A model of lifetime health outcomes in cardiovascular disease based on clinical trials and large cohorts

Background and purpose

Cardiovascular disease (CVD) risk of individuals depends on their socio-demographic characteristics, clinical risk factors, and treatments, and strongly influences their quality of life and survival. Individual-based long-term disease models, which aim to more accurately calculate the lifetime consequences, can help to target treatments, develop disease management programmes, and assess the value of new therapies. We present a new micro-simulation CVD model.

Methods

This micro-simulation model was developed using individual participant data from the Cholesterol Treatment Trialists' collaboration (CTT: 118,000 participants; 15 trials) and calibrated (with added socioeconomic deprivation, ethnicity, physical activity, mental illness, cancer and incident diabetes) in the UK Biobank cohort (UKB: 502,000 participants). Parametric survival models estimated risks of key endpoints (myocardial infarction (MI), stroke, coronary revascularisation (CRV), diabetes, cancer and vascular (VD) and nonvascular death (NVD) using participants' age, sex, ethnicity, physical activity, socioeconomic deprivation, smoking history, lipids, blood pressure, creatinine, previous cardiovascular diseases, diabetes, mental illness and cancer at entry and non-fatal incidents of the key endpoints during follow-up. The model integrates the risk equations and enables annual projection of endpoints and survival over individuals' lifetimes. The model was used to project remaining life expectancy across UK Biobank participants.

Results

Nonfatal cardiovascular events and age were the major determinants of CVD risk and, together with incident diabetes and cancer, of individuals' survival. The cumulative incidence of the key endpoints predicted by the CTT-UKB model corresponded well to their observed incidence in the UK Biobank cohort, overall (Figure 1) and in categories of participants by age, sex, prior CVD and CVD risk. Predicted remaining life expectancy across UK Biobank participants without history of CVD ranged between 22 and 43 years in men and between 24 and 46 years in women, depending on their age and CVD risk (Figure 2). Among UK Biobank participants with history of CVD, depending on their age, predicted remaining life expectancy ranged from 20 to 32 years in men and from 26 to 38 years in women.

Conclusion

This new lifetime CVD model accurately predicts morbidity and mortality in a large UK population cohort. It will be made available to provide individualised projections of expected lifetime health outcomes and benefits of treatments.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, UK Medical Research Council (MRC), British Heart Foundation Figure 1. Predicted (in black) versus observed (95% CI; in red) incidence of major clinical outcomes in the UK Biobank.Figure 2. Predicted remaining life expectancy of participants in UK Biobank cohort, by age and CVD risk or previous CVD at entry. QRISK, a 10-year CVD risk scoring algorithm for people without previous CVD, recommended for use in the UK National Health Service.

Benefits from optimised antihypertensive and statin treatment in high risk people

Background

Hypertension and hypercholesterolaemia are major modifiable risk factors for cardiovascular diseases (CVD) with available effective and low-cost treatments. However, their suboptimal treatment remains widespread. We characterise treatment gaps in a large urban population and quantify the potential long-term health and economic impact with optimised use.

Methods

We studied 1 million UK urban residents served by 123 primary care practices in 2019. We categorised antihypertensive treatment in adults with diagnosed hypertension, and statin treatment in adults with diagnosed CVD, into optimal, suboptimal and not treated following UK clinical guidelines. A long-term CVD model was used to project cardiovascular events avoided, years of life and quality-adjusted life years (QALYs) gained, and healthcare costs saved with optimised treatments for individual patients accounting for their socio-demographic characteristics and risk factors.

Results

21,954 (24%, mean age 59 years; 49% female) of the 91,828 adults with hypertension were either suboptimally treated (20%) or untreated (4%) and 9,062 (38%, mean age 69 years; 43% female) of the 23,723 adults with CVD were either suboptimally treated (24%) or untreated (14%). Per 1000 patients (95% CI) optimised over lifespan, hypertension treatment would prevent 154 (72–230) major vascular events (MVEs, including heart attack, stroke or arterial revascularisation) and 69 (28–103) vascular deaths, and gain 769 (436–1038) QALYs for those sub-optimally treated, and prevent 138 (68–201) MVEs and 50 (21–76) vascular deaths, and gain 674 (386–920) QALYs for those not treated; statin treatment would prevent 68 (46–88) MVEs and 17 (12–21) vascular deaths, and gain 145 (113–178) QALYs for those sub-optimally treated, and prevent 260 (190–319) MVEs and 55 (40–68) vascular deaths, and gain 535 (412–651) QALYs for those not treated (Figure). Hospital cost savings net of medication costs were about £1100 per person over their remaining lifespan.

Conclusion

Optimising preventive cardiovascular treatments in UK primary care is likely to cost-effectively reduce cardiovascular risk and improve life expectancy, while reducing population inequalities.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Barts Charity, British Heart Foundation, and Health Data Research UK Predicted benefits from optimisation

Zinc oxide nanoparticles promotes liver cancer cell apoptosis through inducing autophagy and promoting p53

OBJECTIVE

Emerging evidence has highlighted the promising potential of the application of Zinc Oxide nanoparticles (nano-ZnO) but the mechanism by how it functions in liver cancer remains elusive. We aimed to explore the effect of nano-ZnO on liver cancer cells.

MATERIALS AND METHODS

Liver cancer cells Huh7 cells were transfected with GFP-LC3, and then, treated with DMSO, Sorafenib, and nano-ZnO respectively to set blank group, Sorafenib control group, and nano-ZnO group followed by the analysis of the expression of GFP-LC3, p53, and Caspase by Western blot and RT-qPCR, cell apoptosis and viability by flow cytometry and CCK-8 assay.

