farewell to the show. Actor Justin Chambers was the latest one to quit the show and confirmed he won't be returning for an 17th season. Take a walk through their lives on Amazon Prime Video.

House

This is considered to be actor Hugh Laurie's most popular show that premiered in 2004 and ran for eight seasons. He played the title role of the ingenious and unsociable Dr. Gregory House, who flouts hospital rules, clashes with fellow doctors and his assistants as he comes up with controversial hypotheses about his patients' illnesses. You can watch it on Amazon Prime Video.

The Good Doctor

This is one of the new entrants in the genre. Launched in 2017, the American medical drama television series sees actor Freddie Highmore as Shaun Murphy, a young surgeon with autism and savant syndrome, who relocates from a quiet country life to join a prestigious hospital's surgical unit. It has already been renewed for season four. Watch all the seasons on Amazon Prime Video.

Dil Mill Gayye

Back home, "Dil Mill Gayye" was a sequel to the successful medical TV show "Sanjivani: A Medical Boon" (2002 to 2005) that featured Mohnish Bahl, Karan Singh Grover, Jennifer Winget and Karan Wahi as doctors. It revolved around their characters and their jobs at Sanjeevani hospital. The show started in August 2007 and came to an end in October 2010. It is now available on Disney+ Hotstar.

Sanjivani

Creator Siddharth Malhotra's "Sanjivani" made a return to the small screen last year with mostly a fresh cast and a new story. The new version even took a leap. The story then focussed on how heart-broken Ishani, has given up on her dreams of becoming the best doctor and finding love. The original version's Mohnish Bahl and Gurdeep Kohli were seen in some episodes, but the cast was led by Namit Khanna and Surbhi Chandna. It is streaming on Disney+ Hotstar.

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From Sanjivani to Grey's Anatomy: Best medical dramas to watch on World Health Day 2020 - India TV News

Former ‘Grey’s Anatomy’ Star Jessica Capshaw Was Turned Down For Two Roles Before Landing the Part of Arizona Robbins – Showbiz Cheat Sheet

Fans of Greys Anatomy were saddened to learn that Jessica Capshaw, who portrayed pediatric surgeon Dr. Arizona Robbins, was being written out of the show at the conclusion of Season 14. Few may realize that while Capshaw nailed the role of Dr. Robbins, she had previously auditioned for two parts on the show but was passed over.

Shortly after welcoming her first child in 2007 with husband Christopher Gavigan, Capshaw learned of an available role on the popular medical drama.

I auditioned for this show two weeks after I had my son Luke, and I was not interested in auditioning for anything because I was interested in being a mother, Capshaw recalled, according to TV Guide. But my agent called me and said, I wouldnt call you for any other reason other than Greys Anatomy, because I know thats your favorite show.'

The actress tried out for the part of Nurse Rose, the romantic interest of none other than Dr. Derek McDreamy Shepherd (portrayed by Patrick Dempsey) when he was on the outs with longtime love Dr. Meredith Grey. Capshaw had hoped she had an advantage due to previously working with Demspey.

So two weeks after I had the baby, I auditioned for Nurse Rose. I knew Patrick because I had worked with him two years prior, so he and I got along real well, Capshaw shared. But they picked the other girl and I was like, Man!'

Actress Lauren Stamile was given the part of Nurse Rose, though the characters relationship with Derek was short-lived.

In 2008, Capshaw tried putting her acting skills to the test again when she auditioned for the role of Sadie Harris, a freewheeling intern and former college friend of Meredith. Yet again she wasnt chosen for the part.

I went in for a part that hadnt been named yet, but she was this sexually promiscuous, adventurous part, and I didnt get the role again, Capshaw remembered. That was Melissa Georges part, Sadie.

Capshaw began to get a bit frustrated with producers raving about her performance yet not signing her up for the show. They kept saying they really love me and I was like, If they really love me, I would have a part in the show,' the former Greys star revealed, adding that her persistence did the trick. A month later, I got a three-episode offer to play Arizona Robbins.

Leaving the hit ABC series in 2018 after nine years on the show, Capshaw was began pursuing other projects including a role in the Netflix film Holidate with Kristen Chenoweth and Emma Roberts. Even though the mom of four was continuing a hectic schedule, she made time to give a shout out to her former gig when Greys Anatomy hit a major milestone.

Ok, sooootonight is a BIG night for@greysabc, Capshaw wrote on Instagram in February 2019. The airing of tonights episode makes it the longest running prime time medical drama EVER.

Capshaw even donned her characters lab coat to celebrate the occasion, posting a selfie along with her well-wishes. Soooo in honor of this exceptional distinctionI pulled out Dr. Arizona Robbins trusty lab coat, dusted it off, brought it out into the sunshine and I took it for a spin, she wrote, while giving props to her former colleagues. @shondarhimes and @beersbetsy THANK YOU for bringing this show to our television screens (and computers and phones).

The Greys alum expressed her gratitude for being a part of such a successful series. This show is a total dreamboat and I am so fortunate to have taken a cruise on itgrateful times a millionxoxo Congratulations!!! she wrote.

Fans are hoping that Dr. Robbins makes an appearance back at Grey Sloan Memorial before the series ends for good!

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Former 'Grey's Anatomy' Star Jessica Capshaw Was Turned Down For Two Roles Before Landing the Part of Arizona Robbins - Showbiz Cheat Sheet

‘Grey’s Anatomy’s’ Kevin McKidd Shares Why He Initially Had to Turn Down a Meeting With Shonda Rhimes – Showbiz Cheat Sheet

Kevin McKidd joined Greys Anatomy as a regular cast member in 2008. Taking on the role of Dr. Owen Hunt, the actor had his work cut out for him playing the complex character yet has completely embodied the part.

The Scottish actor had an impressive list of credits to his name before getting the call for the ABC medical drama, as well as being a married father of two. Most trying to make it big in Hollywood would drop everything if they received an invite from show creator Shonda Rhimes, but McKidd had a more pressing engagement when she asked to meet with him for the part of Owen.

The Greys Anatomy star had been working on several projects before the ABC hit came along, including parts in television and film. He described receiving the call about the role of Owen after a previous NBC series ended and he was on location for a movie with two Hollywood heavy hitters.

I went off and did Journeyman and then there was the writers strike. I was waiting around in Hollywood with a young family going, Maybe we should just go back to Britain,' McKidd told TV Guide. I got a phone call from my agent saying Shonda Rhimes called about meeting me. I was actually in Romania doing a movie with Woody Harrelson and Ron Perlman and he said, They need to see you on the day you land.'

At the time, the actor was married to Jane Parker and the couple had two young children son Joe and daughter Iona. McKidd revealed that he had a conflict of interest on the day Rhimes wanted to meet. The day I landed, I had been away for three months [and] it was my sons birthday, he said. So I said, Im sorry. I cant meet her its my sons birthday. I hope she can understand.'

Despite cancelling, McKidds commitment to his son won the women over. Supposedly Shonda tells the story that her and [producer] Betsy [Beers], when they heard that, said, What a great guy,' McKidd shared. So, it kind of paid off.

McKidd was able to reschedule with Rhimes to discuss the character and soon discovered that he was on the short list to play the role. I went and saw them the next day, and we just started chatting. I didnt read for it, the Greys star said. They told me about this new character that was going to be Iraq vet who was dark and messed up. It was between me and one other actor.

And the rest, as they say, is history. Then, sure enough, I got a phone call that Shonda decided to give me the role, McKidd said.

McKidd wasnt told too much about the character before he took it on but knew hed be in good hands with the show producers and writers. I did not know what this character was going to be, he explained. I had to take the role in blind faith.

Though he hadnt yet been introduced to his onscreen romantic partner Sandra Oh, who portrayed Dr. Cristina Yang, McKidd and the actress knew they were going to be a great team after just one scene together.

He was designed to be Cristinas new love interest. Sandra and I hadnt met at that point. The first day Sandra and I met, we did a scene together and she was so sweet, the Scottish actor shared. She said, Thank you! Thank you for being a good actor. And then we just hit it off from that point.

Though Oh departed the hit medical drama in 2014, McKidd would love for her character to reemerge on the show. I hope [Oh] will [return toGreys Anatomy]. I think it would be so much fun and it would open up so much again in the story and mix everything up,he told Entertainment Tonight in 2017. Shes just such an amazing actor that I still miss her to this day, every day at work Were good friends.

Greys Anatomy fans are hoping for the same thing!

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'Grey's Anatomy's' Kevin McKidd Shares Why He Initially Had to Turn Down a Meeting With Shonda Rhimes - Showbiz Cheat Sheet

Resveratrol Market Higher Growth Rate and Forecast 2018 2028 – Science In Me

Global Resveratrol Market: Overview

The rising demand from the pharmaceutical industry is likely to boost growth of the resveratrol market in coming years. Resveratrol has wide application in pharmaceutical industry owing to its healing and managing properties to treat different type of disease to argument growth of this market. Also, its properties to heal several fatal disease like cancer, diabetes, cardio-vascular disease and neurological disease to influence market growth in coming years.

According to National Institute of Health (NIH), the side effects associated with the resveratrol to hamper growth of this market in coming years. As it may have reverse impact such as nausea, gastrointestinal upset, fatigue and headache. These are some of the factors limiting growth of this market at global level. It may leads to supplement drug interactions with estrogen and anticoagulant. This can be another reason negatively impacting growth of the global resveratrol market. However, various applications of resveratrol in other products such as dietary supplements sector and cosmetic industry expected to propel growth of the resveratrol market.

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Global Resveratrol Market: Trends and Opportunities

Resveratrol is considered as potent antioxidant and also provide anti-aging properties in cosmetic industry and when it is consumed as dietary supplement helps in dropping cardiovascular disease. This can be one of the vital factors promoting growth of the global resveratrol market in coming years. Also, the resveratrol act as active ingredient when it is utilized in making cosmetic products, this can be key factor propelling growth of the resveratrol market.

Resveratrol is helps in reducing skin damages; this can be another factor fueling growth of this market at healthy pace. Also, launch and approval of various resveratrol based dietary supplements to boost growth of the resveratrol market in near future.

Global Resveratrol Market: Regional Outlook

On the basis of geography,Asia Pacific to dominate the global market for resveratrol on the basis of its versatile properties. Also,growing government support on account of adoption of resveratrol, this likely to influence growth of the Asia Pacific resveratrol market. For example, according to Japanese Ministry of health and labour welfare has earlier declared that the resveratrol should be considered as non- drug material. This allows accessblity of product in Japan, this can another factor propelling growth of this market.

Global Resveratrol Market: Companies Mentioned

This section of the report highlights key players operating in the global resveratrol market. Some of the key players operating in this market includes SiChuan Xieli Pharmaceutical Co., Ltd., SkinCeuticals, Endurance Products Company,Helix Healthstore,ResVitale,and VitaMonk.

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The manufacturers are highly focused toward research and development activities in order to maintain presence across the globe. The new innovation in cosmetics product to reduce skin damages and defects, this likely to argument for the growth of the resveratrol market.

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Resveratrol Market Higher Growth Rate and Forecast 2018 2028 - Science In Me

Heart health: A crowded, competitive, and niche market for supplements – Nutritional Outlook

Heart health is a solid category where natural solutions have found fertile ground for the last several years. But it is also crowded and very generic. Thats why there is a lot of movement to be more specific about a heart health products benefits, as well as find new angles for innovation.

Offering a sobering view of the market, Julian Mellentin, director, New Nutrition Business, says, Heart health is arguably the most-crowded and competitive of all benefit platforms. The benefit of heart health is offered directly and indirectly by a massive array of products stretching across all categories. In heart health, whatever proposition you developno matter how good its scienceis in competition with a wealth of regular foods that consumers and the media perceive as heart healthy. These include oats, olive oil, dark chocolate, whole grains, almonds, pistachios, blueberries, and many, many others. This competitive reality has helped keep heart health brands in a niche.

Still, heart health remains one of the top reasons why overall supplement users take supplements. This reason is especially popular among supplement users aged 55+, with heart health being the third most popular reason for taking dietary supplements in this age bracket, says Nancy Weindruch, vice president, communications, Council for Responsible Nutrition (CRN; Washington, DC).

In the mass-market retail channel, the top three ingredients for heart health as of October 6, 2019, according to market researchers SPINS and IRI, were fish oil, psyllium, and CoQ10. However, the only categories of the top 10 ingredients listed in this market under cardiovascular health that posted gains compared to the previous year were psyllium (which grew 0.5%) and CoQ10 (ubiquinol; which grew 15%).

In the natural retail channel, the top three ingredients for heart health were CoQ10, fish oil, and garlic. Those posting gains in the natural channels cardiovascular category were garlic at 5%, red yeast rice at 1%, magnesium at 4%, and resveratrol at 9%.

Most top 10 ingredient categories across both channels were in the red, indicating a stagnating and/or declining market from previous years. That being the case, omega-3s and CoQ10 continue to hold the top positions in terms of market share.

Among consumers, according to CRNs 2019 Consumer Survey on Dietary Supplements, usage of omega-3/fatty acid supplements has remained steady over the past five years. Historically and currently, omega-3s are most popular in the 55+ age category, says CRNs Weindruch. Omega-3/fatty acids are in the top five most popular supplements taken by men. In fact, the number of men who take omega-3/fatty acid supplements has grown by four percentage points over the last year.

Mellentin also believes nutrients like omega-3s are among those likely to keep the heart health category afloat for years to come, among others.

Ingredients like walnuts or almonds have strong epidemiological data showing their cardio-protective effects, which helps to strengthen the naturally heart healthy beliefs around whole foods, he says. Ingredients like omega-3, beta-glucan, phytosterols, CoQ10, and lycopene dominate the heart health supplement category. It will be difficult for emerging ingredients to challenge ingredients like omega-3s, which have been studied since the 1970s.

Omega-3 Drugs Dominate Recent Headlines

The omega-3 market has had its share of ups and downs. In 2019, there was a mix of news related mostly to the publication of several high-profile studies. Indeed, REDUCE-IT1, VITAL2, and ASCEND3 were the studies that kept on giving when it came to headlines.

All published about a year ago, new findings generated from these studies continue to shine a light on omega-3s EPA and DHA, especially with regard to heart health.

Most recently, Amarins Vascepa EPA ethyl ester drug stunned the world in the REDUCE-IT1 study by showing its extraordinary ability to reduce the risk of cardiovascular (CV) events by 30%, an achievement a cholesterol medication could only dream of.

This prompted FDA in mid-December to expand label-claim approval for Vascepa for the secondary prevention of cardiovascular events, claiming that it would give patients with elevated triglycerides and other important risk factors, including heart disease, stroke, and diabetes, an adjunctive treatment option that can help decrease their risk of cardiovascular events.

However, the wave omega-3 drugs were riding abruptly crashed in January of this year when two other omega-3 drug makers, AstraZeneca and Acasti, reported the clinical trial results of Epanova (a fish-oil based EPA/DHA drug) and CaPre (a krill oilbased drug), respectively. The STRENGTH trial was halted because Epanova didnt show a likelihood of cutting LDL cholesterol when combined with a statin for patients at risk of heart disease due to high levels of LDL (or bad) cholesterol. At the same time, Acasti reported that its krill oil drug failed to sufficiently perform better than placebo in terms of reducing triglyceride levels.

In the meantime, although a full-scale direct-to-consumer marketing campaign for Vascepa is well underway, many analysts continue to question its future due to intellectual property concerns.

In light of these recent studies and reports, it is important to keep things in perspective. Fish, dietary supplements, and pharmaceutical omega-3s all have an important role to play in delivering omega-3s to support heart health. But at the end of the day, if health outcomes are the goal, then it will always come down to dose, regardless of how these omega-3s are delivered.

The Omega-3 Index: A Tool for Growth

Another aspect of heart health that will likely come into play for 2020 and well into the future is the importance of knowing ones Omega-3 Index. This is simply a measurement of the omega-3s EPA and DHA in red blood cell membranes, and it has the potential to hold more weight than measuring cholesterol as a risk factor for heart disease, according to William S. Harris, PhD, the inventor of the test.

Originally proposed more than 15 years ago by Drs. Harris and his colleague Clemens von Schacky, the Omega-3 Index has since been featured in more than 200 studies, including some of the largest in the world like the Framingham Heart Study and the Womens Health Initiative Memory study, both of which included thousands of subjects.

With a risk factor that can be easily modified (i.e., one just needs to consume more EPA and DHA to raise their Omega-3 Index), this test is particularly attractive to doctors who want to assess risk for their heart patients. Stakeholders hope that the Omega-3 Index will one day become the standard of care like a cholesterol or CRP test. Lending credence to the importance of measuring omega-3 levels was a statement4 released late last year by the International Society for the Study of Fatty Acids and Lipids (ISSFAL) relating to the importance of omega-3 blood testing in research studies.

What this basically means is that any study looking to assess the benefits of omega-3s is heavily encouraged to measure omega-3 levels before and during the study in order to better correlate health outcomes. Similarly, consumers and practitioners should establish a baseline omega-3 blood level (i.e., Omega-3 Index) before deciding where to go next when it comes to strategizing when and how to adopt supplemental heart health strategies.

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Heart health: A crowded, competitive, and niche market for supplements - Nutritional Outlook

B cell Sirt1 deacetylates histone and non-histone proteins for epigenetic modulation of AID expression and the antibody response – Science Advances

Abstract

Activation-induced cytidine deaminase (AID) mediates immunoglobulin class switch DNA recombination (CSR) and somatic hypermutation (SHM), critical processes for maturation of the antibody response. Epigenetic factors, such as histone deacetylases (HDACs), would underpin B cell differentiation stagespecific AID expression. Here, we showed that NAD+-dependent class III HDAC sirtuin 1 (Sirt1) is highly expressed in resting B cells and down-regulated by stimuli inducing AID. B cell Sirt1 down-regulation, deprivation of NAD+ cofactor, or genetic Sirt1 deletion reduced deacetylation of Aicda promoter histones, Dnmt1, and nuclear factorB (NF-B) p65 and increased AID expression. This promoted class-switched and hypermutated T-dependent and T-independent antibody responses or led to generation of autoantibodies. Genetic Sirt1 overexpression, Sirt1 boost by NAD+, or allosteric Sirt1 enhancement by SRT1720 repressed AID expression and CSR/SHM. By deacetylating histone and nonhistone proteins (Dnmt1 and NF-B p65), Sirt1 transduces metabolic cues into epigenetic changes to play an important B cellintrinsic role in modulating antibody and autoantibody responses.

As the master molecule for immunoglobulin (Ig) class switch DNA recombination (CSR) and somatic hypermutation (SHM), activation-induced cytidine deaminase (AID) is central to the maturation of the antibody response (1). Physiologically, AID expression is restricted to B cells only and at a specific B cell differentiation stage only. AID is undetectable in resting B cells, and it is induced at high levels in B cells activated by T-dependent and T-independent stimuli, including CD154:CD40, Toll-like receptor (TLR) ligand:TLR, and select cytokine:cytokine receptors engagement, and then subsides to undetectable levels in resting memory B cells and plasma cells (24). AID is also greatly up-regulated in activated B cells that make class-switched and somatically hypermutated autoantibodies in autoimmune diseases, such as systemic lupus erythematosus (SLE) (3, 4). AID induction is mediated through activation of the Aicda (AID gene) promoter and regulatory regions by transcription factor nuclear factorB (NF-B) as complemented by HoxC4, as well as by Aicda histones acetylation and DNA demethylation (58). Select microRNAs and Aicda cis-elements have been shown to prevent AID expression in nonactivated B cells (7, 9). However, the mechanisms underpinning the suppression of Aicda transcription, which is required to avoid AID expression in B cells either resting or in response to subliminal and/or nonspecific stimuli and to control prolonged AID activation, have remained virtually unexplored.

We contend here that B cellintrinsic regulation of AID expression is mediated by epigenetic mechanisms (3, 4, 10). Epigenetic modifications and factors comprise epigenetic marks, such as DNA methylation/demethylation and histone posttranslational modifications, and epigenetic mediators, including histone methyltransferases and demethylases, histone acyltransferases, and histone deacetylases (HDACs comprise classical class I, II, and IV HDACs and nonclassical class III HDACs or Sirtuins) as well as noncoding RNAs (e.g., microRNAs and long noncoding RNAs) (4, 10). Epigenetic modifications and factors are known to influence gene expression and modulate critical B cell processes, including CSR/SHM and plasma cell differentiation, thereby informing the antibody response (4, 10). By using well-characterized short-chain fatty acid HDAC inhibitors valproic acid and butyrate, which inhibit the classical class I, II, and IV HDACs, we have shown that these HDACs regulate intrinsic B cell functions that are critical in shaping effective antibody and autoantibody responses (11). Sirt1, a nonclassical class III HDAC, has been implicated in innate and adaptive immune responses (12). Sirt1 has been suggested to function as an immune regulator, suppressing the antinuclear autoantibody response in murine lupus and type 1 diabetes through modulation of T cell functions (1214). Also, Sirt1-null mice develop an autoimmune condition with characteristic antinuclear autoantibodies (15).

