Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

THU0104 THE GUT MICROBIOTA AND ITS RELEVANCE TO PERIPHERAL T REGULATORY CELLS AND T HELPER 17 IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is a common autoimmune disorder with joint destruction and synovial inflammation characterized by abnormal immune responses to autoantigens. Our previous studies have demonstrated that impaired peripheral lymphocytes especially insufficiency of regulatory T cells (Tregs) played an important role in pathogenesis of RA1 2. Interestingly, the dysbiosis of gut microbiota triggers several types of autoimmune diseases through the imbalance of T lymphocyte subsets3. However, the detailed gut microbiota of RA patients and its correlation with Tregs and helper T cells 17 (Th17) are unclear up until now.

Objectives:

To compare the difference of gut microbiota between RA and healthy controls (HCs), and to investigate the relevance of gut microbiota with circulating Tregs and Th17 in patients with RA.

Methods:

From December 2018 to August 2019, a total of 205 diagnosed patients with RA and 199 age and sex-matched HCs were enrolled in this study. Stool of Every participant was collected for bacterial DNA extraction and 16S ribosomal RNA (rRNA) gene sequencing. The absolute numbers of Tregs and Th17 in PB of these individuals were measured by Flow Cytometer (FCM) combined with standard absolute counting beads. Data were expressed as mean ± standard deviation to the distribution. Independent-samples T test and Spearman rank correlation test. P value <0.05 were considered statistically significant.

Results:

Patients with RA had a significantly difference of diversity and abundance of intestinal microbiota compared with those of HCs (P< 0.05). Detailedly, the abundance of Proteobacteria was significantly increased in RA patients (P< 0.05), and the abundance of Firmicutes, Fusobacteria and Verrucomicrobia were significantly reduced (P<0.05) at the level of Phylum (Figure 1). At the genus level, in the RA group, the abundance of Escherichia, Ruminococcus2 and Clostridium_sensu_stricto were significantly increased (P< 0.05), but the abundance of Lachnospiracea_incertae_sedis, Prevotella, Clostridium_XlVa, Roseburia, Dialister, Blautia, Megamonas and Gemmiger were significantly lower than the healthy controls (P< 0.05) (Figure 2). Moreover, Blautia, Anaerostipes and Ruminococcus2 have negative correlation with the absolute number of Tregs, and Cloacibacillus and Streptophyta have positive correlation with the absolute number of Th17.

Conclusion:

Patients with RA had a dysbiosis of the gut microbiota in both diversity and abundance, which is closely related to the impaired peripheral lymphocyte subsets, that may be related to the pathogenesis of RA, which might provide a new idea for RA treatment.

References:

[1]Wen HY, Wang J, Zhang SX, et al. Low-Dose Sirolimus Immunoregulation Therapy in Patients with Active Rheumatoid Arthritis: A 24-Week Follow-Up of the Randomized, Open-Label, Parallel-Controlled Trial.J Immunol Res2019;2019:7684352. doi: 10.1155/2019/7684352 [published Online First: 2019/11/30]

[2]Niu HQ, Li ZH, Zhao WP, et al. Sirolimus selectively increases circulating Treg cell numbers and restores the Th17/Treg balance in rheumatoid arthritis patients with low disease activity or in DAS28 remission who previously received conventional disease-modifying anti-rheumatic drugs.Clin Exp Rheumatol2019 [published Online First: 2019/05/11]

[3]Lee N, Kim WU. Microbiota in T-cell homeostasis and inflammatory diseases.Exp Mol Med2017;49(5):e340. doi: 10.1038/emm.2017.36 [published Online First: 2017/05/27]

Acknowledgments:

None

Disclosure of Interests:

None declared

AB0490 CIRCULATING REGULATORY T CELLS WERE ABSOLUTELY DECREASED IN TAKAYASU’S ARTERITIS PATIENTS

Background:

Takayasu arteritis (TA) refers to chronic progressive non-specific inflammation that involves the aorta and its main branches, causing stenosis and occlusion of arteries in different parts, and ischemic manifestations in the corresponding parts. A variety of immune dysfunctions are involved in the occurrence and development of TA(1)Recent studies have shown that Th17/Treg imbalance plays an important role in the pathogenesis of Takayasu’s arteritis, in which T help 17 cells (Th17) cells are up-regulated in TA patients(2). Th17 cells are closely related to Treg cells during differentiation. There are few studies on the expression level of CD4+CD25+FOX3+T lymphocyte (Treg) cells. This study aims to study the clinical significance of Treg cell expression in peripheral blood of patients with Takayasu’s arteritis.

