Comparison of SGLT2 inhibitors vs. DPP4 inhibitors for patients with metabolic dysfunction associated fatty liver disease and diabetes mellitus

PURPOSE

This study aimed to examine the potential benefit of sodium-glucose cotransporter 2 (SGLT2) inhibitors for patients with metabolic dysfunction-associated fatty liver disease (MAFLD) and diabetes mellitus (DM) using a real-world database.

METHODS

We analyzed individuals with MAFLD and DM newly initiated on SGLT2 or dipeptidyl peptidase 4 (DPP4) inhibitors from a large-scale administrative claims database. The primary outcome was the change in the fatty liver index (FLI) assessed using a linear mixed-effects model from the initiation of SGLT2 or DPP4 inhibitors. A propensity score-matching algorithm was used to compare the change in FLI among SGLT2 and DPP4 inhibitors.

RESULTS

After propensity score matching, 6547 well-balanced pairs of SGLT2 and 6547 DPP4 inhibitor users were created. SGLT2 inhibitor use was associated with a greater decline in FLI than DPP4 inhibitor use (difference at 1-year measurement, - 3.8 [95% CI - 4.7 to - 3.0]). The advantage of SGLT2 inhibitor use over DPP4 inhibitor use for improvement in FLI was consistent across subgroups. The relationship between SGLT2 inhibitors and amelioration of FLI was comparable between individual SGLT2 inhibitors.

CONCLUSIONS

Our analysis using large-scale real-world data demonstrated the potential advantage of SGLT2 inhibitors over DPP4 inhibitors in patients with MAFLD and DM.

Association between blood pressure classification using the 2017 American College of Cardiology/American Heart Association blood pressure guideline and hypertensive retinopathy

Purpose

We aimed to explore the association of blood pressure (BP) classification using the 2017 American College of Cardiology/ American Heart Association Guideline and the prevalence of hypertensive retinopathy using a nationwide epidemiological database.

Methods

This study is a retrospective observational cross-sectional analysis using the health claims database of the JMDC between 2005 and 2020. We analyzed 280,599 participants who did not take anti-hypertensive medications. Each participant was categorized as having normal BP (systolic BP [SBP] <120 mm Hg and diastolic BP [DBP] <80 mm Hg; n=159,524); elevated BP (SBP 120–129 mm Hg and DBP <80 mm Hg; n=35,603); stage 1 hypertension (SBP 130–139 mm Hg or DBP 80–89 mm Hg; n=54,795); or stage 2 hypertension (SBP ≥140 mm Hg or DBP ≥90 mm Hg; n=30,677). Retinal photography at health check-up was classified as normal, grade 1, grade 2, grade 3, or grade 4 according to the Keith-Wagener-Barker system.

Results

Median (interquartile range) age was 46 (40–53) years, and 50.4% were men. Hypertensive retinopathy which was defined as ≥ Keith-Wagener-Barker system grade 1, was observed in 16,836 participants (6.0%). Multivariable logistic regression analysis showed that, compared with normal BP, elevated BP (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.23–1.38), stage 1 hypertension (OR 1.71, 95% CI 1.64–1.79), and stage 2 hypertension (OR 4.10, 95% CI 3.93–4.28) were associated with higher prevalence of hypertensive retinopathy. Even among 92,121 participants without obesity, high waist circumference, diabetes mellitus, dyslipidemia, cigarette smoking, and alcohol drinking, multivariable logistic regression analysis showed that, compared with normal BP, elevated BP (odds ratio 1.34, 95% CI 1.19–1.51), stage 1 hypertension (OR 1.79, 95% CI 1.61–1.98), and stage 2 hypertension (OR 4.42, 95% CI 4.00–4.92) were associated with higher prevalence of hypertensive retinopathy. The association between BP category and hypertensive retinopathy was observed in all subgroups stratified by age or sex.