Sirt1 actively deacetylates acetyl-lysine in multiple histones, including H3K9Ac and H3K14Ac, to facilitate chromatin compaction and silence gene transcription (16). In addition to deacetylating histones, Sirt1 deacetylates select nonhistone proteins. These are generally molecules involved in signal transduction, metabolism, or gene transcription. By deacetylating the p65 subunit at lysine 310, Sirt1 inactivates NF-B (17); by deacetylating the catalytic domain of DNA methyltransferase 1 (Dnmt1), Sirt1 boosts this enzymes activity (18). Unlike class I, II, and IV HDACs that are Zn2+ dependent for their function, Sirt1, like the other class III deacetylases, depends on nicotinamide adenosine dinucleotide (NAD+) as cofactor (19). Increased cellular NAD+ boosts Sirt1 activity. Resveratrol, a natural polyphenolic compound found mainly in grape skin and red wine, which increases Sirt1 activity by facilitating NADH oxidation to NAD+ and, likely, by increasing Sirt1 affinity for both NAD+ and acetylated substrate, has been shown to affect protection in lupus mice (20, 21). By contrast, reduced cellular NAD+ concentration, resulting from conversion of NAD+ to NADH by the glucose metabolic pathway (glycolysis), leads to decreased Sirt1 activity (22). As a result of its dependence on NAD+ and, therefore, the cellular NAD+/NADH ratio, Sirt1 has emerged as a key metabolic sensor in various tissues (23). By deacetylating histone and nonhistone proteins, including transcription factors, Sirt1 couples the cell metabolic status (through NAD+) to the modulation of multiple biological processes, such as signal transduction, gene transcription, and DNA repair (24, 25). Although a role for Sirt1 in B cells has remained mostly unexplored, our preliminary findings have suggested that Sirt1 suppresses AID expression in a B cellintrinsic fashion, thereby impacting CSR/SHM in antibody and autoantibody responses.

We hypothesized here that Sirt1 regulates AID expression in a B cellintrinsic fashion to modulate CSR/SHM and the maturation of the antibody response. To test our hypothesis, we generated conditional knockout AicdacreSirt1fl/fl mice and used them together with transgenic mice expressing multiple copies of Sirt1 (Sirt1super mice) to address the B cellintrinsic role of Sirt1 in T-dependent and T-independent antibody responses, namely, the role of Sirt1 in modulating histone acetylation of the Aicda and, for comparison, the Prdm1 (Blimp1 gene) and Xbp1 promoters. In addition, we addressed the potential role of Sirt1 in modulating NF-B acetylation and, therefore, NF-B recruitment to the Aicda promoter for induction of Aicda expression. We also addressed the role of Sirt1 in modulating the methylation status of the Aicda promoter through deacetylation and activation of the DNA methyltransferase Dnmt1. Further, we analyzed the impact of elevated glucose on the cellular NAD+/NADH ratio and Sirt1 activity on Aicda and, for comparison, Prdm1 expression in B cells. Last, we used the small-molecule Sirt1 activator SRT1720, which is 1000-fold more potent than resveratrol, to boost Sirt1 activity in B cells in vitro and in vivo and measured SRT1720 impact on AID levels and CSR/SHM. Overall, our findings outline an important B cellintrinsic role for Sirt1 as an epigenetic modulator of AID and as a regulator of class-switched and hypermutated antibody and autoantibody responses. Sirt1 affects these functions by acetylating histone and nonhistone proteins in response to B cell activation stimuli, the metabolic milieu, or small-molecule activator(s).

Sirt1 has been shown to be expressed in lymphoid tissues (13). We found Sirt1 to be expressed at the highest level among the seven Sirt genes in mouse nave B cells (Fig. 1A). Stimulation of these B cells to induce CSR greatly down-regulated Sirt1 [by 86.5% after stimulation with lipopolysaccharide (LPS) plus interleukin-4 (IL-4) and 87.5% after stimulation with CD154 plus IL-4] while up-regulating Aicda transcripts (Fig. 1B). Like mouse B cells, purified human nave B cells expressed SIRT1 at a high level and down-regulated it by 90.8% after a 72-hour stimulation by CD154 plus IL-4 and IL-21, which up-regulated AICDA, resulting in CSR to IgG (Fig. 1C and fig. S1). By contrast, in B cells activated by cross-linking the B cell antigen receptor (BCR) with anti-Ig monoclonal antibody (mAb), expression of Sirt1 and Aicda was unchanged (Fig. 1D). A reciprocal Sirt1/Aicda expression also occurred in vivo. In B cells isolated from NP-conjugated chicken gamma globulin (NP16-CGG)immunized C57BL/6 mice, in which Aicda expression was greatly increased, Sirt1 expression was significantly reduced, as compared to nonimmunized mice (Fig. 1E). In those B cells, reduced Sirt1 expression was reflected in reduced levels of Sirt1 protein and was concomitant with increased AID protein (Fig. 1F). Sirt1 level in germinal center B cells, which expressed AID, was significantly lower than that in nave B cells or plasma cells, which did not express AID, as shown by intracellular immunofluorescence with anti-Sirt1 and anti-AID Abs. Similarly, in B cells stimulated by LPS plus IL-4 in vitro, Sirt1 protein expression was down-regulated while AID protein was up-regulated, as shown by intracellular immunofluorescence and immunoblotting (Fig. 1, G to I). Thus, Sirt1 is expressed at a high level in resting nave B cells, in which AID expression is virtually nil. Activation of B cells by stimuli that induce CSR down-regulates Sirt1 while reciprocally up-regulating Aicda expression, indicating a role for Sirt1 in modulation of Aicda expression.

(A) Sirt1-7 and Aicda expression in mouse nave B cells before and after stimulation with LPS plus IL-4 for 72 hours, as measured by mRNA-Seq and depicted as RPKM (reads per kilobase of transcripts per million mapped reads; one of two independent experiments yielding comparable results). (B) Sirt1 and Aicda transcript levels [quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis] in mouse B cells stimulated with LPS or CD154 plus IL-4 for 0, 6, 12, 24, 48, or 72 hours. Data are ratios to the expression in unstimulated B cells (set as 1; means SEM of three biological independent experiments, each consisting of triplicates, left panel). Also shown are the inverse correlation scatter plots of Sirt1 and Aicda expression levels (right). (C) SIRT1 and AICDA expression (qRT-PCR analysis) in human nave B cells stimulated with CD154 plus IL-4 and IL-21 for 0, 6, 12, 24, 48, 72, or 96 hours. Data are ratio to the expression in unstimulated B cells (set as 1; means SEM of three biological independent experiments, each consisting of triplicates, left). Also shown are the inverse correlation scatter plots of SIRT1 and AICDA expression levels (right). (D) Sirt1 and Aicda transcript levels (qRT-PCR analysis) in mouse B cells stimulated with anti-Ig mAb or LPS plus IL-4 for 72 hours. Data are ratios to the expression in unstimulated B cells (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (E) Sirt1 and Aicda expression (qRT-PCR analysis) in spleen B cells from C57BL/6 mice immunized with nil or NP16-CGG and analyzed 10 days after immunization. Data are ratios to the expression in nonimmunized mice (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (F) Sirt1 and AID protein levels in CD19+IgDhiGL7CD138 nave B cells, CD19+IgDGL7hiCD138 germinal center (GC) B cells, and CD19loCD138hi plasma cells/plasmablasts in C57BL/6 mice immunized with NP16-CGG, as analyzed by flow cytometry 10 days after immunization. (G to I) Sirt1 and AID protein levels in mouse B cells before (nil) and after stimulation with LPS plus IL-4 for 72 hours analyzed by flow cytometry (G), intracellular immunofluorescence (H), and immunoblotting (I). Densitometry quantification of immunoblotting signals normalized to -actin levels and depicted as ratios of readings in LPS plus IL-4 stimulated B cells to those in unstimulated (0 hours) B cells (I, right). Data in (F) to (I) are one of two independent experiments yielding similar results. ***P < 0.001; ns, not significant, unpaired two-tailed Students t test. Scale bar, 5 m. DAPI, 4,6-diamidino-2-phenylindole.

To address the role of Sirt1 in modulating Aicda in vivo, we used transgenic mice expressing extra copies of Sirt1 (Sirt1super mice) (26). In Sirt1super mice, B cell Sirt1 levels were about 250 to 1000% higher than in Sirt+/+ mice, concomitant with decreased Aicda expression and decreased circulating IgG1 and IgA but normal IgM levels (Fig. 2, A and B). Sirt1super B cells stimulated in vitro by LPS plus IL-4 expressed Sirt1 225% more than wild-type (WT) B cells (Fig. 2C). The increased Sirt1 transcripts and Sirt1 protein in these Sirt1super B cells were associated with decreased Aicda transcripts and AID protein, significantly lower CSR to IgG1, IgG3, IgA, and IgE than WT B cells, but unaltered expression of Prdm1, Xbp1, and plasma cell differentiation (Fig. 2, C to E). Accordingly, enforced Sirt1 expression by a retroviral construct in normal B cells greatly reduced CSR to IgG1 (Fig. 2F). Further, selective activation of Sirt1 by SRT1720 inhibited CSR in WT B cells stimulated with LPS plus IL-4, without affecting plasma cell differentiation, cell proliferation, or viability (Fig. 2, G to I, and fig. S2A). SRT1720-induced inhibition of CSR was associated with reduced Aicda but not reduced Prdm1 or Xbp1 expression (Fig. 2J). Like SRT1720, resveratrol reduced Aicda expression and CSR in a dose-dependent fashion without altering Prdm1 expression or plasma cell differentiation (fig. S2, B and C). Thus, Sirt1 overexpression or Sirt1 activation efficiently inhibits B cell Aicda expression and CSR but not Prdm1 or Xbp1 expression or plasma cell differentiation.

(A) Ex vivo expression of Sirt1 and Aicda (qRT-PCR) in peripheral blood total B cells isolated from non-intentionally immunized Sirt1+/+ and Sirt1super mice. Data are ratios to expression in total B cells from Sirt1+/+ mice (set as 1; means SEM of values from three Sirt1+/+ mice and three Sirt1super mice). (B) Serum titers [enzyme-linked immunosorbent assay (ELISA)] of total IgM, IgG1, and IgA in non-intentionally immunized Sirt1+/+ and Sirt1super mice (means SD of six Sirt1+/+ mice and six Sirt1super mice). (C) Expression of Sirt1, Aicda, Prdm1, and Xbp1 transcripts (qRT-PCR) in Sirt1+/+ (set as 1) and Sirt1super B cells stimulated with LPS plus IL-4 for 72 hours (means SEM of three biological independent experiments, each consisting of triplicates; left) as well as immunoblotting and flow cytometry analysis of Sirt1 and AID protein levels in these cells (one of two independent experiments yielding similar results; right). (D and E) CSR (D) and plasma cell differentiation (E) in Sirt1+/+ and Sirt1super B cells (flow cytometry analysis) after stimulation with appropriate stimuli, as indicated, for 96 hours (left, one representative of three independent experiments; right, means SEM of three independent experiments). (F) CSR to IgG1 (flow cytometry analysis) in (B220+GFP+) B cells transduced by pMIG-GFP or pMIG-GFP-Sirt1 retrovirus (one of two independent experiments yielding similar results). (G to I) C57BL/6 B cells stimulated for 96 hours with LPS plus IL-4 in the presence of SRT1720 at indicated doses. Percentages of IgG1+ B cells and B220lowCD138+ plasma cells (G), cell proliferation [carboxyfluorescein diacetate succinimidyl ester (CFSE)labeled cells] (H), and viability [7-aminoactinomycin Dnegative (7-AAD)] (I) (flow cytometry analysis). Data are means SEM of three independent experiments (G) or one representative of three independent experiments (H and I). (J) Aicda, Prdm1, and Xbp1 transcript levels (qRT-PCR analysis) in purified B cells treated with nil or SRT1720 at the indicated doses and stimulated for 72 hours with LPS plus IL-4. Data are ratios to the expression in B cells treated with nil (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (K) Sirt1 transcript levels (qRT-PCR analysis) in AicdacreSirt1+/+ and AicdacreSirt1fl/fl B cells stimulated with LPS plus IL-4 for 0 and 72 hours. Data are ratios to the expression in unstimulated (0 hours) AicdacreSirt1+/+ B cells (set as 1; SEM of three biological independent experiments, each consisting of triplicates). (L) CSR to different Ig isotypes (flow cytometry analysis) in AidcacreSirt1+/+ and AicdacreSirt1fl/fl B cells stimulated for 96 hours with appropriate stimuli, as indicated. Data are one representative (left) and means SEM (right) of three independent experiments. (M) Expression of indicated genes (qRT-PCR analysis) in AidcacreSirt1+/+ and AicdacreSirt1fl/fl B cells stimulated for 72 hours with LPS plus IL-4 or LPS plus TGF- and anti-Ig mAb-dextran (I-C and I-C). Data are ratios to the expression in AicdacreSirt1+/+ B cells (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (N) AID protein levels in AicdacreSirt1+/+ and AicdacreSirt1fl/fl B cells stimulated with LPS plus IL-4 for 72 hours as analyzed by intracellular staining and flow cytometry. Data are from one of two independent experiments yielding similar results. (O) Plasma cell differentiation (flow cytometry analysis) in AidcacreSirt1+/+ and AicdacreSirt1fl/fl B cells stimulated for 96 hours with appropriate stimuli, as indicated. Data are one representative (left) and means SEM (right) of three biological independent experiments. (P) Proliferation of spleen B220+ B cells labeled with CFSE and stimulated with LPS plus IL-4 for 72 and 96 hours (top) and B cell viability (7-AAD, bottom). Data are one representative of three independent experiments yielding similar results. *P < 0.05 and **P < 0.01, unpaired two-tailed Students t test.

To further define the B cellintrinsic role of Sirt1 in modulating AID expression and CSR/SHM, we cross-bred transgenic Aicdacre mice (5) with Sirt1fl/fl mice (27) to construct AicdacreSirt1fl/fl mice. In these mice, which carry a normal complement of Aicda gene together with a cre gene under control of an extra Aicda promoter/enhancer within a bacterial artificial chromosome (BAC) transgene, cre recombinase expression leading to Sirt1 deletion occurred only in B cells activated to transcribe Aicda-cre. AicdacreSirt1fl/fl mice had an intact Sirt1 locus throughout embryogenesis and were born at an expected Mendelian ratio. They were indistinguishable from their AicdacreSirt1+/+ and AicdacreSirt1+/fl littermates in size, fertility, and organ morphology during development and maturation.

In vitro, AicdacreSirt1fl/fl B cells further reduced Sirt1 expression upon exposure to Aicda- and CSR-inducing stimuli, as compared to their AicdacreSirt1+/+ counterparts (Fig. 2K). Among AicdacreSirt1fl/fl B cells stimulated to undergo CSR to IgG3 (by LPS), to IgG1 and IgE (LPS plus IL-4), or to IgA [LPS plus transforming growth factor (TGF-), IL-5, IL-4, and anti- mAb/dex], the proportion of switched IgG3+, IgG1+, IgA+, or IgE+ B cells was 50 to over 400% greater than among similarly stimulated AicdacreSirt1+/+ B cells, as confirmed by elevated postrecombination I-C1, I-C, and I-C transcripts (Fig. 2, L and M). Further, it was associated with increased expression of Aicda and AID protein, but not Prdm1, Xbp1, or germline I-C, I1-C1, I-C, and I-C transcripts, as measured by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) after a 72-hour culture (Fig. 2, M and N), indicating a role of Sirt1 in regulating AID but not Blimp1 expression. Plasma cell differentiation of AicdacreSirt1fl/fl B cells, as measured by proportion of CD19lowCD138+ cells, was comparable to that of AicdacreSirt1+/+ cells and so were B cell proliferation and survival (Fig. 2, O and P). Thus, ablation of Sirt1 in B cells increases Aicda expression and CSR without altering Prdm1 expression or plasma cell differentiation.

AicdacreSirt1fl/fl mice injected with NP16-CGG, a conjugated hapten that preferentially induces T-dependent NP-specific IgG1 antibodies, mounted a significantly greater NP4-specific IgG1 response than their AicdacreSirt1+/+ littermates (Fig. 3, A and B). NP16-CGGinjected AicdacreSirt1fl/fl mice also showed increased antibody-forming cells (AFCs) secreting NP4-specific IgG1 in the spleen and bone marrow (Fig. 3, C and D). In these mice, gut IgA-producing cells were also increased in small intestine lamina propria, Peyers patches, and mesenteric lymph nodes (Fig. 3E). Consistent with the augmented NP4-specific IgG1 response, somatic mutations in rearranged V186.2DJH-C1 transcripts [V186.2, ImMunoGeneTics information system (IMGT) gene name V1-72, encodes the IgH variable region of NP-binding antibodies) were increased by almost 100% in AicdacreSirt1fl/fl mice as compared to their AicdacreSirt1+/+ littermates (analysis of more than 10,000 Illumina MiSeq sequences) (Fig. 3F and fig. S3, A and B).

(A and B) Serum titers of total IgM, IgG1, and IgA (A) and high-affinity NP4-binding IgG1 (B) (ELISA; RU, relative units) in AicdacreSirt1+/+ and AicdacreSirt1fl/fl mouse littermates immunized with NP16-CGG at days 0 and 21 at different time points, as indicated (n = 7 mice in each group). Dotted lines link paired littermates. (C and D) AFCs secreting IgM and IgG1 or NP4-binding IgG1 (ELISPOTs) in the spleen and bone marrow in AicdacreSirt1+/+ and AicdacreSirt1fl/fl mouse littermates euthanized 28 days after the first NP16-CGG injection. Data are one representative of three independent experiments yielding similar results (C) or means SEM of three independent experiments (D). (E) Fluorescence microscopy analysis of IgA-producing cells in different gut tissues, as indicated, in AicdacreSirt1+/+ and AicdacreSirt1fl/fl mouse littermates AicdacreSirt1fl/fl mice (one representative of three independent experiments yielding similar results). Scale bars, 50 m. (F) Overall frequency (change/base) and distribution (pie charts) of point mutations in the V186.2 region of V186.2DJH-C1 complementary DNA (cDNA; pooled data from two mouse pairs) in AicdacreSirt1+/+ and AicdacreSirt1fl/fl mice injected (intraperitoneally) with NP16-CGG at days 0 and 21 and euthanized at day 28. Also depicted by histograms are frequencies of mutations in the framework (FR) and complementarity-determining (CDR) regions (right). P values were calculated by 2 test. (G and H) Analysis of class-switched IgMIgDIgG+ B cells, NP5-binding IgG1+ B cells, and NP5-binding CD38+IgG1+ memory B cells (flow cytometry) in spleen (G) and quantification of these cells in the NP16-CGG immunized mice (H). (I) Flow cytometry analysis of B220lowCD138+ plasmablasts/plasma cells in the spleen and bone marrow. (J) Quantification of proportion of B220lowCD138+ plasmablasts/plasma cells among total spleen and bone marrow cells. (K) Viable (7-AAD) B cells in the spleen (flow cytometry) of the immunized mice. (L and M) Flow cytometry analysis of proliferating (incorporating BrdU and BrdU+) B cells (L) and proportions of T (CD3+) cells and B (B220+) cells (M). (N) Spleen germinal center (B220+GL7+CD95+) B cells in AicdacreSirt1+/+ and AicdacreSirt1fl/fl mice as analyzed by flow cytometry 10 days after NP-CGG injection. (O) Quantification of the proportion and of B220+GL-7+CD95+ germinal center B cells among total spleen B cells, as analyzed by FACS (left), and total numbers of B220+GL-7+CD95+ germinal center B cells in each spleen (right). (P) Germinal center structure in the spleen (fluorescence microscopy). Data in (G), (I), (K) to (N), and (P) are one representative of three independent experiments yielding similar results. Scale bar, 100 m. (H), (J), and (O) are means SEM of three or four biological independent experiments. *P < 0.05, **P < 0.01, paired two-tailed Students t test.

In AicdacreSirt1fl/fl mice injected with NP16-CGG, class-switched IgMIgDIgG1+ B cells were increased by almost 55% over their AicdacreSirt1+/+ littermates (Fig. 3G). Among these B cells, the proportion of specific NP5-binding B cells was almost twice that in AicdacreSirt1+/+ littermates (19.0% versus 9.9%). In AicdacreSirt1fl/fl mice, 73.5% of these NP5-binding IgG+ B cells were CD38+ memory B cells, compared to only 30.4% in AicdacreSirt1+/+ mice. In addition, AicdacreSirt1fl/fl mice displayed a more than 320% increase in total spleen NP5-binding IgG1+ B cells, of which the proportion of CD38+ memory B cells was more than 570% greater than in AicdacreSirt1+/+ littermates (Fig. 3H). By contrast, the proportion of the spleen and bone marrow CD138+ plasmablasts/plasma cells in AicdacreSirt1fl/fl mice was comparable to that in AicdacreSirt1+/+ mice (Fig. 3, I and J) and so were spleen size and number and size of Peyers patches. AicdacreSirt1fl/fl mice showed normal B cell viability and proliferation (Fig. 3, K and L). They also showed B (B220+) and T (CD3+) cell numbers (Fig. 3M), proportion of B220+GL7+CD95+ germinal center B cells, and germinal center structure comparable to those of AicdacreSirt1+/+ mice (Fig. 3, N to P). Thus, B cellintrinsic Sirt1 deletion leads to increased antigen-specific, class-switched, and hypermutated B cell responses and memory B cell generation, without affecting B cell number, proliferation, survival, germinal center formation, or plasma cell differentiation.