Objectives:

To analyze the levels of circulating lymphocyte subsets and serum cytokines in patients with takayasu arteritis (TA), and explore the relationship between their changes and TA disease activity.

Methods:

A total of 46 TA patients and 43 gender-age-matched healthy controls were enrolled. According to the NIH standard, 30 patients were in active disease. Flow cytometry was used to detect the absolute numbers and ratios of Th1, Th2, Th17 and Treg cells in peripheral blood of all subjects. Magnetic bead-based multiplex immunoassay was used to detect cytokines and statistical analysis was performed.

Results:

Compared with the healthy controls, the absolute number and proportion of peripheral Treg cells of TA patients significantly decreased while those of Th17 cells increased significantly, leading to the increased ratio of Th17 / Treg. Compared with the inactive group, the TA active group had significantly increased IL-6 and TNF-α, and there was no significant difference in the expression of Th17 cells and Treg cells.

Conclusion:

In peripheral blood of TA patients, Treg cells decreased, while Th17 cells increased as compared with healthay controls, leading to an imbalance between Th17 and Treg cells. The levels of IL-6 and TNF-α were related to disease activity.

References:

[1]Russo, R.A.G. and M.M. Katsicas, Takayasu Arteritis. Front Pediatr, 2018. 6: p. 265.

[2]Misra, D.P., S. Chaurasia, and R. Misra. Increased Circulating Th17 Cells, Serum IL-17A, and IL-23 in Takayasu Arteritis. Autoimmune Dis, 2016. 2016: p. 7841718.

Figure 1.

Characteristics of the absolute numbers and proportions of Th1cells,Th2cells,Th17 cells and CD4Treg cells in the PB of patients with TA.(A-C)The levels of Th17 cells and the ratio of Th1/Treg,Th2/Treg,Th17/Treg in PB were significantly increased in patients with TA (n=46). The absolute number and the proportion of CD4Treg cells were significantly decreased in TA(n=46). (D-F) The absolute number of Th2 cells and ratio of Th2/Treg in PB were significantly decreased in active patients with TA (n=30).Neither the absolute number nor proporation of Th1, Th17 and Treg cells was altered significantly between active TA patients(n=30) and inactive TA patients(n=16).*P<0.05; **P<0.001. P<0.05 was considered statistically significant.TA,takayasu arteritis;PB peripheral blood;Tregs, regulatory Tcells.

Figure 2.

Characteristics of serum concentrations of cytokine (including IL-6, IL-10, IL-17 and TNF-α) between active TA patients(n=30) and inactive TA patients(n=16).(A,D)In terms of cytokines, the concentration of IL-6 and TNF-α was significantly up-regulated,(B,C)but no significant changes in IL-10, and IL-17 were found.*P<0.05; **P<0.001. P < 0.05 was considered statistically significant.

Disclosure of Interests:

None declared

SAT0181 ALTERATIONS OF PERIPHERAL LYMPHOCYTE SUBSETS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND THEIR CHANGES AFTER OUR NEW IMMUNOREGULATORY COMBINATION THERAPIES

Background:

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by abnormal activation of circulating lymphocytes and overproduction of autoantibodies1. Breakdown of self-tolerance is considered as a critical cause in the development of SLE2. However, the quantitative changes of lymphocyte subsets in SLE are unclear. Since low-dose IL-2 and several drugs have been used to promote the proliferation of regulatory T cells (Tregs)3, we developed immunoregulatory therapies using these drugs to rebalance effector T cells with Tregs and test whether they are benefit to remission disease activity of SLE.

