Evaluation of different late left ventricular remodeling definitions for predicting long-term outcomes in acute myocardial infarction patients undergoing percutaneous coronary intervention

Background

Late left ventricular remodeling (LLVR) after the index acute myocardial infarction (AMI) is a common complication, and is associated with poor outcome. However, the optimal definition of LLVR has been debated because of its different incidence and influence on prognosis. At present, there are limited data regarding the influence of different LLVR definitions on long-term outcomes in AMI patients undergoing percutaneous coronary intervention (PCI).

Purpose

To explore the impact of different definitions of LLVR on long-term mortality, re-hospitalization or an urgent visit for heart failure, and identify which definition was more suitable for predicting long-term outcomes in AMI patients undergoing PCI.

Methods

We prospectively observed 460 consenting first-time AMI patients undergoing PCI from January 2012 to December 2018. LLVR was defined as a ≥20% increase in left ventricular end-diastolic volume (LVEDV), or a >15% increase in left ventricular end-systolic volume (LVESV) from the initial presentation to the 3–12 months follow-up, or left ventricular ejection fraction (LVEF) <50% at follow up. These parameters of the cardiac structure and function were measuring through the thoracic echocardiography. The association of LLVR with long-term prognosis was investigated by Cox regression analysis.

Results

The incidence rate of LLVR was 38.1% (n=171). The occurrence of LLVR according to LVESV, LVEDV and LVEF definition were 26.6% (n=117), 31.9% (n=142) and 11.5% (n=51), respectively. During a median follow-up of 2 years, after adjusting other potential risk factors, multivariable Cox regression analysis revealed LLVR of LVESV definition [hazard ratio (HR): 2.50, 95% confidence interval (CI): 1.19–5.22, P=0.015], LLVR of LVEF definition (HR: 16.46, 95% CI: 6.96–38.92, P<0.001) and LLVR of Mix definition (HR: 5.86, 95% CI: 2.45–14.04, P<0.001) were risk factors for long-term mortality, re-hospitalization or an urgent visit for heart failure. But only LLVR of LVEF definition was a risk predictor for long-term mortality (HR: 6.84, 95% CI: 1.98–23.65, P=0.002).

Conclusions

LLVR defined by LVESV or LVEF may be more suitable for predicting long-term mortality, re-hospitalization or an urgent visit for heart failure in AMI patients undergoing PCI. However, only LLVR defined by LVEF could be used for predicting long-term mortality.

Funding Acknowledgement

Type of funding sources: None. Association Between LLVR and outcomesKaplan-Meier Estimates of the Mortality

A Biomimetic Approach for Spatially Controlled Cell Membrane Engineering Using Fusogenic Spherical Nucleic Acid

Engineering of the cell plasma membrane using functional DNA is important for studying and controlling cellular behaviors. However, most efforts to apply artificial DNA interactions on cells are limited to external membrane surface due to the lack of suitable synthetic tools to engineer the intracellular side, which impedes many applications in cell biology. Inspired by the natural extracellular vesicle-cell fusion process, we have developed a fusogenic spherical nucleic acid construct to realize robust DNA functionalization on both external and internal cell surfaces via liposome fusion-based transport (LiFT) strategy, which enables applications including the construction of heterotypic cell assembly for programmed signaling pathway and detection of intracellular metabolites. This approach can engineer cell membranes in a highly efficient and spatially controlled manner, allowing one to build anisotropic membrane structures with two orthogonal DNA functionalities.

Predictive value of neutrophil percentage-to-albumin ratio for contrast-associated acute kidney injury in patients without chronic kidney disease undergoing elective percutaneous coronary intervention

Background

Although previous studies have demonstrated that neutrophil and albumin are biomarkers of inflammation and malnutrition, which are highly related with contrast-associated acute kidney injury (CA-AKI). However, there has been no study investigated the combined evaluation of neutrophil and albumin in predicting CA-AKI.

Purpose

To explore the predictive value of neutrophil percentage-to-albumin ratio (NPAR) for CA-AKI in patients undergoing elective percutaneous coronary intervention (PCI).

Methods

We prospectively observed 5083 consenting patients without chronic kidney disease (CKD) undergoing elective PCI from January 2012 to December 2018. NPAR was calculated as neutrophil percentage numerator divided by serum albumin concentration. CA-AKI was defined as an increase in serum creatinine (SCr) ≥50% or 0.3 mg/dL within 48 hours after contrast medium exposure. The association between NPAR and CA-AKI was investigated by logistic regression analysis. The area under the receiver-operating characteristic curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to make comparison for CA-AKI prediction.

