Nano-Layering Adds Strength to the Adhesive Interface

X-ray diffraction (XRD) surface analysis and ultrastructural interfacial characterization using transmission electron microscopy (TEM) confirmed that the functional monomer 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) self-assembles into nano-layers at adhesive-tooth interfaces. Self-assembled nano-layering is thought to contribute to the durability of bonding to tooth dentin, although this has not been proven yet. In order to disclose this potential bond-durability contribution of nano-layering, we observed the 3-dimensional (3D) spreading of nano-layering by a series of focused-ion-beam (FIB) milled cross sections by scanning electron microscopy (FIB-SEM) and examined the mechanical properties of self-assembled nano-layering using scanning probe microscopy (SPM). A commercial 10-MDP-containing 3-step self-etch adhesive partially demineralized dentin up to submicron depth, forming a submicron hydroxyapatite-rich hybrid layer. TEM chemically and ultrastructurally confirmed the formation of interfacial nano-layering. FIB-SEM 3D reconstructions disclosed a 3D network of self-assembled nano-layering extending from the hybrid layer up to within the adjacent adhesive-resin layer. SPM revealed that nano-layering within the adhesive-resin layer possessed a higher elastic modulus than that of the surrounding adhesive resin, hereby suggesting that nano-layering contributes to the mechanical strength of adhesives like filler particles do. Nano-layering's 3D expanded structure is expected to strengthen the surrounding resin, as well to better interconnect the adhesive-resin layer to the hybrid layer. In conclusion, this exploratory study demonstrated that nano-layering constitutes a strong phase at the adhesive interface, which may contribute to the clinical longevity of the 10-MDP-based bond to dentin.

Purification of human iPSC-derived cardiomyocytes by HDAC inhibition through inducing apoptosis and cell arrest in non-cardiomyocytes

Background

Cell therapy is one of the most promising strategies for treatment of heart failure. During preparation of iPSC-derived cardiomyocytes for cells therapy, it is important to eliminate the presence of residual proliferative non-target cells in the preparation as these non-target cells could present the risk of tumorgenicity. To minimize the risk, selective and more precise purification process is necessary.

Purpose

We hypothesized that the differences in proliferative activity between cardiomyocytes and non-target cells might result in different sensitivities to the drugs targeting cell growth/survival. The aim of this study is to obtain compounds that eliminate non-cardiomyocytes selectively and to study the mechanism of action of these compounds.

Methods and results

We screened 314 small compounds using both iPSCs and sorted hiPSC-derived cardiomyocytes (hiPSC-CMs). We identified several compounds, which markedly decreased the cell numbers of iPSCs, but showed minimum effects on those of hiPSC-CMs. Among them, HDAC inhibitors were selected as the most promising candidates. We examined whether HDAC inhibitors could purify hiPSC-CMs containing non-cardiomyocytes populations, which were differentiated using the classical embryoid body (EB) method. As a result, HDAC inhibitors increased the purity of cardiomyocytes (up to 98%) by decreasing non-target cells such as smooth muscle cells, endothelial cells, and endodermal lineage cells. Moreover, we confirmed HDAC inhibitors could be used for purification of cardiomyocytes in monolayer differentiation protocol using GSK3β inhibitor and Wnt inhibitor. We measured the expression levels of mRNA and protein in iPSCs and hiPSC-CMs (EB method) treated with HDAC inhibitors. mRNA levels of CDKN1A (p21) and BAX were upregulated in iPSCs. Western blotting analyses revealed that HDAC inhibitors also induced the expression of p21 and the cleavage of Caspase3 in iPSCs.

Conclusions

Our result suggests that the inhibition of HDAC enables an efficient purification of hiPSC-CMs in multiple differentiation methods. Furthermore, our data indicate that HDAC inhibitors induce the apoptosis and cell cycle arrest in iPSCs but not hiPSC-CMs.

Figure 1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Takeda Pharmaceutical Company Limited

Preclinical proof-of-concept study: antisense-mediated knockdown of CALM as a therapeutic strategy for calmodulinopathy

Background

Calmodulin (CaM) is a ubiquitous Ca2+ sensor molecule encoded by three distinct calmodulin genes, CALM1–3, and has an important role for cardiac ion channel function. Recently, heterozygous missense mutations in CALM genes were reported to cause a new category of life-threatening genetic arrhythmias such as long-QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT), which is called as “calmodulinopathy”. The patients with calmodulinopathy show poor prognosis and there is no effective treatment for them.

Purpose

Considering the dominant-negative effect of mutant calmodulin proteins produced by heterozygous missense mutations in CALMs, we aimed to prove the concept of antisense-based therapy to treat calmodulinopathy using human iPS cell-derived cardiomyocyte (hiPSC-CM) model.

Methods

We designed multiple locked nucleic acid (LNA) gapmer-antisense oligonucleotides (ASOs) targeting CALM2 and analyzed the silencing efficiency and toxicity in cultured cells to select the most potent ASO. Using CMs differentiated from hiPSCs which were generated form a 12-year-old boy with LQTS carrying a heterozygous CALM2-N98S mutation, CALM2 expression and action potentials (APs) were analyzed to evaluate the efficacy of ASOs.

Results

We identified several ASOs which reduced CALM2 expression without affecting cell viability in human cultured cells (HepG2) (ASO 50 nM, n=2; Figure 1A). Considering further experiments in vivo mouse model, we investigated the CALM2 silencing activity in mouse cultured cells (3T3-L1) without transfection (free-uptake) (ASO 1 μM, n=2; †ASOs have homologous sequence between human and mouse; Figure B). After free-uptake CALM2 silencing analysis in 3T3-L1 cells, we identified that ASO #2 has the most potent CALM2 silencing activity and low cytotoxicity (Figure 1B). ASO #2 effectively reduced CALM2 expression even in hiPSC-CMs (ASO(−): n=3, lipofection: n=4, free-uptake: n=3; P<0.05; Figure 1C). In action potential recordings, we demonstrated that ASO #2 ameliorated prolonged AP durations (APD90) in N98S-hiPSC-CMs at 0.5 Hz pacing (ASO(−): 666±123 ms (n=7), lipofection: 329±21 ms (n=8), free-uptake: 388±34 ms (n=12); P<0.05; Figure 1D).

Conclusion

Our results using patient-derived hiPSC-CM model suggest that ASO-based therapy might be a promising strategy for the treatment of calmodulinopathy.

Figure 1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Nissan Chemical Corporation

Visceral fat accumulation and left atrial phasic function in the general population

Background

Obesity carries independent risk for incident atrial fibrillation (AF), although the impact of abdominal fat distribution on LA morphological and functional remodeling is not fully elucidated. Speckle-tracking echocardiography is a novel and sensitive tool that allows quantification and detection of subtle alterations in left atrial (LA) phasic function.

Purpose

This study aimed to investigate whether increased visceral adiposity is independently associated with impaired LA phasic function in a community-based cohort.

Methods

We included 527 participants without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination and speckle-tracking echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess LA phasic function including reservoir, conduit and pump strain as well as left ventricular global longitudinal strain (LVGLS).