Objectives:

To observe the different levels of peripheral lymphocyte subsets at the first laboratory examination of SLE patients with those of healthy controls (HCs) and to evaluate the effect of immunoregulatory combination therapies on levels of lymphocyte subsets in patients with SLE.

Methods:

From September 2014 to December 2019, a total of 985 diagnosed patients with SLE (878 females, 107 males, mean age 42.99±13.37 years) and 206 healthy adults were enrolled in this retrospective cross-sectional study. And 795 patients with SLE (711 females and 84 males, mean age 38.26±15.242 years) were received the immunomodulatory drugs (IMiDs) such as low-dose interleukin-2, rapamycin, metformin, retinoic acid, coenzymes Q10 or other immunomodulatory treatments. The absolute numbers of T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and CD4+CD25+Foxp3+T regulatory cells (Tregs) in peripheral blood (PB) of these individuals were measured by Flow Cytometer (FCM) combined with standard absolute counting beads.

Results:

As compared with those of HCs, patients with SLE had lower absolute numbers of total T, NK, and CD4+T but higher proportions of all lymphocyte subpopulations except NK, CD4+T cells(P< 0.001) (Figure 1 A, C). Notably, the absolute numbers and proportions of Tregs as well as Th1 in CD4+T subsets were decreased (P<0.05) (Figure 1 B, D). Further, there was a significant increase in the ratio of Teffs/Tregs such as Th1/Tregs, Th2/Tregs and Th17/Tregs (P<0.05) (Figure 1 E). After receiving immunoregulatory combination therapies, the absolute numbers and proportions of T, NK, CD4+T, and CD8+T were increased, while the proportion of B cells was decreased (Figure 2 A, C); the absolute numbers of most CD4+T subsets as well as the proportions of only Th1 and Tregs were significantly increased (P< 0.001) (Figure 2 B, D). The ratios of Th1/Th2 and Th1/Tregs increased while that of Th17/Tregs and Th2/Tregs decreased (P<0.01) (Figure 2 E).

Conclusion:

Quantitative and functional alterations of peripheral lymphocyte subsets, especially reduced Tregs, play crucial roles in the pathogenesis of the patients. Immunoregulatory combination therapies mainly promote the proliferation and functional recovery of Tregs to rebalance pro- and anti-inflammatory T cells in patients with SLE for patients’ symptoms remission.

References:

[1]Sharabi A, Tsokos GC. T cell metabolism: new insights in systemic lupus erythematosus pathogenesis and therapy. Nat Rev Rheumatol 2020 doi: 10.1038/s41584-019-0356-x [published Online First: 2020/01/18]

[2]Durcan L, O’Dwyer T, Petri M. Management strategies and future directions for systemic lupus erythematosus in adults. Lancet 2019;393(10188):2332-43. doi: 10.1016/S0140-6736(19)30237-5 [published Online First: 2019/06/11]

[3]Spolski R, Li P, Leonard WJ. Biology and regulation of IL-2: from molecular mechanisms to human therapy. Nat Rev Immunol 2018;18(10):648-59. doi: 10.1038/s41577-018-0046-y [published Online First: 2018/08/10]

Acknowledgments :

None.

Disclosure of Interests:

None declared

AB0126 EXPRESSION CHARACTERISTICS OF ADENOSINE DEAMINASES ACTING ON RNA-1 IN SYSTEMIC LUPUS ERYTHEMATOSUS AND ITS CORRELATION WITH SERUM IFN-Α

Background:

SLE is a multisystem autoimmune disease characterized by the production of multiple autoantibodies and loss of immunity against autoantigens in various tissues. SLE patients have significantly elevated RNA editing levels and the potential to produce new autoantigens.1ADAR1 is an RNA A-I editing enzyme that converts adenine to hypoxanthine and contributes to SLE pathogenesis.2

Objectives:

Dama demonstrated the upregulation of ADAR1p150 expression in SLE T cells, B cells, PBMCs, and NK cells;3however, the following issues were not reported in detail: 1. specific alterations in ADAR1 expression in PBMCs collected from SLE patients with varying degrees of the disease and its correlation with serum IFN-α levels; 2. association between ADAR1 and clinical indicators; and 3. ADAR1 expression in renal tissue of LN patients. Our study therefore aimed to elucidate the abovementioned points.