Result

The incidence of CA-AKI was 5.6% (n=286). The median NPAR was 14.9 (13.0–17.1). According to the receiver operating characteristic curves (ROC), the best cut-off value of NPAR for predicting CA-AKI was 15.7 with 66.8% sensitivity and 61.9% specificity (C statistic=0.679; 95% CI, 0.666–0.691). NPAR displayed higher AUC value in comparison to neutrophil percentage (p<0.001), but not albumin (P=0.063), as a predictor of CA-AKI. However, NPAR significantly improved the prediction of CA-AKI in the continuous NRI and IDI over neutrophil percentage (NRI: 0.353, 95% CI: 0.234–0.472, P<0.001; IDI: 0.017, 95% CI: 0.010–0.024, p<0.001) and albumin (NRI: 0.141, 95% CI: 0.022–0.260, P=0.020; IDI: 0.009, 95% CI: 0.003–0.015, p=0.003) alone. After adjusting for potential confounding risk factors of CA-AKI, multivariable logistic analysis showed that NPAR >15.7 was a strong independent predictor of CA-AKI (OR=1.998, 95% CI, 1.511–2.643, p<0.001).

Conclusion

NPAR is an independent predictor of CA-AKI, which significantly improved the prediction of CA-AKI over neutrophil and albumin alone in patients without CKD undergoing elective PCI.

Funding Acknowledgement

Type of funding sources: None. ROC for NPAR to predict CA-AKIPredictors of CA-AKI

The De-Ritis ratio is associated with contrast-associated acute kidney injury in patients undergoing elective percutaneous coronary intervention

Background

Preoperative liver dysfunction has been demonstrated as a poor prognostic factor after major surgery. Recent researches discovered that an increased De-Ritis ratio (aspartate aminotransferase-to-alanine aminotransferase ratio) reflects the liver dysfunction and was associated with adverse cardiovascular and renal outcomes. However, there is a lack of data exploring the predictive value of the De-Ritis ratio on contrast-associated acute kidney injury (CA-AKI) in patients undergoing elective percutaneous coronary intervention (PCI).

Purpose

To evaluate the predictive value of the De-Ritis ratio for CA-AKI in patients undergoing elective PCI.

Methods

We conducted a prospective, observational study with 5780 consenting patients undergoing elective PCI from January 2012 to December 2018. CA-AKI was defined as an increase in serum creatinine (SCr) ≥50% or 0.3 mg/dL within 48 hours after contrast medium exposure. The relationship between the De-Ritis ratio and CA-AKI was investigated by logistic regression analysis. The predictive utility of the De-Ritis ratio was determined and compared using the area under the receiver-operating characteristic curve (AUC).

Result

CA-AKI developed in 363 (6.3%) patients. The median De-Ritis ratio was 1.00 (0.77–1.33). The De-Ritis ratio showed an AUC of 0.636 (95% confidence interval (CI): 0.624–0.649; P<0.001) in predicting CA-AKI, which was significantly greater than aspartate aminotransferase (AST) (AUC: 0.636 vs 0.589, p=0.015) and alanine aminotransferase (ALT) (AUC: 0.636 vs 0.506, p<0.001). The best cut-off value of the De-Ritis ratio for predicting CA-AKI was 1.30 with 47.1% sensitivity and 74.7% specificity. Multivariable logistic analysis showed that the De-Ritis ratio >1.30 was a remarkable independent predictor of CA-AKI (OR=1.757, 95% CI, 1.385–2.229, p<0.001) even after adjusting for other CA-AKI risk factors.

Conclusion

The De-Ritis ratio is an independent risk factor for predicting CA-AKI in patients undergoing elective PCI.

Funding Acknowledgement

Type of funding sources: None. ROC for De-Ritis ratio to predict CA-AKIPredictors of CA-AKI

[Drug-resistant gene polymorphisms in Plasmodium falciparum isolated from Bioko Island, Equatorial Guinea in 2018 and 2019]

OBJECTIVE

To investigate the genetic polymorphisms of Plasmodium falciparum multidrug resistance protein 1 (PfMDR1), chloroquine resistance transporter (PfCRT) and Kelch 13 (PfK13) genes in Bioko Island, Equatorial Guinea, so as to provide insights into the development of the malaria control strategy in local areas.

METHODS

A total of 85 peripheral blood samples were collected from patients with Plasmodium falciparum infections in Bioko Island, Equatorial Guinea in 2018 and 2019, and genomic DNA was extracted. The PfMDR1, PfCRT and PfK13 genes were amplified using a nested PCR assay. The amplification products were sequenced, and the gene sequences were aligned.

RESULTS

There were no mutations associated with artemisinin resistance in PfK13 gene in Bioko Island, Equatorial Guinea, while drug-resistant mutations were detected in PfMDR1 and PfCRT genes, and the proportions of PfMDR1_N86Y, PfMDR1_Y184F and PfCRT_K76T mutations were 35.29% (30/85), 72.94% (62/85) and 24.71% (21/85), respectively.

CONCLUSIONS

There are mutations in PfMDR1, PfCRT and PfK13 genes in P. falciparum isolates from Bioko Island, Equatorial Guinea.

