P1610The genetic background of the disease in a group of patients with severe course of hypertrophic cardiomyopathy

Background

End-stage hypertrophic cardiomyopathy (esHCM) indicates the most progressive form of HCM with progression to left ventricle remodeling and systolic dysfunction and is common indication to heart transplant. It affects 2.4–15.7% of HCM cases and is associated with a poor prognosis (mortality in this group of patients reaches 11%).

Purpose

In this study patients with esHCM were investigated using next generation sequencing in order to examine the genetic causes of the most severe course of the disease. Despite huge amount of data from many studies, a clear genotype-phenotype correlation is still lacking and predictive value of genetic testing is sometimes undermined. However, there is an ongoing need for a prediction factors in HCM patients.

Methods

Fifty seven patients (21 male, 36.8%) with esHCM were genetically investigated with next generation sequencing of a TruSight Cardio panel by Illumina that provides coverage of 174 genes with known associations to cardiac conditions including cardiomyopathies (n=52) or custom panel of 35 cardiomyopathies genes (n=5).

Results

Disease-causing variants where found in 47 probands (82.5%). Thirty-two probands (77.2%) had a single pathogenic or potentially pathogenic mutation in one of the sarcomeric genes: MYBPC3 (13, 22.8%), MYH7 (11, 19.3%), TNNT2 (3, 5.3%), TNNI3 (3, 5.3%), MYL3 (1, 1.8), TPM1 (1, 1.8%). In 13 (22.8%) probands we found a double mutation: in 7 (12.3) both variants sarcomeric (MYBPC3 and TNNT2 with MYH7, MYBPC3 and ACTA1) and in 5 (8.8%) one sarcomeric and the second non-sarcomeric cardiomyopathy variant (BAG3, ILK, PRKAG2, RBM20, SCN5A). In 3 (5.3%) probands we identified mutations or potentially disease-causing variants in genes associated Danon disease (LAMP2), glycogen storage disease of heart (PRKAG2) and double mutation FHL1 + PTPN11 (myopathy/Emery-Dreifuss muscular dystrophy and Noonan syndrome). In 10 (17.5%) patients, genetic examination did not reveal a candidate for disease-causing mutation. Surprisingly, a half of them had documented familial history of the disease. The majority of mutations in MYBPC3 were truncating variants (14/18, 78%). Thirty-three probands (57.9%) had a heart transplant or qualification to the procedure.

Conclusion

Despite a similar background of typical HCM and esHCM and still ambiguous genotype-phenotype correlation, results may indicate that certain mutations (and not genes) may determine a more severe course of the disease. The majority of truncating variants in MYBPC3 gene may suggest their very strong impact on the course of the disease. Also, 3 neighboring variants in TNNT2 gene indicate a hot spot region for esHCM in our population. As expected, in single cases esHCM was related to specific non-sarcomeric genes (LAMP2, PRKAG2, FHL1). 17.5% of unsolved cases suggests that in such cases whole exome/genome sequencing might be needed to recognize the disease-causing mutation, especially when disease is familial.

Acknowledgement/Funding

This work was supported by a grant 2.7/II/17 from the Institute of Cardiology, Warsaw, Poland.

P1743Assessment of quality of care of patients with ST-segment elevation myocardial infarction in Poland

Introduction

2017 ESC Guidelines for the management of ST-elevation myocardial infarction (STEMI) patients have called for the assessment of the quality of care to establish measurable quality indicators in order to ensure that every patient with STEMI receives the best possible care. We investigated the quality indicators of health care services in Poland provided to STEMI patients.

Methods

The Polish Registry of Acute Coronary Syndromes (PL-ACS) is an ongoing, nationwide, multicenter, prospective, observational study of consecutively hospitalized patients with the whole spectrum of ACS in Poland. For the purpose of assessing quality indicators, we included 8,279 patients from the PL-ACS Registry hospitalized with STEMI between January 1 and December 31, 2018.