Conclusion

Our investigation showed that the prevalence of hypertensive retinopathy increased with the blood pressure category, suggesting that atherosclerotic change could start even in elevated BP and stage 1 hypertension.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141).

A novel three-dimensional visualization system revealed an essential adaptive angiogenic response during the early phase of pulmonary hypertension

Background

Pulmonary hypertension (PH) is characterized by increased pulmonary vascular resistance and right heart failure with progressive narrowing or occlusion of the pulmonary artery. However, the assessment of vascular remodeling is mostly limited to averaged increases in wall thickening, and even the role of vascular endothelial growth factor (VEGF), remains incompletely understood; Although abundantly expressed VEGF is expected to elicit angio-obliteration and the knockout of hypoxia inducible factor (HIF) prevents PH in mice, VEGF inhibitor Sugen exacerbates hypoxia (Hx)-induced PH model, which is referred to as VEGF paradox.

Purpose

To analyze three-dimensional (3D) spatiotemporal changes of pulmonary microstructure and function, which reflect the disease activity and lead to resolve the paradox.

Methods and results

We developed a novel 3D visualization system of microstructural networks in whole mouse organ with single-cell resolution, using combined tissue clearing technique called CUBIC and multiphoton excitation microscope. The system enabled the simultaneous 3D evaluation of microvascular structure, invaded macrophages and fibrosis with effective penetration of several mm (whole organ). Three-dimensional observations of PH mice models including Hx, Sugen/Hx, and human-like Alk1+/− hereditary PH models, revealed that not only inward (negative) microvessel remodeling with stenosis, but also marked elongation of microvascular ECs, was evident except Sugen/Hx model at the early phase, which had not been detected by 2D histological sections. Comparable transcriptome analysis revealed that PGC1α, which regulates HIF-independent VEGF expression and angiogenesis, plays an important role in the characteristic response for mitochondrial and microvascular maintenance. PGC1α was up-regulated in the early phage in Hx and Alk1+/− PH models with microvascular angiogenetic change, whereas Sugen/Hx-model did not increase PGC1α expression and did not show microvascular remodeling. Furthermore pulmonary ECs-specific PGC1α-deficient mice exacerbated Hx-PH model with decreased VEGF expression and microvessel density, and administration of Baicalin, a flavonoid enhancing PGC1α expression, ameliorated Hx-PH model with increased VEGF expression.

Conclusions

The 3D visualization system disclosed an unexpected change of angiogenic microvascular structure in the early phage of PH, which is regulated by EC PGC1α. Microvascular angiogenesis which is induced by up-regulation in PGC1α -VEGF pathway is a crucial factor for compensation of PH in the early phase, which provides a potential novel therapeutic target for PH.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): JSJP

Characterization of porcine sapelovirus isolated from Japanese swine with PLC/PRF/5 cells

Porcine sapelovirus (PSV) is a causative agent of neurological disorders, fertility disorders and dermal lesions of swine. In this study, we isolated two PSV strains, Jpsv477 and Jpsv1315, from swine faecal specimens using a PLC/PRF/5 cell culture system. The PSV infection of PLC/PRF/5 cells induced a cytopathic effect (CPE). Two types of virus particles with identical diameter (~35 nm) but different densities (1.300 and 1.285 g/cm³ ) were observed in the cell culture supernatants. Analysis of the entire genome sequence of Jpsv477 and Jpsv1315 revealed that both strains possess 7,558 nucleotides and the poly (A) tail and have a typical PSV genome organization consisting of a 5' terminal untranslated region (5'UTR), a large open reading frame (ORF), and a 3' terminal untranslated region (3'UTR). The ORF encodes a single polyprotein that is subsequently processed into a leader protein (L), four structural proteins (VP1, VP2, VP3 and VP4) and seven functional proteins (2A, 2B, 2C, 3A, 3B, 3C and 3D). The structural proteins VP1, VP2, VP3 and VP4 have molecular masses of ~35, ~26, ~25 and ~6 kDa. The N-terminal amino acid sequence analysis of VP1, VP2, VP3 and VP4 confirmed that the cleavage sites between VP4 and VP2, VP2 and VP3, and VP3 and VP1 are K/A, Q/G and Q/G, respectively. We further confirmed that HepG2/C3A, Vero E6 and primary green monkey kidney cells (PGMKC) were also susceptible to PSV infection. The stability assay demonstrated that PSV was inactivated by heating at 60°C for 10 min or 65°C for 5 min. The virus also lost infectivity by incubation with 62.5 ppm of NaClO for 30 min.