P–412 Low serum hCG levels adjusted for the hCG trigger dose in fresh cycles may be associated with a poor clinical pregnancy rate of FET cycles

Study question

Is there any association between serum human chorionic gonadotropin (hCG) levels after trigger at previous fresh cycles and pregnancy outcomes of frozen-thawed embryo transfer (FET) cycles?

Summary answer

Low adjusted serum hCG level after hCG trigger at fresh cycles is negatively associated with clinical pregnancy rates (CPR) of hormone replacement treatment-FET (HRT-FET). What is known already: Literature showed that low serum hCG levels after the same dose of hCG trigger was associated with reduced pregnancy outcomes of the fresh cycles. However, the relationship between hCG levels after trigger at fresh cycles and pregnancy outcomes of FET cycles remains unknown.

Study design, size, duration

This matched retrospective study was conducted at a Reproductive Medicine Center between 2016 and 2018. Subjects performing HRT-FET cycles, whose previous fresh cycles used a bolus of hCG alone or a bolus of GnRHa combined with hCG for trigger were included. A total of 186 HRT-FET cycles with complete data was included for the final analysis.

Participants/materials, setting, methods

The study population was grouped into women with intramuscular injection of hCG prior to secretory transformation (hCG group, n = 93) and a comparison group (control group, n = 93) of women without hCG addition matched for patients’ age and duration of infertility. At the previous fresh cycles, serum hCG levels were measured 12 hours later after hCG trigger (defined as the “hCG+12 h” timepoint), and were adjusted for doses (defined as adjusted hCG levels). Main results and the role of chance: For patients achieving clinical pregnancy, the adjusted hCG level significantly increased (P < 0.05). Meanwhile, the ROC curve also showed a significantly predictive value of adjusted serum hCG levels at the “hCG+12 h” timepoint for CPR in HRT- FET cycles (AUC=0.626, 95%CI: 0.512–0.740) and the optimal hCG threshold proposed by ROC for CPR was 46.31 mIU/mL with sensitivity of 71.4% and specificity of 56.9%. For all patients, the CPR in hCG group was significantly higher than that in control group (61.3% vs. 44.1%). Furthermore, all cycles were then divided into four groups based on the injection of hCG prior to secretory transformation in HRT-FET cycles and this cut-off value of hCG levels at the “hCG+12 h” timepoint. For patients with adjusted hCG levels ≤46.31 mIU/mL, the CPR was significantly improved in hCG group compared with control group (61.1% vs. 29.3%). But for patients with adjusted hCG levels >46.31 mIU/mL, no statistically significant difference was observed between the hCG and control group (61.4% vs. 55.8%).

Limitations, reasons for caution

Although the results achieved statistically significant, the sample size was relatively small, which limits our ability to draw a definitive conclusion. The reason of the small sample size may be that to reduce the risk of OHSS, doctors would give preference to trigger with GnRH agonist in our center.

Wider implications of the findings: Adjusted serum hCG levels might represent a potential factor to guide adequate support in the subsequent HRT-FET cycles. Meanwhile, for patients with low adjusted serum hCG levels, intramuscular hCG injection prior to secretory transformation may be a good compensation way to rescue pregnancy impair in the subsequent HRT-FET cycles.

Trial registration number

N/A.

Patterns of MTT reduction in mammalian spermatozoa

MTT is widely used in biology as a probe for cell viability by virtue of its ability to generate deposits of insoluble formazan at sites of intense oxidoreductase activity. This response is generally held to reflect mitochondrial redox activity; however, extra-mitochondrial MTT reduction has also been recorded in certain cell types. Given this background, we set out to determine the major sites of formazan deposition in mammalian spermatozoa. In the mouse, most MTT reduction took place within the extensive mitochondrial gyres, with a single minor site of formazan deposition on the sperm head. By contrast, human spermatozoa generally displayed small disorganized midpieces exhibiting moderate MTT reduction activity accompanied by a major extra-mitochondrial formazan deposit on various locations in the sperm head from the neck to the anterior acrosome. Equine spermatozoa presented a combination of these two patterns, with major formazan deposition in the mitochondria accompanied by an extra-mitochondrial formazan deposit in around 20% of cells. The functionality of human spermatozoa was positively associated with the presence of an extra-mitochondrial formazan granule. Subsequent studies indicated that this extra-mitochondrial activity was suppressed by the presence of diphenylene iodonium, zinc, 2-deoxyglucose, co-enzyme Q, an SOD mimetic and NADPH oxidase inhibitors. We conclude that the pattern of MTT reduction to formazan by spermatozoa is species specific and conveys significant information about the relative importance of mitochondrial vs extra-mitochondrial redox activity that, in turn, defines the functional qualities of these cells.