Results

Mean age was 57±10 years and 362 of the participants (69%) were men. LA reservoir and conduit strain were decreased according to the VFA quartiles (both p<0.05), whereas there was no significant difference in LA volume index and LA pump strain. When stratified by SFA, there was no significant differences in LA volume index and all LA phasic strain across the quartiles. In multivariable analysis, VFA as continuous variable was significantly associated with LA conduit strain, independent of traditional cardiovascular risk factors, pertinent laboratory parameters and LV morphology and function including LVGLS (standardized b=−0.146, p=0.011). Representative cases are shown in the Figure.

Conclusion

In a sample of the general population, VFA accumulation was independently associated with worse LA conduit strain, which may be involved in the pathophysiological mechanism of obesity-related AF.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Yamauchi Susumu Scholarship for Cardiovascular Research

Obesity associated pro-fibrotic protein augments fibrosis in heart

 

Chronic sterile inflammation in visceral fat has causal roles for systemic metabolic disorders in obesity. Inflamed visceral adipose tissue secretes pro-inflammatory adipokines, and this contributes to tissue remodeling under a metabolically stressed condition. Various kinds of white adipokines are broadly studied, however, roles of brown adipose tissue (BAT) derived adipokines (BATokine) remain to be explored. In this project, we tried to characterize pathogenic role of BATokine in obesity related fibrotic disorders, especially focusing on heart failure with preserved ejection fraction (HFpEF). For this purpose, we analyzed two sets of DNA microarray data, and identified an obesity associated pro-fibrotic protein (OAFP) as a possible pathogenic BATokine. Our biobank studies showed OAFP increased in patients with diastolic dysfunction, and E/e' analyzed with cardiac echo increased in direct proportion to circulating OAFP level in humans. We generated dietary obese mice model, and found OAFP increased both in BAT and circulation. We generated a murine systemic or BAT specific OAFP knockout (KO) models, and found that obesity-induced diastolic dysfunction ameliorated in these models. Cardiac fibrosis was also suppressed by genetic depletion of OAFP. We found OAFP increased in circulation in aged humans and mice, and studies in chronologically aged mice showed this molecule increased in BAT with aging. Our results indicate that OAFP is secreted predominantly from BAT, and mediates pathogenic roles by augmenting cardiac fibrosis in dietary obesity or aging. Suppression of OAFP may become a therapy for HFpEF.

Funding Acknowledgement

Type of funding source: None

Sarcopenia-derived exosomal micro-RNA 16-5p exerts the cardio-repair disturbance via pro-apoptotic mechanism in myocardial infarction of mice

Background

Sarcopenia is a pathophysiological malfunction induced by skeletal muscle atrophy, and several studies reported an association between sarcopenia-induced cardiac cachexia and poor prognosis in heart disease. Since only a few established animal models are recently available, the underlying mechanism of disturbed cardiac repair accompanied with sarcopenia remains poorly understood.

Purpose

We hypothesized that specific microRNAs in sarcopenia-derived exosomes play crucial roles in disturbed cardiac repair with sarcopenia, and these microRNAs directly exacerbate cardiomyocyte injury following cardiac ischemia and reperfusion.

Methods

We developed a novel sarcopenia-induced cardiac repair disturbance mouse model that is induced by tail suspension (TS) 7 days after a 45-min coronary occlusion of cardiac ischemia and reperfusion (I/R). The reduction of the left ventricular ejection fraction (LVEF) after I/R was compared in mice with TS [I/R-TS(+), n=14] and without [I/R-TS(−), n=12] by echocardiography. To investigate the exosomal mechanism of cardiac repair disturbance, a comprehensive analysis of extracted exosomal microRNAs from mice serum was performed in the 2 groups at day 8. Then, we investigated the impact of the identified candidate microRNA in neonatal rat cardiomyocytes (NRVMs). After 4 days in primary culture, candidate microRNA was transfected into NRVMs under hypoxic culture conditions. TUNEL analysis and quantitative PCR analysis of apoptosis-related genes were performed on the NRVMs.

Results

At day 8 after I/R, the LVEF of I/R-TS(+) was not significantly ameliorated compared to that of I/R-TS(−) (ΔLVEF; 1.59±6.92 vs. 8.04±7.71% p=0.034). Four candidate microRNAs obtained from I/R mice serum were identified in the microRNA array analysis. The re-analysis of these candidate micro-RNAs using all I/R mice demonstrated that the level of mir-16-5p in I/R-TS(+) was raised by approximately nine-fold than that in I/R-TS(−) (9.67±13.35 vs. 0.99±1.41, p<0.05). Next, an in vitro experimental model using a microRNA mimic revealed that apoptosis in NRVMs was greatly enhanced by the transfection of a mir-16-5p mimic in hypoxic culture conditions (mir-16-5p vs. control = 5.77±2.84 vs. 1.72±0.55%, p<0.01). Furthermore, by qRT-PCR analysis, the expression of CASP3 and TRP53 were upregulated in NRVMs treated with a mir-16-5p mimic than in control NRVMs.

Conclusion

Myocardial I/R injury in sarcopenia ended in cardiac repair disturbance accompanying with the enhanced expression of exosomal-mir-16-5p. A pro-apoptotic effect of mir-16-5p may exacerbate myocardial I/R injury and thus can be a novel therapeutic target for cardiac repair disturbance in sarcopenia.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science

The crucial roles of coagulation factors in inducing brown adipose tissue dysfunction and systemic metabolic disorder in obesity

 

The prevalence of obesity is increasing worldwide. Obese individuals are predisposed to cardio-metabolic disorders. Brown adipose tissue (BAT) is an active metabolic organ abundant with mitochondria, and studies suggest a potential role of BAT in the maintenance of metabolic health in rodents and humans. Metabolic stress causes BAT dysfunction, but the underlying mechanisms are largely unknown. Coagulation factor Xa (FXa) is critically involved in a coagulation cascade, and it is also known to mediate biological effects by the activation of protease-activated receptor (PAR)-signaling. Accumulating evidence shows that PAR1 contributes to tissue remodeling in cardiovascular system. Analyzing deposited microarray data, we found transcripts for coagulation factors including factor VII (F7), factor X (F10), and PAR1 receptor were increased in BAT from obese mice. Here we show a previously unknown role of FXa-PAR signaling in promoting BAT dysfunction and systemic metabolic disorder in a murine dietary obese model.

Imposing a high fat diet (HFD) on C57BL/6NCr mice led to a marked increase in tissue factor (TF), coagulation factor VII and FXa in BAT. TF-FVIIa (activated form of FVII)-FXa complex is known to activate PAR1, and we found a significant increase in PAR1 expression in BAT upon metabolic stress. Administration of a FXa inhibitor ameliorated BAT whitening, improved thermogenic response and systemic glucose intolerance upon dietary obesity. Fxa inhibition reduced reactive oxygen species (ROS) level in BAT. In contrast, administration of warfarin did not show any phenotype in BAT. BAT specific TF and PAR1 over-expression model showed significant whitening of this tissue, which was associated with systemic glucose intolerance. We generated BAT specific PAR1 KO mice. BAT-PAR1 KO mice exhibited re-browning of BAT along with reduced ROS level in this tissue. In BAT-PAR1 KO mice, glucose intolerance and thermogenic response under a metabolically stressed condition were ameliorated. In differentiated brown adipocytes, FXa markedly increased mitochondrial ROS and reduced mitochondrial membrane potential. Inhibition of PAR1 ameliorated FXa-induced mitochondrial ROS production and reduction in membrane potential. We also found that plasma FXa level did not increase in obese mice as well as in obese individuals. These results suggest the previously unknown role of coagulation systems in promoting BAT dysfunction, leading to systemic metabolic disorders. Maintenance of BAT homeostasis through the suppression of FXa-PAR1 signaling would become a new therapeutic target for obesity and diabetes.