Peripartum type B aortic dissection in patients with Marfan syndrome who underwent aortic root replacement: a case series study

OBJECTIVE

To investigate pregnancy outcomes, especially the risk of pregnancy-related aortic dissection (AD), in patients with Marfan syndrome (MFS) after prophylactic aortic root replacement (ARR).

DESIGN

Retrospective case series study.

SETTING

Tertiary perinatal care centre at a university hospital.

POPULATION

Pregnant women fulfilling the revised Ghent nosology (2010) criteria for MFS who were managed at our institute.

METHODS

The pregnancy outcomes of all patients with MFS managed at our institute between 1982 and September 2016 were reviewed retrospectively based on medical records.

MAIN OUTCOME MEASURES

Obstetrical management and complication including the incidence of AD throughout the peripartum period.

RESULTS

Among 22 patients (28 pregnancies) who had been managed as potential MFS or related disorders, 14 (17 pregnancies) fulfilled the revised Ghent nosology (2010) criteria for MFS and were enrolled in this study. Five patients (five pregnancies) had received ARR before conception: three (60%) developed type B aortic dissection [AD(B)] during the peripartum period, compared with only one of 10 patients (12 pregnancies) without ARR (P < 0.05, Chi-square test).

CONCLUSIONS

Our study results suggest that MFS patients after prophylactic ARR are still at high risk of AD(B) during the peripartum period. Careful pre-pregnancy counselling and multidisciplinary care throughout the peripartum period are essential for the management of MFS, even after surgical repair of an ascending aortic aneurysm.

TWEETABLE ABSTRACT

MFS patients after prophylactic ARR are still at high risk of type B aortic dissection during the peripartum period.

Abstract P1-11-12: Re-evaluating outcomes of partial-breast irradiation using multicatheter brachytherapy for Japanese patients with breast cancer by European brachytherapy phase 3 trial

[Purpose] The Groupe European de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) has reported the equivalent outcomes of partial-breast irradiation (PBI) using multicatheter interstitial brachytherapy (MCB) to whole-breast irradiation (WBI) in breast-conserving therapy, showing that the incidence of local recurrence was 1.44% with MCB-PBI and 0.92% with WBI. Based on the trial, MCB-PBI could be considered as an alternative method to WBI for low-risk breast cancer patients. However, it would be difficult to translate it directly into Japanese community practice. After categorization of Japanese patients using the inclusion and exclusion criteria of this trial, our databases were re-evaluated to validate the data for Japanese patients, and the possibility to extend the candidate for MCB-PBI was also investigated.

[Methods] Patients undergoing BCT were retrospectively examined between November 2007 and December 2015. The technique involved an open-cavity implant with a dose of 32 Gy in eight fractions. WBI was performed with a total dose of 50 Gy in fractions of 2 Gy. The 4-year clinical outcomes of MCB-PBI were evaluated in the two distinct categories, and comparisons of outcomes between MCB-PBI and WBI were performed in patients with unfavorable features.