RESULTS

With a diameter of nano-ZnO 14.13±0.92 nm, the amount of GFP-LC3 protein was increased after treatment of nano-ZnO. Besides, the expressions of GFP-LC3, p53, and Caspase in Sorafenib group and nano-ZnO group were significantly higher than that of control group, while their levels were highest in nano-ZnO group (p<0.05). In nano-ZnO group, the values of D450nm at 24 h, 48h, and 72 h were 0.56±0.06, 0.39±0.05, and 0.22±0.04, respectively, and the apoptotic rate (83.11±2.79%) was significantly lower than that of blank group and control group.

CONCLUSIONS

Nano-ZnO induced autophagy, upregulated the p53 gene, and facilitated the apoptosis of liver cancer cells, indicating that nano-ZnO might be a therapeutic approach for the treatment of liver cancer patients.

TDP-43 maintains chondrocyte homeostasis and alleviates cartilage degradation in osteoarthritis

OBJECTIVE

Osteoarthritis (OA) is the most prevalent age-related disorder due to cartilage degradation. Previous studies have identified aberrant chondrocyte homeostasis under extracellular stress as a key pathological mechanism behind cartilage degradation in OA. TDP-43, a DNA/RNA-binding protein has been demonstrated to participate in processing many extracellular stress responses; however, understanding of the role of TDP-43 in OA is limited. This study aims to investigate the role of TDP-43 in chondrocyte homeostasis and cartilage degradation in OA.

METHODS

The role of TDP-43 during degradation of cartilage is examined by experimental posttraumatic OA animal models and human cartilage specimens. Cartilage degradation is assessed by histological analysis, qPCR, and Western blot. The molecular mechanisms are investigated in vitro using human primary chondrocytes.

RESULTS

TDP-43 decreases significantly in degenerated cartilage. TDP-43 concentration is positively correlated with IL-1β concentration in synovial fluid derived from OA patients (Pearson r = 0.95, CI (95%) [0.80, 0.99], P < 0.0001). Intra-articular injection of recombinant TDP-43 significantly alleviates cartilage degradation and subchondral bone remodeling in vivo. In vitro mechanistic analyses show that TDP-43 maintains chondrocyte homeostasis under oxidative stress through regulating stress granule dynamics via G3BP1.

CONCLUSION

The present study indicates that TDP-43 maintains chondrocyte homeostasis under oxidative stress and alleviates cartilage degeneration in osteoarthritis, identifying TDP-43 as a potential target for the diagnosis and treatment of knee OA.

POS0396 THE LEVEL OF PERIPHERAL REGULATORY T CELLS IS ASSOCIATED WITH THE CHANGES OF INTESTINAL MICROBIOTA IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is a systemic autoimmunity inflammation disease characterized with chronic aggressive arthritis and the presence of abnormal antibodies. Several observations showed that the breakdown of immune tolerance caused by many complex interactions was involved in the development of RA[1]. However, the pathogenesis of RA remained unclear. It has been confirmed that the imbalance of Th17 and Treg cells play a crucial role in destroying immune tolerance [2]. Besides, researches showed that intestinal microbiota can influence host immunity by acting on the immune cells to play pro-inflammatory or anti-inflammatory effect, and in turn immune system can also regulate the microbiota[3, 4]. Thus, a frontier point of view in the field of rheumatism, immune microecology, was proposed, which is a novel concept for the breakdown of immune tolerance. Studies have confirmed that there was an imbalance of intestinal microbiota in patients with RA [4]. But the relationship between the CD4+T subsets cells and intestinal microbiota in RA is unknown.

Objectives:

We detected and compared the absolute number of CD4+T cells subsets in the peripheral blood and the proportion or abundance of intestinal microbiota in patients with RA and healthy adults, and then analyzed the relationship between them to explore the role of CD4+T cells subsets and intestinal microbiota in the pathogenesis of RA.

Methods:

We collected the sample of stool and blood from 15 patients with RA hospitalized at the Second Hospital of Shanxi Medical University and 8 age and gender-matched healthy controls(HC). The absolute number of CD4+T cells subsets including Th1, Th2, Th17 and Treg cells were detected by flow cytometry. The 16S rRNA in the stool specimens were sequenced by the Roche/45 high-throughput sequencing platform. We analyzed whether there was correlarion between CD4+T subsets cells and intestinal microbiota.

Results:

Patients with RA had a higher level of Christensenellaceae and a lower level of Pseudomonadaceae as compared with those of HCs at the family level (p<0.05). And at the genus level, the patients with RA had higher levels of Ruminococcus torques, Christensenellaceae R-7, Ruminiclostridium 9 and Ruminococcus 1 compared with those of HCs (p<0.05) (Figure 1).And the Ruminococcus torques at the genus level was negative correlated with the absolute number of Treg cells (p<0.001) (Figure 2).

Conclusion:

The results here suggested that there were different proportion or abundance of intestinal microbiota between the patients with RA andHCs. And the changes of intestinal microbiota such as Ruminococcus torques were associated with Treg cells, further indicating that the imbalance of intestinal microbiota in RA can destory the immune tolerance. The above results uncovered that the intestinal microbiota had immunomodulatory function, which may be the upstream mechanism participated in the pathogenesis of RA.

References:

[1]Weyand CM, Goronzy JJ. The immunology of rheumatoid arthritis. Nat Immunol 2021, 22(1): 10-18.

[2]Weyand CM, Goronzy JJ. Immunometabolism in the development of rheumatoid arthritis. Immunol Rev 2020, 294(1): 177-187.

[3]Brown EM, Kenny DJ, Xavier RJ. Gut Microbiota Regulation of T Cells During Inflammation and Autoimmunity. Annu Rev Immunol 2019, 37: 599-624.

[4]du Teil Espina M, Gabarrini G, Harmsen HJM, Westra J, van Winkelhoff AJ, van Dijl JM. Talk to your gut: the oral-gut microbiome axis and its immunomodulatory role in the etiology of rheumatoid arthritis. FEMS Microbiol Rev 2019, 43(1).