Funding Acknowledgement

Type of funding source: None

Differential expression levels of CD151 enable enrichment of atrial cardiomyocytes derived from human induced-pluripotent stem cell

Introduction

Human iPSCs-derived cardiomyocytes (hiPSCs-CMs) are heterogeneous populations that contain ventricular-like CMs (VCMs), atrial-like CMs (ACMs) and pacemaker cells. Isolation of pure populations of each hiPSCs-CM subtype corresponding to the target regions of the heart enables effective drug screening process and stable engraftment of hiPSCs-CMs (e.g. ventricular cardiomyocytes without impurities).

Purpose

Atrial and ventricular cardiomyocytes develop from distinct mesoderm populations, and many of different genes are expressed between two subtypes. Since our method of cardiomyocytes differentiation from hiPSCs mimics in vivo cardiomyocytes development, we hypothesized that two subtypes could be separated by differentially expressed genes in hiPSCs-CMs differentiation process. In this study, we focused cell surface genes which are useful for analysis by flow cytometry, and then identified cell surface marker that can distinguish atrial and ventricular cardiomyocytes from hiPSCs-CMs.

Methods

We performed an antibody-based screening using hiPSCs-CMs induced under atrial induction condition (AIC) and ventricular induction condition (VIC) by flow cytometry. To identify cell surface markers which enable discrimination of cardiac subtypes, we isolated the cell populations using the antibodies against the cell surface markers. Quantitative PCR was performed to analyze expression levels of subtype-specific genes in sorted cells. We confirmed subtype classification of cells using patch-clamp method.

Results

We identified CD151 as a novel candidate of atrial/ventricular selectable marker. The expression level of CD151 was low in most hiPSCs-CMs under AIC. In these cells, CD151-low cells highly expressed atrial genes compared to CD151-high cells. In contrast, the expression level of CD151 was high in most hiPSCs-CMs under VIC. In these cells, CD151-high cells highly expressed ventricular genes compared to CD151-low cells. Furthermore, we investigated the electrophysiological properties of CD151-high and -low cells using patch-clamp experiments. As expected, the cells showing atrial type action potential were enriched in AIC with low expression of CD151 (n=17). On the other hand, CD151-high cells (n=16) contained no atrial CMs, but mostly nodal like cells. In addition, CD151-low cells in AIC were affected with action potential duration by exposure of atrial specific channel blocker (4-aminopyridine) and activator (carbachol). In VIC, CD151-high cells (n=16) demonstrated ventricular type action potential property compared to CD151-low cells (n=21).

Conclusion

These results suggest that CD151 is a useful marker which can enrich ACMs from hiPSCs-CMs. Because these enriched ACMs are uniform population, it may be appropriate for atrial-selective drug screening. Additionally, this marker can reduce contaminated ACMs from hiPSCs-CMs cultured in VIC.

Action potential of CD151-high/low CMs

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Takeda pharmaceutical company limited, Japan society for the promotion of science(JSPS) KAKENHI

Carotid intima-media thickness and subclinical left heart dysfunction in the general population

Background

Although carotid intima-media thickness (IMT) is an established marker of atherosclerosis and carries independent risk for cardiovascular disease, its possible association with subclinical cardiac dysfunction has not been extensively evaluated. Left ventricular global longitudinal strain (LVGLS) and peak left atrial longitudinal systolic strain (PALS) can detect subclinical left heart dysfunction.

Purpose

This study aimed to investigate the association between carotid IMT and subclinical left heart dysfunction in a large sample of the general population without overt cardiac disease.

Methods

We examined 1,161 participants who underwent extensive cardiovascular examination. Ultrasonography of common carotid artery was performed for the measurement of maximal carotid IMT. LVGLS and PALS were assessed by 2-dimensional speckle-tracking echocardiography.

Results

Mean age was 62±12 years, and 56% were male. The prevalence of abnormal LVGLS (>−18.6%) and PALS (<31.4%) was greatest in the upper quartile of carotid IMT (both p<0.001; Figure). In multivariable analyses, carotid IMT was associated with abnormal LVGLS (adjusted odds ratio = 1.33 per 1SD increase of IMT, p=0.003) as well as PALS (adjusted odds ratio = 1.33 per 1SD increase of IMT, p=0.005) independent of traditional cardiovascular risk factors, echocardiographic parameters including LV ejection fraction, LV mass index and diastolic dysfunction, and pertinent laboratory parameters. The independent association between carotid IMT and PALS persisted even after adjustment for LVGLS. When carotid IMT was examined as a categorical variable, the upper quartile of carotid IMT carried a significant risk of abnormal LVGLS and PALS in a fully-adjusted model including echocardiographic and laboratory parameters (adjusted odds ratio 2.27 and 3.03 vs. lower quartile, both p<0.01).

Conclusion

Participants with increased IMT had significantly impaired LV and LA function in an unselected community-based cohort. This association may be involved in the higher incidence of cardiovascular disease in individuals with increased carotid IMT.

Funding Acknowledgement

Type of funding source: None

Development of matured hiPSCs-derived 3D cardiac tissue using ERR gamma agonist and mechanical stress and application for Hypertrophic Cardiomyopathy (HCM) model

Introduction

Tissue engineering using human induced pluripotent stem cells-derived cardiomyocytes (hiPSCs-CMs) is one of the potential tools to replicate human heart in vitro. Although there are many publications on 3 dimensional (3D) heart tissues (1), these tissues show fetal like phenotypes. For that reason, several maturation methods such as electrical stimulation and mechanical stress have been investigated (2, 3). However, these methods have been inadequate in differentiating fetal like phenotype tissue from adult tissues. Previously, we identified a novel compound, T112, which induced hiPSCs-CMs maturation from approximately 9,000 compounds using Troponin I1-EmGFP and Troponin I3-mCherry double reporter hiPSCs-CMs. This compound enhanced morphological and metabolic maturation of hiPSCs-CMs via estrogen-rerated receptor gamma activation

Purpose

We hypothesized that our novel compound, T112, in combination with mechanical stress could result in further maturation of 3D heart tissue. Therefore, our specific aim is to develop a novel maturation method applicable to genetic disease model of HCM using 3D heart tissue combined with T112.

Methods

We constructed 3D heart tissue mixed with fibroblast and double reporter hiPSCs-CMs by the hydrogel methods using Flex cell system®. We added T112 with or without mechanical stretching to 3D tissue from 7 to 15 days after 3D heart tissue was constructed. Then we measured maturation related phenotype such as sarcomere gene expression, mitochondrial DNA content and cell size.