Methods:

We used qRT-PCR to determine ADAR1 expression levels in PBMCs and renal tissues of controls and SLE patients. We also conducted immunohistochemical studies to detect positive ADAR1 expression rate in renal cells of controls and LN patients.

Results:

ADAR1 expression was higher in PBMCs of SLE patients than in those of controls and was positively correlated with SLEDAI. When serum IFN-α levels in SLE patients decreased <260.0 pg/mL, ADAR1 expression in PBMCs increased with the increase in IFN-α concentration, and serum IFN-α may regulate ADAR1 level in PBMC in SLE patients, which may require the participation of serum IgG antibody and related immune complex. However, there was no significant difference between the expression in renal tissues in all patients.

Conclusion:

There was a certain correlation between ADAR1 expression and serum IFN-α levels in PBMCs of SLE patients.

References:

[1]Roth SH, Danan-Gotthold M, Ben-Izhak M, et al. Increased RNA Editing May Provide a Source for Autoantigens in Systemic Lupus Erythematosus.Cell Rep2018; 23: 50-57.

[2]Hogg M, Paro S, Keegan LP and O’Connell MA. RNA editing by mammalian ADARs.Adv Genet2011; 73: 87-120.

[3]Laxminarayana D, Khan IU, O’Rourke KS and Giri B. Induction of 150-kDa adenosine deaminase that acts on RNA (ADAR)-1 gene expression in normal T lymphocytes by anti-CD3-epsilon and anti-CD28.Immunology2007; 122: 623-633.

Figure 1.

Analysis of ADAR1 expression levels. a. The ADAR1 expression in PBMCs was higher in SLE patients (n=30) than in healthy controls (n = 30) (p<0.05). b. SLE patients were divided into three groups: NSLE (SLEDAI 0–4, n = 6), LSLE (SLEDAI 5–9, n = 12), and SSLE (SLEDAI ≥10, n = 12) according to SLEDAI score. c. Based on the effect of the disease on the kidneys, the patients were divided into the SLE#group (#:SLE patient group without the kidney involved, n = 17) and LN group (lupus nephritis group, n = 13). d. There was no significant difference observed between the renal tissues of controls (n = 5) and LN patients (n = 10) (p>0.05).

Figure 2.

a. Immunohistochemical image of renal tissues from the two groups (200×). b. There was no significant difference in the ADAR1 cell positive rate between controls (n = 5), LN patients(n = 20), and different pathological subgroups (class III, n = 5; class IV, n = 5; class V, n = 5; class III+IV, n = 5) (p>0.05). c. The positive expression rate of ADAR1 in renal tubular cells was higher than that in glomerular cells both in the two groups (p<0.05).

Figure 3.

a. Correlation between ADAR1 and serum IFN-α levels in PBMCs of SLE patients. b. Correlation between ADAR1p150 and serum IFN-α levels in PBMCs of SLE patients.

Figure 4.

In vitroPBMCs assay. a. Western blot (WB) analysis of ADAR1p150 and ADAR1p110 in PBMCs using different concentrations of IFN-α, combined with 1.5 mg/mL IgG purified from the serum of SLE patients or without it, and cultured for 24 hours. b. The line graph depicts the trend of ADAR1, ADAR1p150, and ADAR1p110 expression with increase in IFN-α concentrationin vitroPBMCs co-cultured with serum IgG from SLE patients.

Disclosure of Interests:

None declared

SAT0357 LEVELS OF PERIPHERAL LYMPHOCYTE SUBPOPULATIONS IN PATIENTS WITH ANKYLOSING SPONDYLITIS AND THEIR CHANGES AFTER RECEIVING IMMUNOREGULATORY COMBINATION THERAPIES

Background:

Ankylosing spondylitis is an immune-mediated inflammatory disease involving of the axial skeleton, joints, and entheses1. Although the homeostatic balance of effector T cells (Teffs) and regulatory T cells (Tregs) is considered to play an important role in the pathogenesis of ankylosing spondylitis(AS)2, it is unclear whether the levels of peripheral blood lymphocyte subpopulations in patients with ankylosing spondylitis are abnormal or not.