Figure 1.

At the family level (a-b) and the genus level(c-f), the relative abundance of intestinal microbiota in patients with RA and HCs were different. Data were expressed as median (Q1, Q3) and analyzed by Wilcoxon test. (*** P < 0.001, **P < 0.01 and *P < 0.05).

Figure 2.

A heatmap shows the correlation between the intestinal microbiota and CD4+T cells in patients with RA, and Ruminococcus torques at the genus level was negative related with Treg cells. (Colors indicate the Spearman rank correlation, *** P < 0.001).

Disclosure of Interests:

None declared

CircABCB10 promotes the proliferation and migration of lung cancer cells through down-regulating microRNA-217 expression

OBJECTIVE

We aimed at studying the role and molecular mechanism of circular RNA circABCB10 in the progression of lung cancer (LCa).

PATIENTS AND METHODS

We collected LCa tissues using quantitative real-time polymerase chain reaction (qRT-PCR) technology to determine circABCB10 expression and performed survival analysis based on the clinical data of LCa patients. At the same time, the specific effects of circABCB10 on the biological function of LCa cell lines were determined by certain cell function experiments, including cell counting kit-8 (CCK-8) test, plate cloning experiment, transwell and cell wound healing assays. The downstream key gene microRNA-217 of circABCB10 was predicted through bioinformatics analysis and the potential regulation between them was confirmed by luciferase assay. microRNA-217 was knocked down in LCa cell lines to verify its important role in the progression of LCa.

RESULTS

CircABCB10 showed abnormally high expression in LCa tissues and cell lines and was related to the poor prognosis of patients. In vitro cell experiments demonstrated that knocking down circABCB10 remarkably suppressed the proliferation and migration ability of LCa cells. In addition, circABCB10 can specifically bind to microRNA-217 and negatively regulate its expression of microRNA-217 in LCa cells. Finally, cell functional experiments showed that microRNA-217 is a key downstream gene that mediates the regulation of circABCB10 on LCa cell function.

CONCLUSIONS

CircABCB10, abnormally highly expressed in LCa tissues, is able to induce the malignant progression of this cancer.

Texture analysis applied in T1 maps and extracellular volume obtained using cardiac MRI in the diagnosis of hypertrophic cardiomyopathy and hypertensive heart disease compared with normal controls

AIM

To assess the potential of texture analysis (TA) applied in T1 maps and extracellular volume (ECV) obtained using cardiac magnetic resonance (CMR) in the diagnosis of hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) compared with normal controls (NC). Strain parameters were analysed to compare with final TA models.

MATERIALS AND METHODS

This retrospective study included 66 HCM patients, 39 HHD patients, and 41 NC. Step-wise dimension reduction and feature selection were performed by reproducibility, machine learning, collinearity, and multivariable regression analysis to select the texture features that enable diagnosis of and differentiation between HCM and HHD. Strain parameters were calculated by short-axis and three long-axis cine sequences.

RESULTS

Independent features in T1 maps and ECV analysis allowed for the differentiation between patients (HCM and HHD) and NC. Of the best-calculated model, the areas under the receiver operating curve (AUCs) were as follows: 0.969 for T1 map and 0.964 for ECV. To distinguish HCM from HHD, two independent features were screened out for both T1 and ECV maps. The AUCs were as follows: 0.793 for T1 map and 0.894 for ECV. Radial, circumferential, and longitudinal strain parameters could differentiate patients from NC, but only longitudinal strain parameters was significantly different between HCM and HHD.

CONCLUSIONS

Texture analysis of T1 maps and ECV shows high accuracy in differentiating hypertrophic myocardium from NC, and HCM from HHD. Strain parameters are able to demonstrate the difference between patients and NC, but were less impressive in differentiating HCM and HHD.

SAT0278 LOW-DOSE IL-2 RESTORES TREG-MEDIATED IMMUNE TOLERANCE IN PATIENTS WITH ANCA-ASSOCIATED VASCULITIS

Background:

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of autoimmune disease that can cause systemic organ damage, including granulomatosis with polyangiitis(GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis(EGPA)[1]. Several observations have showed that the breakdown of immune tolerance was involved in the pathogenesis of AAV [2], furthermore, a single, open and clinical trial demonstrates that IL-2 can be used to treat patients with GPA [3]. But there is still a lack of understanding of the relationship between Th17 / Treg and AAV and evidence for the therapeutic effect of IL-2 on AAV, which needs further exploration.

Objectives:

We first measured the absolute number of CD4+T subsets in peripheral blood of patients to explore the pathogenesis of AAV, and then investigated the effects of short-term and low-dose recombinant human IL-2 (rhIL-2) on CD4+T subsets of patients to analyze the regulatory effect of IL-2 on AAV.

Methods:

49 patients with AAV, hospitalized at the Second Hospital of Shanxi Medical University from the May 2016 to the November 2019 were enrolled, including 36 patients who were only received conventional glucocorticoids and DMARDs, and other 13 patients who were not only received these treatments but were also injected subcutaneously rhIL-2(50WIU/day for a 5-day course). 31 age and gender-matched healthy adults were selected as controls. The absolute number of Th17 and Treg cells in peripheral blood of health controls and the patients before and after treatment was detected by flow cytometry.

Results:

There was significant decreased level of Treg cells in the patients with AAV compared with healthy controls (P<0.001) leading to a higher Th17/Treg ratio in the patients with AAV, but there was no statistically significant in the absolute number of Th17 cells between the patients and healthy controls. After the treatment of short-term and low-dose IL-2, there was a significant increase in the absolute number of Treg cells (P<0.01) leading to a decrease in the ratio of Th17 and Treg (p<0.05).The absolute number of Th17 had a trend towards higher values but was not statistical significance.