Results

All emergency medical services (EMS) are equipped with ECG/defibrillators. 408 of 8,279 patients (4.9%) arrived at PCI center by self-transport, 4,791 patients (57.9%) patients arrived at PCI center by direct EMS transport, and 2,900 patients (37.2%) were transferred from non-PCI facilities. Whilst 95.1% of STEMI patients arriving in the first 12 hours received reperfusion therapy, the rates of timely reperfusion were much lower (ranging from 39.4% to 55.0% for various STEMI pathways). 7,807 patients (94.3%) underwent PCI as a mode of primary reperfusion strategy. The median left ventricular ejection fraction (LVEF) was 46% and was assessed before discharge in 86.0% of patients. 489 of 8,279 patients (5.9%) died during hospital stay. Optimal medical therapy is prescribed in 50–85% of patients depending on various clinical settings. Only one in two STEMI patient is enrolled in a cardiac rehabilitation program at discharge. No patient-reported outcomes were recorded in the PL-ACS Registry.

Figure 1

Conclusions

The results of this study identified areas of healthcare systems that require solid improvement. These include prehospital ECG decision strategy, direct transport to PCI center, timely reperfusion, guidelines-based medical therapy (in particular in patients with heart failure), referral to cardiac rehabilitation/secondary prevention programs. More importantly, we recognized an urgent need for the initiation of recording quality indicators associated with patient-reported outcomes.

P1855Multiple and posterior location of moderate paravalvular leaks are associated with worse long-term outcome after successful TAVR

Background

Posterior location of a paravalvular leak (PVL) affects left ventricle fluid dynamics in a more unfavorable way than leaks of the other locations.

Purpose

To assess impact of the PVL location and its grade on subsequent long term mortality after successful TAVR.

Methods

Out of 445 consecutive patients treated between 8/2009 and 10/2017 within the single-center, prospective TAVR Registry, there were 432 pts [median 83.0 years of age, 63.4% female] with device success (97.1%) as per VARC-2. Post-procedural TTE studies done within 7 days post-TAVR were analyzed for PVL location (anterior vs posterior vs medial vs lateral) and grade (none/trace/mild vs moderate). Long-term mortality was assessed.

Results

Median follow-up was 29.3 (15.8–53.1) months with 1-year follow-up in all pts. The 30-day and 1-year mortality rates were 3.0% (n=13) and 13.4% (n=58) with an estimated 4-year mortality of 35.5%. Moderate PVL was reported in 28.5% (n=123) of pts, with 12.0% (n=52) having multiple locations (>1 PVL). Among moderate PVLs (n=184), most were of anterior (33.2%), 29.3% were posterior, 25.2% were lateral, and the least common location was medial (12.0%). Whereas moderate PVL alone was not associated with worse long-term outcome, the 1-year mortality rates tended to be higher for pts with PVL found at multiple or posterior locations (19.2% vs 12.6% among the rest of the subjects, p=0.20, and 18.5% vs 12.7%, p=0.28, respectively). The KM curves suggest mid-term clinical importance of multiple or posterior PVLs (Fig 1A and 1B).

Figure 1

Conclusions

Moderate PVL found in multiple locations or recognized in the posterior location tend to be associated with worse midterm (1–2 years) prognosis after successful TAVR.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Discovery of a kleptoplastic 'dinotom' dinoflagellate and the unique nuclear dynamics of converting kleptoplastids to permanent plastids

A monophyletic group of dinoflagellates, called ‘dinotoms’, are known to possess evolutionarily intermediate plastids derived from diatoms. The diatoms maintain their nuclei, mitochondria, and the endoplasmic reticulum in addition with their plastids, while it has been observed that the host dinoflagellates retain the diatoms permanently by controlling diatom karyokinesis. Previously, we showed that dinotoms have repeatedly replaced their diatoms. Here, we show the process of replacements is at two different evolutionary stages in two closely related dinotoms, Durinskia capensis and D. kwazulunatalensis. We clarify that D. capensis is a kleptoplastic protist keeping its diatoms temporarily, only for two months. On the other hand, D. kwazulunatalensis is able to keep several diatoms permanently and exhibits unique dynamics to maintain the diatom nuclei: the nuclei change their morphologies into a complex string-shape alongside the plastids during interphase and these string-shaped nuclei then condense into multiple round nuclei when the host divides. These dynamics have been observed in other dinotoms that possess permanent diatoms, while they have never been observed in any other eukaryotes. We suggest that the establishment of this unique mechanism might be a critical step for dinotoms to be able to convert kleptoplastids into permanent plastids.