Objectives:

To explore the differences of lymphocyte subpopulations of peripheral blood (PB) between AS patients and healthy controls (HCs), and further evaluate the therapeutic effect of immunoregulatory drugs on the lymphocyte subpopulations.

Methods:

Total 1141 patients with AS and 206 healthy individuals were enrolled in the study and donated their blood to measure the levels of T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and Tregs by flow cytometry combined with standard absolute counting beads. And 456 patients received immunoregulatory combination treatments which includes low-dose interleukin-2, rapamycin, metformin, retinoic acid etc. and donated their PB after the therapies. Data were expressed as mean ± standard deviation to the distribution. Independent-samples T test and paired-samples T test were applied.Pvalue <0.05 were considered statistically significant.

Results:

Compared with HCs, AS patients had a lower absolute number of Tregs but higher numbers of peripheral T, B, CD4+T, CD8+T and Th17 cells (P<0.05). Further, there was a significant increase in the percentage of B, CD4+T and the ratios of Teffs/Tregs such as Th1/Tregs, Th2/Tregs and Th17/Tregs compared with HCs (P<0.05)(Figure 1). Although, after receiving the immunoregulatory combination treatments, the absolute numbers of various peripheral lymphocyte subpopulations such as T, B, NK, CD4+T, CD8+T, Th1, Th17 and Tregs and the percentage of Tregs, Th1 and CD8+T significantly increased (P<0.05), the ratios of Th2/Tregs significantly decreased (P<0.05)(Figure 2), suggesting a rebalance of immune systems.

Conclusion:

The insufficiency of Tregs may involve in pathogenesis of AS. Immunoregulatory combination therapies could promote the proliferation of Tregs as well as other lymphocytes to some degree, which may be a new target for AS treatment.

References:

[1]van der Heijde D, Song IH, Pangan AL, et al. Efficacy and safety of upadacitinib in patients with active ankylosing spondylitis (SELECT-AXIS 1): a multicentre, randomised, double-blind, placebo-controlled, phase 2/3 trial. Lancet 2019;394(10214):2108-17. doi: 10.1016/S0140-6736(19)32534-6 [published Online First: 2019/11/17]

[2]Xu D, Fan J, Chen Q, et al. OP0028 Low dose IL-2 therapy can recovery TH17/TREG cell balance in patients with ankylosing spondylitis. Oral Presentations, 2017:63.1-63.

Disclosure of Interests:

None declared

THU0317 EXPANDED DOUBLE NEGATIVE T CELLS IN PATIENTS WITH ANTINEUTROPHIL CYTOPLASMIC AUTOANTIBODY ASSOCIATED VASCULITIS PRODUCE CYTOKINES AND INDUCE RENAL DAMAGE

Background:

Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) are recognized as a small-vessel vasculitis of autoimmune origin characterized by inflammation and the presence of circulating ANCA with the major target antigens identified as proteinase 3 (PR3) and myeloperoxidase (MPO). A very minor T cell subpopulation which lacks both CD4 and CD8 markers, known as CD4-CD8- double negative (DN) represents less than 5% of the total peripheral blood (PB) T cells in healthy individuals and plays a vital role in the pathogenesis of autoimmune disorders.

Objectives:

To investigate whether DN T cells and cytokine (IFN-γ, IL-4 and IL-17) are involved in the pathogenesis of AAV and to verify whether DN T cells are associated with kidney damage.

Methods:

Nineteen healthy controls (HCs) and 40 active patients with AAV were enrolled in this study. Peripheral blood mononuclear cells from AAV patients and controls were isolated by magnetic bead separation, and phenotypic characterisation of mononuclear cells were determined via flow cytometry. The diagnostic value for DN T subsets was evaluated by the areas under the receiver operating characteristic curves (AUC).