Conclusion:

The difference of Treg cells between the patients and healthy controls suggested that the decreased number of Treg cells failed to control autoimmune inflammatory response contributing to the pathogenesis of AAV. After the treatment of short-term and low-dose rhIL-2, there was a more significant increase in the absolute number of Treg cells showing that IL-2 could selectively stimulate the growth of Treg cells and restore the Treg-mediated immune tolerance in patients with AAV to achieve disease remission.

References:

[1]Cosmi, L.,Th17 and Treg lymphocytes as cellular biomarkers of disease activity in Granulomatosis with Polyangiitis.Eur J Immunol, 2017.47(4): p. 633-636.

[2]Pagnoux, C.,Updates in ANCA-associated vasculitis.Eur J Rheumatol, 2016.3: p. 122-133.

[3]Rosenzwajg, M., et al.,Immunological and clinical effects of low-dose interleukin-2 across 11 autoimmune diseases in a single, open clinical trial.Annals of the Rheumatic Diseases, 2019.78(2): p. 209-217.

Disclosure of Interests:

None declared

THU0252 CORRELATION BETWEEN DISEASE ACTIVITY AND MENTAL HEALTH IN SLE PATIENTS: A CROSS-SECTION STUDY WITH SELF-ASSESSMENTS BASED ON SMART SYSTEM OF DISEASE MANAGEMENT (SSDM) MOBILE TOOLS

Background:

WHO survey showed that the prevalence of anxiety and depression in Chinese population and Chinese patients with chronic diseases were between 3.1% - 4.2% and 3.1% - 7.3%, respectively. SLEDAI-2K and Hospital Anxiety and Depression Scale (HADS) are commonly used to evaluate SLE patients’ disease activity and mental health. All the Assessments were mainly performed by health professionals (HCPs) with paper questionnaire previously. SSDM is a novel smart disease management tool that allows patients to do self-assessments on SLEDAI-2K and HADS by mobile App.

Objectives:

To investigate the prevalence of anxiety and depression in Chinese patients with SLE and to analyze the potential association between disease activity of SLE and mental health.

Methods:

Under the guidance and training by HCPs, SLE patients downloaded SSDM and performed self-assessments bundle of SLEDAI-2K and HADS with SSDM. SLEDAI-2K <=4, 5-9, 10-14 and >=15 are defined SLE inactive, low (LDA), moderate (MDA) and high (HDA) disease activity, respectively. SLEDAI-2K score <= 4 is set as the main criteria for Lupus Low Disease Activity State (LLDAS) and achievement of T2T. HADS score >=8 can be diagnosed with anxiety or depression.

Results:

From June 2016 to Jan 2020, 3,332 SLE patients (199 male, 3,133 female) with a mean age of 36.34 ± 12.80 (10-91) years and the median disease duration of 3.43 years from 216 hospitals performed bundle self-assessments for 4,967 times in total. According to the HADS and SLEDAI-2K Assessment results, the prevalence of anxiety and depression in all patients was 36.7% and 39.3% respectively, which was significantly higher than that in the WHO survey in Chinese population and chronic disease patients. The proportion of patients achieved and failed on LLDAS was 53% and 47%, respectively. The prevalence of anxiety (A) and depression (D) was 19% and 27% among LLDAS achievers; 41% and 47% among LLDAS failures, respectively (pA<0.01, pD<0.01).

According to SLEDAI-2K, in LLDAS, LDA, MDA and HDA subgroups, the prevalence of anxiety and depression was 19%, 30%, 37%, 54% and 27%, 36%, 44%, 61%, respectively. The correlation coefficients of anxiety (A) and depression (D) with SLEDAI-2K were rA=0.9957 and rD=0.9819. It suggested that with the increase of disease activity, the proportion of SLE patients with anxiety and depression increased significantly. (Figure 1)

Conclusion:

Conclusion: Higher prevalence of anxiety and depression were Associated with higher levels of disease activity in SLE patients. SSDM is an effective mobile interface to monitor and study entanglement of disease activity and mental health in SLE patients, which build a foundation for proactive interventions physically and mentally in future.

References:

Acknowledgments:

SSDM was developed by Shanghai Gothic Internet Technology Co., Ltd.

Disclosure of Interests:

None declared

AB1140 ABNORMAL RIGHT VENTRICLE RESERVE FOLLOWING EXERCISE IN PATIENTS WITH CONNECTIVE TISSUE DISEASES

Background:

Recent studies have indicated that cardiac autonomic dysfunction is an early sign of cardiovascular impairment in patients with connective tissue disease (CTD). Previous studies have mainly focused on autonomic regulation during rest in this population. The cardiac autonomic responses to an acute physiological stress might provide additional information on the autonomic dysfunction, serving as a powerful predictor of cardiovascular disease and mortality in patients with CTD.

Objectives:

We aimed to use exercise stress echocardiography to detect early right heart dysfunction in patients with CTD and healthy controls.

Methods:

Treadmill exercise stress echocardiography was performed in 19 CTD patients (8 systemic sclerosis, 6 mixed CTD and 5 SLE) and 20 healthy volunteers. Parameters of right ventricular (RV) systolic function (RV fractional area change, Doppler tissue s’ velocity, and systolic strain and strain rate) and diastolic function (peak E and A velocity, Doppler tissue e’, a’ and early and late diastolic strain rate) were evaluated at baseline and after exercise, with the difference (Δ) being systolic and diastolic reserve. The immunoblotting assay was performed to detect the levels of rheumatoid factor (RF) and C-reactive protein (CRP) as well as autoantibodies such as, antinuclear antibody (ANA), anti-U1 ribonucleoproteins (U1RNP), anti-dsDNA, anti-Sm, anti-SSA, anti-SSB, anti-SCL-70 and RO-52. The correlation between these proteins and RV function was analyzed.