Correction to: Sphingadienes show therapeutic efficacy in neuroblastoma in vitro and in vivo by targeting the AKT signaling pathway

The authors would like to note an omission of disclosure in this paper. Author JDS is cofounder, equity-holder, and consultant of GILTRx Therapeutics.

Toward a multigene phylogeny of the Cymatosiraceae (Bacillariophyta, Mediophyceae) II: morphological and molecular insights into the taxonomy of the forgotten species Campylosira africana and of Extubocellulus, with a description of two new taxa

New molecular and morphological insights are presented on Campylosira africana and two new species, Extubocellulus cupola sp. nov. and Plagiogrammopsis castigatus sp. nov. Species descriptions were based on LM/SEM micrographs and a data set with concatenated sequences of SSU, rbcL and psbC loci constructed from 56 cymatosiroid strains isolated from global geographic locations. Extubocellulus cupola is distinguished by a mesh-like marginal ridge and dome-shaped areolation, and P. castigatus, by a prominent marginal extension at the valve center. Campylosira africana, a species from South Africa described by Professor Malcolm Giffen, has never been documented through LM or SEM, which led some authors to place it in synonymy under Campylosira cymbelliformis. We confirm that C. africana is a distinct species and provide microphotographic documentation and DNA sequences. We present morphological evidence for the well-known cymatosiroid species Extubocellulus spinifer possessing complete pili, and we emend the generic description of Extubocellulus.

Oxidation of methionine residues in human apolipoprotein A-I generates a potent pro-inflammatory molecule

Amyloid deposits of apolipoprotein A-I (apoA-I) and inflammation are common in atherosclerotic arteries. In this study, we investigated the interplay between oxidation of apoA-I methionine residues (Met(O)-ApoA-I), a known amyloidogenic modification of apoA-I, and the inflammatory response of immune cells. Soluble pre-fibrillar Met(O)-ApoA-I, but not apoA-I, induced intracellular accumulation of pro-interleukin (IL)-1β and secretion of the pro-inflammatory cytokines tumor necrosis factor α (TNFα) and IL-6 in mouse bone marrow-derived macrophages (BMDMs) and human primary monocytes. Additionally, secretion of mature IL-1β was also activated in human monocytes. The pro-inflammatory activity of Met(O)-ApoA-I was Toll-like receptor 4 (TLR4)-dependent and CD36-independent and was solely determined by oxidation of apoA-I methionine residues, in particular Met-86 and Met-148. In contrast, amyloid fibrils or reconstituted high-density lipoproteins (HDLs) generated from Met(O)-ApoA-I did not induce cytokine production in BMDMs. Although lipid-free Met(O)-ApoA-I remained functional in extracting lipids from cells and generating HDL, it gained strong pro-inflammatory properties that may aggravate local inflammation in the arteries and atherosclerosis. Our study indicates that oxidation of apoA-I methionine residues produces a potent danger-associated molecular pattern capable of stimulating pro-inflammatory cytokine secretion at levels similar to those induced by known pathogen-associated molecular patterns, such as lipopolysaccharide.

Complete mitochondrial genome of a rare diatom (Bacillariophyta) Proschkinia and its phylogenetic and taxonomic implications

We obtained the complete mitogenome of Proschkinia sp. strain SZCZR1824, a strain belonging to a poorly known diatom genus with no previous molecular data. This genome is 48,863 bp long, with two group I introns in rnl and three group II introns in cox1. Using mitogenomic data, Proschkinia sp. was recovered with Fistulifera solaris, far distant from Navicula and Nitzschia, two genera with which Proschkinia has sometimes been associated based on morphology.