Results

Similar to hiPSCs-CM, the addition of T112 to the constructed 3D heart tissue significantly increased TNNI3 mRNA compared to that of DMSO. Furthermore, T112 treated 3D heart tissue showed increased cell size and oblong shape. Next, in order to promote more maturation of 3D heart tissue, we performed mechanical stretching with the addition of T112. The combination of T112 with mechanical stretching showed higher expression of mCherry, a reporter protein for TNNI3 expression, and higher isotropy of sarcomere alignment in 3D heart tissue than that with the static condition. Furthermore, 3D heart tissue in the treatment of T112 with or without mechanical stretching showed higher mitochondrial DNA content compared to the respective DMSO controls. Interestingly, we applied this combination method to hiPSCs carrying MYH7 R719Q mutation which is known to cause hypertrophic cardiomyopathy, and the 3D heart tissue composed of cardiomyocytes derived from mutant iPSCs demonstrated increased sarcomere disarray compared to isogenic wild-type 3D heart tissue.

Conclusion

These results suggest that the combination of T112 and mechanical stretching promotes metabolic and structural maturation of 3D heart tissue and would be useful for creating a HCM disease model.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): T-CiRA project, Takeda Pharmaceutical Company Limited

Comparison between optical frequency domain imaging and intravascular ultrasound in PCI guidance for Biolimus A9 eluting stent implantation

Background

It has been reported that intravascular ultrasound (IVUS) guided PCI reduced a risk of major adverse cardiac event compared to conventional angiography guided PCI, while comparison between IVUS-guided and optical frequency domain imaging (OFDI)-guided PCI specifically in long-term clinical outcomes (>1 year) has been unexplored.

Purpose

We sought to compare imaging surrogates at 8 months and clinical outcomes beyond 1 year after drug-eluting stent implantation between IVUS and OFDI guidance.

Methods

The MISTIC-1 is a prospective, multi-centre, single-blinded, randomised-controlled, non-inferiority trial comparing OFDI-guided and IVUS-guided PCI using Biolimus A9 eluting Nobori stent. We enrolled patients with stable coronary artery disease who have symptoms or clinically relevant myocardial ischemia. Stent landing zones were selected in the most normal looking sites with largest lumen and without percentage plaque area >50% in IVUS group while without lipidic plaque of >2 quadrants or suggestive thin-cap fibroatheroma in OFDI group. Stent sizing was based on external elastic lamina (EEL) in IVUS group, while by taking 10% or 0.25mm larger than mean lumen diameter at reference sites in OFDI group. Stent optimisation with in-stent minimum lumen area ≥80% of the average lumen area at proximal and distal reference sites was encouraged in both groups. Primary efficacy endpoint is in-segment minimum lumen area (MLA) assessed by OFDI at 8 months. Secondary safety endpoint is a composite of cardiovascular death, target vessel myocardial infarction, or target lesion revascularisation. Based on the assumption that mean in-segment MLA at follow-up was 4.5mm2 with a standard deviation of 2.0mm2 in the control (IVUS) group and a non-inferiority limit of 1.2mm2 for OFDI group, sample size was estimated as 48 cases in each group with 5% type I error and 90% statistical power.

Results

Since June-2014 and August-2016, we prospectively enrolled 109 patients (mean age 70 years, male 78%) with 126 lesions. Baseline patient and lesion characteristics were well balanced and average nominal size and length of stent used did not differ between OFDI-guided and IVUS-guided PCI (3.0 and 19.1mm vs. 3.1 and 19.3mm, respectively). Post-procedural minimum stent area was 6.24mm2 in OFDI group and 6.72mm2 in IVUS group (p=0.20). At 8-month follow-up, in-segment MLA was 4.56mm2 in OFDI group and 4.13mm2 in IVUS group (P for non-inferiority <0.001). During the follow-up (median 4.5 years [1654 days]), incidence rates of major adverse cardiac event were comparable between the two groups (7.4% in OFDI group and 7.3% in IVUS group, hazard ratio 0.96, 95% CI 0.24–3.83, p=0.95). No definite or probable stent thrombosis were documented in both groups.

Conclusion

OFDI-guided PCI demonstrated comparable results in achieving satisfactory imaging surrogates as well as long-term clinical outcomes after newer generation DES implantation as compared to IVUS-guided PCI.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Suzuken Memorial Foundation

Sex-specific difference in the association between arterial stiffness and subclinical left ventricular dysfunction

Background

Increased arterial stiffness has been proposed as one of the key mechanisms of incident heart failure with preserved ejection fraction (HFpEF). However, the possible association between arterial stiffness and subclinical left ventricular (LV) dysfunction and possible sex-specific differences remain unclarified. LV strain is emerging as a highly sensitive tool to unmask early LV abnormalities.

Purpose

We investigated whether increased arterial stiffness is independently associated with subclinical LV dysfunction in a large community-based cohort without overt cardiovascular disease.

Methods

We examined 1,155 participants who underwent extensive cardiovascular examination. Speckle-tracking echocardiography was employed to assess LV global longitudinal strain (LVGLS) and circumferential strain (GCS), and arterial stiffness was assessed by cardio-ankle vascular index (CAVI).

Results

Mean age was 62±12 years, and 56% were male. CAVI as continuous variable was associated with abnormal LVGLS (>−18.6%), independent of cardiovascular risk factors and pertinent laboratory and echocardiographic parameters (adjusted odds ratio [OR] 1.23, p=0.034), whereas there was no relationship with LVGCS. In sex-stratified analysis, more pronounced association between quartiles of CAVI and abnormal LVGLS was observed in women than in men (unadjusted OR = 6.43 in women and 2.46 in men for upper quartile vs. lower quartile, both p<0.01; Figure). Multivariable analyses demonstrated that CAVI was significantly associated with abnormal LVGLS independent of cardiovascular risk factors in both sexes. However, after further adjustment for LV mass index and diastolic parameters, the independent association persisted in women (adjusted OR 1.49, p=0.041), but not in men (adjusted OR 1.15, p=0.209).

Conclusion

Increased arterial stiffness was independently associated with decreased LVGLS even in the absence of overt cardiovascular disease; a sex-specific pattern exists in the alteration of vascular-ventricular coupling, which might partially explain the greater susceptibility to HFpEF in women.

Funding Acknowledgement

Type of funding source: None

Elimination of senescent cells targeting Senescence associated glycoprotein (SAGP) improved the ageing-associated diseases and extended the lifespan

 

Cellular senescence entails an irreversible growth arrest and a pro-inflammatory secretory phenotype, which contributes to aging-associated disorders such as atherosclerosis and diabetes, however, underlying mechanisms are largely unknown. In this study, we identified a novel protein, senescence-associated glycoprotein (SAGP), as a biomarker of cellular senescence and we also found that elimination of senescent cells targeting SAGP attenuated aging-associated disorders such as atherosclerosis, diabetes and frailty.