Results:

Both the patients with CTD and healthy controls had a normal range of BMI, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG). The average age of patients with CTD was 46.0 ± 10.4 years. At baseline, these patients presented no cardiovascular disease or pulmonary hypertension. No significant difference in the body weight, height, age, sex, blood pressure, RV and left ventricular (LV) function at rest between the two groups (allP>0.05). The parameters of RV systolic reserve decreased significantly in CTD group compared to those of the healthy controls (Δs’: 5.8±2.1 vs 8.3±2.5cm-1,P<0.01; ΔSr: 2.5±0.8 vs 2.8±0.7s-1,P<0.01). Consistently, RV diastolic reserve was significantly decreased in CTD patients compared to controls (Δe’: 2.8±1.5 vs 3.9±2.3cm-1,P<0.05; Δa’: 5.8±2.5 vs 10.9±6.3cm-1,P<0.05; ΔE-Sr: 0.8±0.2 vs 1.2±0.5s-1,P<0.05; ΔA-Sr: 0.9±0.3 vs 1.3±0.6s-1,P<0.05). To identify independent predictors of RV function in CTD patients, linear regression was conducted. This suggested that ANA, anti-U1RNP, anti-dsDNA, anti-Sm, anti-SSA, anti-SSB, anti-SCL-70 and RO-52 were not correlated with RV reserve (allP>0.05). A logistic regression analysis revealed that RF (P<0.05) and CRP (P<0.01) were independently associated with RV reserve in CTD patients in response to an acute physiological stress.

Conclusion:

Treadmill exercise echocardiography could detect right heart dysfunction early before diagnosed as cardiovascular diseases in patients with CTD. RV reserve after exercise might be a promising parameter to detect cardiovascular disease early in CTD patients.

References:

[1]Lazzerini PE, Capecchi PL, Laghi-Pasini F. Systemic inflammation and arrhythmic risk: lessons from rheumatoid arthritis.Eur Heart J. 2017;38(22):1717–1727.

[2]Peçanha T, Rodrigues R, Pinto AJ, et al. Chronotropic Incompetence and Reduced Heart Rate Recovery in Rheumatoid Arthritis.J Clin Rheumatol. 2018;24(7):375–380.

Disclosure of Interests:

None declared

AB0028 IMBALANCES OF TH17/TREG IN CARDIOVASCULAR EVENTS OF PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

Ankylosing spondylitis (AS) is a common inflammatory joint disease affecting articulations of axial skeleton and asymmetrical peripheral arthrosis. It has been highlighted that patients with AS exhibit an increased risk of cardiovascular diseases (CVD) compared to the general population [1]. However, little is known about the relationship between cardiovascular burden in AS patients and Th17/Treg imbalance.

Objectives:

We aimed to investigated the relationship between cardiovascular events in AS patients and the status of T cell subsets. Furthermore, we want to identify other clinical and/or laboratory features which are associated with the cardiovascular risk in AS patients.

Methods:

The study included 32 AS patients with cardiovascular diseases and 32 age-matched AS patients as controls. All the AS patients were hospitalised at the Second Hospital of Shanxi Medical University and met the diagnostic criteria for AS revised in New York in 1984. We collected demographics, laboratory features [erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), DD (D-dimer), PLT (platelet count)], and absolute counts of lymphocyte and CD4+ T cell subset. The absolute numbers of lymphocytes and CD4+ T cells in peripheral blood were measured by Flow Cytometer.

Results:

1. There was statistically significant decrease in Th17 levels (P=0.012) in the AS with CVD group compared to the AS group, while the Treg cells number (P=0.426) and the ratio of Th17/Treg (P=0.202) have no statistically significant differences; 2. DD was significantly increased in AS patients with CVD; 3. The use of NSAIDs between the two groups is significantly different(P=0.013). 86.7% of the AS group have received NSAIDs, while only 58.1% of the AS patients with CVD have received the NSAIDs.

Conclusion:

The findings suggested that the cardiovascular events of AS patients correlated with imbalanced T cell subsets and the decreased Th17 cells may be a laboratory feature of AS patients with CVD. Patients with high DD level might have a higher risk of CVD. Monitoring of Th17 cells and DD could be beneficial in cardiovascular burden of patients with AS. However, current studies indicate that Th17 cells mediate the inflammatory response and play a crucial role in the development of CVD [2]. One explanation is that the AS patients with CVD in our study had a long disease duration and immunomodulatory therapy might have an impact on the status of T cell subsets. Meanwhile, the different disease activities of AS patients can be additional factors.

References:

[1]Haroon N, Paterson J M, Li P, et al. Patients with Ankylosing Spondylitis Have Increased Cardiovascular and Cerebrovascular Mortality[J]. Annals of Internal Medicine, 2015, 163(6):409. doi:10.7326/M14-2470

[2]van Bruggen, N. and W. Ouyang, Th17 Cells at the Crossroads of Autoimmunity, Inflammation, and Atherosclerosis. Immunity, 2014. 40(1): p. 10-12. doi:https://doi.org/10.1016/j.immuni.2013.12.00

Table 1.

Absolute lymphocyte and CD4+ T cell subset counts (cells/μL) in the AS with CVD group and AS group

Cell count (cells/μL)AS with CVDASP-valueTotal T1447.97±11.491442.49±11.490.970Total B217.06(144.55- 324.97)291.27(171.13-321.16)0.262NK268.09(171.51-396.99)277.71(167.08- 462.45)0.858Th1137.23(69.8-185.45)127.04(76.9-197.26)0.693Th28.42(5.56-10.47)8.03(5.50-9.95)0.848Th175.77(4.00-8.61)8.89(5.91-13.88)0.012*Treg29.64(17.07-47.19)34.51(23.26-47.19)0.426Th1/Th214.99(10.50-24.21)17.36(12.71-25.98)0.430Th17/Treg0.23(0.12-0.39)0.31(0.18-0.52)0.202

*P<0.05 **p <0.01. Data with a normal distribution and homogeneity of variance are presented as mean±standard deviation. Data without a normal distribution are presented as the median (interquartile range)

Figure 1.