[Results] Of a total of 501 lesions undergoing BCT, 301 lesions were treated with MCB-PBI and 200 lesions with WBI. At a median follow-up time of 52 months, the 4-year rate of ipsilateral breast tumor recurrence (IBTR)-free, disease-free, and overall survival in patients with MCB-PBI and WBI were 98.9% vs. 98.0% (p = 0.56), 97.0% vs. 95.3% (p = 0.78), and 99.6% vs. 98.2% (p = 0.38), respectively. In the exclusion cohort treated with MCB-PBI, IBTR-free and disease-free survival were significantly poorer than in the inclusion cohort.However, no significant differences in the outcomes between the two radiotherapy techniques were demonstrated with respect to either IBTR-FS (95.0% vs. 97.2%, p = 0.24), DFS (95.0% vs. 95.8%, p = 0.31), or OS (100% vs. 99.0%, p = 0.80) in patients with exclusion criteria

Univariate and multivariate analysis of prognostic factors for IBTR and breast cancer eventVariablesIBTR  Locoregional and distant recurrences   P-value  P-value   UnivariateMultivariateHR (95% CI)UnivariateMultivariateHR (95% CI)Age ≥ 40 vs &lt; 40years.25—2.49 (0.53–11.72) —0.90 (0.21–3.85)Axillary node negative vs. positive&lt;.05&lt;.054.09 (1.18–14.12)&lt;.05&lt;.052.75 (1.19–6.36)Margin negative vs. positive&lt;.01&lt;.015.58 (1.54–20.29).075.0682.55 (0.93–6.97)WBI vs. MCB-PBI.56—0.69 (0.20–2.39).78—0.89 (0.39–2.03).

ConclusionsTo our knowledge, this study includes the largest cohort of Asian patients undergoing MCB-PBI. Although the retrospective chart review with relatively short follow-up time and small number of patients does not allow reaching any definite conclusion, we could expect the same outcomes by MCB-PBI as those in the GEC-ESTRO trial with respect to the tumor control only for Japanese but for Asian patients with breast cancer. Moreover, no negative impact on the outcomes of MCB-PBI as compared to WBI was not found in patients with exclusion criteria.

Citation Format: Sato K, Mizuno Y, Fuchikami H, Takeda N, Kato M. Re-evaluating outcomes of partial-breast irradiation using multicatheter brachytherapy for Japanese patients with breast cancer by European brachytherapy phase 3 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-11-12.

Skin pigmentation is inversely associated with insulin resistance in healthy Japanese women

AIM

As a low-pigment skin type is prevalent in men and women with type 1 diabetes, it is possible that skin pigmentation may be associated with insulin resistance. This study aimed to cross-sectionally examine this association in healthy women.

METHODS

Study participants were 792 Japanese women who attended a health examination and were not taking any medication for diabetes. Skin pigmentation on the inner upper and lower arms and forehead was measured using a Mexameter^® skin colorimeter, a narrow-band reflective spectrophotometer. Data are expressed as a melanin index, which quantifies melanin content. Fasting blood glucose and insulin levels were also measured, and homoeostasis model assessment for insulin resistance (HOMA-IR) scores were calculated. Information on medical history and lifestyle factors were obtained by a self-administered questionnaire, while data on sun exposure were collected through interviews. Plasma 25-hydroxyvitamin D levels were measured in a subsample of women (n=464).

RESULTS

Melanin indices at the inner upper and lower arms were significantly and inversely associated with fasting insulin levels and HOMA-IR after controlling for age, body mass index, smoking status, indicators for rater effects, cumulative sun exposure and season at the time of measurement. Additional adjustment for plasma 25-hydroxyvitamin D levels did not alter the results.

CONCLUSION

These data suggest that skin pigmentation is associated with insulin resistance, and encourage future studies into the potential role of melanin and related factors in glucose homoeostasis.

Abstract P3-12-19: Impact of young age on local control after partial-breast irradiation in early-stage breast cancer

Background: Although the rate of breast-conserving surgery (BCS) increased, the receipt of adjuvant radiotherapy after BCS decreased especially for young patients. The long-term daily visit to radiation facilities must be the most relevant barriers to receiving radiation therapy. The use of partial-breast irradiation (PBI) is considered an alternative option. However, there are limited data to be seen how safe PBI is as an option of adjuvant radiation therapy in young patients compared with whole-breast irradiation (WBI). In this report, we reviewed our single-institution experience with PBI compared with WBI in young breast cancer patients.