First, we identified that SAGP as a senescent marker by microarray analysis of senescent human endothelial cells compared with young endothelial cells. The expression of SAGP was significantly increased in the aorta of chronological aging mice and ApoE-knockout mice. Then we measured SAGP expression in the patients registered in our hospital and found that mean SAGP expression was significantly higher in patients with atherosclerotic diseases compared to patients without atherosclerotic diseases. These data suggest that SAGP would become the novel marker of cellular senescence and/or aging-associated disorders.

We found SAGP co-localized with lysosome and bound to V-ATPase, proton pump in the acid organelles such as lysosome. The electron microscopy analysis revealed that the dysfunctional lysosomes were accumulated in SAGP knockdown endothelial cell. The genetic deletion of SAGP resulted in the increase of lysosomal pH and the suppression of mitochondrial autophagy, mitophagy. And this associated with the high level of mitochondrial reactive oxygen species (ROS) and promoted premature senescence in human endothelial cells. These data suggest that SAGP was induced by the lysosomal stress in the senescent cells to protects senescent cells by maintaining the lysosomal homeostasis.

Recently, it is reported that elimination of senescent cells (senolysis) reversibly improved pathological aging phenotypes and also extended the lifespan. We established senolytic therapy targeting SAGP. We generated SAGP-DTR (diphtheria toxin receptor) transgenic mice, in which we could eliminate the SAGP- positive senescent cells using DT (diphtheria toxin). We found elimination of SAGP positive senescent cells significantly reduced the atherosclerotic plaque burden in the aorta of ApoE-KO mice and improved the glucose metabolism of dietary obese mice, indicating that SAGP could be a useful target for senolytic therapy. For clinical implication, we then developed a cytotoxic vaccine targeting SAGP. Treatment with SAGP vaccine successfully eliminated SAGP positive senescent cells and attenuated atherosclerosis and metabolic dysfunction. Surprisingly, administration of SAGP vaccine to Zmpste24-KO mice, premature aging mice, extended the lifespan. These data indicate that targeting SAGP-positive cells could be a novel strategy for senolytic therapy.

Effect of SAGP vaccine

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research by Japan Society for the Promotion of Science (JSPS)

Cardiac mitofusin-1 is declined in non-responding patients with idiopathic dilated cardiomyopathy

Background/Introduction

Mitochondria are dynamic regulators of cellular metabolism and homeostasis. The dysfunction of mitochondria has long been considered a major contributor to aging and age-related diseases. The prognosis of severe heart failure is still unacceptably poor and it is urgent to establish new therapies for this critical condition. Some patients with heart failure do not respond to established multidisciplinary treatment and they are classified as “non-responders”. The outcome is especially poor for non-responders, and underlying mechanisms are largely unknown.

Purpose

Studies indicate mitochondrial dysfunction has causal roles for metabolic remodeling in the failing heart, but underlying mechanisms remain to be explored. This study tried to elucidate the role of Mitofusin-1 in a failing heart.

Methods

We examined twenty-two heart failure patients who underwent endomyocardial biopsy of intraventricular septum. Patients were classified as non-responders when their left-ventricular (LV) ejection fraction did not show more than 10% improvement at remote phase after biopsy. Fourteen patients were classified as responders, and eight as non-responders. Electron microscopy, quantitative PCR, and immunofluorescence studies were performed to explore the biological processes or molecules involved in failure to respond. In addition to studies with cardiac tissue specific knockout mice, we also conducted functional in-vitro studies with neonatal rat ventricular myocytes.

Results

Twenty-two patients with IDCM who underwent endomyocardial biopsy were enrolled in this study, including 14 responders and 8 non-responders. Transmission electron microscopy (EM) showed a significant reduction in mitochondrial size in cardiomyocytes of non-responders compared to responders. Quantitative PCR revealed that transcript of mitochondrial fusion protein, Mitofusin-1, was significantly reduced in non-responders. Studies with neonatal rat ventricular myocytes (NRVMs) indicated that the beta-1 adrenergic receptor-mediated signaling pathway negatively regulates Mitofusin-1 expression. Suppression of Mitofusin-1 resulted in a significant reduction in mitochondrial respiration of NRVMs. We generated left ventricular pressure overload model with thoracic aortic constriction (TAC) in cardiac specific Mitofusin-1 knockout model (c-Mfn1 KO). Systolic function was reduced in c-Mfn1 KO mice, and EM study showed an increase in dysfunctional mitochondria in the KO group subjected to TAC.

Conclusions

Mitofusin-1 becomes a biomarker for non-responders with heart failure. In addition, our results suggest that therapies targeting mitochondrial dynamics and homeostasis would become next generation therapy for severe heart failure patients.

Funding Acknowledgement

Type of funding source: None

Uninterrupted twice-daily direct oral anticoagulants are safer than once-daily ones for atrial fibrillation catheter ablation

Background

In patients undergoing AF catheter ablation (CA), uninterpreted DOACs reduced bleeding events without increasing ischemic events compared with vitamin K antagonist, and the continuation of anticoagulants is recommended for AF ablation. However, in the past studies, patients received once-daily DOACs in the evening, not in the morning of the procedure day. Moreover, there has been no study comparing uninterrupted 4 DOACs; therefore, the safety and effect of uninterpreted DOACs taken just in the morning of AF ablation is unknown.

Objective

The purpose of this study was to compare bleeding complications and thromboembolism events between 4 DOACs in patients undergoing AF ablation.

Method

This study was the retrospective single-center cohort study of consecutive patients who underwent AF ablation between April 2014 to July 2019. All patients continued DOAC uninterruptedly including just in the morning of the procedure. The primary endpoint included major bleeding events within the first 30 days after CA. The secondary endpoints included the composite events of ischemic stroke, systemic embolism, myocardial infarction, and vascular death.

Result

A total of 713 patients (mean age 64±12 years, 72% male) were included in this analysis; enrolled patients were 88, 238, 218, and 169 respectively in dabigatran, rivaroxaban, apixaban and edoxaban group. At the baseline, the ratio of age ≥75 years and CHADS2 score was higher in apixaban group, though all other baseline variables were similar between them.

The primary endpoint was observed 0%, 2.1%, 0.45%, and 4.7% respectively in dabigatran, rivaroxaban, apixaban, and edoxaban group (P=0.013) without significant difference about secondary endpoint between them (P=0.3).

Comparing twice-daily vs once-daily DOACs, the primary endpoint was observed significantly lower in the twice-daily group than in once-daily group (0.32% and 3.2% respectively, P=0.0054), without any significant difference about secondary endpoint (0% and 0.73% respectively, P=0.26).

Conclusion

Taking DOACs also in the morning of AF ablation, uninterrupted twice-daily DOACs are safer than once-daily DOACs without increasing ischemic event, although twice-daily DOACs, especially apixaban, were used in higher aged patients.

Figure 1

Funding Acknowledgement

Type of funding source: None

A novel senolytic drug, seno-7284 ameliorates aging phenotype and age-related cardiometabolic diseases

Background

Cellular senescence occurs as a result of various genotoxic stresses and it plays a pivotal role in aging and age-related disorders. Recently, it was shown that elimination of senescent cells, so-called “senolysis” has the potential to become a promising novel therapy for age-related disorders in several mice models including cardiovascular diseases. However, there is no senolytic drug available in clinical settings currently.