Differences in Treg, Th17 cell counts and Th17/Treg between AS with CVD group and AS group. There was statistically significant decrease in Th17 levels(P=0.012) in the AS with CVD group. * P < 0.05 **P < 0.01. Data were compared using the Wilcoxon’s rank sum test.

Disclosure of Interests:

None declared

THU0242 REGULATORY ROLE OF TRANSCRIPTION FACTOR BLIMP-1 IN SJÖGREN’S SYNDROME

Background:

The pathogenesis of primary sjögren’s syndrome (pSS) is multifactorial. Self-antigen-driven responses perform a vital function in the development of autoimmune diseases [1]. B cells, only 20-25% of total infiltrating cells in labial glands, are the cellular basis for spontaneous antibody production [2].Genome-wide association studies (GWAS) have identified Blimp-1 as a susceptibility gene for autoimmune diseases and played an important role in the pathogenesis of autoimmune diseases [3].

Objectives:

To investigate the expression and effect of B lymphocyte induced maturation protein 1 (Blimp-1) in pSS and the correlation of Blimp-1 with B cell subsets and clinical features.

Methods:

The PRDM1 mRNA expression in B lymphocyte and labial gland were examined by RT-PCR. The levels of B cell subsets were examined by flow cytometry. Hematoxylin-eosin (HE) staining and immunohistochemistry (IHC) were used to examine the invasion degree of lymph cell and Blimp-1 distribution, respectively. The correlation of PRDM1 mRNA with B cell subsets and clinical indicators were also analyzed.

Results:

The levels of PRDM1 mRNA expression of B cells were significantly higher in SS than in healthy controls (HC) and which were also significantly higher in the high immunoglobulin (Ig) group than that in normal Ig group (P<0.02, Fig. 1a-b). The number of CD19+B cells and CD138+ plasma cells(PC) have increased while the CD27+ cells decreased in SS(P<0.05). The percentage of PC and PC/B is positively correlated with PRDM1 mRNA(r=0.380,P=0.002;r=0.317,P=0.009, Fig. 1c-d). Blimp-1 expression level showed a positive correlation with invasion degree of lymph cell in histology (Fig. 2a-c), Ig levels and ESSDAI score and an inverse correlation with the glucocorticoids usage (Fig. 3c).

Fig. 1

(a-b) RT-PCR showed that PRDM1 mRNA expression in SS patients and HC. (c-d) Correlation between PRDM1 mRNA expression and PC and PC/B.

Fig. 2

(a) Expression of Blimp-1 in labial glands of sjögren’s syndrome. (b) PRDM1 mRNA levels in different invasion degree of lymph cell group. (c) Correlation between PRDM1 mRNA expression and invasion degree of lymph cell. *p<0.05, ***p<0.001.

Fig. 3

(a-b) RT-PCR showed that PRDM1 mRNA expression in different usage of glucocorticoids. (c) Correlation between PRDM1 mRNA expression and different glucocorticoid usage. **p<0.01, ***p<0.001.

Conclusion:

Blimp-1 displayed high expression in SS, which could affect pSS disease activity. SS activity is suppressed by glucocorticoid which might be through inhibition of Blimp-1.

References:

[1]Kapsogeorgou EK, Abu-Helu RF, Moutsopoulos HM, Manoussakis MN (2005) Salivary gland epithelial cell exosomes: A source of autoantigenic ribonucleoproteins. Arthritis Rheum 52(5):1517-21.https://doi.org/10.1002/art.21005

[2]Arneth BM (2019) Impact of B cells to the pathophysiology of multiple sclerosis. J Neuroinflammation 16(1):128.https://doi.org/10.1186/s12974-019-1517-1

[3]Bönelt P, Wöhner M, Minnich M et al (2019) Precocious expression of Blimp-1 in B cells causes autoimmune disease with increased self-reactive plasma cells. EMBO J 38(2). pii:e100010.https://doi.org/10.15252/embj.2018100010

Table 1.

Clinical characteristics of pSS and HC.

HC(n=17)pSS(n=50)Sex (Male/Female)0/170/50Age(x±s)45.24±18.5546.8±11.05Xerostomia(positive/negative)0/1743/7Keratoconjunctivitis sicca0/1735/15Arthralgia0/1732/18Fatigue0/1718/32ESSDAI(x±s)-2.78±1.61 (0~7)ESSPRI(x±s)-3.3±1.39 (1~6)ANA(positive/negative)-49/1SSA-49/1SSB-18/32

pSS: primary sjögren ‘s syndrome; HC: Healthy controls; ESSDAI: The European League Against Rheumatism Sjögren’s Syndrome Disease Activity Index; ESSPRI: EULAR Sjögren’s Syndrome Patient Reported Index.** P<0.01,*** P<0.001.

Acknowledgments :

This study was supported by the grants from the National Natural Science Foundation of China (81871271).

Disclosure of Interests: :

None declared

THU0325 REDUCED OF TREG CELLS ASSOCIATED WITH THE DISEASE ACTIVITY OF ANCA-ASSOCIATED VASCULITIS

Background:

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of autoimmune disease that can cause systemic organ damage, characterized with the presence of abnormal antibodies (ANCAs) in the circulation and the small- and medium-vessel vasculitis[1].However,the etiology of AAV remained unclear. Several observations have showed that the breakdown of immune tolerance caused by many complex interactions was involved in the pathogenesis of AAV[2].It has been confirmed that the disorder of the CD4+T cell,especially the imbalance of Th17 and Treg cells can destroy the immune tolerance and cause many autoimmune disease[3]. But the relationship between the Th17/Treg and AAV is unknown.