Complete mitogenome of Cerithidea obtusa, the red chut-chut snail from the Cần Giờ Mangrove in Vietnam

We sequenced the complete mitogenome of the red chut-chut snail Cerithidea obtusa, from the Cần Giờ mangrove in Vietnam. The mitogenome is 15,708 bp long. It is colinear with the mitogenomes of other members of the superfamily Cerithioidea, and the maximum-likelihood phylogeny obtained with the cox1, cox2 and cox3 genes of several Caenogastropoda associated all Cerithioidea together inside a strongly supported clade.

Identification of quantitative trait loci affecting production and biochemical traits in a unique Japanese quail resource population

The objective of the current study was to identify QTL associated with body weight, growth rate, egg quality traits, concentration of selected blood plasma, and yolk lipids as well as concentration of selected macro- and microelements, color, pH, basic chemical composition, and drip loss of breast muscle of Japanese quail (Coturnix japonica). Twenty-two meat-type males (line F33) were crossed with twenty-two laying-type females (line S22) to produce a generation of F1 hybrids. The F2 generation was created by mating 44 randomly chosen F1 hybrids, which were full siblings. The birds were individually weighed from the first to eighth week of age. At the age of 19 wk, 2 to 4 eggs were individually collected from each female and an analysis of the egg quality traits was performed. At slaughter, blood and breast muscles were collected from 324 individuals of the resource population. The basic chemical composition, concentration of chosen macro- and microelements, color, pH, and drip loss were determined in the muscle samples. The concentration of chosen lipids was determined in egg yolk and blood plasma. In total, 30 microsatellite markers located on chromosome 1 and 2 were genotyped. QTL mapping including additive and dominance genetic effects revealed 6 loci on chromosome 1 of the Japanese quail affecting the egg number, egg production rate, egg weight, specific gravity, egg shell weight, concentration of Na in breast muscle. In turn, there were 9 loci on chromosome 2 affecting the body weight in the first, fourth, and sixth week of age, growth rate in the second and seventh week of age, specific gravity, concentration of K and Cu in breast muscle, and the levels of triacylglycerols in blood plasma. In this study, QTL with a potential effect on the Na, K, and Cu content in breast muscles in poultry and on specific gravity in the Japanese quail were mapped for the first time.

Sphingadienes show therapeutic efficacy in neuroblastoma in vitro and in vivo by targeting the AKT signaling pathway

Neuroblastoma is a childhood malignancy that accounts for approximately 15% of childhood cancer deaths. Only 20-35% of children with metastatic neuroblastoma survive with standard therapy. Identification of more effective therapies is essential to improving the outcome of children with high-stage disease. Sphingadienes (SD) are growth-inhibitory sphingolipids found in natural sources including soy. They exhibit chemopreventive activity in mouse models of colon cancer, where they mediate cytotoxicity by inhibiting key pro-carcinogenic signaling pathways. In this study, the effect of SD on neuroblastoma was analyzed. Low micromolar concentrations of SD were cytotoxic to transformed and primary neuroblastoma cells independently of N-Myc amplification status. SD induced both caspase-dependent apoptosis and autophagy in neuroblastoma cells. However, only inhibition of caspase-dependent apoptosis protected neuroblastoma cells from SD-mediated cytotoxicity. SD also inhibited AKT activation in neuroblastoma cells as shown by reduced phosphorylated AKT levels. Pre-treatment with insulin attenuated SD-mediated cytotoxicity in vitro. SD-loaded nanoparticles (NP) administered parenterally to immunodeficient mice carrying neuroblastoma xenografts resulted in cytotoxic levels of SD in the circulation and significantly reduced tumor growth compared to vehicle-treated controls. Analysis of tumor extracts demonstrated reduced AKT activation in tumors of mice treated with SD-NP compared to controls treated with empty NP. Our findings indicate SD are novel potential chemotherapeutic agents that promote neuroblastoma cell death and reduce tumorigenicity in vivo.