Purpose

The present study was aimed to identify a novel senolytic reagent effective for cardiometabolic disease among compounds already available in clinical settings. Here we demonstrate that a compound called “seno-7284” exhibits senolytic effect in murine models of type 2 diabetes, atherosclerosis, progeroid and chronological aging.

Methods

We generated diet-induced obesity/diabetic mice model by imposing high-fat diet from 4-week-old for two months, atherosclerosis mice model by imposing western diet to ApoE homozygous knockout mice (ApoE-KO mice) from 4-week-old for 3 months. We administered seno-7284 mixed in the diet (0.03% w/w) to each mouse model for 1, 2 or 4 weeks. For the analysis, we carried out some physiological examinations including glucose tolerance test (GTT) and insulin tolerance test (ITT), then harvested tissue samples and took them to molecular biological analysis including real-time PCR, western blotting, RNA-sequence, etc. We also generated Zmpste24 homozygous knockout mice (Zmpste24-KO mice) as a progeroid mice model to measure their lifespan. Seno-7284 was administered to Zmpste24-KO mice from 12-week-old to the end of life. We also administrated seno-7284 to chronological aged mice at 1-year-old for 20 weeks and their physical function was examined with rotarod running test and hand-grip test.

Results

Seno-7284 reduced the accumulation of senescent cells in visceral adipose tissue of dietary obese mice as senescence-associated beta-galactosidase (SA-beta-gal) staining exhibits (Figure 1a). This effect results in ameliorating insulin tolerance (Figure 1b) and adipose tissue inflammation after 4-week administration of seno-7284. We also found administrating Seno-7284 for two weeks also reduced the accumulation of senescent cells in the atherosclerotic lesion in the aorta of ApoE-KO mice (Figure 1c) and inhibited advancing atherosclerosis (Figure 1d). Surprisingly, seno-7284 significantly improved the lifespan of Zmpste24 KO mice (Figure 1e). Seno-7284 also improved the physical function of chronologically aged mice by administrating it from 1-year-old for 20 weeks (Figure 1f). In-vitro studies didn't exhibit seno-7284 kills senescent cells directly, but further analysis including RNA-seq or metabolomic analysis speculated that seno-7284 stimulates endogenous senolytic function of NK-cells and CD8+ T-cells.

Conclusion

Our results indicate that seno-7284 would become a promising senolytic drug that exhibits novel therapeutic machinery for aging and age-related cardiometabolic diseases.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research (KAKENHI) C, Niigata University Tsukada medical research grant

Circulating pro fibrotic protein promotes fibrosis in liver

Background/Introduction

Non-alcoholic steatohepatitis (NASH), driven by the obesity epidemic, has become the most common form of liver disease. Inflamed visceral adipose tissue secretes pro-inflammatory adipokines that are causal for systemic metabolic disorders. Role of adipokines in NASH, especially those from brown adipose tissues (BATokine) remain unclear.

Purpose

To show the pathogenic role of BATokine in NASH.

Methods

To identify and characterize the pathological roles of pro-fibrotic BATokine, we generated a murine obese NASH model by imposing a high fat diet in C57BL6/NCr mice, and murine systemic or BAT specific knockout (KO) models. We also conducted functional in-vitro studies with differentiated brown adipocytes.

Results

Analyzing two sets of DNA micro array data with bioinformatics, we identified a secreted form pro-fibrotic protein (sPFP) expressed in dysfunctional brown adipose tissues (BAT) in mice. Testing our biobank samples, we found this protein increased in plasma of NASH patients. We generated a murine obese NASH model by imposing a high fat diet in C57BL6/NCr mice for 9–10 months since 4 weeks of age, and found that sPFP is produced predominantly by BAT. In this model, we also found that sPFP increased in plasma. We generated a murine systemic or BAT specific sPFP knockout (KO) models and found that liver fibrosis ameliorated in these models. We also suppressed circulating sPFP with a peptide vaccine targeting this molecule, and found that sPFP vaccination therapy inhibited liver fibrosis. Next, we generated sPFP gain of function (GOF) model by the administration of plasmid encoding sPFP into skeletal muscle. Liver fibrosis augmented in sPFP-GOF model, and these results suggested that sPFP has causal role for the progression of fibrotic response in liver. In vitro studies with differentiated brown adipocytes showed that metabolic stress increased c-Fos in nuclear, and this was causal for an increase in sPFP level.

Conclusions

Our results suggest that one of the BATokines, sPFP, contributes for the progression of fibrotic responses in obese-NASH model. Inhibition of sPFP may become a therapy for NASH or obesity related fibrotic disorders.

Funding Acknowledgement

Type of funding source: None

Abstract 245: Cardiac Mitofusin-1 is Suppressed in Non-responding Patients With Heart Failure

Background/Introduction: Mitochondria are dynamic regulators of cellular metabolism and homeostasis. The dysfunction of mitochondria has long been considered a major contributor to aging and age-related diseases. The prognosis of severe heart failure is still unacceptably poor and it is urgent to establish new therapies for this critical condition. Some patients with heart failure do not respond to established multidisciplinary treatment and they are classified as “non-responders”. The outcome is especially poor for non-responders, and underlying mechanisms are largely unknown.

Purpose: Studies indicate mitochondrial dysfunction has causal roles for metabolic remodeling in the failing heart, but underlying mechanisms remain to be explored. This study tried to elucidate the role of Mitofusin-1 in a failing heart.

Methods: We examined twenty-two heart failure patients who underwent endomyocardial biopsy of intraventricular septum. Patients were classified as non-responders when their left-ventricular (LV) ejection fraction did not show more than 10% improvement at remote phase after biopsy. Fourteen patients were classified as responders, and eight as non-responders. Electron microscopy, quantitative PCR, and immunofluorescence studies were performed to explore the biological processes or molecules involved in failure to respond. In addition to studies with cardiac tissue specific knockout mice, we also conducted functional in-vitro studies with neonatal rat ventricular myocytes.

Results: Twenty-two patients with IDCM who underwent endomyocardial biopsy were enrolled in this study, including 14 responders and 8 non-responders. Transmission electron microscopy (EM) showed a significant reduction in mitochondrial size in cardiomyocytes of non-responders compared to responders. Quantitative PCR revealed that transcript of mitochondrial fusion protein, Mitofusin-1, was significantly reduced in non-responders. Studies with neonatal rat ventricular myocytes (NRVMs) indicated that the beta-1 adrenergic receptor-mediated signaling pathway induced microRNA-140 3p and 5p, which is negatively regulated Mitofusin-1 expression. Suppression of Mitofusin-1 resulted in a significant reduction in mitochondrial respiration of NRVMs. We generated left ventricular pressure overload model with thoracic aortic constriction (TAC) in cardiac specific Mitofusin-1 knockout model (c-Mfn1 KO). Systolic function was reduced in c-Mfn1 KO mice, and EM study showed an increase in dysfunctional mitochondria in the KO group subjected to TAC.