Objectives:

We investigated the absolute numbers of CD4+T subsets cells in peripheral blood of patients with AAV and healthy adults,and then compared them in different disease activity of AAV to explore the role of CD4+T subsets cells in the pathogenesis and development of AAV.

Methods:

49 patients with AAV,hospitalized at the Second Hospital of Shanxi Medical University from the May 2016 to the November 2019 were enrolled, and 31 age and gender-matched healthy adults were anticipated as controls.According to BVAS, the patients were divided into disease-activity group (BVAS≥15, n=27) and non-disease-activity group (BVAS<15, n=22). The absolute numbers of CD4+T subsets cells including Th17 and Tregs in peripheral blood of these individuals were detected by flow cytometry.We analyzed whether there was difference of CD4+T subsets between the patients and healthy controls,and between disease-activity group and non-disease-activity group.

Results:

There was significant decreased level of Treg cells in the patients with AAV compared with healthy controls,especially in the disease-activity group. The absolute numbers of Treg cells was decreased in the patients with AAV compared with healthy controls (P<0.001) leading to a higher Th17/Treg ratio in the patients (P<0.01).Similarly,the absolute number of Treg cells was decreased in the disease- activity group (P<0.01) compared with the non-disease-activity group, and the absolute number of Treg cells was significant negative correlation with the disease activity indexes such as BVAS (r=-0.342,P=0.016), erythrocyte sedimentation rate(ESR) (r=-0.315,P=0.027) and C-reactive protein(CRP) (r=-0.305,P=0.033). But there was no statistically significant in the absolute number of Th17 cells between the patients and healthy controls, and between disease-activity group and non-disease-activity group.

Conclusion:

The results we investigated here suggested that the decreased number of Treg cells failed to control autoimmune inflammatory response and maintain immune tolerance, and the disease activity of AAV was associated with the reduced number of Treg cells.

Figure 1.

(A-C) Characteristics of the absolute number of Th17 cells and Treg cells in peripheral blood of healthy controls (n=31) and the patients with AAV (n=49). There was significant decreased level of Treg cells in the patients with AAV compared with healthy controls leading to a higher Th17/Treg ratio in the patients with AAV. (D-F) The absolute number of Treg cells was decreased in the disease- activity group (n=27) compared with the non-disease-activity group (n=21). The absolute number of Th17 cells and Treg cells was detected by flow cytometry. Statistical analyses were performed by the Mann-Whitney U test. *p<0.05,**p<0.01, ***p<0.001.

References:

[1]Cosmi, L., Th17 and Treg lymphocytes as cellular biomarkers of disease activity in Granulomatosis with Polyangiitis. Eur J Immunol, 2017.47(4): p. 633-636.

[2]Pagnoux, C.,Updates in ANCA-associated vasculitis.Eur J Rheumatol, 2016.3: p. 122-133.

[3]Diller, M.L., et al., Balancing Inflammation: The Link between Th17 and Regulatory T Cells. Mediators Inflamm, 2016.2016: p. 6309219.

Disclosure of Interests:

None declared

Molecular cloning of the goose GnRH gene and identification of GnRH polymorphisms associated with laying traits

1. Egg-laying traits are important economic characteristics in goose production (Anser cygnoides). The gene GnRH, which encodes gonadotropin-releasing hormone, is a strong candidate gene for egg-laying traits in avian species. 2. In this study, a 3520 bp genomic sequence and a 279 bp mRNA sequence for GnRH, which encoded 92 amino acids, were determined. The GnRH DNA sequence contains four exons and three introns, and the DNA and deduced amino acid sequences were highly conserved across mammals (human, macaque, cow, and sheep) and avians (chicken, fulmar and quail). 3. Using a direct sequencing method, 46 single nucleotide polymorphisms (SNPs) were identified in the GnRH genomic sequence that were shared between two Sichuan White goose populations (217 and 208 individuals). Furthermore, 44 haplotypes were constructed using a sliding window approach. Association analysis between the SNPs and haplotypes and egg-laying traits showed that 10 SNPs affected the first egg weight, average egg weight, egg number at 48 weeks and egg number at 64 weeks. 4. These results lay the foundation for further studies of the function of GnRH in geese and provide a theoretical basis for marker-assisted selection of egg-laying traits in the Sichuan white goose population.

MicroRNA-577 inhibits cardiomyocyte apoptosis induced by myocardial infarction via targeting PARP1

OBJECTIVE

The aim of this study was to investigate whether microRNA-577 could inhibit myocardial infarction (MI)-induced cardiomyocyte apoptosis by regulating poly ADP-ribose polymerase 1 (PARP1).

MATERIALS AND METHODS

MI model was successfully established in mice by ligation of the left anterior descending coronary artery (LAD). The expression levels of microRNA-577 and PARP1 in myocardial tissues of mice were examined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). MI model in cells was established by hypoxia pre-treatment in primary cardiomyocytes and MCM cells. Subsequently, the expression levels of microRNA-577 and PARP1 in hypoxia preconditioning cardiomyocytes were determined as well. Meanwhile, Caspase3 activity in cardiomyocytes overexpressing microRNA-577 or PARP1 was detected using a relative commercial kit. Furthermore, the binding relationship between microRNA-577 and PARP1 was examined by Dual-Luciferase reporter gene assay.

RESULTS

Infarct size/risk region and risk region/LV in MI group were (62.1±2.2)% and (57.6±1.9)%, respectively. Both of the above two indexes in the MI group were significantly higher than those of the control group. The serum level of LDH in MI mice increased by 2.8-fold when compared with controls. Meanwhile, the expressions of microRNA-577 and PARP1 in myocardial tissues of MI mice were markedly down-regulated in a time-dependent manner. Compared with normoxia preconditioning cardiomyocytes, microRNA-577 expression in hypoxia preconditioning MCM cells and primary cardiomyocytes was remarkably decreased. Dual-Luciferase reporter gene assay confirmed that microRNA-577 could bind to PARP1. After transfection of microRNA-577 mimics, the expression of PARP1 was significantly down-regulated. Moreover, microRNA-577 over-expression inhibited caspase3 expression in hypoxia preconditioning cells, which could be reversed by PARP1 up-regulation. Similarly, microRNA-577 over-expression markedly decreased infarct size, risk region and serum level of LDH in MI mice, which could be reversed by PAPR1 over-expression.