[Study of B10 cells in the pathogenesis of the interaction between chronic obstructive pulmonary disease and periodontal disease]

Objective: To determine the ratio of ingerleukin(IL)-10 secreting regulatory B cells (B10 cells) and the levels of IL-10 in peripheral blood of periodontitis patients with or without chronic obstructive pulmonary disease (COPD), and to explore the function of B10 cells in the pathogenesis of the interaction between COPD and periodontitis. Methods: Forty-five periodontitis patients and healthy people were recruited and divided into three groups: COPD group, COPD+periodontitis group and health controls with 15 people in each group. Peripheral blood samples were collected to determine the B10 population. Another group of 93 periodontitis patients and healthy people were also collected and divided into the same 3 groups with 31 people in each group. Peripheral blood samples were collected to determine the cytokine IL-10. Results: After stimulation with lipopolysaccharide (LPS)+phorbol-12-myristate13-acetate+ionomycin+brefeldin A (PIB) for 5 h, the ratio of B10 in COPD+periodontitis group [(0.44±0.11)%] was significantly lower than that in the control group [(0.63±0.14)%] and periodontitis group [(0.62±0.13)%] (P<0.01), respectively. The ratio of B10 cells showed no significant difference between periodontitis group and healthy control group (P>0.05). After stimulation with LPS+PIB for 48 h, the ratio of B10 cells in COPD+periodontitis group [(7.59±1.33)%] was significantly lower than that in the periodontitis group [(10.14±2.02)%] and the healthy controls [(11.80±1.71)%] (P<0.01), respectively. The ratio of B10 cells in periodontitis group was significantly lower than that in the healthy controls (P<0.05). The levels of IL-10 in periodontitis group [(2.55±0.61) ng/L] and COPD+periodontitis group [(1.95±0.45) ng/L] were significantly lower than that in the control group [(3.96±1.15) ng/L] (P<0.01) respectively. Moreover, the level of IL-10 in COPD+periodontitis group was significantly lower than that in the periodontitis group (P<0.01). Conclusions: The dysfunction of immune system caused by the decreased proportion of B10 cells might be involved in the pathological process of COPD promoted by periodontitis.

[Protein Disulfide Bonds Detected by Tagging with High Molecular Weight Maleimide Derivative]

Disulfide bridges are essential for maintaining the structure and function of proteins. Traditionally, studies of the disulfide bonds require expensive equipment and high purity of the protein sample, therefore, the development of simpler techniques is warranted. Here, were present a novel protocol for the detection of disulfide bonds in proteins, which is based on the labeling reduced disulfide bridges with a high molecular weight (HMW) maleimide derivative. After irreversible blocking of free thiol groups of proteins, the labeling of new thiols released from disulfide bridges with a high-molecular-weight (HMW) maleimide derivative is performed. To confirm localization of cysteines involved in the formation of disulfide bonds, cysteine mutagenesis was conducted. For validation, aquaporin 5 (AQP5) and transient receptor potential cation channel subfamily V member 4 (TRPV4) proteins were tagged with FLAG (DYKDDDDK) on N-termini. Increase in MW of the target proteins from immunoblot indicated the presence of disulfide bonds. No bands with increased MW were detected in AQP5, while TPRV4 cysteines at disulfide bridges-constituting positions 639, 645, 652, 660, 770 were detected and confirmed by cysteine mutagenesis. These data indicate that the proposed technique is feasible and effective for the detection of protein disulfide bonds.

AB0251 INCREASED ACCUMULATION OF ERYTHROCYTE METHOTREXATE POLYGLUTAMATES DURING EARLY PHASE SUBCUTANEOUS VERSUS ORAL METHOTREXATE TREATMENT OF RHEUMATOID ARTHRITIS PATIENTS

Background:

Optimal dosing of methotrexate (MTX) for individual rheumatoid arthritis (RA) patients to achieve adequate disease control is an ongoing challenge. Assessment of erythrocyte MTX-polyglutamates (PGs) levels has been employed as a tool to monitor clinical response of RA patients in the first 3-12 months of treatment and MTX-PG2-4 and total MTX-PGs were associated with a lower DAS28 over 9 months.1 However, data from earlier time points, MTX-PG6 and per route of administration are unavailable.

Objectives:

To investigate the pharmacokinetics and -dynamics of erythrocyte MTX-PG accumulation in RA patients receiving oral or subcutaneous MTX in the early phase (1, 2, and 3 months) of MTX treatment initiation.

Methods:

In a clinical prospective cohort study (MeMo study (NTR7149)), newly diagnosed RA patients were administered oral (n=24) or subcutaneous (n=22) MTX, mostly according to the COBRA-light schedule (start 10 mg MTX, increased to 25 mg MTX in 8 weeks). At 1, 2, and 3 months after start of therapy, blood was collected and individual MTX-PGs (MTX-PG1 – MTX-PG6) were analyzed in erythrocytes at a minimal detection limit of 1 nmol/L, using a validated UHPLC-MS/MS method with labeled internal standards.1 Dosing, concomitant treatments and DAS28-ESR assessments were in conformity with clinical practice. Adverse events were recorded.