To further address the direct B cellintrinsic role of Sirt1 in modulating the antibody response, we developed the NBSGW/B mouse model by engrafting highly immunodeficient NBSGW (NOD.Cg-KitW-41J Tyr+Prkdcscid Il2rgtm1Wjl/ThomJ) mice, which lack T cells, B cells, natural killer (NK) cells, functional dendritic cells, and macrophages (28), with highly purified C57BL/6 mouse spleen B cells. We segregated 10 NBSGW/B mice into two groups, 5 mice each, and injected (intraperitoneally) 5 mice with SRT1720 and 5 mice with phosphate-buffered saline (PBS) once every 2 days. All 10 mice were injected intraperitoneally, immediately after engraftment with NP-LPS (to induce an NP-specific T-independent antibody response), and all produced NP4-binding IgM, IgG3, and IgG2b antibodies (fig. S4A). However, the NBSGW/B mice given SRT1720 showed reduced total and NP4-binding class-switched IgG3 and IgG2b and marginally increased unswitched IgM antibodies, without alteration in B cell viability and numbers (fig. S4B). This was concomitant with reduced numbers of IgG3+ and IgG2b+ B cells and normal numbers of CD138+ plasmablasts/plasma cells (fig. S4C) and underpinned by reduced Aicda, but not Prdm1 expression, and decreased postrecombination I-C3 and I-C2b transcripts (fig. S4D). In NBSGW/B mice, Aicda down-regulation by SRT1720 also resulted in a reduced mutational load in V186.2DJH-C3 and V186.2DJH-C2b transcripts encoding the IgH chain of NP-binding IgG3 and IgG2b, as assessed by enumerating point mutations in the V186.2 segment of three comparable V186.2DJH-C3 and three comparable V186.2DJH-C2b clone pairs, each pair consisting of sequences from one SRT1720-treated and one nontreated mouse. Comparable pairs were defined as B cell clones expressing V186.2DJH-C3 or V186.2DJH-C2b with IgH CDR3s being identical in length (7 to 12 amino acids), identical in the first two amino acids and the last three or four amino acids. One of the three V186.2DJH-C3 clone pairs was identical in the whole IgH CDR3 sequence (ARGYFDY). The average change/base in transcripts from mice treated with nil versus mice treated with SRT1720 was 0.48 versus 0.35, 0.44 versus 0.30, and 0.48 versus 0.28 (V186.2DJH-C3) and 0.60 versus 0.35, 0.33 versus 0.19, and 0.33 versus 0.23 (V186.2DJH-C2b) (fig. S4E). Thus, activation of Sirt1 inhibits the maturation of a class-switched and hypermutated T-independent antibody response by down-regulating Aicda expression and dampening CSR/SHM, but not Prdm1 or plasma cell differentiation, in a B cellintrinsic fashion, independent of T cells, dendritic cells, NK cells, or macrophages.

In resting B cells, which do not express AID but express abundant Sirt1 (Fig. 1), histone H3 is hypoacetylated across the Aicda locus (5). Only upon activation by LPS and IL-4, which induced profound Sirt1 down-regulation and Aicda promoter activation, was the Aicda locus histone H3 acetylation greatly increased (Fig. 4A), Sirt1 deacetylates H3Ac, including H3K9 and H3K14, to shape heterochromatin (16). The lack of Sirt1 resulted in increased histone acetylation and gene expression, indicating that in B cells expressing AID, decreased Sirt1 expression enhanced Aicda histone acetylation and transition to euchromatin. Stimulation of B cells with LPS plus IL-4 increased Aicda promoter histone acetylation (H3K9Ac/K14Ac) and induced robust Aicda expression, with no change in H3K9Ac/K14Ac of Prdm1 or Xbp1 promoter (Fig. 4A). Increased Aicda promoter histone H3 acetylation reflected a reduced recruitment of Sirt1 to this region (Fig. 4B) and was not significantly increased in activated AicdacreSirt1fl/fl B cells stimulated with LPS plus IL-4 (fig. S5A), likely due to the physiologically extensive Aicda histone hyperacetylation in B cells induced to express AID and undergoing CSR (5). Thus, LPS plus IL-4induced Sirt1 down-regulation limits Sirt1 recruitment to and deacetylation of the Aicda promoter, thereby increasing Aicda promoter histone acetylation, AID expression, and CSR.

(A and B) ChIP-qPCR analysis of acetylated H3K9/K14 in Aicda, Prdm1, and Xbp1 promoters (A) and Sirt1 recruitment to the Aicda promoter (B) of WT C57BL/6 B cells nonstimulated (Nil) or stimulated with LPS plus IL-4 for 72 hours. Data are ratios to nonstimulated B cells (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (C to I) AicdacreSirt1+/+ and AicdacreSirt1fl/fl B cells were stimulated with LPS plus IL-4 (C to I) or CD154 plus IL-4 (G to I) for 72 hours. (C) Acetylated Dnmt1 and total Dnmt1 (left, immunoblotting; one representative of three independent experiments yielding similar results) and densitometry quantification of signals normalized to -actin levels and depicted as ratios to signals in AicdacreSirt1+/+ B cells (set as 1; means SD of three independent experiments; right). (D) Recruitment of Dnmt1 to the Aicda promoter or a Prdm1 regulatory region (ChIP-qPCR). Data are ratios to recruitment in AicdacreSirt1fl/fl B cells to AicdacreSirt1+/+ B cells (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (E) CpG DNA methylation at the Aicda promoter and Prdm1 regulatory region, as assessed by bisulfite sequencing. Depicted is the proportion of methylated dC nucleotides within the CpG motifs (pooled data from two mice in each group, with at least 5000 sequences from each mouse; means SD). (F) DNA methylation of Aicda and Xbp1 promoters, as well as Prdm1 regulatory region (MeDIP-qPCR). Data are normalized to DNA used as input (means SEM of three biological independent experiments, each consisting of triplicates). (G and H) Immunoblotting analysis of acetylated NF-B p65 and total NF-B p65 (G) and densitometry quantification of signals normalized to -actin levels and depicted as ratios to signals in AicdacreSirt1+/+ B cells (set as 1; means SD of three independent experiments) (H). (I) Recruitment of acetylated NF-B p65 to Aicda promoter or Prdm1 regulatory region (ChIP-qPCR) in B cells. Data are ratios of recruitment in AicdacreSirt1fl/fl cells to that in AicdacreSirt1+/+ B cells (set as 1; means SEM of three biological independent experiments). (J to L) Sirt1+/+ and Sirt1super B cells were stimulated with LPS plus IL-4 for 72 hours. (J) Acetylated H3K9/K14 in the Aicda, Prdm1, or Xbp1 promoter (ChIP-qPCR). Data are ratios of determinations in Sirt1super B cells to those in Sirt1+/+ B cells (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (K) Acetylated NF-B p65 and total NF-B p65 (immunoblotting analysis; left) and densitometry quantification of signals normalized to -actin levels and depicted as the ratio to that in Sirt1+/+ B cells (set as 1; means SD of three independent experiments; right). (L) Recruitment of acetylated NF-B p65 to Aicda, Prdm1, and Xbp1 promoters (ChIP-qPCR analysis). Data are ratios to recruitment in Sirt1+/+ B cells (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (M) Aicda expression (qRT-PCR analysis) in AicdacreSirt1+/+ and AicdacreSirt1fl/fl B cells treated with nil or SRT1720 and stimulated with LPS plus IL-4 for 72 hours (means SEM of three biological independent experiments, each consisting of triplicates). (N to Q) WT C57BL/6 B cells were treated with nil or SRT1720 and stimulated with LPS plus IL-4 for 72 hours. (N and O) ChIP-qPCR analysis of Sirt1 recruitment to Aicda, Prdm1, and Xbp1 promoters (N) as well as acetylated H3K9/K14 of these regions (O). Data are ratios of readings in SRT1720-treated B cells to those in nil-treated B cells (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (P) Immunoblotting of acetylated NF-B p65 and total NF-B p65 in B cells; densitometry quantification of signals normalized to -actin levels and depicted as ratios of readings in SRT1720-treated B cells to those in nil-treated B cells (set as 1; means SD of three independent experiments). (Q) Recruitment of acetylated NF-B p65 to the Aicda, Prdm1, and Xbp1 promoters (ChIP-qPCR analysis). Data are ratios of readings in SRT1720-treated B cells to those in nil-treated B cells (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). *P < 0.05, **P < 0.01, ***P < 0.001, paired two-tailed Students t test.

In addition to histones, Sirt1 deacetylates nonhistone proteins. Sirt1 has been suggested to boost DNA methylation by enhancing Dnmt1 activity through Dnmt1 deacetylation (18). LPS plus IL-4stimulated AicdacreSirt1fl/fl B cells increased acetylated (inactive) Dnmt1, as compared to AicdacreSirt1+/+ B cells, while total Dnmt1 protein levels were unchanged (Fig. 4C). Inactive Dnmt1 resulted in reduced recruitment of this DNA methyltransferase to and reduced DNA methylation of the Aicda promoter [28 and 44% of deoxycytidine (dC) nucleotides within CpG motifs were methylated in LPS plus IL-4stimulated AicdacreSirt1fl/fl and AicdacreSirt1+/+B cells, respectively, as shown by bisulfite sequencing of genomic DNA (gDNA)] (Fig. 4D), leading to increased Aicda expression. The methylation of Prdm1 promoter and the intronic regulatory region or Xbp1 promoter [as further shown by methylated DNA immunoprecipitation (MeDIP)qPCR] in AicdacreSirt1fl/fl B cells were unchanged (Fig. 4, E and F, and fig. S5, B to D).

Another nonhistone protein deacetylated by Sirt1 is NF-B p65, as occurring in macrophages, epithelial cells, and liver cancer cells, in which Sirt1 deacetylates p65 to dampen NF-B activity (17). Given the important role of NF-B in Aicda induction, we hypothesized that deletion of Sirt1 in B cells would lead to increased NF-B p65 acetylation, resulting in enhanced NF-B activity, and therefore, Aicda expression. Upon stimulation with LPS or CD154 plus IL-4, AicdacreSirt1fl/fl B cells significantly increased acetylated-p65 (p65-Ac) as compared to their AicdacreSirt1+/+ counterparts, concomitant with unchanged total p65 protein levels (Fig. 4, G and H). In AicdacreSirt1fl/fl B cells, increased p65 acetylation resulted in increased recruitment of p65-Ac to the Aicda promoter, as shown by chromatin immunoprecipitation (ChIP) with antip65-Ac mAb (Fig. 4I); despite some increased recruitment of p65-Ac to the Prdm1 promoter in AicdacreSirt1fl/fl B cells, Prdm1 expression was not increased (Fig. 2M), likely reflecting this regions unchanged H3K9/K14 acetylation (fig. S5A) and DNA methylation (Fig. 4, E and F), as well as the down-regulation of Irf4 in these B cells (fig. S6 and S7).

Thus, in resting B cells, in addition to being recruited to the Aicda promoter where it deacetylates histones, Sirt1 deacetylates and activates Dnmt1, and deacetylates and inactivates NF-B p65, overall resulting in silencing Aicda expression. Upon B cell stimulation to undergo CSR, down-regulated Sirt1 is not available for recruitment to and deacetylation of Aicda histones nor is it available to deacetylate Dnmt1-Ac, thereby keeping it in an inactive state, or NF-B p65-Ac, thereby keeping it activated. This increased acetylation of Aicda promoter histones, decreased Dnmt1 recruitment to and methylation of the Aicda promoter DNA, and increased NF-B acetylation for an overall combined activation of Aicda expression.

In Sirt1super B cells, impaired Aicda expression and CSR were associated with decreased Aicda promoter histone acetylation (H3K9Ac/K14Ac), as determined by ChIP assays of LPS and IL-4stimulated Sirt1super B cells and WT counterparts, with no concomitant change in H3K9Ac/K14Ac of Prdm1 or Xbp1 promoters (Fig. 4J). In addition, in these stimulated Sirt1super B cells, NF-B p65 acetylation and p65-Ac recruitment to the Aicda promoter were greatly reduced (Fig. 4, K and L). Similarly, Aicda expression was reduced in WT B cells treated with the potent SRT1720 Sirt1 activator; failure of SRT1720 to alter Aicda expression in Sirt1-deficient AicdacreSirt1fl/fl B cells confirmed that this was mediated by Sirt1 (Fig. 4M). SRT1720-mediated reduction of Aicda expression and CSR in B cells was also associated with reduced histone H3K9Ac/K14Ac of the Aicda promoter, but not Prdm1 or Xbp1 promoter, as a result of an increased recruitment of Sirt1 to the Aicda promoter (Fig. 4, N and O). In addition, SRT1720-mediated Sirt1 activation also significantly reduced NF-B p65 acetylation and recruitment of p65-Ac to the Aicda promoter, but not to the Prdm1 or Xbp1 promoter, in LPS plus IL-4stimulated B cells (Fig. 4, P and Q). Thus, overexpression or activation of B cell Sirt1 leads to reduced histone Aicda promoter histone and p65 protein acetylation, resulting in decreased Sirt1 and NF-B recruitment to the Aicda promoter, decreased Aicda expression, and impaired CSR.

NAD+ is the critical Sirt1 cofactor, and NAD+ availability is a function of NAD+/NADH ratio, which is metabolically regulated by glycolysis (19). In the glucose metabolic pathway, glycolysis converts NAD+ to NADH, thereby lowering cytosolic NAD+/NADH ratio. To test that this leads to decreased Sirt1 activity and increased Aicda expression, we cultured B cells with LPS plus IL-4 in medium containing increasing doses of glucose (0 to 20 mM), yielding lower cytosolic NAD+/NADH ratios. This resulted in dose-dependent increased expression of Aicda and CSR, concomitant with normal expression of Prdm1 and plasma cell differentiation (Fig. 5A and fig. S8), and reduced Irf4 expression. While this would generally lead to decreased Prdm1 expression (29), it was counteracted by the potential Prdm1 up-regulation due to increased NF-B p65 acetylation (Fig. 5A and fig. S7), thereby resulting in an unchanged Prdm1 expression level. These increased Aicda expression and CSR were not due to increased carbon/energy provided by glucose, as shown by failure of the same concentrations of galactose (galactose shares the same molecular formula with glucose and serves as a cell energy source but does not effectively feed into glycolysis) to affect Aicda expression and CSR (Fig. 5B). By contrast, B cells cultured with increased amounts of Sirt1 cofactor NAD+ (0 to 500 M) or glucose analog 2-deoxyglucose (2-DG; 0.1 to 1.0 mM), a prototypical glycolytic pathway blocker that has been shown to increase intracellular NAD+ levels and Sirt1 activity (30), reduced Aicda expression and CSR in a dose-dependent manner, with no alteration of Prdm1 expression and plasma cell differentiation (Fig. 5, C and D, and fig. S8)glucose, galactose, or NAD+ concentrations used in these experiments did not alter B cell viability (fig. S9).

B cells were cultured in glucose-free fetal bovine serum (FBS)RPMI medium supplemented with increased concentrations of (A) glucose or (B) galactose or in complete FBS-RPMI-1640 medium supplemented with increased concentrations of (C) 2-DG or (D) NAD+ and stimulated with LPS plus IL-4. Surface expression of B220 and IgG1 was analyzed by flow cytometry after 96 hours of culture. Expression of Aicda, Prdm1, and Irf4 was analyzed by qRT-PCR after 72 hours of culture. NAD+ and NADH concentrations in B cells cultured with increased amount of glucose were also determined after 72 hours. Data are from one representative of three independent experiments yielding comparable results (left) or means SEM of three biological independent experiments, each consisting of triplicates (right). C57BL/6 (E to L) or AicdacreSirt1+/+ and AicdacreSirt1fl/fl (M and N) B cells were cultured in glucose-free FBS-RPMI medium supplied with indicated concentrations of glucose and stimulated with LPS plus IL-4 for 72 (E to M) or 96 hours (N). (E and F) ChIP-qPCR analysis of acetylated H3K9/K14 in Aicda, Prdm1, and Xbp1 promoters (E) and recruitment of Sirt1 to the Aicda promoter (F) in B cells cultured with 0 or 20 mM of glucose. Data are ratios to recruitment in nil-treated B cells (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (G) Densitometry quantification of immunoblotting signals of acetylated Dnmt1 and total Dnmt1 after normalization to -actin levels in B cells. Data are ratios of acetylated Dnmt1 and Dnmt1 in B cells cultured with increased concentrations of glucose to B cells cultured without glucose (set as 1; means SD of three independent experiments). (H) ChIP-qPCR analysis of recruitment of Dnmt1 to the Aicda promoter in B cells cultured in different concentrations of glucose, as indicated. Data are ratios of recruitment in B cells cultured with glucose to that in B cells cultured without glucose (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (I) MeDIP-qPCR analysis of DNA methylation in the Aicda promoter of B cells cultured in different concentrations of glucose, as indicated. Data are ratios of values in B cells cultured in glucose to those in B cells cultured without glucose (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (J and K) Immunoblotting analysis of acetylated NF-B p65 and total NF-B p65 in B cells cultured in different concentrations of glucose, as indicated (J); densitometry quantification of signals expressed as ratios of signal in B cells cultured in glucose to that in B cells cultured without glucose (set as 1; means SD of three independent experiments) (K). (L) Recruitment of acetylated NF-B p65 to the Aicda promoter (ChIP-qPCR analysis) in induced B cells. Data are ratios of recruitment of acetylated NF-B p65 to Aicda promoter in B cells cultured with glucose to that in B cells cultured without glucose (set as 1; means SEM of three biological independent experiments). (M) qRT-PCR analysis of Aicda expression in AicdacreSirt1+/+ and AicdacreSirt1fl/fl B cells cultured in the different concentrations of glucose. Data are ratios of Aicda expression in AicdacreSirt1fl/fl B cells to that in AicdacreSirt1+/+ B cells (set as 1; means SEM of three biological independent experiments, each consisting of triplicates). (N) Flow cytometry analysis of CSR to IgG1 in AicdacreSirt1+/+ and AicdacreSirt1fl/fl B cells cultured in different concentrations of glucose. Data are ratios of IgG1+ AicdacreSirt1fl/fl B cells to AicdacreSirt1+/+ B cells (set as 1 in each glucose concentration; means SEM of three biological independent experiments). *P < 0.05, **P < 0.01, and ***P < 0.001, unpaired two-tailed Students t test.

To further define the role of Sirt1 in glucose-mediated up-regulation of Aicda expression and CSR, we stimulated AicdacreSirt1fl/fl and AicdacreSirt1+/+ B cells with LPS plus IL-4 and cultured them in RPMI medium containing no or increasing concentrations of glucose. In WT B cells, glucose-induced decreased NAD+/NADH ratio and Sirt1 activity resulted in reduced Sirt1 recruitment to the Aicda promoter, leading to increased promoter histone acetylation, increased acetylated (inactive) Dnmt1, reduced recruitment of Dnmt1 to the Aicda promoter, as defined by ChIP-qPCR, thereby limiting Aicda promoter DNA methylation, as defined by MeDIP-qPCR. This together with increased p65-Ac (not total p65 level) and increased recruitment of p65-Ac to the Aicda promoter led to increased Aicda expression and CSR (Fig. 5, E to L). At the highest glucose concentration (20 mM), the enhancement of Aicda expression and CSR to IgG1 in AicdacreSirt1+/+ B cells was comparable to those observed in AicdacreSirt1fl/fl B cells (Fig. 5, M and N). Thus, B cell glycolysis, which results in reduced NAD+/NADH ratio, paucity of Sirt1 cofactor NAD+, or decreased Sirt1 activity, leads to increased Aicda expression and CSR, mimicking the increased Aicda expression and CSR resulting from ablation of Sirt1.

In AicdacreSirt1fl/fl mice, deletion of Sirt1 in activated B cells led to production of class-switched anti-nuclear antigen autoantibodies (ANAs), including antidouble-stranded DNA (dsDNA), anti-histone, antiribonucleoprotein (RNP), and anti-RNA IgG (Fig. 6, A and B). In B cells isolated from female lupus MRL/Faslpr/lpr (12-week-old) and BXD2 (36-week-old) mice or patients with SLE, enhanced Aicda/AICDA expression was associated with significantly reduced Sirt1/SIRT1 expression, as compared to healthy female C57BL/6 mice or healthy humans, respectively (Fig. 6, C and D). Accordingly, Sirt1 protein was significantly decreased in MRL/Faslpr/lpr B cells, in which AID expression was elevated (Fig. 6G). Further, reduced Sirt1 expression was associated with hyperacetylated Aicda/AICDA promoter histone H3 in mouse and human lupus B cells (Fig. 6, E and F). Last, SRT1720 treatment reduced AID expression in MRL/Faslpr/lpr B cells and decreased anti-dsDNA and anti-histone IgG1 and IgG2a, but not IgM, as well as reduced IgG1/IgG2a kidney deposition and glomerular damage in MRL/Faslpr/lpr mice (Fig. 6, G to I). Thus, Sirt1 deletion in activated B cells leads to emergence of lupus autoantibodies in otherwise normal female C57BL/6 mice. In mouse and human lupus B cells, high levels of Aicda/AICDA expression occur concomitantly with decreased Sirt1/SIRT1 expression, in association with increased Aicda promoter histone acetylation. In addition, Sirt1 activation by SRT1720 reduces AID expression, autoantibody production, and autoimmunity in lupus MRL/Faslpr/lpr mice.