Conclusions: Mitofusin-1 becomes a biomarker for non-responders with heart failure. In addition, our results suggest that therapies targeting mitochondrial dynamics and homeostasis would become next generation therapy for severe heart failure patients.

AB0612 SHORT-TERM REVERSIBLE IMPROVEMENT IN EARLY-PHASE ELEMENTS OF NAILFOLD CAPILLARY ABNORMALITIES IN PATIENTS WITH SYSTEMIC SCLEROSIS BY INTRAVENOUS CYCLOPHOSPHAMIDE (IVCY)

Background:

Nailfold capillary abnormalities are one of representative signs in systemic sclerosis (SSc). However, previous reports about changes in nailfold capillary by immunosuppressive therapy have been limited. Especially, there have been no reports about short-term changes in nailfold capillary abnormalities.

Objectives:

To clarify whether intravenous cyclophosphamide (IVCY) treatment for SSc patients can improve nailfold capillary abnormalities in half a year.

Methods:

Among patients diagnosed as having SSc according to the 2013 ACR/EULAR classification criteria at our hospital from May 2018 to December 2019, those who treated with IVCY for interstitial lung disease (ILD) were consecutively registered. All patients received IVCY six times. Nailfold capillary abnormalities on eight fingers including both second to the fifth fingers were observed with a nailfold videocapillaroscopy (NVC). Each finger was evaluated for enlarged capillary, giant capillaries, hemorrhage, loss of capillary, disorganization of the vascular array, and capillary ramification. Quantitative scoring was performed on a scale of 0 to 3 in accordance with the ratio of each of them. NVC tests were evaluated before IVCY treatment intervention and after IVCY. In all cases, the evaluation of NVC after IVCY treatment was performed 6 months after the administration day. Skin changes were evaluated by modified Rodnan’s total skin thickness score (mRSS) at performing NVC. Anti-centromere antibodies, anti-Scl-70 antibodies, anti-RNA polymerase III, and anti-RNP antibodies were measured. Pulmonary function tests (PFTs) including forced vital capacity (FVC) and diffusing capacity of the lung carbon monoxide (DLCO) were performed before and after IVCY. The statistical significance of the differences between means of two groups was evaluated by paired t-test. A p level of 0.05 or less was considered statistically significant.

Results:

Five patients were included. The mean age was 59 years and 4 patients were female (80%). High dose corticosteroids were used in 2 patients (40%). Anti-RNA polymerase III was positive in 2 patients (40%), anti-Scl-70 antibody was positive in 1 (20%), and negative test for any specific antibodies was in 2 (40%). Changes in NVC scores, which were total scores of 8 fingers, were as follows: Enlarged; 13.2±4.8 to 6.4±5.9 (p=0.018), Giant; 7.0±5.7 to 1.6±1.1 (p=0.0314), Hemorrhage; 8.4±6.2 to 3.2±2.3 (p=0.0274), Loss; 4.0±2.5 to 0.6±1.3 (p=0.0288), Disorganization; 0.6±0.9 to 1.0±1.0 (p=0.7065), Ramification; 0.6±0.9 to 0.8±1.8 (p=0.5730). (Table) After IVCY treatment, mRSS reduced in 4 cases (80%). Changes in mRSS scores were as follows: 18.8±8.3 to 12.4±13.3 (p=0.0677). The cases with improved mRSS and those with improved NVC findings were consistent. The mean FVC before and after IVCY was 2077 ml and 2062 ml, respectively. The mean DLCObefore and after IVCY was 9.88 mL/min/mmHg and 9.58 mL/min/mmHg, respectively.

Conclusion:

Nailfold capillary abnormalities in patients with SSc could be improved in half a year with IVCY. Especially, early phase elements including enlargement, giant, and hemorrhage were specifically reversible.

Table.No.(E)(G)(H)(L)(D)(R)mRSS121→1416→319→70→00→20→014→9212→34→26→14→02→11→015→1314→118→26→27→00→00→410→5410→46→18→34→30→22→025→1259→01→03→35→01→00→030→35mean ± SD13.2±4.87.0±5.78.4±6.24.0±2.50.6±0.90.6±0.918.8±8.36.4±5.91.6±1.13.2±2.30.6±1.31.0±1.00.8±1.812.4±13.3p-value0.0180.03140.02740.02880.70650.57300.0677

E: enlarged, G: giant, H: hemorrhage, L: loss, D: disorganization, R: ramification.

The table shows the total of eight points for each finding in the NVC test. The previously described values are before treatment and the later values are after treatment.

Disclosure of Interests:

Tomohiro Sugimoto: None declared, Shintaro Hirata Grant/research support from: Eli Lilly, Consultant of: Bristol-Myers Squibb, UCB, Paid instructor for: AbbVie, Eisai, Tanabe-Mitsubishi, Speakers bureau: AbbVie, Eisai, Tanabe-Mitsubishi, Astellas, Ayumi, Bristol-Myers Squibb, UCB, Chugai, Eli Lilly, Janssen, Kissei, Sanofi, Takeda, Hiroki Kohno: None declared, Hirofumi Watanabe: None declared, Yusuke Yoshida Grant/research support from: Astellas, Paid instructor for: Astellas, Tanabe Mitsubishi, Sanofi, Novartis, GlaxoSmithKline, Eli Lilly, Bristol-Myers Squibb, Chugai, Asahikasei, Eisai, Janssen, Speakers bureau: Astellas, Tanabe Mitsubishi, Sanofi, Novartis, GlaxoSmithKline, Eli Lilly, Bristol-Myers Squibb, Chugai, Asahikasei, Sho Mokuda: None declared, Eiji Sugiyama Grant/research support from: AbbVie, Astellas, Ayumi, Kissei, Pfizer, Sanofi, Takeda, Tanabe-Mitsubishi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Speakers bureau: AbbVie, Astellas, Ayumi, Kissei, Pfizer, Sanofi, Takeda, Tanabe-Mitsubishi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Actelion

AB0452 PREDICTIVE FACTORS FOR INSUFFICIENT RESPONSE TO INITIAL TREATMENT OR RECURRENCE IN PATIENTS WITH LUPUS ENTERITIS

Background:

Lupus enteritis (LE) is a rare but well-known complication of systemic lupus erythematosus (SLE). However, little knowledge about risk factors for insufficient response to initial treatment or recurrence have been reported.

Objectives:

To identify prognostic factors associated with poor response in patients with LE.

Methods:

Patients diagnosed as having LE at our hospital were consecutively registered from January 2009 to October 2019. The diagnosis of LE was made according to the criteria of BILAG 2004 which is defined as either vasculitis or inflammation of small or large bowel with supportive imaging and/or biopsy findings. Poor response was defined as insufficient response to initial therapy or relapse. We retrospectively compared clinical characteristics collected from medical records of the patients with good vs. poor response, using a non-parametric Wilcoxon signed-rank test for numerical variables and Fisher’s exact test for categorical variables.