Results:

46 consecutive patients were included in this study; 76% female, mean age: 57.8 years, BMI: 25.8, 20% smokers, mean baseline DAS28-ESR: 3.5. Notwithstanding marked interpatient variability, patients starting subcutaneous MTX had accumulated significantly higher (approximately 2-fold) long chain MTX-PGs (MTX-PG4-6) when compared to patients in the oral MTX group at 1 and 2 months (Figure 1A, Table 1). Similarly, MTX-PG1-6 and MTX-PG3 accumulation were higher in subcutaneous MTX-users at month 1 (p=0.022 and p=0.011) compared to the oral group (median 68.6 nmol/L (IQR:40.5) vs 51.9 (55.6) and 17.4 (11.1) vs 11.2 (15.6), respectively (Figure 1B, Table 1).

Table 1.

Linear regression of MTX-PG levels and administration route, corrected for age, baseline DAS28, smoking, BMI, eGFR and MTX dose.

monthß (P-value)1ß (P-value)2ß (P-value)3MTX-PG1-61.65 (0.022)1.51 (0.073)1.30 (0.233)MTX-PG1,21.13 (0.599)1.19 (0.470)1.12 (0.623)MTX-PG31.75 (0.011)1.51 (0.071)1.19 (0.439)MTX-PG4-61.97 (0.036)2.04 (0.033)1.55 (0.136)

Mean MTX dose at baseline was 10.5mg (SD 1.5) for both groups, 15.4 (4.4) and 16.8 (1.8) at 1 month and 22.8 (3.9) and 22.4 (5.2) at 2 months for oral and subcutaneous use respectively.

DAS28 decreased with 1.6 in the oral group and 1.1 in the subcutaneous group (p=0.382). With and without corrections for age, baseline DAS28, eGFR, MTX dose (1 month before sampling), smoking and BMI, no significant relation between MTX-PG concentrations and DAS28 was observed during the first 3 months of treatment.

43 patients reported any side effect, mostly headache and dizziness, which was similar in both groups and uncorrelated with MTX-PG levels.

No association was found between MTX-PG1 levels and number of days between timing of blood withdrawal and last administration.

Figure 1.

Erythrocyte long chain MTX-PG(A) and total MTX-PG(B) accumulation in RA patients of the first 3 months of oral(C) or subcutaneous(D) MTX administration. At 3 months, 18 patients using oral and 18 patients using subcutaneous MTX were still continuing MTX treatment. Medians and IQR are depicted.

Conclusion:

This study shows the feasibility of measuring erythrocyte MTX-PGs early on in the treatment of RA patients with MTX and demonstrated significantly higher accumulation of MTX-PGs following subcutaneous versus oral MTX administration. Early phase erythrocyte MTX-PG analyses may hold potential for positioning in optimizing individual patient MTX dose scheduling.

References:

[1]de Rotte MC, et al. Methotrexate polyglutamates in erythrocytes are associated with lower disease activity in patients with rheumatoid arthritis. Ann Rheum Dis 2015(74):408-14.

Acknowledgements:

We would like to thank all participating patients and Pfizer (grant 53233663 / WI230458).

Disclosure of Interests:

Renske Hebing Grant/research support from: Pfizer, Ittai Muller: None declared, Marry Lin: None declared, Sohaila Mahmoud: None declared, Sandra Heil: None declared, WIllem Lems: None declared, Michael Nurmohamed: None declared, Robert De Jonge: None declared, Gerrit Jansen: None declared

OP0021 IDENTIFICATION OF DIFFERENTIALLY EXPRESSED GENES IN EARLY RHEUMATOID ARTHRITIS PATIENTS RESPONDING TO TOCILIZUMAB

Background:

Tocilizumab (TCZ) is a monoclonal antibody that binds to the interleukin 6 receptor (IL-6R), inhibiting IL-6R signal transduction to downstream inflammatory mediators. TCZ has shown to be effective as monotherapy in early rheumatoid arthritis (RA) patients (1). However, approximately one third of patients inadequately respond to therapy and the biological mechanisms underlying lack of efficacy for TCZ remain elusive (1). Here we report gene expression differences, in both whole blood and peripheral blood mononuclear cells (PBMC) RNA samples between early RA patients, categorized by clinical TCZ response (reaching DAS28 < 3.2 at 6 months). These findings could lead to identification of predictive biomarkers for TCZ response and improve RA treatment strategies.

Objectives:

To identify potential baseline gene expression markers for TCZ response in early RA patients using an RNA-sequencing approach.

Methods:

Two cohorts of RA patients were included and blood was collected at baseline, before initiating TCZ treatment (8 mg/kg every 4 weeks, intravenously). DAS28-ESR scores were calculated at baseline and clinical response to TCZ was defined as DAS28 < 3.2 at 6 months of treatment. In the first cohort (n=21 patients, previously treated with DMARDs), RNA-sequencing (RNA-seq) was performed on baseline whole blood PAXgene RNA (Illumina TruSeq mRNA Stranded) and differential gene expression (DGE) profiles were measured between responders (n=14) and non-responders (n=7). For external replication, in a second cohort (n=95 therapy-naïve patients receiving TCZ monotherapy), RNA-seq was conducted on baseline PBMC RNA (SMARTer Stranded Total RNA-Seq Kit, Takara Bio) from the 2-year, multicenter, double-blind, placebo-controlled, randomized U-Act-Early trial (ClinicalTrials.gov identifier: NCT01034137) and DGE was analyzed between 84 responders and 11 non-responders.