(A) IgG1+ and IgG2a+ ANAs in sera from 35-week-old female AicdacreSirt1+/+ and AicdacreSirt1fl/fl mice (immunofluorescence microscopy of one representative of three independent experiments). Scale bar, 50 m. (B) Anti-dsDNA, anti-histone, anti-RNP, and anti-RNA IgG titers (ELISAs) in sera from 35-week-old female AicdacreSirt1+/+ and AicdacreSirt1fl/fl mice (means SD of six AicdacreSirt1+/+ and six AicdacreSirt1fl/fl mice, each tested in triplicates). (C) Expression of Sirt1 and Aicda (qRT-PCR analysis) in spleen B cells from C57BL/6 mice and lupus-prone MRL/Faslpr/lpr and BXD2 mice. Data are relative expression to -Actin (means SD of three mice in each group). Dotted lines depict trends. (D) qRT-PCR analysis of expression of SIRT1 and AICDA in B cells from healthy humans and patients with SLE. Data are normalized to expression of -ACTIN (means SD of three healthy individuals and three patients with SLE). Dotted lines depict trends. (E) Acetylated H3K9/K14 in the Aicda, Prdm1, and Xbp1 promoters (ChIP-qPCR analysis) in B cells from C57BL/6 and MRL/Faslpr/lpr mice. Data are ratios of acetylated H3K9/K14 in MRL/Faslpr/lpr mice to that in C57BL/6 mice (set as 1; means SD of three mice in each group). (F) Acetylated H3K9/K14 in the AICDA and PRDM1 promoters in B cells from healthy human individuals (HS) and patients with SLE (ChIP-qPCR analysis). Data are ratios of acetylated H3K9/K14 in the AICDA and PRDM1 promoters of B cells from patients with SLE to that of healthy individuals (set as 1; means SD of three healthy individuals and three patients with SLE). (G) Intracellular staining of Sirt1 and AID protein levels in spleen B cells from age-matched female C57BL/6 mice, untreated MRL/Faslpr/lpr mice, and MRL/Faslpr/lpr mice treated with SRT1720 (flow cytometry analysis, one representative of three independent experiments). (H) Serum anti-dsDNA and anti-histone IgM, IgG1, and IgG2a titers (ELISAs) in female MRL/Faslpr/lpr mice treated with Nil or SRT1720 (means SD of six mice in each group). (I) Photomicrographs of kidney sections from MRL/Faslpr/lpr mice treated with Nil or SRT1720, after hematoxylin and eosin (H&E) staining (left) or fluorescence staining of mouse IgG1/IgG2a (right). One representative of three independent experiments yielding similar results. Scale bars, 100 m. *P < 0.05, **P < 0.01, unpaired two-tailed Students t test.

By introducing single-strand nicks and double-strand breaks in the Ig locus DNA, AID affects the first and critical step in the cascade of events that lead to B cell CSR/SHM. Being a potent mutator, AID is under tight regulation. Its expression is cell type specific, being confined to B lymphocytes, and B cell differentiation is stage specific, being limited to activated B cells stimulated to undergo CSR/SHM (24). AID is not expressed in nave resting B cells, resting memory B cells, or plasma cells. Its targeting is also specific, being restricted to the Ig locus. However, under nonphysiological conditions, AID can target DNA outside the Ig locus (AID off-targeting) and, as a potent mutator, can cause genome instability in lymphoid and nonlymphoid cells, thereby promoting neoplastic transformation (4, 31). Genomic damage by AID off-targeting has been well documented, emphasizing the need for tight regulation of AID expression to maintain genomic integrity (31). The mechanisms targeting AID to the Ig locus, including DNA hotspots and epigenetic marks, such as histone acetylation and phosphorylation, are relatively understood. However, what keeps AID expression in check in resting B cells and limits it to B cells activated to undergo CSR/SHM has remained unaddressed.

Here, we provide evidence that Sirt1 is central to a B cellintrinsic mechanism that, together with transcription factors and other epigenetic modulators, regulates AID expression for CSR/SHM in the maturation of the antibody response. Sirt1-mediated regulation of AID is B cell differentiation stage specific, as shown by high levels of Sirt1 in human and mouse resting B cells and Sirt1 down-regulation by stimuli that induce Aicda expression and CSR/SHM. The B cellintrinsic function of Sirt1 in the regulation of these processes was addressed in vitro in experiments using purified mouse and human nave B cells and was extended to in vivo analysis of class-switched and hypermutated T-dependent and T-independent antibody responses in AicdacreSirt1fl/fl mice and NBSGW/B mice. The specificity of such a B cell Sirt1 function was underlined by Sirt1 regulation of Aicda but not Prdm1 or Xbp1, thereby affecting CSR/SHM but not plasma cell differentiation. The importance of B cellintrinsic and differentiation stagespecific Sirt1 expression was further emphasized by the fast kinetics of Sirt1 down-regulation that preceded AID up-regulation, as well as the compelling phenotypes generated upon manipulation of B cell Sirt1 expression or activity. Sirt1 would keep Aicda expression in check in resting B cells and allows Aicda to be expressed only to initiate CSR/SHM. By negatively regulating Aicda expression, Sirt1 would function as a key safeguard of AID-mediated DNA damage.

Sirt1 has been implicated in the functions of other immune elements. Through deacetylation of histone and nonhistone proteins, Sirt1 controls the intracellular localization, stability, and activity of these proteins, making this class III HDAC involved in multiple, mainly epigenetic, functions (16). In addition to deacetylating gene promoter histones, Sirt1 modifies other epigenetic mediators, including DNA methyltransferases, acetyltransferases, and transcription factors. Sirt1 has been shown to be highly expressed in medullary thymic epithelial cells, in which it is required for the expression of Aire-dependent, tissue-restricted antigen-encoding genes and, therefore, induction of central immunological T cell tolerance (32). Sirt1 negatively regulates T cell activation and would play a role in maintaining T cell tolerance and T celldependent humoral immune responses (13). It can also function as a molecular switch in controlling regulatory T cell (Treg) and T helper cell 17 (TH17) cell differentiation (33). Stimulation of nave T cells with IL-4 plus TGF-1 decreased Sirt1 expression and induced TH9 cell differentiation (34). In humans, SIRT1 is a regulator of resting CD8+ memory T cell metabolism and activity, and it is significantly down-regulated in terminally differentiated CD8+CD28 memory T cells (35). Also, Sirt1 has been suggested to modulate cytokine production by dendritic cells and skewing the balance between proinflammatory TH1/TH17 cells and anti-inflammatory Treg cells (14, 36). Last, Sirt1 inhibits inflammatory pathways in macrophages and regulates macrophage self-renewal (37).

Sirt1 keeps Aicda transcription in check by a three-pronged mechanism (fig. S10) involving (i) deacetylation of Aicda promoter histones, (ii) deacetylation of Dnmt1, and (iii) deacetylation of the p65 component of NF-B. First, Sirt1 plays a major (negative) regulatory role in Aicda locus H3 acetylation. Deacetylation of core histones promotes chromatin condensation, making promoters inaccessible to transcription factors and suppressing gene expression. Sirt deacetylates H3K9Ac and H3K14Ac (as shown here), as well as H3K4Ac and H3K36Ac (38). Accordingly, in B cells stimulated with LPS plus IL-4, H3K9Ac and H3K14Ac were hyperacetylated, reflecting Sirt1 down-regulation and, consequently, the loss of Sirt1-mediated deacetylation at these H3 Lys residues. By contrast, Sirt1 did not affect Prdm1 locus H3 acetylation, which occurred mainly at H3K27 [our analysis of primary ChIP-Seq data GEO:GSE82144 deposited in the National Center for Biotechnology Information (39)]. In nucleosomes, this H3K27 is not targeted nor is deacetylated by Sirt1 (40). Last, while histone acetylation of the Aicda promoter was increased in C57BL/6 B cells induced to undergo CSR and decreased by enforced Sirt1 expression or Sirt1 activation, the histone acetylation status of the Aicda promoter in AicdacreSirt1fl/fl B cells was unaltered, as compared to AicdacreSirt1+/+ B cells under similar CSR induction. Likely, the deep down-regulation of Sirt1 expression in B cells undergoing CSR led to Aicda promoter histone hyperacetylation, which left virtually no room for further histone acetylation upon Sirt1 ablation. All nucleosomes of Aicda exon 1 and its vicinity, including the promoter region, have been shown to be extensively acetylated in B cells induced to express Aicda and undergoing CSR (5).

Second, upon Sirt1-mediated acetylation, activated Dnmt1 was recruited to and methylated Aicda promoter DNA, thereby silencing this gene. The Dnmt1 selectivity in being recruited to and methylating the Aicda promoter DNA contrasted with the failure of this DNA methyltransferase to be recruited and methylate Prdm1 or Xbp1 promoter DNA. This is consistent with the Prdm1 promoter showing constitutively demethylated CpG islands and, therefore, being hardly further acetylated through modulation of DNA demethylation (not shown). This would not exclude the possibility, however, that Prdm1 DNA methylation can also be mediated by additional DNA methyltransferases, such as Dnmt3a and Dnmt3b (41).

Third, deacetylation of NF-B effectively inactivates this important B cell transcription factor. NF-B together with HoxC4 is critical to Aicda promoter activation (6, 7). NF-B function is modulated by posttranscriptional modifications, such as phosphorylation, acetylation, and methylation (42). Acetylated NF-B displays enhanced transcriptional activity (43), which is reduced by Sirt1-mediated deacetylation (17). The critical role of Sirt1 in modulating NF-B acetylation and, therefore, activity was further emphasized by the reduced p65 acetylation and Aicda expression by Sirt1 overexpression in Sirt1super B cells and boost of Sirt1 activation by NAD+ or SRT1720. The increased p65Ac recruitment to the Prdm1 promoter in AicdacreSirt1fl/fl B cells was likely insufficient to up-regulate the induction of Prdm1 in light of the marginal role of Sirt1 in Prdm1 promoter H3 deacetylation, as well as the acetylation and activation of Dnmt3l (due to decreased Sirt1 activity) and the consequent Irf4 DNA methylation and down-regulation by this DNA methylase (fig. S7).

In B cells stimulated in a T-dependent or T-independent fashion, the significant drop in Sirt1 led to decreased Sirt1 recruitment to the Aicda promoter, but not Prdm1 or Xbp1 promoter, and reduced Aicda deacetylation. This together with greater acetylation of NF-B p65 promoted Aicda expression and CSR in B cells in vitro, as further facilitated by reduced Aicda promoter DNA methylation resulting from acetylation and inactivation of Dnmt1, which failed to be recruited to the Aicda promoter. These events were magnified by differentiation stagespecific Sirt1 ablation in AicdacreSirt1fl/fl B cells, which further increased Aicda expression, but did not affect Prdm1 or Xbp1. In AicdacreSirt1fl/fl mice, the same events boosted B cell Aicda expression and the generation of class-switched and somatically mutated antibody response, which included increased specific switched memory B cells but not plasma cells. Non-intentionally immunized AicdacreSirt1fl/fl mice produced a spectrum of lupus-like autoantibodies, pointing at a role of intrinsic B cell mechanisms in the development of the lupus-like autoimmune condition in constitutive Sirt1 knockout mice (15). A role of Sirt1 in regulating Aicda expression and the autoantibody response was further supported by our demonstration of correlation between down-regulated SIRT/Sirt1 and up-regulated AICDA/Aicda in human and mouse lupus B cells. Such a role would be consistent with the suggestion that SIRT1 rs375891 allele modifies lupus morbidity, with rs375891T being a risk factor for nephritis (44), and the reduced expression levels of SIRT1/Sirt1 in lupus B cells, in which AID is known to be greatly up-regulated.

The definition of the mechanism by which Sirt1 is down-regulated in B cells induced to undergo CSR/SHM is beyond the scope of these investigations. Nevertheless, it is known that Sirt1 expression is regulated at both transcriptional and posttranscriptional levels (45). Interferon- (IFN-) has been shown to repress Sirt1 transcription (46). IFN- induces transcription factor Class II Major Histocompatibility Complex Transactivator (CIITA), which is recruited to the Sirt1 promoter by a transcriptional repressor hypermethylated in cancer 1 (46). Once recruited to Sirt1, CIITA represses Sirt1 transcription, via active deacetylation of core histones surrounding the Sirt1 proximal promoter (46). At the posttranscriptional level, Sirt1 can be regulated by microRNAs or RNA-binding proteins (45). More than 16 microRNAs have been shown to modulate Sirt1 expression in different types of cells. These include miR-22, which is expressed in B cells and has been shown to be up-regulated by CD154 plus IL-4 in chronic lymphocytic leukemia B cells (45). In dendritic cells, miR-22 can be induced by TLR ligands such as LPS through NF-B (47). Thus, CIITA and select microRNAs, such as miR-22, may play a role in mediating Sirt1 down-regulation in B cells, as induced to undergo CSR/SHM.

Sirtuins have emerged as important metabolic sensors of energy status in mammalian cells (2325). Sirt1 activity is directly modulated by the cellular level of its critical cofactor NAD+, whose concentration increases in response to energy or nutrient stresses such as fasting or calorie restriction (2325). All these conditions boost Sirt1 activity (19), leading to histone deacetylation and chromatin silencing. Conversely, glycolysis, as induced by high blood sugar levels, converts cellular NAD+ to NADH, decreasing NAD+/NADH ratio and NAD+ availability, which blunts Sirt1 activity (24, 25). Accordingly, increased glucose concentration led to up-regulation of Aicda and CSR. Like intrinsic B cell overexpression of Sirt1, boosting Sirt1 function by NAD+ or the small-molecule SRT1720, a specific and potent Sirt1 activator, dampened Aicda expression and CSR/SHM in the T-independent IgG response to NP-LPS in our NSGW/B mice. This novel and powerful model has unveiled a significant B cell SHM activity in the absence of T cells or other immune cells. This SHM was likely induced by our previously described mechanism of BCR and TLR4-linked co-engagement (48).

Activation of Sirt1 by SRT1720 dampened the autoantibody response in lupus MRL/Faslpr/lpr mice. In these mice, not only did SRT1720-mediated Sirt1 activation suppress the autoantibody response but it also led to a marked amelioration of lupus immunopathology. The decreased SIRT1/Sirt1 expression shown here in human and mouse lupus B cells would provide an explanation for the hyperacetylation of the AICDA/Aicda promoter in human and mouse lupus (3, 4), as confirmed by our findings in those B cells. Our demonstration of a regulation of AID expression through Sirt1 metabolic sensor would outline a possible mechanism by which the diabetes therapeutic metformin (inhibitor of gluconeogenesis) and 2-DG (a glucose analog, which competitively inhibits glucose uptake and glycolytic flux) dampened anti-dsDNA IgG and ANA IgG in lupus B6.Sle1.Sle2.Sle3 mice (49).

Sirt1 expression has been shown to fluctuate under physiological and pathological conditions (25). Collectively, our findings identified Sirt1 as a critical B cellintrinsic epigenetic element in AID silencing in resting B cells in regulating this potent dC deaminator, and, therefore, CSR/SHM in the maturation of the antibody response. Sirt1 suppresses Aicda expression and CSR/SHM through deacetylation of both histone and nonhistone proteins, that is, deacetylation of Aicda promoter histones, NF-B p65 and Dnmt1. In both human and mouse B cells, SIRT1/Sirt1 is down-regulated in response to stimuli that induced expression of AID and CSR/SHM, as it is in B cells from humans and mice with lupus. By showing that B cell Sirt1 inactivation by reduction of NAD+ can be an inducer of AID expression, our findings add an important effector function to Sirt1 as a metabolic sensor and suggest a role of glycolysis in the regulation of AID.

C57BL/6 (C57BL/6J, stock no. 000664), MRL/Faslpr/lpr (MRL/MpJ-Faslpr/J, 000485), BXD2 (BXD2/TyJ, 000075), Sirt1fl/fl (B6.129-Sirt1tm3Fwa/DsinJ, 029603), Aicdacre [B6;FVB-Tg(Aicda-cre)1Rcas/J, 018422], Sirt1super [B6.Cg-Tg(Sirt1)ASrn/J, 024510], and NBSGW (NOD.Cg-KitW-41J Tyr + Prkdcscid Il2rgtm1Wjl/ThomJ, 026622) mice were from The Jackson Laboratory (Bar Harbor, Maine). Sirt1fl/fl mice carry insertion mutations in the neomycin-resistant gene and lox sequences of the Sirt1 gene flanking exon 4 that encodes a conserved Sir2 motif (27). Sirt1super mice display abnormally increased Sirt1 expression, as a result of carrying multiple copies of a BAC transgene containing the Sirt1 locus with the endogenous promoter/enhancer regions (26). In BAC transgenic Aicdacre mice, the bacterial cre recombinase gene was introduced in lieu of Aicda exon 1 in a supplementary Aicda locus and under control of the Aicda promoter/enhancers within the BAC transgene (5). We generated AicdacreSirt1fl/fl mice by cross-breeding Aicdacre with Sirt1fl/fl mice (fig. S3). For NP-CGG immunization, AicdacreSirt1fl/fl mice and their sex-matched AicdacreSirt1+/+ littermates (8 to 12 weeks of age) were injected intraperitoneally with 100 g of NP16-CGG (average 16 molecules of 4-hydroxy-3-nitrophenyl acetyl coupled with 1 molecule of chicken -globulin; Biosearch Technologies) in 100 l of alum (Imject Alum, Pierce). Mice were given a booster intraperitoneal injection of 100 g of NP16-CGG in PBS at day 21. Serum samples were collected, and mice were euthanized for ex vivo analysis at time points indicated.

To generate NBSGW/B mice, nave B cells were purified from splenocytes of 8-week-old female C57BL/6 mice by negative selection using the EasySep Mouse B Cell Isolation Kit (STEMCELL Technologies) following the manufacturers instructions and supplemented with additional anti-CD3 mAb (clone 17A2; BioLegend), resulting in more than 99% purity. Purified B cells (3.0 107 cells per mouse in 250 l of PBS) were injected intravenously through lateral tail veins into 8-week-old female NBSGW mice. NBSGW/B mice were injected intraperitoneally with NP0.5-LPS (average 0.5 molecule of NP conjugated to 1 molecule of LPS; 50 g in PBS) at days 0 (after B cell engraftment), 2, 4, and 6. For in vivo Sirt1 activation, NP-LPSimmunized NBSGW/B mice were injected intraperitoneally with SRT1720 (0.3 mg in 200 l of PBS) or PBS every other day, starting at day 0 and until the end of the experiment. Mice were euthanized 7 days after the last NP-LPS injection. All mice were housed under pathogen-free conditions and were fed autoclaved food and deionized water. The Institutional Animal Care and Use Committee of the University of Texas Health Science Center San Antonio (UTHSCSA) approved all animal protocols.

For in vitro CSR induction, human IgD+ nave B cells were purified by negative selection from peripheral blood mononuclear cells (PBMCs) of healthy donors fresh buffy coats (San Antonio Blood and Tissue Center) using the EasySep Human Nave B Cell Enrichment Kit (19254, STEMCELL Technologies) following the manufacturers directions, resulting in more than 98% purity. Nave B cells were stimulated with CD154 (5 U/ml; obtained from membrane fragments of baculovirus-infected Sf21 insect cells) and cultured in fetal bovine serum (FBS)RPMI (RPMI-1640 supplemented with 10% FBS, 50 mM -mercaptoethanol, and antibiotic-antimycotic mixture) and recombinant human IL-21 (50 ng/ml; R&D Systems) in the presence or absence of recombinant human IL-4 (20 ng/ml; R&D Systems) for up to 120 hours. B cells were then stained with 7-aminoactinomycin D (7-AAD; BD Biosciences) and fluorochrome-conjugated mAbs specific for human CD19 (clone HIB19; BioLegend) and human IgG (clone G18-125; BD Biosciences) and then analyzed by flow cytometry using an LSR-II flow cytometer (BD Biosciences). Dead cells (7-AAD+) were excluded from analysis. All flow cytometry data were analyzed using FlowJo (Tree Star).

For SIRT1 and AICDA qRT-PCR analysis and histone acetylation ChIP assays, B cells were purified by positive selection from PBMCs of healthy donors fresh buffy coats (San Antonio Blood and Tissue Center) or peripheral blood from patients with SLE (Division of Rheumatology, Department of Medicine, Long School of Medicine, UTHSCSA) using mouse biotinanti-human CD19 mAb (clone HIB19; BioLegend) and streptavidin-coupled magnetic beads, resulting in more than 99% purity. All experiments involving human blood were approved by the Institutional Review Board of UTHSCSA.