Results:

The percentage (p<0.001) and absolute numbers (p=0.028) of DN T cells were found to be significantly higher in patients with AAV as compared with controls. Less the percentage of DN T cells from patients with AAV were of CD62L+CD45RO+ (p=0.024) phenotype than was found in HCs, and the percentage of CD62L-CD45RO- (p=0.043) was higher. The percentage of DN T cells expressing IFN-γ (p=0.032), IL-4 (p=0.039) and IL-17 (p=0.042) increased in AAV patients. In AAV with renal damage, the percentage of DN T cells was expanded (p=0.016) than those patients without renal damage. After conventional methylprednisolone treatment, the percentage of DN T cells in patients with remission was significantly lower than those active patients (p=0.028). The ROC curve analysis showed that the ratios of CD4+ T cells to DN T cells and CD8+ T cells to DN T cells were useful in diagnosing AAV patients. The AUCs were 0.967 (95% confidence interval [CI] 0.922-1.000; p<0.001) and 0.879 (95%CI 0.789-0.969; p<0.001), respectively.

Conclusion:

DN T cells represent a inflammatory T cell subset that produces inflammatory cytokines (IFN-γ, IL-4 and IL-17) in AAV patients. Suppression of DN T cells may be new specific treatment in autoimmune disorder such as AAV.

References:

[1]Geetha D, Jefferson JA. ANCA-Associated Vasculitis: Core Curriculum 2020. Am J Kidney Dis. 2019 Jul; pii: S0272-6386(19)30826-1.

[2]Tedesco M, Gallieni M, Pellegata F. Update on ANCA-associated vasculitis: from biomarkers to therapy.J Nephrol. 2019 Jul 12. doi: 10.1007/s40620-019-00628-9. [Epub ahead of print].

[3]Nicholas Crispe I. CD4/CD8-negative T cells with ab antigen receptors. Curr Opin Immunol 1994;6:438-441.

[4]Dean GS, Anand A, Blofeld A, et al. Characterization of CD3+ CD4- CD8- (double negative) T cells in patients with systemic lupus erythematosus: production of IL-4. Lupus 2002;11:501-507.

[5]Liu MF, Yang CY, Chao SC, et al. Distribution of Double-Negative (CD4-CD8-, DN) T Subsets in Blood and Synovial Fluid from Patients with Rheumatoid Arthritis[J]. Clinical Rheumatology, 1999, 18(3):227-231.

[6]Alunno A, Bistoni O, Bartoloni E, et al. IL-17-producing CD4-CD8- T cells are expanded in the peripheral blood, infiltrate salivary glands and are resistant to corticosteroids in patients with primary Sjogren’s syndrome [J]. Annals of the Rheumatic Diseases, 2013, 72(2):286-292.

Disclosure of Interests:

None declared

SAT0330 NEW IMMUNOMODULATORY COMBINATION THERAPIES IN PATIENTS WITH SYSTEMIC SCLEROSIS: A RETROSPECTIVE CROSS-SECTIONAL STUDY

Background:

Systemic sclerosis (scleroderma, SSc) is a rare complex connective tissue disease associated with high mortality and high morbidity1. Active SSc are typically treated with immunosuppressants, which may create a variety of severe side-effects, especially for long-term treatment2. As the pathogenesis of SSc is still a matter of debate, growing evidences have focused on the immune disorders3. However, the quantitative status of lymphocyte subsets in SSc patients are unclear and effects of immunomodulatory combination therapies (avoiding side-effects of conventional therapy) on the lymphocyte subsets are unknown.

Objectives:

To investigate the quantitative status of peripheral lymphocyte subpopulations and CD4+T subsets in SSc patients for the exploration of SSc pathogenesis and evaluate the effects of new immunomodulatory combination therapies on those cells.

Methods:

From July 2014 to December 2019, total 166 patients with SSc and 206 healthy controls (HCs) were enrolled in this study, in which, 79 follow-up patients received immunomodulatory drugs (IMiDs) such as low-dose interleukin-2, rapamycin, metformin, retinoic acid and coenzyme Q10. The absolute numbers of T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and Tregs in peripheral blood of these subjects were detected by flow cytometry combined with standard absolute counting beads.