Results:

Whole blood DGE analysis showed two significantly higher expressed genes in TCZ non-responders (False Discovery Rate, FDR < 0.05): urotensin 2 (UTS2) and caveolin-1 (CAV1). Subsequent analysis of U-Act-Early PBMC DGE showed nine differentially expressed genes (FDR < 0.05) of which expression in clinical TCZ non-responders was significantly higher for eight genes (MTCOP12, ZNF774, UTS2, SLC4A1, FECH, IFIT1B, AHSP, and SPTB) and significantly lower for one gene (TND2P28M). Both analyses were corrected for baseline DAS28-ESR, age and gender. Expression of UTS2, with a proposed function in regulatory T-cells (2), was significantly higher in TCZ non-responders in both cohorts. Furthermore, gene ontology enrichment analysis revealed no distinct gene ontology or IL-6 related pathway(s) that were significantly different between TCZ-responders and non-responders.

Conclusion:

Several genes are differentially expressed at baseline between responders and non-responders to TCZ therapy at 6 months. Most notably, UTS2 expression is significantly higher in TCZ non-responders in both whole blood as well as PBMC cohorts. UTS2 could be a promising target for further analyses as a potential predictive biomarker for TCZ response in RA patients in combination with clinical parameters (3).

References:

[1]Bijlsma JWJ, Welsing PMJ, Woodworth TG, et al. Early rheumatoid arthritis treated with tocilizumab, methotrexate, or their combination (U-Act-Early): a multicentre, randomised, double-blind, double-dummy, strategy trial. Lancet. 2016;388(10042):343-55.

[2]Bhairavabhotla R, Kim YC, Glass DD, et al. Transcriptome profiling of human FoxP3+ regulatory T cells. Human Immunology. 2016;77(2):201-13.

[3]Gosselt HR, Verhoeven MMA, Bulatovic-Calasan M, et al. Complex machine-learning algorithms and multivariable logistic regression on par in the prediction of insufficient clinical response to methotrexate in rheumatoid arthritis. Journal of Personalized Medicine. 2021;11(1).

Disclosure of Interests:

None declared

Controllable performance of a dopamine-modified silk fibroin-based bio-adhesive by doping metal ions

Bio-adhesives are essential for wound healing because of their convenience and safety. Although widely used as biomaterials, silk fibroin's (SF's) further application as bio-adhesive is hindered due to its weak stickiness with tissue and slow gelation speed. Here, a dopamine-modified SF-based bio-adhesive is fabricated by using genipin as the chemical cross-linking agent. Furthermore, metal ions have been used to adjust the adhesion property of the bio-adhesive. The experimental results shows that the dopamine-modified SF-based composite holds a better stickiness except slow gelation speed. The doping of Cu²⁺and Fe³⁺can accelerate the gelation of the bio-adhesive. Compared with Cu²⁺, Fe³⁺has a stronger effect on the gelation speed of the bio-adhesive, which is positive correlative to the concentration of Fe³⁺. The adhesive has injectability and degradability. In addition, the SF-based adhesive has good biocompatibility and good improvement for cell migrationin vitro. The SF-based bio-adhesive holds potential application in the field of rapid fixation of wounds.

Acute fibrinous and organizing pneumonia with myelodysplastic syndrome and pneumocystis jiroveci pneumonia: a case report

Acute fibrinous and organizing pneumonia (AFOP) is an unusual pathological pattern which is characterized by intra-alveolar deposition of fibrin (fibrin ball) and organizing pneumonia in a scattered distribution, and the pathological diagnosis plays an irreplaceable role in the diagnosis. Most Patients cannot confirm etiology, till now, known etiology included connective tissue disease, infection, environmental and occupational exposure, drugs, organ transplant, and tumor. It can be divided into acute and subacute subtype according to the extent of progress. The most common symptoms of AFOP were fever, cough, and dyspnea. Bilateral consolidations and ground-glass opacities (GGO) usually can be seen on chest CT images. At present, the treatment protocol for AFOP has not reached a consensus Glucocorticoid, immunosuppressants, stem cell transplantation or lung transplantation may contribute to improved clinical outcome. Here, we report a case of AFOP with myelodysplastic syndrome and pneumocystis jiroveci pneumonia (PJP). After treatments of glucocorticoid, immunosuppressant, chemotherapy, antibiotics and blood transfusion, the patient's clinical symptoms, peripheral blood test, and imaging findings were obviously improved. In this case, we consider the AFOP was caused by MDS and the immunodeficiency after chemotherapy lead to secondary PJP. This typical case highlights the importance of appropriate therapy for coexisted diseases of those patients with refractory AFOP.