For in vitro CSR induction, nave B cells isolated from red blood celldepleted splenocytes of 8- to 12-week-old mice were purified by negative selection of cells expressing CD43, CD4, CD8, CD11b, CD49b, CD90.2, Gr-1, or Ter-119 using the EasySep Mouse B Cell Isolation Kit (STEMCELL Technologies). B cells were resuspended in FBS-RPMI at 37C in 48-well plates and stimulated with the following reagents: LPS (1 or 5 g/ml) from Escherichia coli (055:B5, Sigma-Aldrich) for CSR to IgG3; LPS (3 g/ml) or CD154 (1 U/ml) plus IL-4 (5 ng/ml; R&D Systems) for CSR to IgG1; LPS (3 g/ml) plus IFN- (50 ng/ml) for CSR to IgG2a; LPS (3 g/ml) plus TGF- (2 ng/ml; R&D Systems), IL-4 (5 ng/ml), IL-5 (3 ng/ml; R&D Systems), and anti-Ig mAb-dextran (Fina Biosolutions) for CSR to IgA. After 96 hours, cells were analyzed for surface Ig after being stained with fluorescein isothiocyanate (FITC)labeled rat mAb to mouse IgG1 (clone A85-1), mouse IgG2a (clone R19-15), mouse IgG3 (clone R40-82), and mouse IgA (clone C10-3) or phycoerythrin (PE)labeled rat mAb to mouse B220 (clone RA3-6B2), all from BD Biosciences. Cells were analyzed by flow cytometry, with dead cells (7-AAD+) excluded from analysis. All flow cytometry data were analyzed using FlowJo (Tree Star). All the Abs and mAbs used in the above experiments are listed in table S1A. For Sirt1 and Aicda qRT-PCR analysis and histone acetylation ChIP assays, B cells were isolated from C57BL/6 or lupus-prone MRL/Faslpr/lpr and BXD2 mice by positive selection using biotinylated rat anti-mouse CD19 mAb (clone 6D5; BioLegend) and streptavidin-coupled magnetic beads, resulting in more than 99% purity.

Single-cell suspensions were prepared from mouse spleen and stained with the following antibodies and reagents in different combinations for flow cytometry analysis (LSR-II flow cytometer, BD Biosciences) of B cells (B220+), T cells (CD3+), germinal center (GL-7hiB220+) B cells and plasma cells (B220lowCD138+), antigen-specific B cells, and class-switched B cells: PEanti-B220 mAb (clone RA3-6B2; eBioscience), Pacific Blue anti-B220 mAb (clone RA3-6B2; BioLegend), FITCanti-CD3 mAb (clone 17A2; BioLegend), and biotinanti-CD138 mAb (clone 281-2; BD Biosciences) followed by FITC-streptavidin (11-4317-87, eBioscience) or PE-streptavidin (12-4317-87, eBioscience), PE-Cy7-anti-CD38 mAB (clone 90; BioLegend), PE or FITCanti-IgM mAb (clone RMM-1; BioLegend), FITCanti-IgG1 mAb (clone A85-1; BD Biosciences), allophycocyanin (APC)anti-IgG1 mAb (clone X56; BD Biosciences), FITCanti-IgG3 mAb (clone R40-82; BD Biosciences), FITCanti-IgA mAb (clone C10-3; BD Biosciences), and biotinanti-IgD mAb (clone IA6-2; BioLegend) followed by FITC-streptavidin (11-4317-87, eBioscience) or APC-streptavidin (550874, eBioscience), PE-NP4 (N-5070, Biosearch Technologies), and 7-AAD, as all previously described (6, 11).

B cell division in vitro was analyzed by carboxyfluorescein diacetate succinimidyl ester (CFSE) dilution using the CellTrace CFSE Cell Proliferation Kit (Invitrogen). Briefly, B cells were incubated for 5 min at 37C in 3 ml of PBS with 2.5 M CFSE at a density of 1 107 cells/ml and then washed in FBS-RPMI. Cells were then cultured in the presence of LPS or CD154 plus IL-4 for 3 days and then stained with PEanti-B220 mAb and 7-AAD for flow cytometry analysis. For intracellular staining, cells were reacted with an anti-CD19 mAb (clone 1D3; Tonbo) and fixable viability dye eFluor 450 (FVD 450, eBiosciences), followed by incubation with the BD Cytofix/Cytoperm buffer at 4C for 20 min. After washing twice with the BD Perm/Wash buffer, cells were resuspended in Hanks balanced salt solution with 1% bovine serum albumin (BSA) and stored overnight at 4C. Cells were then stained with anti-Sirt1 Ab (A11267, ABclonal; labeled with APC using Mix-n-Stain Fluorescent Protein & Tandem Dye Antibody Labeling Kit, Biotium) and FITCanti-AID Ab (bs-7855R-FITC, Bioss) in Perm/Wash buffer. Dead (eFluor 450+) cells were excluded. All the Abs and mAbs used in the above experiments are listed in table S1A.

To visualize Sirt1 and AID expression in B cells, cells were spun onto glass slides (800 rpm for 5 min; Cytospin 4, Thermo Fisher Scientific) and then fixed with 3% paraformaldehyde in 250 mM Hepes (pH 7.4), stained with APC-labeled anti-Sirt1 Ab (as above) or Alexa Fluor 647anti-AID Ab (bs-7855R-A647, Bioss), and mounted in ProLong Gold Antifade Reagent with DAPI (4,6-diamidino-2-phenylindole; Invitrogen). Fluorescent images were captured using a 10 objective lens with a Zeiss Axio Imager Z1 fluorescence microscope.

To analyze IgM- and IgA-producing cells, intestinal sections were heated at 80C to adhere to glass slides, washed four times in xylene for 2 min, dehydrated twice with 100% ethanol for 1 min, twice with 95% ethanol for 1 min, and washed twice in water for 1 min. Antigens were unmasked using 2 mM EDTA in 100C for 40 min followed by a cooling step at 25C, washed three times with tris-buffered saline (TBS), and blocked using 10% BSA for 15 min. Slides were again washed three times with TBS and stained with rabbit anti-IgA Ab (PA-1-30826, Thermo Fisher Scientific) followed by Alexa Fluor 488conjugated anti-rabbit IgG (H+L) Ab F(ab)2 fragment (4414, Cell Signaling Technology) and PE-conjugated goat-anti mouse-IgM mAb (clone RMM-1; BioLegend) for 2 hours in a moist dark chamber. After washing three times with Triton X-100 (0.1%) in TBS, slides were air-dried, and coverslips were mounted with ProLong Gold Antifade Reagent using DAPI (Invitrogen). To analyze germinal center structure, 10-m spleen sections were prepared by cryostat and loaded onto positively charged slides, fixed in cold acetone and stained with PE-GL7 and FITC-B220 mAb for 1 hour at 25C in a moist chamber. Coverslips were mounted using ProLong Gold Antifade Reagent with DAPI for microscopy analysis. All the Abs and mAbs used in the above experiments are listed in table S1A.

Titers of total and NP4-binding IgM, IgG1, IgG3, IgG2b, and IgA were measured by enzyme-linked immunosorbent assay (ELISA), as described (6, 11). Anti-dsDNA, anti-histone, anti-RNP, and anti-RNA IgG1 and IgG2a titers were measured by ELISA, as described (11)titers were expressed in relative units (RU), defined as the dilution factor needed to reach 50% of binding saturation, as calculated using the Prism software (GraphPad). To detect ANAs, sera were serially diluted in PBS (from 1:20 to 1:400), incubated on ANA substrate slides (HEp-2 cellcoated slides, MBL-BION), and detected with FITCanti-IgG1 mAb (clone 85-1; BD Biosciences) and FITCanti-IgG2a mAb (clone R19-15; BD Biosciences). Images were acquired with a 40 objective on a Zeiss Axio Imager Z1 fluorescence microscope. To analyze kidney IgG deposition, kidneys from MRL/Faslpr/lpr mice were fixed in 4% formaldehyde and paraffin-embedded for hematoxylin and eosin staining. For immunofluorescence, 5-m cryostat sections were loaded onto positively charged slides, fixed in cold acetone, and stained with a mixture of FITC-labeled rat anti-mouse IgG1 or anti-mouse IgG2a mAb. Cover slips were mounted using ProLong Gold Antifade Reagent for microscopy analysis. All the Abs and mAbs used in the above experiments are listed in table S1A.

MultiScreen ELISPOT plates (MAIPS4510, Millipore) were activated with ethanol (35%), washed four times with PBS, and then coated with 100 l NP4-BSA (5 g/ml; N-5050L, Biosearch Technologies), goat anti-mouse IgG1 Ab (5 g/ml; 1071-01, Southern Biotech), or goat anti-mouse IgM Ab (5 g/ml; 1121-01, Southern Biotech) in PBS overnight at 4C. The plates were then washed six times with PBS and blocked with BSA (0.5%) in RPMI/Hepes plus l-glutamine for 1 hour at room temperature. Single-cell suspensions (250,000 or 100,000 cells/ml) from the spleen and bone marrow of immunized mice were cultured in plates at 37C for 16 hours in FBS-RPMI. The cultures were removed, and the plates were washed six times, incubated with biotin-goat anti-mouse IgG1 Ab (1070-08, Southern Biotech) or biotin-rat anti-mouse IgM mAb (1022-08, Southern Biotech) for 2 hours on a shaker at room temperature, washed six times, incubated with horseradish peroxidase (HRP)streptavidin (Santa Cruz Biotechnology) for 1 hour on a shaker at room temperature, washed 10 times, and developed using the VECTASTAIN AEC Peroxidase Substrate Kit (SK-4200, Vector Laboratories) following the manufacturers protocol. Plates were imaged and quantified using a CTL-ImmunoSpot Analyzer (Cellular Technology). All the Abs and mAbs used in the above experiments are listed in table S1A.

The mutations in V186.2 of rearranged V186.2DJH-C1, V186.2DJH-C2b, and/or V186.2DJH-C3 NP-binding IgG1, IgG3, and IgG2b were analyzed by high-throughput Illumina MiSeq amplicon sequencing. Spleen B cells were isolated for RNA extraction using the RNeasy Mini Kit (Qiagen). Residual DNA was removed from the extracted RNA with gDNA eliminator columns (Qiagen). Complementary DNA (cDNA) was synthesized from 1 to 2 g of total RNA using SuperScript III First-Strand Synthesis System (Invitrogen) and oligo-dT primer. Rearranged V186.2DJH-C1, V186.2DJH-C2b, and/or V186.2DJH-C3 cDNAs encoding the anti-NP IgG1, IgG2b, and IgG3 heavy chains were amplified using a V186.2 leaderspecific forward primer together with a reverse C1-, C3-, or C2b-specific primer (11) tagged with Illumina clustering adapters and Phusion high-fidelity DNA polymerase (New England BioLabs). PCR conditions were 98C for 10 s, 60C for 45 s, and 72C for 1 min for 30 cycles. The amplified library was tagged with barcodes for sample multiplexing, and PCR was enriched and annealed to the required Illumina clustering adapters. High-throughput 300base pair (bp) paired-end sequencing was performed by the UTHSCSA Genome Sequencing Facility using the Illumina MiSeq platform. Somatic mutations and clonotypes in rearranged V186.2(V1-72)-DJH gene encoding NP-binding IgG3 and IgG2b were analyzed using IMGT/High V-QUEST (http://imgt.org/HighV-QUEST/doc.action). The frequency of mutations in rearranged V186.2DJH-C2b and/or V186.2DJH-C3 NP-binding IgG3 and IgG2b, as analyzed by MiSeq amplicon sequencing in SIRT1720-treated and nontreated NBSGW/B mice, was compared by enumerating the point mutations in the V186.2 segment of three comparable V186.2DJH-C3 and three comparable V186.2DJH-C2b clone pairs (each pair consisting of a mouse treated with nil and one with SRT1720). Comparable pairs were defined as B cell clones expressing V186.2DJH-C3 or V186.2DJH-C2b with IgH CDR3s being identical in length (7 to 12 amino acids), identical in the first two amino acids and the last three or four amino acids. One of the three V186.2DJH-C3 clone pairs was identical in the whole IgH CDR3 sequence (ARGYFDY).

Total RNA was extracted from 2.0 to 5.0 106 pelleted B cells using the RNeasy Mini Kit (Qiagen). Residual DNA was removed from the extracted RNA with gDNA eliminator columns (Qiagen). cDNA was synthesized from 1.0 to 2.0 g of total RNA with the SuperScript III First-Strand Synthesis System (Invitrogen) using oligo-dT primer. Specific transcripts were measured by real-time qRT-PCR with appropriate primers as described (6). An Applied Biosystems QuantStudio 3 Real-Time PCR System (Thermo Fisher Scientific) was used to measure SYBR Green (Bio-Rad Laboratories) incorporation with the following protocol: 95C for 15 s, 40 cycles of 94C for 10 s, 60C for 30 s, and 72C for 30 s. Data acquisition was performed during a 72C extension step. Melting curve analysis was performed from 72 to 95C. The change in cycling threshold (Ct) method was used to analyze levels of transcripts. Data were normalized to the expression level of -ACTIN/-Actin except noted otherwise (e.g., normalized to the Gapdh expression level).

B cells were lysed in Laemmli buffer. Cell extracts containing equal amounts of protein (20 g) were fractionated through 10% SDSpolyacrylamide gel electrophoresis. The fractionated proteins were transferred onto polyvinylidene difluoride membranes (Bio-Rad) overnight (30 V/90 mA) at 4C. After blocking and overnight incubation at 4C with mouse anti-AID mAb (clone ZA001; Invitrogen), mouse antiNF-B p65 mAb (clone D14E12; Cell Signaling Technology), rabbit antiAcetyl-(Lys310)NF-B p65 mAb (clone D2S3J; Cell Signaling Technology), rabbit antiAcetyl-DNMT1-K1127/K1129/K1131/K1133 Ab (A5595, ABclonal), rabbit anti-Sirt1 Ab (A11267, ABclonal), rabbit anti-Dnmt1 Ab (A-1700, Epigentek), or rat anti-actin mAb (clone AC-15, Sigma), the membranes were incubated with HRP-conjugated secondary Abs. After washing with TBSTween 20 (0.05%), bound HRP-conjugated mAbs or Abs were revealed using Western Lightning Plus-ECL reagents (PerkinElmer Life and Analytical Sciences). Densitometry was performed with Fiji software. All the Abs and mAbs used in the above experiments are listed in table S1.

DNA methylation was analyzed by bisulfite DNA conversion and Sanger or MiSeq sequencing. For bisulfite conversion, gDNA was treated with sodium bisulfite using the EpiTect Bisulfite Kit (Qiagen) according to the manufacturers instructions. Bisulfite-treated DNA was amplified by PCR using GoTaq Hot Start Polymerase (Promega). The primers for bisulfite sequencing PCR were designed using MethPrimer2 (www.urogene.org/cgi-bin/methprimer2/MethPrimer.cgi) and tagged with Illumina clustering adapters. PCR products were purified with a QIAquick PCR purification kit (Qiagen) and used directly for Sanger sequencing with a sequencing primer which reverse-complemented the adapter sequence. For MiSeq sequencing, the amplified library was tagged with barcodes for sample multiplexing, PCR-enriched, and annealed to the required Illumina clustering adapters. High-throughput 300-bp paired-end sequencing was performed by the UTHSCSA Genome Sequencing Facility using the Illumina MiSeq platform. DNA methylation was also analyzed by MeDIP using the MeDIP Kit (Active Motif) following the manufacturers instructions. Precipitated DNA was used as a template for qPCR analysis involving specific primers (table S1B).

ChIP assays were performed as previously described (6). B cells (1.0 107) were treated with formaldehyde (1.0%, v/v) for 10 min at 25C to cross-link chromatin. After quenching with 100 mM glycine (pH 8.0) and washing with cold PBS containing protease inhibitors (Roche), B cells were resuspended in lysis buffer [20 mM trisHCl, 200 mM NaCl, 2 mM EDTA, 0.1% (w/v) SDS, and protease inhibitors (pH 8.0)]. Chromatin was sonicated to yield DNA fragments (about 200 to 600 bp), precleared with Pierce Protein A beads (Thermo Fisher Scientific), and incubated with rabbit antiNF-B p65, antiAcetyl-(Lys310) NF-B p65 and anti-Sirt1 Abs (as above), rabbit anti-H3K9Ac/K14Ac (17-615, Millipore), rabbit anti-DNMT1 Ab (A-1700, EpiGentek), rabbit anti-Sirt1 Ab (A11267, ABclonal), mouse anti-Dnmt3l mAb (S117-9, StressMarq Biosciences), or control rabbit or mouse IgG with irrelevant specificities at 4C overnight. Immune complexes were precipitated by Protein A agarose beads, washed, and eluted [50 mM tris-HCl, 0.5% SDS, 200 mM NaCl, and proteinase K (100 g/ml) (pH 8.0)], followed by incubation at 65C for 4 hours. DNA was purified using a QIAquick PCR purification kit (Qiagen). The precipitated DNA was used as a template for qPCR analysis involving specific primers (table S1B).

Sirt1 coding region cDNA was amplified from unstimulated mouse B cells using the appropriate primers (table S1) and cloned into the pMIG retroviral expression vector. To generate the retrovirus, the pMIG vector encoding green fluorescent protein (GFP) only or the pMIG-Sirt1 vector encoding GFP and Sirt1 was used with the pCL-Eco retrovirus-packaging vector (Imgenex) to transfect human embryonic kidney293T cells by a Ca++ phosphate (ProFection Mammalian Transfection System, Promega). Viral supernatants were collected and used to transduce spleen B cells from C57BL/6 mice after a 12-hour LPS activation, as we reported (6). Transduced B cells were then stimulated with LPS plus IL-4 for 96 hours before analysis of GFP+ and/or IgG1+ B cells by flow cytometry. Dead (7-AAD+) cells were excluded from analysis.

NAD+ and NADH concentrations were measured using a fluorescence-based assay with Amplite Fluorimetric total NAD and NADH Assay Kit (Red Fluorescence, AAT Bioquest), following the manufactures instruction.

Differences in Ig titers, CSR, and RNA transcript expression were analyzed with the Students paired t test unless otherwise noted, assuming two-tailed distributions. Differences in the frequency of somatic point mutations were analyzed with 2 tests. The Excel (Microsoft) or Prism software was used for all statistical analyses and calculation of P values (*P < 0.05, **P < 0.01, and ***P < 0.001).

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial license, which permits use, distribution, and reproduction in any medium, so long as the resultant use is not for commercial advantage and provided the original work is properly cited.

Acknowledgments: We would like to thank G. Excalante for SLE blood samples, Z. Lai (UTHSCSA Genome Sequencing Facility) for high-throughput sequencing, and Y. Chen for bioinformatics analysis. We would also like to acknowledge the critical contribution of K. Gorena and M. Berton (UT Health Flow Cytometry core) for helping us on FACS analysis and cell sorting. Funding: This work was supported by NIH grants R01 AI105813, R01 AI079705, and T32 AI138944 and the Lupus Research Alliance Target Identification in Lupus Grant ALR 641363. H.G., T.S., and X.L. were supported by Xiangya Medical School, Central South University, Changsha, China, in the context of the Xiangya-UT Long School of Medicine San Antonio medical student visiting program. Author contributions: H.G., T.S., J.R.T., D.P.C., H.N.S., and X.L. performed experiments. Z.X. helped in experimental design. H.Z. designed and performed experiments, analyzed data, supervised the work, and wrote the manuscript. P.C. planned the study, designed the experiments, analyzed the data, supervised the work, and wrote the manuscript. Competing interests: The authors declare that they have no competing interests. Data and materials availability: All data needed to evaluate the conclusions in the paper are present in the paper and/or the Supplementary Materials. Additional data related to this paper may be requested from the authors.

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B cell Sirt1 deacetylates histone and non-histone proteins for epigenetic modulation of AID expression and the antibody response - Science Advances

12 Healthiest Dried Fruit Snacks Of 2020, Per Nutritionists – Women’s Health

Jason Speakman

Dried fruit snacks are pretty much the adult version of Fruit Roll-Ups and Gushersand (shocking, I know) they're typically way healthier than those tongue-staining blue raspberry snacks of childhood.

Dried fruit can help you meet your fiber needsand it also provides a source of complex carbs, says nutritionist Jessica Cording, RD, author of The Little Book of Game-Changers.

Dietitian Keri Gans, RD, author of The Small Change Diet, agrees: Like fresh fruit, dried fruit provides plenty of vitamins and minerals." It's just, you know, dried. (Some snacks are freeze-dried, some are dried in a dehydrator machine, and others are even dried in the sun.)

But, like anything, dried fruit isnt perfect. Since dried fruit is condensed and its water is removed, you typically eat more of it and may consume many more calories than you realize, Gans says. The average portion size of dried fruit snacks is just about a quarter of a cup, which doesn't look like much because, well, it's not.

Going overboard isn't the only trap you can fall into with this stuff. Some companies add sugar and preservatives to make their dried fruit even sweeter and shelf-stable, Cording says. (People with sulfite sensitivities should look out for the preservative sulfur dioxide on ingredient lists.)