Methods: We evaluated 443 consecutive patients with T≤3-cm N0–1 breast cancer who underwent breast-conserving therapy (BCT) between November 2007 and May 2015. 268 patients received PBI using interstitial multicatheter brachytherapy. The interstitial brachytherapy was performed in an accelerated fashion with a dose of 32 Gy in eight fractions over 5-6 days. 185 patients received WBI with a dose of 50 Gy in fractions of 2 Gy. Patients with risk factors such as positive margins and young age received a subsequent 10 Gy boost to the tumor bed, and the regional nodal irradiation was added in patients with ≥ 4 positive nodes. Patients who underwent neoadjuvant chemotherapy were excluded from the analysis. Our primary objective was to assess outcome rates of ipsilateral breast tumor recurrence (IBTR), disease-free survival (DFS), and overall survival (OS), and compare the patterns of treatment failures between the cohorts.

Results: Patients aged &lt;50 years with a minimum follow-up period of 6 months were selected for the analysis. Of those patients who could be completely followed, there were 95 women receiving PBI and 81 women receiving WBI. In PBI cohort, 4 patients also received WBI because of adverse histological features with positive nodes or positive margins by final pathology. Median follow-up was 4.0 years for PBI patients and 3.9 years for WBI patients. Median age was 43.9 years old for PBI and 42.1 years old for WBI cohort. Mean tumor size was equivalent for the cohorts (12 mm). Positive lymph nodes were seen more frequently in WBI cohort (9.5% and 29.6%, p &lt; 0.05). There was no significant difference in the 3-year probability of disease-free survival (97.4% and 98.1% for PBI and WBI, respectively; p = 0.95). No breast cancer related death was observed. With our follow-up period, there were 5 IBTR (2.8%). Of these IBTRs, 4 were true recurrences (2 were in PBI and 2 were in WBI). There was 1 elsewhere recurrence in PBI cohort. The actual rate of IBTR was 3.2% and 2.5% in PBI and WBI, respectively (p = 0.64).

Conclusions: We observed equivalent IBTR rates between PBI and WBI cohorts in young breast cancer patients. If there are no differences in survival between the two radiotherapy regimens, PBI may be a better option than WBI after BCS in such a population. To our knowledge, this is the first report describing that the efficacy of PBI after BCS is comparable with WBI in young breast cancer patients in Asia. However, our data are limited by our short median follow-up with small number of patients. The application of PBI should still be carefully considered until mature Phase III trial data are available.

Citation Format: Sato K, Mizuno Y, Fuchikami H, Takeda N, Kato M. Impact of young age on local control after partial-breast irradiation in early-stage breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-12-19.

A two-step hybrid technique for accurately localizing acoustic source in anisotropic structures without knowing their material properties

Acoustic source localization techniques generally assume straight line propagation of waves from the acoustic source to the sensor. However, it is well-known that in anisotropic plates the acoustic energy does not always propagate in straight lines. Even for isotropic plates containing a cavity or an inclusion between the acoustic source and the sensor the straight line propagation assumption is violated. In such cases only options available in localizing acoustic source is to use relatively expensive distributed sensor systems, or to follow time reversal techniques based on the impulse response functions which is labor intensive and computationally demanding. A two-step hybrid technique is proposed in this paper for predicting acoustic source in anisotropic plates. During the first step it was assumed that the waves propagated along straight lines from the acoustic source to the sensor. The source was localized with this simplifying assumption. Then this first prediction was improved in the second step by solving an optimization problem. Experimental results showed that the second step always moved the estimates towards the actual source location. Thus it always reduced the prediction error irrespective of whether the final prediction coincided with the actual source location or not.