Quantitative Secretome Analysis Reveals Clinical Values of Carbonic Anhydrase II in Hepatocellular Carcinoma

Early detection and intervention are key strategies to reduce mortality, increase long-term survival, and improve the therapeutic effects of hepatocellular carcinoma (HCC) patients. Herein, the isobaric tag for relative and absolute quantitation (iTRAQ)-based quantitative proteomic strategy was used to study the secretomes in conditioned media from HCC cancerous tissues, surrounding noncancerous tissues, and distal noncancerous tissues to identify diagnostic and prognostic biomarkers for HCC. In total, 22 and 49 dysregulated secretory proteins were identified in the cancerous and surrounding noncancerous tissues, respectively, compared with the distal noncancerous tissues. Among these proteins, carbonic anhydrase II (CA2) was identified to be significantly upregulated in the secretome of cancerous tissues; correspondingly, the serum concentrations of CA2 were remarkably increased in HCC patients compared with that in normal populations. Interestingly, a significant increase of serum CA2 in recurrent HCC patients after radical resection was also confirmed compared with HCC patients without recurrence, and the serum level of CA2 could act as an independent prognostic factor for time to recurrence and overall survival. Regarding the mechanism, the secreted CA2 enhances the migration and invasion of HCC cells by activating the epithelial mesenchymal transition pathway. Taken together, this study identified a novel biomarker for HCC diagnosis and prognosis, and provided a valuable resource of HCC secretome for investigating serological biomarkers.

Dose-response relationship between serum fibroblast growth factor 21 and liver fat content in non-alcoholic fatty liver disease

BACKGROUND & AIM

Although serum fibroblast growth factor 21 (FGF21) levels are associated with liver fat content in non-alcoholic liver fat disease (NAFLD), the precise nature of the association remains undetermined. Therefore, this study aimed to explore the potential dose-response relationship between FGF21 and liver fat content in NAFLD.

METHODS

For this exploratory study from a randomized trial, 220 NAFLD patients with central obesity were recruited via community-based screening and randomly assigned to either control, moderate or vigorous-moderate exercise groups for 12 months. After this exercise intervention, patients were followed-up for a further 12 months. Serum FGF21 levels were measured by ELISA. Intrahepatic triglyceride (IHTG) content was determined by proton magnetic resonance spectroscopy.

RESULTS

Of the 220 patients, 149 (67.7%) were female; mean age was 53.9 ± 7.1 years and mean BMI was 28.0 ± 2.9 kg/m² for all patients. Baseline IHGT increased gradually (P = 0.029 for trend) according to baseline serum FGF21 quartiles 1, 2, 3 and 4 (212.3, 358.9, 538.7 and 793.5 pg/mL, respectively). On grouping the distribution of serum FGF21 level changes into quartiles at month 12, the relative IHTG loss increased as serum FGF21 levels were reduced (P = 0.004 for trend). A similar trend was observed at month 24 (P = 0.006 for trend). Multivariate linear regression analysis revealed that changes in serum FGF21 levels were independently associated with changes in IHTG at both month 12 [β (SE), 0.136 (0.118); P = 0.048] and month 24 [β (SE), 0.152 (0.139); P = 0.041]. Using restricted cubic spline regression, changes in serum FGF21 were strongly and positively associated with their corresponding relative IHTG loss at both month 12 and follow-up (P_overall = 0.017, P_non-linear = 0.044 and P_overall = 0.020, P_non-linear = 0.361, respectively, for dose-response).

CONCLUSION

Serum FGF21 is strongly associated with liver fat content in a dose-response manner in centrally obese NAFLD patients. These findings support the use of serum FGF21 as a biomarker of liver fat content in NAFLD.

Hepatocyte high-mobility group box 1 protects against steatosis and cellular stress during high fat diet feeding

BACKGROUND

Circulating high-mobility group box 1 (HMGB1) plays important roles in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). Intracellular HMGB1 is critical for the biology of hepatocytes. However, the intracellular role of HMGB1 in hepatocellular steatosis is unknown. Therefore, we aimed to investigate the role of hepatocyte-specific HMGB1 (HC-HMGB1) in development of hepatic steatosis.

METHODS

Wild type (WT) C57BL/6 and HC-HMGB1-/- mice were fed high-fat diet (HFD) or low-fat diet (LFD) for up to 16 weeks.