Though you can totally enjoy dried fruit snacks on their own, Cording recommends pairing them with protein and fat (like yogurt or nuts) to make them more satisfyingand to keep your blood sugar more stable.

The next time you get a hankering for the sweet fruit snacks of yesteryear, these healthy dried fruit snacks are nutritionist-approved and totally do the job (minus the blue tongue, of course).

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Best No-Sugar-Added Fruit Snack

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These apple chips are made with just one ingredient: apples. Yep,thats it. Bare alsobakes their dried fruit snacks, whichnever contain preservatives, something Cording appreciates.

Per serving: 60 calories, 0 g fat, 0 mg sodium, 14 g carbs, 2 g fiber, 11 g sugar, 0 g protein

Best Combo Dried Fruit Snack

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Bares apple and strawberry chip mix contains justapples and strawberries, which Gans likes. The delicious comboalso provides a little fiber.

Per serving: 170 calories, 0 g fat, 5 mg sodium, 42 g carbs, 6 g fiber, 30 g sugar, 1 g protein

Best Organic Option

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Peeled isnt messing around in the dried fruit department. Their gently-dried mango doesn't containpreservatives and is USDA certified organic (which Cording ishere for).

This mango snack is also gluten-free, vegan, and non-GMO Project verified.

Per 1.23 ounce serving: 110 cals, 0 g fat, 0 mg sodium, 25 g carbs, 2 g fiber, 18 g sugar, 2 g protein

Best On-The-Go Fruit Snack

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Sunsweet is practically synonymous with prunes, and theyve now packaged these little guys individually to prevent sticky fingers. Gans recommends grabbing a few and stashing them in your bag for later.

Per serving: 100 cals, 0 g fat, 0 mg sodium, 26 g carbs, 3 g fiber, 15 g sugar, 1 g protein

Best Feel-Good Snack

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Mavuno Harvests healthy dried fruit snacks are made with 100-percentfruit that's finely sliced and then rolled into bites for a nostalgic treat that Gans is a big fan of.

A cool bonus: The brand also helps support farms in one of the poorest regions on Earth. I love that the brand works with small farming cooperatives in rural Africa, Gans says.

Per serving: 171 calories, 2.25 g fat (1.85 g saturated fat), 0 mg sodium, 34.6 g carbs, 2.9 g fiber, 30.7 g sugar, 1.6 g protein

Best Fruit-Juice-Sweetened Snack

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Montmorency cherries (including the dried ones, Cording notes)are known for their health benefits, including their high antioxidant content and athletic performance-boosting abilities.

Since these cherries tend to be really tart, Eden Selecteds dried cherries are sweetened with organic apple juice concentrate.

Per serving: 130 calories, 0 g fat, 10 mg sodium, 32 g carbs, 2 g fiber, 24 g sugar (7 g added sugar), 1 g protein

Best Sun-Dried Snack

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These cute little dates are made through an interesting process: Theyre picked, dried in the sun, steamed, and then packaged, which makes the finished product soft and surprisingly juicy.

They're also added sugar-freeand easy to tote around in theirresealable pouch, says Cording.

Per 1.25 ounce serving: 100 cals, 0 g fat, 0 mg sodium, 24 g carbs, 2 g fiber, 15 g sugar, 1 g protein

Best Sulfur-Free Snack

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Mulberries probably arent part of your regular fruit rotation, but the superfood deserves a spot in your diet.

Navitas Organics mulberries are packed with antioxidants (including resveratrol) and work well as a mildly-sweet topping for things like salads and oatmeal, Cording says.

Per serving: 110 calories, 1 g fat, 0 mg sodium, 25 g carbs, 2 g fiber, 21 g sugar, 1 g protein

Best Freeze-Dried Snack

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Freeze-drying fruit isnt necessarily better than drying it in the sun or through other methods, Cording says; its just different.

Crispy Greens freeze-dried cantaloupe has no sugar added, so you can munch on the sweetness in confidence. (Also, have you ever seen freeze-dried melon before?!)

Per serving: 35 calories, 0 g fat, 0 mg sodium, 8 g carbs, 1 g fiber, 6 g sugar, 1 g protein

Best Antioxidant Snack

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These blueberries have a totally different texture than the ones in your fridge: Thanks to the freeze-drying process they undergo, they're crunchy.

Like regular blueberries, though, these little guys are packed with antioxidants and are an awesome source of fiber.

Per serving: 80 calories, 0 g fat, 0 mg sodium, 19 g carbs, 4 g fiber, 12 g sugar, 0 g protein

Best Preservative-Free Classic Snack

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Life Grape's vine-dried grapes are essentially raisins, but without the added sugar that comes with many varieties. They're alsonon-GMO, sulfur-free, and preservative-free.

Cording loves them on top of salads, grain dishes, breads, and baked goods.

Per serving: 80 calories, 0 g fat, 0 mg sodium, 22 g carbs, 1 g fiber, 17 g sugar, 1 g protein

Best Fiber-Packed Snack

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These freeze-dried orange slices have a lot going for them. Theyre a phenomenal source of fiber (10 grams per serving!) and provide allof your daily recommended intake of vitamin C.

They're made withoranges and oranges alone,which is a major perk, Gans says.

Per serving: 130 calories, 0 g fat, 0 mg sodium, 12 g carbs, 10 g fiber, 12 g sugar, 0 g protein

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12 Healthiest Dried Fruit Snacks Of 2020, Per Nutritionists - Women's Health

I survived the coronavirus. It wasnt easy, but we can get through it – The Globe and Mail

Illustration by Mary Kirkpatrick

I am a physician well on my way to recovery from COVID-19, the coronavirus, the same virus that is tearing apart families, communities, whole nations and our global economy. The fear of this viral terror is palpable.

I likely acquired the virus in the small ski town of Ischgl, Austria: not on the glorious powder-filled ski slopes but rather in the uproarious, festive, aprs-ski bars. When I began to have fevers and a mild cough a few days before flying home, I assumed I had a local flu. I remained housebound, and when flying home I wore a mask and washed my hands frequently.

By then news of Ischgl being a hotbed for coronavirus was in the media and I knew I had to get tested. I did, and then self-isolated with whatever advice and information I could organize from the Internet.

My fevers and chills and coughing had increased once I returned to Canada after four days of gradually getting better while in Europe, I got worse at home. The Public Health nurse called me confirming I had COVID-19 when I was already beginning to heal, five days after my return.

For some, COVID-19 feels like nothing. They have no symptoms, but may become healthy helpers who unwittingly become an unidentified source of transmission. For me, COVID-19 felt like a really bad flu. Night and day feverish sweats were drenching, my muscles ached, the coughing left me weary. For three days the cough was relentless although I was fortunately never truly short of breath. I lost five pounds in the first two days I was home. I had no appetite and felt nauseous.

I was also alone; my partner was still in Germany and my 15-year-old daughter was safely sequestered with her dad up the street.

At no point did I wonder about my own ability to survive what I was experiencing, but after three days of unchanged symptoms I realized how much of a physical toll this would take upon someone with much less robust health. I did plan to call 911 if I worsened, but mostly I dealt with my fear by realizing that my healthy friends and family were far more terrified of my illness than I was. Immobilized on my couch, reassuring others that I was going to be fine, I could see that I would be.

Seventeen days after symptoms began I was still in isolation but virtually symptom free. The public health department informed me that I could have gone out into the community 10 days after symptoms began if I were symptom free, while my extensive online research suggested that some people still shed the virus up to 20 days after initial symptoms. Since my province is no longer testing for recovery, even in confirmed COVID-19 cases, how can they know if I stopped shedding at five or 20 days? As the well-being of my daughter and community was at risk, I remained in isolation, erring on the side of caution.

Even as a physician, I could not access any of the medications that theoretically might decrease viral shedding. Instead, I added higher doses of vitamins D and C, zinc, quercetin, magnesium and extra antioxidants such as curcumin and resveratrol.

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What else did I do that helped? Lots and lots of sleep and rest. I only watched milder Netflix shows as I found violence and discord overwhelmed my nervous system. I drank endless fluids with sea salt to replace the electrolytes I lost in the sweats. I lived on chicken- and beef-broth soups. I made sure to eat some protein daily but oranges and green apples were all that tasted normal to me for two weeks. I drank pots of tea made from fresh lemon, ginger and honey. Then I made sure to get more rest and practised gratitude daily. Sunshine and fresh air helped immeasurably.

I know how simply lucky I am, and I have learned from my personal experience that many of us who acquire COVID-19 will be fine without accessing formal health care and by managing our symptoms at home. Where I have been most fortunate is in my community of friends and family who have dropped food and supplies at my doorstep. Many calls, texts and e-mails have kept me connected. I am grateful for the outpouring and of love and good wishes. My friend Val reminds me that, when you have a life changing experience, let it change your life. And so, I have become a COVID Ambassador: Teaching, reassuring, calming, instructing my network that this is survivable for most of us.

We can contribute to the communal good by dealing with our fears and our worries realistically, and leaving the health-care providers time, energy and limited equipment to those who are significantly short of breath with the virus or who develop secondary illnesses. Try not to judge others.

Even when I was coughing and sweating alone, praying my symptoms would not worsen, I marvelled at this amazing human body and mind, and its ability to tolerate, heal and grow strong from the challenges faced. I could have focused upon why I got sick but the greater miracle is how I got well and how we mostly stay well. I know that more lives will be tragically lost to this virus, but we also need to recognize and celebrate survival.

This global virus binds us in our humanity. When there is nothing else to do, call an elderly neighbour or someone self-isolating, buy someone some groceries, share your hoarded toilet paper, write, draw, laugh, create and talk to each other. There remains so much to be grateful for as we slow down and appreciate what we were previously too busy to notice. We are changing. We need to evolve. But most importantly we need to know we can thrive through this pandemic.

Dr. Anita Tannis lives in North Vancouver, B.C.

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I survived the coronavirus. It wasnt easy, but we can get through it - The Globe and Mail

Healthy Living: What you need to know about the coronavirus – Norwich Bulletin

Dr. John Graham of Day Kimball Healthcare provides information on the coronavirus.

By Dr. John Graham, For The Bulletin

COVID-19, the respiratory disease caused by the new coronavirus (SARS-CoV-2), continues to spread around the world and in the United States.

Coronaviruses, named for their crownlike shape, are a large family of viruses that range from the common cold to more serious diseases and can infect both humans and animals. The virus at the center of the latest outbreak is being referred to as a novel (new) coronavirus, since its something that health offices have not seen before.

Note to readers: All of The Bulletins coverage of coronavirus is being provided for free to our readers. Please consider supporting local journalism by subscribing to The Bulletin at https://www.norwichbulletin.com/subscribenow.

The virus is thought to spread mainly from person-to-person:

Between people who are in close contact with one another (within about 6 feet).

Through respiratory droplets produced when an infected person coughs or sneezes.

The best way to prevent the spread of COVID-19 is to limit exposure. This means staying home as much as you can and minimizing contact with others.

Symptoms can appear anywhere between 2 to 14 days after exposure and may include fever, cough and shortness of breath.

You should call your medical provider for advice if you experience these symptoms, especially if you have been in close contact with a person known to have COVID-19 or live in an area with ongoing spread of the disease.

Seek medical attention immediately if you experience emergency warning signs, including difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or ability to arouse, or bluish lips or face. This list is not inclusive, so consult your medical provider if you notice other concerning symptoms.

As you go about your day, you should assume that everyone has the virus including you and could possibly spread it. Although there is no vaccine available to prevent infection with COVID-19, you can follow safe hygiene practices to stay healthy and prevent illness including:

Practice social distancing. Physically distance yourself from others by at least six feet.

Wash your hands often with soap and warm water for at least 20 seconds, or use an alcohol-based gel.

Cover your mouth and nose with your elbow or tissue when you cough or sneeze.

Avoid touching your eyes, nose and mouth.

Avoid close contact with people who are sick.

Stay home if youre sick.

Clean and disinfect frequently touched objects and surfaces.

As with any new infection, recommendations are changing frequently. For the latest information, refer to the Centers for Disease Control and Prevention website, http://www.cdc.gov, and the CT Department of Public Health website, http://www.ct.gov/coronavirus.

Dr. John Graham is the chief medical officer and vice president of Quality and Medical Affairs at Day Kimball Healthcare. For more information on Day Kimball Healthcares response to the coronavirus disease 2019, visit http://www.daykimball.org/coronavirus.

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Healthy Living: What you need to know about the coronavirus - Norwich Bulletin

HEALTHY LIVING Healthy living, tobacco and you – Port Arthur News – The Port Arthur News

You have decided to work towards a healthier lifestyle. You have increased your activity levels. You are making better food choices based on fueling your body rather than rewarding yourself with calorie dense foods. However you are still using some form of tobacco, even if you have cut down, or even worse, you have switched to smokeless tobacco with the idea it is better for your lungs. You are still addicted to tobacco. Yes, that is the correct term, addicted. Tobacco is very addictive and smokeless tobacco is even more addictive that smoking.

Smoking in America is down but not out. Today, 20% of U.S. adults are smokers, compared to 45% in 1965, when smoking was at its peak. But even at the current level of tobacco use, an estimated 440,000 Americans per year lose their lives to lung cancer, heart disease, emphysema, or other smoking-related illnesses. On average, smokers die 14 years before nonsmokers, and half of all smokers who dont quit are killed by their habit, even if they are following other healthy habits. Recent reports show tobacco use is on the rise in teens, a tragic situation.

Lets go over some very common myths, reasons, and excuses. I have heard them all. The most pathetic thing I see is people smoking while they walk across the parking lot to the front door of the gym and then stamp out the cigarette just before walking in. Worse yet, wads of tobacco spit out near the front door. Yuk.

Myth: My other healthy habits make up for my tobacco use. Some tobacco users justify their habit by insisting that proper nutrition and lots of exercise is enough to keep them healthy. Not so. Tobacco use affects every organ system in the body, and thinking that youre going to find the perfect lifestyle to counteract it effects are just not realistic.

Myth: Switching to light cigarettes will cut my risk. Smokers who switch to brands labeled light or mild inevitably compensate for the lower levels of tar and nicotine by inhaling smoke more deeply or by smoking more of each cigarette. Similarly, cigarettes labeled natural or organic are no safer than ordinary cigarettes.

Myth: Ive smoked for so long; the damage is already done. The damage caused by smoking is cumulative, and the longer a person smokes, the greater his/her risk for life-threatening ailments. But quitting smoking at any age brings health benefits. According to the American Cancer Society, smokers who quit before age 35 prevent 90% of the risk of health problems from smoking. A smoker who quits before age 50 halves his/her risk of dying within the next 15 years compared to someone who continues to smoke.

Myth: Trying to quit smoking will stress me out and thats unhealthy. True, tobacco withdrawal is stressful. But theres no evidence that the stress has negative long-term effects. In fact, research shows that smokers who quit begin eating better, exercising more, and feeling better about themselves.

Myth: The weight gain that comes with quitting is just as unhealthy as smoking. Smokers who quit gain an average of 14 pounds. But the risk posed by carrying the extra pounds is miniscule compared to the risk of continuing to smoke. Besides, you have already made that decision to live healthier and you arent filling your body with junk foods anymore.

Myth: Nicotine products are just as unhealthful as smoking. Nicotine is safe when used as directed. Even using nicotine every day for years would be safer than smoking. After all, nicotine products deliver only nicotine. Cigarettes deliver nicotine along with 4,000 other compounds, including more than 60 known carcinogens, according to the American Lung Association.

You can do this. No one can make you; YOU have to really want to quit. And lets look at another bright bit of news; the average one pack a day smoker spends $2,000. each year!! Just think of what you can do with an extra 2 Grand!

Its all up to you, living healthy is a total lifestyle commitment that you are in complete control of. I believe in you. You can do it!

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HEALTHY LIVING Healthy living, tobacco and you - Port Arthur News - The Port Arthur News

How to Keep Up Your Healthy Habits When Youre Working From Home – POPSUGAR

We've partnered with Revive Superfoods to help you prioritize your health and wellness and live well, no matter what. Use the code 60OFF to get 60 percent off your first box!

Weekdays are usually for being responsible. A typical Monday through Friday might include getting up early to work out before going into the office, where you'll eat your carefully meal-prepped salad and maybe snack on a protein bar.

Being told that you're working from home for the foreseeable future completely upends your usual healthy weekday routine. Now, your living room is your office, gym, and dining room plus, your snack stash is just a few feet away. Keeping up your same healthy habits while working from home requires a little more planning and a bit more discipline, but it's still totally doable. Rely on these six healthy-living strategies to get through it.

Even though you're not commuting to the office, try to still get up at the usual time. Sticking to a routine makes it feel more like a regular workday, and you can use extra time at home to ease into your morning. Spend a few minutes stretching, get some reading done, or just sip your coffee and enjoy some peace and quiet.

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No commute means you have no reason to rush right into the workday. Instead, make time to slow down and practice mindfulness before checking your inbox. Set a timer on your phone and spend five minutes quietly meditating, or jot down three things you're grateful for in your journal.

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Image Source: Revive Superfoods

Away from the office donuts and candy jar, it might seem like it would be easier to eat healthy at home. But, the temptation to pop into the kitchen for some chips can be really tough to resist when you're working just a few feet away. To encourage yourself to eat well, order healthy meals from Revive Superfoods, a meal delivery service offering everything from ready-to-blend smoothies to heat-and-serve burrito bowls. All of these nutritionally balanced meals are ready in minutes perfect for days with back-to-back conference calls and video meetings!

You can order on a weekly or monthly basis, and choose the number of meals that work best for you. Best of all, your order arrives through contactless delivery right to your doorstep. Knowing that you have a healthy (and tasty!) breakfast, lunch, and dinner on lock reduces the temptation to snack all day long.

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Just because you can work from your bed doesn't necessarily mean you should. As comfy as it might seem at first, a slouchy couch or squishy mattress can wreak havoc on your back after a few hours. Pick an area to designate as your workspace, then deck it out with everything you need to set yourself up for success. Consider a supportive yet comfortable desk chair, a big-screen monitor, a wireless mouse, an adjustable standing desk, and anything else you might need.

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With no water cooler to walk to, it's all too easy to forget to hydrate while working from home. Set calendar reminders to drink water, or fill a stylish glass carafe with water and place it near your desk.

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While you can't sign up for a barre class at your usual studio right now, you can still plan your workouts into your day. Countless studios and gyms are offering live and on-demand classes through their websites and social media accounts right now. Whether you choose to follow along at home or direct your own self-guided workout, try planning your fitness routine at the beginning of each week. Actually writing down a schedule will help you stick to your goals and ensure you don't fall victim to the siren song of the couch after a long day on the computer.

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How to Keep Up Your Healthy Habits When Youre Working From Home - POPSUGAR

Healthy lifestyle reduces risk of disease – Jill Lopez

he longer you lead a healthy lifestyle during midlife, the less likely you are to develop certain diseases in later life.

The more time a person doesn't smoke, eats healthy, exercises regularly, maintains healthy blood pressure, blood sugar and cholesterol levels and maintains a normal weight, the less likely they are to develop diseases such as hypertension, diabetes, chronic kidney disease and cardiovascular disease or to die during early adulthood.

The American Heart Association (AHA) had recommended a renewed focus on prevention to reduce the development of risk factors for cardiovascular disease (CVD) as part of its 2020 Impact Goal to improve population cardiovascular health (CVH) by 20 percent and reduce CVD mortality by 20 percent. While unhealthy lifestyle behaviors are associated with higher risks for certain diseases and death, the association of the duration in which people maintain a healthy lifestyle with the risk of disease and death had not yet been studied.

Using data from the Framingham Heart Study (FHS), researchers from Boston University School of Medicine observed participants for approximately 16 years and assessed the development of disease or death. They found that for each five-year period that participants had intermediate or ideal cardiovascular health, they were 33 percent less likely to develop hypertension, approximately 25 percent less likely to develop diabetes, chronic kidney disease and cardiovascular disease, and 14 percent less likely to die compared to individuals in poor cardiovascular health.

"Our results indicate that living a longer period of time in adulthood with better cardiovascular health may be potentially beneficial, regardless of age. Overall, our findings underscore the importance of promoting healthy behaviors throughout the life-course," explained corresponding author Vanessa Xanthakis, PhD, FAHA, assistant professor of medicine at BUSM and Investigator for FHS.

The researchers hope this study will help people understand the importance of achieving an ideal cardiovascular health early in life and motivate them to maintain a healthy lifestyle. "On the community-level, this will overall help reduce morbidity and mortality associated with diseases such as hypertension, diabetes, chronic kidney disease and death during late adulthood."

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Healthy lifestyle reduces risk of disease - Jill Lopez

The Best Health and Wellness Programs to Keep You Balanced at Home – Us Weekly

Most ofUshave been living without access to our usual gyms or workout spaces for weeks now. Its easy to completely get off track with a fitness regimen, but there are plenty of resources out there that can help you keep up with your exercise routine and maintaining normalcy is crucial at the moment!

Though its not quite like going to a group fitness class, there are a wide variety of apps and online programs that stream workouts from the best instructors and studios in the country. Some of these resources also provide nutritional guides so that you can feel as healthy as possible even with a well-stocked pantry nearby. This is a great time to dedicate some unused energy to focus on getting in shape especially if thats something that youve been putting off since the new year kicked off. Not only is working out beneficial for the body, it can help you center yourself and keep busy while spending more time in the house.