Results:

A total of 12 patients (16 episodes) diagnosed with LE were reviewed. The median age was 44.5 years and 11 were females. Six patients had a history of SLE (median disease duration; 3.0 years), of which 4 had a history of LE prior to the study period. And in the remaining 6 patients, LE was the primary symptom (Table 1). The comorbidities were 4 lupus cystitis, 1 biopsy-proven lupus nephritis, 1 pseudo-obstruction and 1 protein-losing enteropathy. Computed Tomography (CT) imaging of all 16 episodes showed small bowel wall thickening. Dilatation of intestine was observed in 81.3%, ascites in 81.3%, comb sign in 80.0% and target sign in 62.5%. When comparing clinical characteristics between the groups revealed that CT findings were similar in both groups, however serum CH50 levels (median (interquartile ranges (IQR)) 37.2 (25.3-46.9) U/mL vs 17.6 (7.1-21.4) U/mL, p=0.0095) were significantly lower in poor response group. Furthermore, patients who initiated glucocorticoids (GCs) at a lower dose (less than or equal to 0.6mg/kg prednisolone equivalent dose (PEQ)) was significantly more frequent in poor response group (Table 2).

Table 1.

Baseline demographics and outcomes of LE patients

VariablesN=12DemographicsFemale (%)91.7Age (yrs), median (IQR)44.5 (34.0-47.5)SLE duration (yrs), median (IQR)3.0 (0-9.0)Baseline therapyPrednisolone (mg), median (IQR)7.0 (0-10.5)Cyclosporine (%)16.7Azathioprine (%)8.3Mycophenolate mofetil (%)8.3Tacrolimus (%)8.3OutcomesFollow-up period (yrs), median (IQR)4.0 (1.9-5.0)Poor response to initial therapy (%)33.3Recurrence (%)33.3Need for surgical intervention (%)8.3Death (%)0Table 2.

Comparison of baseline characteristics and initial treatment between LE patients with good vs. poor response

VariablesGood response(N=10)Poor response(N=6)p valueComorbiditiesLupus cystitis (%)30.033.31.0Lupus nephritis (%)016.70.38CT findingsMaximum external diameterof small intestine (mm), median (IQR)30.8 (22.2-37.9)25.3 (19.4-29.0)0.083Colon involvement (%)30.066.70.30Dilatation of intestine (%)90.066.70.52Ascites (%)90.066.70.52Comb sign (%)90.066.70.52Target sign (%)70.050.00.61Laboratoryfindingsanti-dsDNA Ab (IU/mL), median (IQR)5.4 (1.6-12.6)10.1 (3.8-111.5)0.17CH50 (U/mL), median (IQR)37.2 (25.3-46.9)17.6 (7.1-21.4)0.0095C4 (mg/dL), median (IQR)16.0 (10.5-27.3)10.0 (10.0-13.8)0.11C3 (mg/dL), median (IQR)66.0 (56.8-79.8)46.5 (33.0-58.3)0.10Initial treatmentLess than or equal to 0.6mg/kg PEQ (%)10.066.70.036Intravenous cyclophosphamide10.016.71.0

Conclusion:

Lower level of CH50 and initial treatment with GCs at a lower dose were identified as prognostic factors associated with poor response to initial therapy or recurrence in LE.

Disclosure of Interests: :

Yusuke Yoshida Grant/research support from: Astellas, Paid instructor for: Astellas, Tanabe Mitsubishi, Sanofi, Novartis, GlaxoSmithKline, Eli Lilly, Bristol-Myers Squibb, Chugai, Asahikasei, Eisai, Janssen, Speakers bureau: Astellas, Tanabe Mitsubishi, Sanofi, Novartis, GlaxoSmithKline, Eli Lilly, Bristol-Myers Squibb, Chugai, Asahikasei, Tomohiro Sugimoto: None declared, Hiroki Kohno: None declared, Hirofumi Watanabe: None declared, Sho Mokuda: None declared, Shintaro Hirata Grant/research support from: Eli Lilly, Consultant of: Bristol-Myers Squibb, UCB, Paid instructor for: AbbVie, Eisai, Tanabe-Mitsubishi, Speakers bureau: AbbVie, Eisai, Tanabe-Mitsubishi, Astellas, Ayumi, Bristol-Myers Squibb, UCB, Chugai, Eli Lilly, Janssen, Kissei, Sanofi, Takeda, Eiji Sugiyama Grant/research support from: AbbVie, Astellas, Ayumi, Kissei, Pfizer, Sanofi, Takeda, Tanabe-Mitsubishi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Speakers bureau: AbbVie, Astellas, Ayumi, Kissei, Pfizer, Sanofi, Takeda, Tanabe-Mitsubishi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Actelion

Alteration in faecal bile acids, gut microbial composition and diversity after laparoscopic sleeve gastrectomy

Background

Laparoscopic sleeve gastrectomy (LSG) is a well established treatment for severe obesity and type 2 diabetes. Although the gut microbiota is linked to the efficacy of LSG, the underlying mechanisms remain elusive. The effect of LSG for morbid obesity on the gut microbiota and bile acids was assessed here.

Methods

Severely obese subjects who were candidates for LSG were included and followed until 6 months after surgery. The composition and abundance of the microbiota and bile acids in faeces were assessed by 16S ribosomal RNA sequencing, quantitative PCR and liquid chromatography–mass spectrometry.

Results

In total, 28 patients with a mean(s.d.) BMI of 44·2(6·6) kg/m2 were enrolled. These patients had achieved excess weight loss of 53·2(19·0) per cent and showed improvement in metabolic diseases by 6 months after LSG, accompanied by an alteration in the faecal microbial community. The increase in α-diversity and abundance of specific taxa, such as Rikenellaceae and Christensenellaceae, was strongly associated with reduced faecal bile acid levels. These changes had a significant positive association with excess weight loss and metabolic alterations. However, the total number of faecal bacteria was lower in patients before (mean(s.d.) 10·26(0·36) log10 cells per g faeces) and after (10·39(0·29) log10 cells per g faeces) operation than in healthy subjects (10·83(0·27) log10 cells per g faeces).

Conclusion

LSG is associated with a reduction in faecal bile acids and greater abundance of specific bacterial taxa and α-diversity that may contribute to the metabolic changes.

The cooling mechanism of minuscule ribbed surfaces

One reason human beings wear stockings is to warm their legs. Ordinary textile materials are thermally insulative, which prevents body’s heat from dissipating. In contrary to this common sense, it was discovered that some knitted stockings made up of them permanently promote heat release and cool body. This non-intuitive phenomenon emerges when micro-size yarns are knitted to form wide spacing between neighboring yarns. However, the reason why they cool body was unclear because conventional principles of cooling garments cannot account for it. Here, in the basis of fluid-solid conjugate heat transfer analysis of natural convection, we have clarified the cooling mechanism originates from relative relationship between their geometric structure, a periodic alignment of minuscule ribs, and thermal boundary layer. Our novel finding revealed that sufficiently small ribs on the surface are exposed to steep temperature gradient within thermal boundary layer. Thereby, thermal conduction via ribs is enhanced complementarily as they are separated to guide cooler flow onto the surface. Our study provides a general insight into understanding permanent cooling mechanism on micro-size ribbed surfaces in contrast to conventional theory for heat sink, which is applicable not only to other clothes, but also to artificial devices or natural structures.