Mitogenome sequence of a Black Sea isolate of the kinetoplastid Bodo saltans

We obtained the mitogenome sequence of a Black Sea isolate of the kinetoplastid Bodo saltans. This sequence consists of two contigs totaling 24,925 bp and encodes ten protein-coding genes, one conserved ORF and one rRNA gene. Alignment of the Black Sea mitogenome with the limited sequence data currently available in public databases for another strain of B. saltans revealed significant genetic divergence between the two isolates. Maximum likelihood phylogenetic inference clearly resolved the Bodonidae from the Trypanosomatidae.

The complete mitochondrial DNA of the tropical oyster Crassostrea belcheri from the Cần Giò' mangrove in Vietnam

The complete mitochondrial genome of the oyster Crassostrea belcheri from the Cần Giò' mangrove in Vietnam has been sequenced. It consists of a circular DNA molecule of 21020 base pairs (bp), coding for 12 proteins, 20 transfer RNAs, and two ribosomal RNAs. Like the mitogenomes of Crassostrea iredalei and Crassostrea sp. DB1, it contains a non-coding region and two ORFs. The C. belcheri mitogenome provides information that could improve the molecular phylogeny of Asian oysters and be useful to the development of oyster aquaculture in South East Asia.

Methionine oxidized apolipoprotein A-I at the crossroads of HDL biogenesis and amyloid formation

Apolipoprotein A-I (apoA-I) shares with other exchangeable apolipoproteins a high level of structural plasticity. In the lipid-free state, the apolipoprotein amphipathic α-helices interact intra- and intermolecularly, providing structural stabilization by self-association. We have reported that lipid-free apoA-I becomes amyloidogenic upon physiologically relevant (myeloperoxidase-mediated) Met oxidation. In this study, we established that Met oxidation promotes amyloidogenesis by reducing the stability of apoA-I monomers and irreversibly disrupting self-association. The oxidized apoA-I monomers also exhibited increased cellular cholesterol release capacity and stronger association with macrophages, compared to nonoxidized apoA-I. Of physiologic relevance, preformed oxidized apoA-I amyloid fibrils induced amyloid formation in nonoxidized apoA-I. This process was enhanced when self-association of nonoxidized apoA-I was disrupted by thermal treatment. Solid state NMR analysis revealed that aggregates formed by seeded nonoxidized apoA-I were structurally similar to those formed by the oxidized protein, featuring a β-structure-rich amyloid fold alongside α-helices retained from the native state. In atherosclerotic lesions, the conditions that promote apoA-I amyloid formation are readily available: myeloperoxidase, active oxygen species, low pH, and high concentration of lipid-free apoA-I. Our results suggest that even partial Met oxidation of apoA-I can nucleate amyloidogenesis, thus sequestering and inactivating otherwise antiatherogenic and HDL-forming apoA-I.-Witkowski, A., Chan, G. K. L., Boatz, J. C., Li, N. J., Inoue, A. P., Wong, J. C., van der Wel, P. C. A., Cavigiolio, G. Methionine oxidized apolipoprotein A-I at the crossroads of HDL biogenesis and amyloid formation.

Ardissonea crystallina has a type of sexual reproduction that is unusual for centric diatoms

Molecular phylogenetic analyses place Ardissonea crystallina (C. Agardh) Grunow and all Toxariids among the bi- and multipolar centric diatoms, almost always recovered as a derived lineage sister to Lampriscus. In all centrics where sexual reproduction has been documented, oogamy, with larger immobile eggs and smaller flagellated sperm has been observed. We were able to initiate both homothallic and heterothallic reproduction in A. crystallina. The heterothallic reproduction turned out to be non-oogamous; gametes were more or less equal in size but no flagellated cells were detected. At the same time, two mating types (“male” and “female”) were recognized by the distinct morphology and behaviour of the gametes. While no flagella were observed, periodically thin cytoplasmic projections arose on the surface of the “male” gametes. These projections similar to those found in some pennate diatoms facilitated contact with the “female” cells. In each gametangial cell, regardless of the mating type, only one gamete was formed. Thus, the Toxariids may represent a unique evolutionary group, at least in respect to their reproductive biology. The hypothesis discussed is that non-oogamous mode of reproduction could have evolved in Ardissonea (and possibly in other Toxariids) independently of the pennate lineage of diatoms.