Weve rounded up all of our at-home favorite options below so that you can find one that works for your needs!

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The Best Health and Wellness Programs to Keep You Balanced at Home - Us Weekly

Size & State of the South African Health & Beauty Spa Industry, 2020 – Increasing Interest in Alternative Treatments such as Yoga, Reiki,…

DUBLIN, April 6, 2020 /PRNewswire/ -- The "Health and Beauty Spa Industry in South Africa 2020" report has been added to ResearchAndMarkets.com's offering.

This report focuses on the Health and Beauty Spa Industry including the latest trends and developments and factors that influence the sector. There are profiles of 25 companies including national chains and franchises such as Mangwanani, Amani, Africology Imbalie and Sorbet. There are also profiles of hotels that operate in the sector such as the Mount Nelson and One and Only.

The Health and Beauty Spa Industry:

Spending on spa products and services had been growing in line with a growing middle class, booming wellness tourism industry and interest in healthy living and stress reduction. However, the coronavirus lockdown and travel restrictions have effectively stopped travel and tourism, which will have serious implications for the tourism and spa industries. The lockdown has seen all spas in South Africa close their doors. Many spas and beauty salons had already closed prior to the lockdown in order to protect their staff and customers. As an industry that comes into direct, close contact with the public, the spa industry will experience significant losses, even after the virus is contained, as customers may continue to exercise social distancing.

New Trends:

Spas have responded to a rising need for mental wellness, stress reduction and improved health with additional services such as nutritional assessments, counselling, holistic personal wellness plans and coaching. Wellness tourism grew faster than other tourism, and there has been an increasing interest in alternative treatments such as yoga, reiki, mindfulness sessions and sound, light and water therapy. More spas were also offering medical aesthetics treatments, which include micro-needling, chemical peels, laser and intense pulsed light treatments. Other trends include demand for tandem or group sessions and mobile spas.

Opportunities for SMEs:

There are many franchise and entrepreneurial opportunities in the sector including nail bars and mobile spas which have been growing in popularity at company events and wellness days as well as by people who prefer to have these treatments at home. Manufacturing and selling product ranges to spas and other retail outlets is an opportunity for SMEs.

Key Topics Covered

1. Introduction

2. Description of the Industry

2.1. Industry Value Chain

2.2. Geographic Position

3. Size of the Industry

4. State of the Industry

4.1. Local

4.1.1. Corporate Actions

4.1.2. Regulations

4.1.3. Enterprise Development and Social Economic Development

4.2. Continental

4.3. International

5. Influencing Factors

5.1. Coronavirus

5.2. Tourism

5.3. Economic Environment

5.4. Rising Operating Costs

5.5. Technology, Research & Development (R&D) and Innovation

5.6. Labour

5.7. Cyclicality

5.8. Environmental Concerns

6. Competition

6.1. Barriers to Entry

7. SWOT Analysis

8. Outlook

9. Industry Associations

10. References

10.1. Publications

10.2. Websites

Company Profiles

For more information about this report visit https://www.researchandmarkets.com/r/tq45qc

Research and Markets also offers Custom Research services providing focused, comprehensive and tailored research.

Media Contact:

Research and Markets Laura Wood, Senior Manager [emailprotected]

For E.S.T Office Hours Call +1-917-300-0470 For U.S./CAN Toll Free Call +1-800-526-8630 For GMT Office Hours Call +353-1-416-8900

U.S. Fax: 646-607-1907 Fax (outside U.S.): +353-1-481-1716

SOURCE Research and Markets

http://www.researchandmarkets.com

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Size & State of the South African Health & Beauty Spa Industry, 2020 - Increasing Interest in Alternative Treatments such as Yoga, Reiki,...

Urban farming is the future of healthy living – DAWN.com

Exploring the ins and outs of how you can begin to start growing in your own backyards and balconies.

Whether its a window, balcony, garage, patio or lawn what makes urban farming a particularly viable avocation in our fast-paced daily lives is that it can be tailored to fit the budget and space you have at hand.

And while eating food youve grown yourself sits at the junction of fulfilment, tradition and modernity, adapting to a rapidly changing world and new ways of eating it isn't an easy feat.

In fact, it requires seriousness and commitment.

Essentially, urban farming is all about growing food in a densely populated city or urban environment for sale, barter or consumption, and varies greatly in terms of productivity and scale and even extends to include raising animals as well.

In Pakistan, there exists a growing urban farming community that is not only involved in promoting sustainability and adaptive food consumption but also in encouraging habits of slow food, organic eating, buying local, seasonal produce and using traceable ingredients in cooking.

By speaking to those who know the ins and outs of urban farming and gardening, Images explores how you can begin to start growing in your own backyards and balconies.

Years ago, Sanaa Zubairi started her garden when she and her aunt decided to bring a dormant turai (gourd) creeper back to life in their yard with their gardeners help. It worked, and they added a few banana trees and a lemon tree.

They grew well and we had a lot of fruit, says Zubairi, a 36-year-old mental health counsellor, clinical supervisor and life coach.

Our maali started teaching me about [farming] since he had done it before in his village. Gradually, we experimented, researched online, picked up ideas and added more vegetables to the garden.

Zubairi and her aunt were never alone on their journey. The pair was inspired early on by others in their circle with already thriving kitchen gardens and consulted with their local Karachi chapter of Ikebana International the 20,000-strong international organisation to promote the Japanese art of flower arrangement where members meet once a month for workshops, lectures and discussions of plant and flower-related subjects and Tofiq Pasha, a renowned local farmer who regularly opens his farm to the public for planting workshops and lessons.

Along the way, we started hearing a lot about others growing their own food. I also met with Tofiq Pasha and saw his farm. It was pretty clear it is possible to grow [food] at home. The best part is opening up my window to a lush garden every morning, seeing the fruit hanging all around. Theres nothing like picking your own food, heading into the kitchen and cooking up a storm.

Zubairi revealed that for the past six or seven years, they havent needed to purchase the vegetables they already grow at home. That includes loki, turai, karaila and kakri, as well as spinach for six to eight months of the year and seasonal veggies besides.

There is always something that you can grow even if you don't have resources. Our pantries are packed with seeds; potatoes, garlic and ginger are always available to begin with. When you don't have everything listed in a gardening book or website, then you truly learn how to be creative and how nature finds a way to keep producing.

We have our lemons, basil and mint throughout the year. Seasonal vegetables like broccoli, tomato, eggplant, coriander and peppers keep us going for some months. We've added more fruit and have been enjoying mulberries (shaitoot) for a while now.

Every season, she says, We assess what we want to grow that time around and how much. Some stuff we manage to freeze as well and use whenever.

With a lot of produce coming through, Zubairi shares it with family, friends and house staff, and has also set up a barter system with other growers like her.

Seema Khuled has been regularly conducting gardening workshops and training sessions across Lahore and Islamabad for years.

Each session is three hours long and begins with basic theory the hows and whys followed by a tea break and an interactive practice session.

Workshops are registration-based and cover the basics like organic kitchen gardening, but also go beyond for the more serious enthusiasts with sessions on bonsai, vertical gardening, espaliering and growing mushrooms.

We have quite an informal interactive session where the participants are at ease to ask [questions] and understand. The best part which is very encouraging is that participants execute all the ideas that we discuss during the workshop, says Khuled.

I am always there whenever they need any further guidance but they are well equipped to try on their own.

And the interactive guidance goes beyond the weekend workshops. Khuled helps run Our Gardens, a Facebook group with over 114,000 members who use the platform for everything from help identifying plants (Is this lettuce edible?), to advice on techniques (Will this trellis be strong enough to hold up my vine?; Should I repot or transfer this into the ground?) to why their tomatoes arent thriving.

People also trade seeds and plants there are even giveaways from time to time and share photos and videos of the literal fruits of their labour for others to see. Plus, lots of wholesome memes.

I believe that nobody knows everything but everybody knows something. That is why an urban gardening community is important, says Khuled.

Everyone has something to contribute [with their] experience and knowledge.

Though she'd always had an affinity for nature and the outdoors since childhood, Karachi-based sustainability educator and writer Zahra Ali became a full-time urban farmer in 2008 after she had an accident that caused her to put her career on hold as a result.

During that one year, I asked myself, what will really make me happy if I had no pressures from society and no worry about my future?

I wanted to grow my own food and since then, I have found my way in the most magical ways possible. I gave up my career, which was all about consumerism and was totally not making me happy. It was a daring thing to do back then but amazing things happen when you follow your heart.

Around the same time, she started Crops In Pots, a blog that has since blossomed into a community of urban farmers and led to other projects and initiatives. Organic City, the organisation she started with her husband Yasir Husain, holds horticulture therapy sessions with The Recovery House, runs an heirloom seed bank and opened up the Organic City Eco-Store in 2016.

Then theres The Learning Garden, an initiative that promotes sustainability and conservation in schools through classroom and experiential learning via planting and caring for an organic vegetable patch. Over 7,000 children have participated in the programme over the last 12 years.

I learned gardening skills mainly through reading online and emailing experts from around the world who were very supportive. I watched [videos] and practised. That is why I started my blog in 2008: to share what works and what doesn't, says Ali.

I also got in touch with a group of urban farmers in the Philippines that emerged after the [2004] tsunami hit their area. They used trash to make fertilisers and planters; that truly inspired me.

At home and in the gardens she manages across the city, Ali mainly grows organic heirloom vegetables, herbs and fruits in containers or grow boxes and native trees for tree plantations, along with flowers, which help attract pollinating bees.

Flowers are always a part of any organic and permaculture garden. I have grown all kinds of plants, from orchids, cacti, bonsai [to] tropical and water plants as well. All these years, I have never planted hybrid or genetically modified seeds, and all my initiatives [have also grown] only heirloom vegetables each year since day one.

Lahore-based software project manager Muhammad Khabbab has a similar story. Back in 2008, he first got into gardening because of rising tomato prices at the time. Apart from the standard vegetables and some dwarf fruit trees, he is now growing hundreds of plants on his rooftop and is also a collector of rare and exotic flowers which can get tricky thanks to the fluctuating exchange rate and import restrictions.

Like Ali, he too created a community when he could not find one.

An active member of international gardening forums like Dave's Garden and Houzz, Khabbab started a blog, discussion board and an online store selling local and exotic bulbs, seeds and plants. His forum, Gardening Pakistan, often organises workshops and he makes sure to attend workshops run by others in the city.

I always learn a thing or two whenever I attend a workshop, says Khabbab. When you meet with other gardeners who see things from another perspective, then you get to know many new ideas and many solutions which you did not know in the first place. Learning is a process which never stops.

But for the urban gardening community, the learning is not all online.

Those who have access to or contacts in the rural farmlands regularly travel to interact with farmers on the ground to gain a deeper understanding of how to grow and how to grow better.

For example, Dr Sabeeka Kazilbash, who grows guava and mango trees at her home on the outskirts of Karachi, often visits her aunts in Punjab during the sugarcane or rice harvest seasons and consults with local farmworkers there to add to her knowledge.

She also writes directly to local nurseries in Karachi to ask what theyre up to and shares her own progress.

Extreme temperatures and deadly heatwaves in Pakistan over the past decade led to recognising the impact of losing green spaces in cities to concrete and urbanisation, resulting in government and private efforts to restore tree cover and urban forests.

Although climate change was named as a key contributing factor behind the exceptionally high temperatures of up to 49 degrees Celsius during the deadly 2015 heatwave which killed nearly 2,000 people in mostly Karachi and Sindh, what really drove the phenomenon (and subsequent heatwaves) are deforestation and the loss of green spaces in densely populated areas. This is known as the urban heat island effect.

Though urban gardening and farming also took off around the same time, campaigns calling to increase greenery in cities apparently arent responsible for their popularity.

According to Ali, heatwaves have not been the driving factor behind the growing interest in growing.

Speaking of lawns, Its important to point out that the gardens under discussion almost tend to be privately-held in homes and not, for example, public or commonly-held allotments or gardens, as is often the case in contemporary cities around the world.

Heatwaves did encourage mass tree plantations, she notes, referring to drives to plant trees in public spaces but people have always wanted to be closer to nature.

Over the years, so many gardening societies have bloomed and established, garden stores are spreading and nurseries are [more] accessible. People have also started growing vegetables now and are more aware of the harmful effects of genetically-modified seeds and chemicals used in agriculture.

Khuled concurs with Ali and says growing things has been an integral part of home life for generations. If we rewind our memories, we can see our elders growing a few things and surely having one or two fruit trees in our houses. It's kind of reviving that culture again.

Though they say the heatwaves arent directly behind the rising interest in gardening, both Khuled and Ali do credit a greater awareness of climate change and its effects and declining air quality among young people.

Zubairi who is also an active member of a Karachi-based gardening Facebook group acknowledges there are lots of pitfalls when it comes to growing and sustaining your own food and garden.

In fact, she says, failure is an important teacher. It hasnt been easy dealing with bugs and birds, but the experts shared their experiences, and desi fixes, totkas and failures here and there prepped me.

It takes patience and work.

While water is a constant and omnipresent challenge in Karachi, there are ways to work around it.

Dr Kazilbash, for example, grows according to Karachis climate in a limited space and is lucky her home is on the outer edge of the city, so the soil is richer.

Certain limitations of space and resources are a common factor here [in Pakistan] and turning them into opportunities is a collective effort beneficial to all. Small space gardening is one of the primary examples on which we have gone quite far, Khuled adds, referring to the most common type of setup group members have.

For the last 10 years, 29-year-old digital marketer Mavra Azeemi and her family have grown mostly fruit trees, flowers and ornamentals within their Lahore home: kinnow, mosambi, chikoo, red and green grapes, papaya, curry leaf, lemongrass, basil, date, guava, aloe, jasmine and rose.

Then theres the empty plot of land next door, where theyve planted moringa described as a miracle tree for all its nutritious benefits and a diverse vegetable patch.

She says, Thanks to the empty plot next to our house, we've been lucky enough to grow a whole bunch of different seasonal vegetables.

And though Lahore has better soil conditions and season differentiation, the smog and other irregularities can lead to an uneven or sometimes no output, which can get expensive in terms of time and effort.

Although, for Ali, who grows heirloom and organic, it was all about learning slowly through experience over the years.

She says, It was very challenging to find organic experts, garden shops or even local gardening social media groups back then.

Nearly a decade ago, she created a guide for starting a vegetable garden on a less than shoestring budget based on her own experience.

Dr Kazilbash, who is in her 30s, grew up watching her grandparents harvest their own kitchen essentials and took on gardening as a hobby as her interest grew.

Their encouragement, however, came from the pain of their own experience.

My grandfather often recalled his pre-Partition days and always advised that if a war-like situation [like that] happens again, [you must be prepared and] you have to plant food for your own survival. I always laughed, but this point always remains in my mind.

For some, the drive and satisfaction of growing food lies in maintaining family tradition and a kind of modern pastoral nostalgia. Linked to that are concerns like eliminating food miles or avoiding pesticide biomagnification. Plus, when you grow spinach and lettuce in your own yard, you know they havent been watered with sewage.

There is nothing as rewarding as picking up fresh food from your garden just before cooking, says Ali, who grows organic produce in all her gardens.

We are missing out [on] a diverse range of vegetables thanks to commercial farming. We need to revive heirloom seeds especially because over the past few decades, the world has lost a huge percentage of heirloom seed diversity.

The joy of picking a fresh orange from the tree that grows in your garden can never be matched by anything you get in the market, explains Azeemi, who comes from a landowning family in Punjab.

The connection you feel to the food you grow runs a lot deeper. You've shared the same piece of earth and gotten the same sun, grown up together, it's like the most beautiful friendship.

Food is the basic fuel for our body, says Khuled, who notes that pesticide intake tends to be highest when it comes to raw leaves and vegetables.

Growing your own food is taking charge of your health with your own hands. It also tastes much better.

I know we cannot grow everything but at least we can grow those which are consumed raw.

Organic farming can be challenging enough at subsistence level but even more so at scale, and is much less commercially viable in comparison to conventionally grown crops. Even when produce is labelled organic, its difficult to ensure it is 100% so and hasnt been exposed to harmful pesticides or fertilisers at some point.

This means the Pakistani urban garden is atomic, individual and domestic, with no infrastructure or sustainable model to turn it into a true community project that can build social cohesion and empower people.

Commercial farms cannot be completely organic even if they try [to be] due to pesticide sprays in adjacent farms, says Khuled, alluding to the fact that, though there are exceptions, organic farms are often located near or on the same properties as conventional ones.

For Zubairi, however, the benefits of urban farming go far beyond solely clean food: it can be revitalising in terms of mental health too.

Kitchen gardening and nature are a huge personal resource to help reconnect with the world and nature, ground the self and teach and encourage others to do the same.

It also helps to enjoy the many things we discover every now and then: butterflies, all kinds of winged bugs and different birds coming in to share the fruit. Some are just absolutely fascinating.

Dr Kazilbash, who also grows herbs, garlic, ginger, eggplant, potatoes and chillies, finds similar happiness when she gives much of her produce away.

When a friend shares her experience of how she used brinjal Ive grown in tarkari and raita, Im just overwhelmed with joy.

So what does the future of urban farming look like in Pakistan?

Ali is optimistic. It is bright, especially since [many] schools have started educating children about being close to nature. I am very hopeful to see our future community leaders shaping greener communities.

Urban gardeners are getting more active with the food growing movement now, says Khuled, which indicates a break from pristine balconies and the primly landscaped yet monotonous lawn.

"Along with beautiful, colourful and fragrant gardens, we are seeing edibles grown all along. This is very encouraging.

It's going to get even better if kitchen gardening can be introduced in every school and college, Khuled echoes.

She says, It's important to bring young children close to nature. I am seeing a much greener and healthier environment in years to come with all these youngsters joining us.

Speaking of lawns, Its important to point out that the gardens under discussion almost tend to be privately-held in homes and not, for example, public or commonly-held allotments or gardens, as is often the case in contemporary cities around the world.

This means the Pakistani urban garden is atomic, individual and domestic, with no infrastructure or sustainable model to turn it into a true community project that can build social cohesion and empower people.

Mid-February to early April is the spring planting season, which means right now is the perfect time to plan and start your very own garden.

Ali recommends growing locally available flowers, herbs and vegetables.

Try to include a water feature for bees, butterflies and birds, she adds.

There is always something that you can grow even if you don't have resources. Our pantries are packed with seeds; potatoes, garlic and ginger are always available to begin with. When you don't have everything listed in a gardening book or website, then you truly learn how to be creative and how nature finds a way to keep producing.

If that seems too daunting, Khuled recommends starting small.

Start with growing things you love to see or eat, she says. Always ask others for help and information with your gardening. Don't get discouraged if you fail to grow something. That is a part of learning.

Gardening is addictive. Once youre in, there is no way back.

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Urban farming is the future of healthy living - DAWN.com

Why we ought to create a healthy lifestyle rut? – Updates Junction

Some people overwork, and have ill health, while some people underwork, and still, they suffer from ill-health. Couple hundred years ago, people used to possess a healthy life just because of their healthy lifestyle. If we had to live the same life over again, we would have been doing 20 times more activities as to what we have been doing so far. Its an undeniable fact that people back then were way more strong both physically and mentally than the people of today.

That means we are weakening humanity, and over time, we will be degenerative humanity.

Considering the ongoing COVID-19 coronavirus pandemic, it is found that people having a healthier immune system have recovered from the infection as compared to those whose immunity has been compromised due to various factors. It all relates and this is the reason why we have to start living a healthier lifestyle to be better prepared to overcome such challenges.

Also Read: Healthy life hacks for busy people

When wesay health that means physical health, you must usethis bodyto get things done instead of letting technology do it for you. The more you use it, the better it gets. If you do workoutsufficiently, the body will remain healthy.

If we physically use our body as much as we should, then 80 percent of the ailments on this planet would just disappear, and out of the remaining 20 percent, 10 percent is because of our bad eating habits. But, now the number of diseases is so high because we neither eat nor exercise properly.

Health is not something you can invent, health is not a medical idea, health is all about making our life disciplined. But we act as if health is our idea and as if we have created health. But the truth is that what we have created is ill-health.

Today, we all are building gadgets, but if we build activity into our lives, activities like physical, mental and energy, health will automatically come.

Medical fraternity and medical knowledge have become more and more essential because we have built a very unhealthy lifestyle. Never before in the world, medicine had got this kind of importance as it is having today because we are becoming more and more sedentary and because of this we are becoming more and more unhealthy.

The whole world is going through a lockdown because of the ongoing pandemic. Think of it as an opportunity to start working on developing a healthier lifestyle and also making it a daily routine so that one could adjust to it later when things go back to normal.

So, just knuckle down, and lift yourself to start living a healthy life. After all, a healthy life is a wealthy life.

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Why we ought to create a healthy lifestyle rut? - Updates Junction

What is secret to a long, healthy and meaningful life? – Mirage News

Here, we asked Professor Fontana to elaborate on just a few of the many questions and myths his book tackles.