CONCLUSIONS

MicroRNA-577 inhibits MI-induced cardiomyocyte apoptosis by degrading PARP1.

Detection of Spin-Vibration States in Single Magnetic Molecules

The spin states of magnetic molecules have advantageous attributes as carriers of quantum information. However, spin-vibration coupling in molecules causes a decay of excited spin states and a loss of spin coherence. Here, we detect excitations of spin-vibration states in single nickelocene molecules on Ag(110) with a scanning tunneling microscope. By transferring a nickelocene to the tip, the joint spin-vibration states with an adsorbed nickelocene were measured. Chemical variations in magnetic molecules offer the opportunity to tune spin-vibration coupling for controlling the spin coherence.

HLA-A*02:01:01:28, a novel HLA allele identified by next-generation sequencing in a Chinese family

HLA-A*02:01:01:28 differs from A*02:01:01:01 by one nucleotide transition, T>A 2952 in intron 6.

Next-generation sequencing-based typing of a new allele HLA-DQB1*03:01:01:20 in a Chinese family

DQB1*03:01:01:20 showed one nucleotide difference when compared to DQB1*03:01:01:01 at 224 (C>T).

Abstract P1-10-04: Racial and ethnic differences in weight gain during and after chemotherapy among women with early-stage breast cancer

Objective

Clinically significant weight gain of ≥5% from baseline has been commonly reported during chemotherapy treatment for early stage breast cancer and persisting after completion. Based on the known poorer outcomes associated with weight gain after a breast cancer diagnosis, we evaluated differential weight gain by race/ethnicity as a potential explanation for disparities in breast cancer clinical outcomes among racial/ethnic minorities compared to non-Hispanic white women.

Methods

We conducted a retrospective cohort study among women diagnosed with stage I-III breast cancer between 2007 and 2016, who received chemotherapy at Columbia University Medical Center (CUMC) in New York, NY. We extracted data on demographics, clinical characteristics, chemotherapy regimens, and height/weight from the electronic health records. Our main exposure variable of interest was race/ethnicity. The outcome variable was dichotomized as ≥5% weight gain or stable weight (defined as &lt;5% weight gain or loss/≥5% weight loss) from baseline at 3, 6, 12, and 18 months after initiating chemotherapy. We used multinomial logistic regression analyses to determine the association between race/ethnicity and weight gain before and after adjusting for confounders.

Results

Among 789 evaluable women, median age was 55 years (range, 19-92) and the study cohort was racially/ethnically diverse: 39.8% non-Hispanic white, 30.4% Hispanic, 18.0% non-Hispanic black, 10.4% Asian, and 1.4% other. Mean baseline body mass index (BMI) was highest among black women (30.7 kg/m2 ± 7.0), followed by Hispanic (29.4 kg/m2 ± 5.2), non-Hispanic white (27.9 kg/m2 ± 6.9), and Asian (25.5 kg/m2 ± 5.4) women. The proportion of women with ≥5% weight gain increased over time with 13.6% at 3 months, 15.2% at 6 months, 19.0% at 12 months, and 23.6% at 18 months. Compared to non-Hispanic whites, Asian women had a 63% lower odds of ≥5% weight gain (95% Confidence Interval [CI]: 0.15-0.92) at 3 months after initiating chemotherapy. No statistically significant associations were found between other racial/ethnic groups and ≥5% weight gain. Factors associated with weight gain after chemotherapy included younger age at diagnosis, lower baseline BMI, longer duration of chemotherapy, and having Medicaid insurance coverage.

Conclusions

Race/ethnicity was not significantly associated with weight gain after chemotherapy among women with early stage breast cancer. Socioeconomic status (SES) rather than race/ethnicity may be a contributing factor in disparities in weight gain and breast cancer clinical outcomes. Future weight loss programs should target younger, pre-menopausal women and those with lower SES.

Citation Format: Wu R, Crew KD. Racial and ethnic differences in weight gain during and after chemotherapy among women with early-stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-10-04.

Risk of systemic lupus erythematosus in patients with human papillomavirus infection: a population-based retrospective cohort study

Background: Viral infection contributing to systemic lupus erythematosus (SLE) development has been largely reported. However, the SLE risk in patients with human papillomavirus (HPV) infection is unknown. Methods: Data were retrieved from the Longitudinal Health Insurance Database (2000) in Taiwan. We identified 43,567 patients with HPV infection and 174,268 age- and sex-matched uninfected controls from 2002 to 2012. Individuals were followed up from index date (first date of diagnosis with HPV) until the occurrence of SLE, at the end of the study (December 2013), or when they were withdrawn from the insurance program. The incidence rate ratio (IRR) was calculated using the univariate Poisson regression. The adjusted hazard ratios (aHRs) were calculated, and sensitive and subgroups analyses were also conducted. Results: Compared with the non-HPV controls, the IRR of SLE in HPV patients was 1.52 (95% confidence interval (CI): 1.09–2.12). The risk of SLE in HPV-infected individuals was significantly high (aHR: 1.48, 95% CI: 1.06–2.06) after adjusting for age, sex, and comorbidities. Men aged between 16 and 45 years were more susceptible to developing SLE (aHR: 21.57, 95% CI: 2.52–184.60, p = 0.0051). Conclusion: Our study showed a significantly higher risk of SLE among HPV-infected patients, especially in men aged between 16 and 45 years.