RESULTS

As expected, HMGB1 translocated from nuclear into cytoplasm and released into circulation after HFD treatment. HC-HMGB1 deficiency significantly reduced circulating HMGB1, suggesting that hepatocyte is a major source of circulating HMGB1 during NAFLD. Unexpectedly, HC-HMGB1 deficiency promoted rapid weight gain with enhanced hepatic fat deposition compared with WT at as early as 4 weeks after HFD treatment. Furthermore, there was no difference between WT and HC-HMGB1-/- mice in glucose tolerance, energy expenditure, liver damage or systemic inflammation. Interestingly, hepatic gene expression related to free fatty acid (FFA) β-oxidation was significantly down-regulated in HC-HMGB1-/- mice compared with WT, and endoplasmic reticulum (ER) stress markers were significantly higher in livers of HC-HMGB1-/- mice. In vitro experiments using primary mouse hepatocytes showed absence of HMGB1 increased FFA-induced intracellular lipid accumulation, accompanied by increased ER-stress, significant downregulation of FFA β-oxidation, and reduced oxidative phosphorylation.

CONCLUSIONS

Our findings suggest that hepatocyte HMGB1 protects against dysregulated lipid metabolism via maintenance of β-oxidation and prevention of ER stress. This represents a novel mechanism for HMGB1-regulation of hepatocellular steatosis, and suggests that stabilizing HMGB1 in hepatocytes may be effective strategies for prevention and treatment of NAFLD.

Associations between Household Water Fluoridation Status and Plain Tap or Bottled Water Consumption

INTRODUCTION

The benefits of community water fluoridation for preventing dental caries are attenuated if people do not consume tap water.

OBJECTIVES

We examined associations between household water fluoride content and consuming plain tap or bottled water among US youth.

METHODS

We used National Health and Nutrition Examination Survey data for 2013 to 2016 for 5,193 youth aged 2 to 19 y. Fluoride content in youth's household tap water samples was measured electrometrically with ion-specific electrodes and designated low (<0.6 mg/L) or about optimal (0.6 to 1.2 mg/L). Plain tap and bottled water consumption was obtained from one 24-h dietary recall. We used binomial regression models to estimate adjusted prevalence ratios (APRs) and 95% CIs for consuming plain tap water (including tap only or both tap and bottled) and consuming only bottled water as related to household water fluoride content (low or about optimal) and sociodemographic characteristics.

RESULTS

On a given day, 52.6% of youth consumed plain tap water (43.8% exclusively and 8.8% both tap and bottled) and 28%, only bottled water. Neither tap water (APR, 0.96; 95% CI, 0.84 to 1.10) nor only bottled water (APR, 1.03; 95% CI, 0.86 to 1.22) consumption was associated with household water fluoride content. Non-Hispanic Black youth and Hispanic youth were about 30% relatively less likely to consume tap water and 60% to 80% relatively more likely to consume only bottled water than non-Hispanic Whites. Low income, low parental education, and no past-year dental visit were associated with not consuming tap water.

CONCLUSION

Half of youth consumed plain tap water on a given day. Consuming plain tap water was not associated with community water fluoridation status. This study is the first to find that up to 50% of the population served by fluoridated water may not receive its full caries-preventive benefits due to not consuming plain tap water.

KNOWLEDGE TRANSFER STATEMENT

Half of US youth consumed plain tap water on a given day. Consuming plain tap water was not associated with community water fluoridation status. This finding suggests that up to 50% of the population served by fluoridated water systems may not receive its full caries-preventive benefits due to not consuming plain tap water. Our findings add support for the need to identify and address barriers to tap water consumption and promote health benefits of fluoridation.

Primary tumour location is an important prognostic factor in colorectal cancer liver metastases following radiofrequency ablation

AIM

To examine the outcomes and different prognoses for colorectal cancer patients with liver metastases (CRCLM) treated with radiofrequency ablation (RFA) based on the origin of the primary tumour (rectum versus colon).

MATERIALS AND METHODS

Patients diagnosed with CRCLM from July 2011 to June 2018 were assessed in the study. The study included 114 patients with 176 lesions. All of the patients underwent RFA of their CRCLM. The overall survival (OS) and progression-free survival (PFS) were assessed with Kaplan-Meier survival function estimate curves and Cox regression analysis between the group of patients with rectal cancer liver metastases (RCLM) and colon cancer liver metastases (CCLM).

RESULTS

Patients with RCLM exhibited worse OS and PFS than those with CCLM. The 1-, 2-, and 3-year OS rates were 87.5%, 75%, and 54.2% in the RCLM group and 93.9%, 87.8%, and 81.8% in the CCLM group (p=0.001), respectively. The 1-, 2-, and 3-year PFS rates were 43.7%, 22.9%, and 20.8% in the RCLM group and 57.6%, 45.4%, and 36.5% in the CCLM group (p=0.001), respectively. Multivariate analysis showed that primary tumour location, carcinoembryonic antigen (CEA), and response to pre-ablation chemotherapy were independent variables for OS and PFS. The N state of the primary tumour also had a significant impact on OS.

CONCLUSION

This study showed that patients with CCLM had better prognoses than those with RCLM following RFA treatment. If patients intend to undergo RFA for CRCLM, the location of the primary tumour should be considered in the assessment of long-term therapeutic effects.