The first step is to acknowledge our health problems and limitations and challenge the underlying assumptions. Most of us will reshape our behaviours only if we have a clear understanding of why it is important to change, and we approve of it. Then we just need to set our goals, pursue them and have faith in them.

Smart people never stop learning, because they know that this is the way to deeper insights and revolutionary changes.

None of these: many are just fads, oversimplifications of a complex reality. Our society has become obsessed with losing weight, but the real question we should ask is not How can I drop some extra kilos?, but How can I avoid developing chronic diseases as I age, and possibly live a much longer and healthier life?

As I have tried to explain in this book, the knowledge we have acquired over the past couple of decades about the metabolic and molecular mechanisms that regulate ageing is allowing us to more accurately choose what to eat, how much of it and when, to meet our nutrient needs.

Sleep regenerates the brain, improves the efficiency of the immune system and reduces the risk of infections, while also playing a vital role in consolidating memories and reducing the risk of dementia.

There is no magic number of hours that works for everyone. The most important thing is that sleep is deep and restful, and you wake feeling restored. This can be difficult for some so the book explores strategies like endurance exercise to improve sleep quality or using yoga and meditation.

One of the features of centenarians living in Okinawa and Sardinia is the strong sense of belonging to the family and to a broader social group of friends. One of the Okinawans mottos is Shikinoo chui shiihii shiru kurasuru, which means: We live in this world by helping one another.

Positive social relationships and friendship play a key role in promoting metabolic, emotional and mental health so seek them out as challenging as that may be in current times.

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What is secret to a long, healthy and meaningful life? - Mirage News

The Atmospheric Indie Exploration Title In Other Waters Has Been Released! – Happy Gamer

Indie games make the world go around, especially nowadays with everyone being forced to spend so much time indoors. Indie games are typically cheaper, but their quality is no lower than non-independent games, making them a perpetually great choice. Of course, you also have the legendary indie releases, likeUndertale.

The latest indie game to be released in search of reaching that acclaim just hit stores across multiple platforms. Players that want to dive into the waters of another world can playIn Other Waters on Nintendo Switch or Steam.

In Other Waters is a unique title where you explore the oceans of an extraterrestrial planet without ever seeing them. Rather than playing as the explorer, you play as the explorers AI in their suit. Helping navigate for xenobiologist Ellery Vas, youll scan the environment to keep her up to date on any incoming threats or changes as you explore the planet together.

If youve heard ofIn Other Waters before, its likely from the accolades the indie title has acquired. Back in 2019, the title became an awardee at the Indie Cade International Festival of Independent Games, and gaming journalism outlet Rock, Paper, Shotgun also gave it their Bestest Bests award recently. Both titles applaud the unique gameplay and entrancing nature of the game as great draws.

Guide Ellery and keep her safe as you dive deeper and explore an underwater alien landscape, The description reads. The planets unique life, and its dark history, are yours to uncover and the bond between you and Ellery will be tested by the secrets you learn.

Players wont just be passively scanning. You take the role of the AI within her malfunctioning dive suit, but you arent some pre-programmed force for all good. As the story continues through a shifting narrative, youll discuss your discoveries with Ellery Vas as she tries to decide whether she can trust you to do the job she needs to do. Building your relationship with the xenobiologist is absolutely vital to the game.

Through this shifting narrative,In Other Watersasks questions about the nature of natural and artificial life, and investigates what it means to be a human in an epoch of extreme environmental destruction.

As the title states, for life to continue, it must change.In Other Waters is a fantastically posthuman romp that makes up for its lack of graphical spark with an intriguing story, strategic gameplay, and addicting progression.

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The Atmospheric Indie Exploration Title In Other Waters Has Been Released! - Happy Gamer

These Are the Must-See TV Shows Premiering in April – HYPEBEAST

Well, as many already know, there arent any movies premiering in theaters this month. Due to the recent COVID-19 pandemic, many films have pushed back their release dates some even a full year ahead of schedule. This has led many recently released movies to debut on Digital or VOD early, such as Bad Boys for Life, Sonic the Hedgehog and Birds of Prey.

Although there will be a list of the must-see films on Digital or VOD in the future, there are for now still must-see television shows arriving to streaming services this month as usual on platforms such as Netflix, Disney+, HBO Now and more. Read on for our picks of the best TV shows to arrive on those platforms, with more to come on how you can keep up with the latest movies.

After being imprisoned by the Pykes, Ahsoka Tano and the Martez sisters manage a daring escape of their stronghold. Together they flee through the city to their ship, desperate to evade the Pyke forces in pursuit.

Why its worth your time:This is probably the best series launching from the lackluster slate of new content Disney+ is offering. Whats more, this final season looks to be wrapping up a few loose ends in Ronin Jedi Ahsoka Tano before her live-action debut inThe Mandalorian season 2. If you plan to catch everything thats happening when the show comes back in October (well, if it comes back), youre going to want to know about Anakins former Padawan.

Harley Quinn has taken down the Joker and Gotham City is finally hers for the taking following the huge earthquake caused by the collapse of Jokers tower in season one. Penguin, Bane, Mr. Freeze, The Riddler and Two-Face join forces to form the Injustice League, who now stands in the way of Harley and her crew from taking sole control of Gotham as the top villains of the city.

Why its worth your time:Shazam, Aquaman and Harley Quinn have singlehandedly kept whats left of the DC extended universe afloat. The best ofHarley Quinn may not be her spot-on live-action counterpart in Margot Robbie, but her animated form in this series. It currently hold 86% on Rotten Tomatoes and is heralded as one of the biggest selling points of the entire DC Universe. Its got a lot to say about the superhero industry far more than the big-budget adaptations.

Its 1996, and second-year high school students Haruo Yaguchi, Akira Oono and Koharu Hidaka live their lives as passionately about video games as they did five years ago. Brought together by arcade games, what began as a healthy rivalry and friendship has now turned into something more.

Why its worth your time:The first season took us by surprise. Not only is it a sweet tale full of typical anime charm, but it also pays deep respect to the fighting arcade game scene throughout the 90s. Theyve got a pretty interesting love triangle too that seemed to be ramping up in the season one finale.

Season four sees the return of Insecures core characters, Issa, Molly and Lawrence as they navigate the aftermath of the previous season. We also see some characters grow up a bit more, particularly Tiffany whose new baby changes her friendships.

Why its worth your time:This show has found its niche in its fourth season and remains one of the best long-running series on HBO. Issa Rae continues to put the main focus on the current generation of black women, but also shines a light on the plight of contemporary black men through fan-favorite characters like Lawrence.

Ruby Richardson walks away from her ordinary life in the suburbs to revisit her past with her college boyfriend, Billy Johnson. The two made a pact 17 years earlier: If either one of them texted the word RUN and the other replied with the same, they would drop everything and meet in Grand Central Station and travel across America together.

Why its worth your time:This comedy looks like itll turn into more of a touching dramedy come the season finale. Its also an HBO joint, and the platform has been on fire with its recent releases. Although most of those shows have been limited series, were hoping the streak of excellence continues in their upcoming ongoing shows.

Inspired by Kenya Barris irreverent, highly flawed, unbelievably real-life marriage and approach to parenting, race, and culture, this new show stars Barris himself alongside Rashida Jones.

Why its worth your time:The show boasts that its looking to revamp the traditional family sitcom. Its a bold claim, especially when Barris other show Black-ish looked to achieve a similar goal initially though it fell flat in later seasons. Were hoping the restrains are lifted by partnering with a streaming service this time around, alongside getting more star-studded faces like Jones and several noticeable stars of color make cameos throughout the trailer above. Fingers crossed.

A space caster traverses trippy worlds inside his universe simulator, exploring existential questions about life, death and everything in between.

Why its worth your time:We all have our favorite reccurringJoe Rogan Experience guests, and one of ours is this shows creator Duncan Trussell. If the series is anywhere near as psychedelic as his appearances on JRE or even his own podcast, then were sure The Midnight Gospel will be a hit among its April 20 demographic. Well be tuning in.

The series takes place in the year 2045 following Stand Alone Complex and after an event called Synchronized Global Default has provoked an economic disaster in the world. AI technology has now become so advanced that its sparked a conflict called the Sustainable War and a new dangerous posthuman species.

Why its worth your time:Okay we know anime fans are sick of Netflix using CG animation in every single product they deliver. But this isGhost in the Shell, they got Kenji Kamiyama and Shinji Aramaki to direct. Motoko Kusanagi and Public Security Section 9 are back. But we dont think Yoko Kanno is returning to give us another stellar opening intro, sorry guys.

The limited drama series unfolds around a shocking crime that rocks a small Massachusetts town and one family in particular, forcing an assistant district attorney to choose between his sworn duty to uphold justice and his unconditional love for his son.

Why its worth your time:The series marks Chris Evans first leading role post-Marveland reveals one of Apple TV+s biggest scores in terms of star power. Evans now joins Hollywood heavy-hitters likeStephen Speilberg and Tom Hankswho have signed on to produce upcoming content for the platform.

After a grisly murder, Detective Tiago Vegan and his partner, Lewis Michener, become embroiled in an investigation that reflects the history of Los Angeles.

Why its worth your time:We are suckers for good stories about the Devil, and this season is set to portray a conflict between those who worship the Santa Muerte and Satan himself. The season is set 40 years after the original series, during the Golden Age of Hollywood and will explore LA, but also the deep traditions of Mexican-American folklore. It all sounds intriguing, and Game of Thrones alum Natalie Dormer looks electric in the trailer. We just hope the series is able to handle this many nuanced themes.

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These Are the Must-See TV Shows Premiering in April - HYPEBEAST

Gary K. Wolfe Reviews The Hidden Girl and Other Stories by Ken Liu – Locus Online

The Hidden Girl and Other Stories, Ken Liu (Saga 978-1-9821-3403-7, $26.00, 432pp, hc) February 2020.

In his introduction to The Hidden Girl and Other Stories, Ken Lius much-anticipated second collection, Liu tells us that selecting the stories was easier, since he no longer felt the pressure to present, but rather decided to stick with stories that most pleased myself. In fact, more than half of the 18 stories (plus an excerpt from the forthcoming third volume of his Dandelion Dynasty novels) are old enough that they might have been included in The Paper Menagerie and Other Stories back in 2016; the oldest date to 2011. This is one reason that second or third story collections are often more revealing than first collections; rather than showing us this is what I can do, they show this is what Im interested in. In no sense do any of the stories here feel like leftovers from that first collection, although a couple seem a bit fragmentary, like the Borgesian parable Cutting in which a group of monks annually cut out more words from their holy book as offerings to the gods, a kind of clever inversion of Clarkes The Nine Billion Names of God. What most of the stories reveal, however, is what Liu seems to be thinking about the past few years and a few clear themes emerge. One, which isnt too surprising given Lius background in computers, is the notion of the digital singularity, the now-familiar SF trope of uploading consciousness. But if that suggests the hard-SF side of Lius imagination, what emerges as an abiding concern of his humanist side is even more interesting: the problems, pitfalls, and rewards of child-parent relationships, which figure in fully half the stories here, as they did in his most celebrated story, The Paper Menagerie. Those same relationships often reveal a third theme: balancing dual identities, such as a British-educated student returning to his Chinese family in Hong Kong, or a parent who is also a distributed web intelligence, or a child learning to be a parent to a mother suffer ing dementia.

Perhaps not surprisingly, these themes converge in a number of stories, which together form a kind of meta-narrative of the singularity, which Liu treats as a mass migration into cyberspace. Lius singularity has some draconian rules: in order to upload, the living brain has to be scanned, but the procedure leaves the brain a bloody, pulpy mess. In other words, and not unlike in many religious beliefs, the geek rapture (to borrow a term already masticated into baby bird food) only works if your body dies, or at least your brain. In Lius more or less consistent chronology, one of the first to undergo such a procedure is a brilliant computer scientist in The Gods Will Not Be Chained, one of three connected stories originally published in John Joseph Adams & Hugh Howies Apocalypse Triptych anthologies. The narrator of the story is his daughter Maddie, who discovers a mysterious web presence speaking entirely in emojis that helps her deal with online bullying. The story maintains a fine balance between the account of a grieving and unhappy girl coming to terms with her parents and the cyber-thriller of what really happened to her father and why. The immediate sequel, The Gods Will Not be Slain, retains Maddies appealing narrative voice but moves into Colossus/Terminator territory as her dad battles against other uploaded consciousnesses, or gods, who have concluded that helping humanity destroy itself by taking control of weapons systems would be a dandy payback. By the third installment, The Gods Have Not Died in Vain, Maddies home life is more focused on dealing with her overworked mom, but now she meets a virtual sister she names Mist a native of the uploaded world, created by her father and the two of them form a bond even as Mist raises the argument that a post-scarcity paradise can be achieved only as people are willing to give up their physical bodies to enter the now rapidly growing cybercommunity. None of these arguments are particularly original with Liu, nor is the assumption that gender identities and family relationships will somehow persist in a nonbiological environment, but the sympathetic focus on Maddie, as she comes to terms with radical changes in her life and future, keeps the tale from turning into programmatic spec-fic.

By the time of Staying Behind, the rapture term left behind is invoked to describe those who resist uploading, even as the physical world grows depopulated and increasingly primitive and violent. The parents here cynically refer to the uploaded as the dead and have convinced their kids that the singularity is a false promise, but when the mother begins dying from a long illness, the desperate father has her uploaded against her fervent wishes, leaving the children to face a dilemma when the mother emails them that I was wrong and claims the digital world leaves her ecstatic another loaded quasi-religious term. Still later, in Altogether Elsewhere, Vast Herds of Reindeer (interestingly, a title taken from the same Auden poem that gave us Catherynne Valentes Silently and Very Fast), most kids are virtual-world natives, living in multidimensional constructs. The mother of the narrator, one of the few remaining ancients who lived part of her life in flesh, worries that humanity has turned inward and become complacent, as she tries to persuade her daughter to join her in exploring the physical universe by having herself beamed to a robot sent to a distant planet. The timescale shifts more radically in Seven Birthdays, a kind of formal experiment in which Liu forces himself into ever more remote futures by the simple trick of having each of the birthdays a multiple by seven of the previous one so that it begins with the young-girl narrators seventh birthday, then jumps to 49, to 343, and so on until were well past a million years in the future. Its the sort of device used before in stories like Jonathan Lethems Five Fucks or Sean Williamss All the Wrong Places, but as usual Liu casts it as a family drama: the overworked mom nearly misses Mias seventh birthday, and by the time Mia turns 49, she herself is so busy working on the problem of scanning brains that the roles are reversed, with the now elderly mother suffering from dementia. By her 343rd birthday, the focus shifts to Mias relations with her own daughter, both now living in virtuality. The parental problems move to the background a bit in subsequent jumps into deep time, but the tale ends with a somewhat contrived but nonetheless moving full-circle conclusion.

Family dynamics arent confined to Lius singularity tales, however. Other familiar SF tropes are also invoked in service of exploring parent/child relations. A mother given only two years to live realizes that the time dilation of repeated space journeys will enable her to see her daughter grow up and even grow old in the brief but elegant Memories of My Mother, while an enigmatic alien structure on a distant planet brings together an alienated father and daughter in The Message, a story which in many ways inverts and critiques Godwins The Cold Equations, though its nearly as front-loaded as that chestnut. One of the most complex and provocative tales is the lead story, Ghost Days, in which an ancient Chinese spade-shaped bubi coin passes from a British-educated Chinese student in 1905 Hong Kong who is facing cultural tensions with his father, to a Chinese-American student confronting racism in Reagan-era Connecticut, and finally to a genetically engineered posthuman student on a remote planet in the 24th century. Each is confronted with the conundrum of living in two worlds, symbolized by the bubi, and Lius ingeniously layered structure only adds to the resonance between the different time frames. The question of dual identity is made even more explicit in the one story involving aliens, The Reborn, depicting a problematical kind of symbiosis that in some ways reflects the debate over embodiment vs. uploading in those other stories.

As should be evident by now, Liu is fond of narrative packets tales whose segments jump forward or backward in time or shift viewpointscovering thousands of millennia in the case of Seven Birthdays and this can be equally effective when the time frames are more intimate as in Maxwells Demon. The collections most direct indictment of racism, it describes the fate of a young Japanese American physicist interned at the Tule Lake concentration camp in 1943, first classified as a no-no girl, then sent as a scientific spy to Japan. Because of her apparent affinity with spirits, she finds herself attached to a paranormal research unit which assigns her to train the spirits to act as a literal Maxwells demon in order to create a superweapon. Despite its odd mix of supernaturalism and classic physics, the storys bitterly ironic ending, which moves forward to 1945, is powerful. Equally powerful, but in a very different and disturbing way, is Thoughts and Prayers, which shifts among the viewpoints of family members of a young woman killed in a mass shooting, as they helplessly watch internet trolls cruelly manipulate images from her memorial video into porn videos. The memorial video itself is produced using algorithms which feature much more prominently in Real Artists, a rather slight satirical piece about the film industrys growing obsession with audience research.

As those last two stories suggest, an abiding concern of Lius is how technologies that are already with us may be used or misused in the near future. Byzantine Empathy is not only the most provocative story Ive read concerning the possible uses of blockchain technology, but one of the clearest explanations of blockchain itself (not surprising that it originally appeared in the MIT anthology Twelve Tomorrows). After opening with a genuinely disturbing VR scene of Myanmar refugees being brutalized by soldiers, though, it develops into what amounts to a policy debate between two former college roommates over the relative benefits of a new VR-based blockchain called Empathium which radically decentralizes fundraising for worthy causes compared to more traditional charity organizations. (The title comes from a parable about Byzantine generals needing secure communications lines.) Despite the sympathetic portraits of its two main characters, the story cant help but turn into a fairly abstruse debate about resource allocation. By contrast, Lius treatment of another hot-button issue, global warming, is given the unwieldy title Dispatches from the Cradle: The Hermit Forty-Eight Hours in the Sea of Massachusetts and is set in a more distant 27th century, when (somewhat as in Kim Stanley Robinsons 2312) terraforming efforts are underway to make Earth once again habitable. Much of the action is set in a sunken Boston, hauntingly evoked in a way which recalls Robinsons Venice Drowned.

Given Lius success with his epic Dandelion Dynasty fantasy novels, its interesting that only three of the selections here approach fantasy, and one of those is a brief preview of The Veiled Throne, the forthcoming third volume in that series (which is fun, but Ill refrain from commenting until the novel shows up). Each of the two other fantasy tales seems ready to open up into broader narratives. The title story, The Hidden Girl, is set in Tang Dynasty China, where a young girl is abducted by a bhikkhuni, or Buddhist nun, who trains her as an acrobatically skilled assassin. But on her first assignment, her encounter with the targeted warlord and his son causes her to re-evaluate her training, placing her at odds with her sister assassins and setting her on her own course to protect the innocent and guard the timid. Its basically a superhero origin story, and its not surprising that Hollywood optioned it a few years ago. Grey Rabbit, Crimson Mare, Coal Leopard, the only story original to the collection, also concludes with a suggestion of further adventures. In a repressive sort of steampunk dystopia, Ava works as a miner sifting through the middens of an ancient technological civilization destroyed by an apocalyptic Plague. One of the few avenues for the repressed miners to gain social status is to partake of Revelation wine, a magical potion which allowed its drinkers to reshape their body into a second form, a form that displayed their latent talents and hidden abilities. Avas transformation simply turns her into a rabbit. Those rabbit skills prove useful in unexpected ways as she rescues a mare (the revealed shape of another woman) and the two of them join forces with a poacher who takes the form of the coal leopard. With the three women learning how their individual powers can work together, the story seems to set the stage for an epic revolution yet to come. Perhaps this sort of adventure which, as we know from the Dandelion Dynasty, Liu can write with the best of them liberates him from the conscientiousness and tech-savvy explanations that sometimes clog the movement of his SF tales, even while deepening their power. Lius fantasies may be more freewheeling than his SF, but The Hidden Girl and Other Stories leaves us wanting a lot more of both.

Gary K. Wolfe is Emeritus Professor of Humanities at Roosevelt University and a reviewer for Locus magazine since 1991. His reviews have been collected in Soundings (BSFA Award 2006; Hugo nominee), Bearings (Hugo nominee 2011), and Sightings (2011), and his Evaporating Genres: Essays on Fantastic Literature (Wesleyan) received the Locus Award in 2012. Earlier books include The Known and the Unknown: The Iconography of Science Fiction (Eaton Award, 1981), Harlan Ellison: The Edge of Forever (with Ellen Weil, 2002), and David Lindsay (1982). For the Library of America, he edited American Science Fiction: Nine Classic Novels of the 1950s in 2012, with a similar set for the 1960s forthcoming. He has received the Pilgrim Award from the Science Fiction Research Association, the Distinguished Scholarship Award from the International Association for the Fantastic in the Arts, and a Special World Fantasy Award for criticism. His 24-lecture series How Great Science Fiction Works appeared from The Great Courses in 2016. He has received six Hugo nominations, two for his reviews collections and four for The Coode Street Podcast, which he has co-hosted with Jonathan Strahan for more than 300 episodes. He lives in Chicago.

This review and more like it in the February 2020 issue of Locus.

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Gary K. Wolfe Reviews The Hidden Girl and Other Stories by Ken Liu - Locus Online