Results:

Patients with SSc had lower absolute counts of total T, NK, Th2, Th17 and Tregs as compared with those of HCs (P<0.05) (Figure 1). After immunomodulatory combination treatments, there were increases in a various of peripheral lymphocyte subsets such as T, B and CD8+T (P< 0.05). Moreover, the increased level of Tregs was much more dramatical than those of other lymphocyte subsets, resulting in the decrease ratios of Teffs/Tregs such as Th1/Tregs and Th2/Tregs and rebuilding immunologic equilibrium (Figure 2).

Conclusion:

This cross-sectional study clarified the abnormal status of lymphocyte subsets in SSc patients, suggesting lymphocyte subsets, especially Tregs, might be relevant and play a crucial role in the pathogenesis of SSc, thus providing a potential therapeutic target for SSc patients. Immunomodulatory combination therapies effectively increase the level of Tregs as well as other lymphocytes to some degree and maintain the immunologic equilibrium, which may help for SSc patients’ symptom remission.

References:

[1]Denton CP, Khanna D. Systemic sclerosis. Lancet 2017;390(10103):1685-99. doi: 10.1016/S0140-6736(17)30933-9 [published Online First: 2017/04/18]

[2]Winthrop KL, Weinblatt ME, Bathon J, et al. Unmet need in rheumatology: reports from the Targeted Therapies meeting 2019. Ann Rheum Dis 2020;79(1):88-93. doi: 10.1136/annrheumdis-2019-216151 [published Online First: 2019/10/31]

[3]Skaug B, Khanna D, Swindell WR, et al. Global skin gene expression analysis of early diffuse cutaneous systemic sclerosis shows a prominent innate and adaptive inflammatory profile. Ann Rheum Dis 2019 doi: 10.1136/annrheumdis-2019-215894 [published Online First: 2019/11/27]

Acknowledgments :

None.

Disclosure of Interests:

None declared

AB0587 IMMUNOMODULATORY COMBINATION THERAPIES IN PATIENTS WITH DERMATOMYOSITIS /POLYMYOSITIS: A RETROSPECTIVE CROSS-SECTIONAL STUDY

Background:

Dermatomyositis (DM)/Polymyositis(PM) is an autoimmune disease that typically involve the striated muscle with a variable involvement of the skin and other organs1. Lymphocyte subsets disorders may contribute to the pathogenesis of DM/PM. It has been discovered that immunomodulatory drugs such as low-dose interleukin (IL)−2, rapamycin can help to regulate the lymphocyte subsets and control the disease and improve the prognosis2-4.

Objectives:

To investigate the levels of peripheral lymphocyte and CD4+T subsets of DM/PM patients and further to observe the regulatory effect of modulatory therapy on these cells in PM/DM at a relative large-sample size.

Methods:

Total 450 patients with PM/DM and 206 healthy controls (HCs) were enrolled in this study. Among these participations, 320 patients received immunomodulatory combination therapies (immunomodulatory drugs include low-dose interleukin-2, rapamycin, metformin, retinoic acid etc). The absolute numbers of T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and Tregs in peripheral blood of these individuals were detected by flow cytometry combined with standard absolute counting beads before and after the treatment.

Results:

Patients with DM/PM had lower levels of total T, CD4+T, CD8+T, Th2, Th17, NK, Th1 and Tregs compared with those of HCs (P < 0.05). After immunomodulatory combination treatments, there was a dramatically increases various peripheral lymphocyte subsets such as T, B, CD4+T, CD8+T, NK, Th1, Th17 and Tregs (P < 0.05). Moreover, the increase in Tregs was much more than that in effector T cells (Teffs), resulting a rebalance of immune systems.

Conclusion:

The unbalance of lymphocyte cells should contribute to the pathogenesis of DM/PM patients. Immunomodulatory combination therapies could promote the proliferation and functional recovery of Tregs in patients and might help to alleviate disease activity.

References:

[1]Herbelet S, De Bleecker JL. Immune checkpoint failures in inflammatory myopathies: An overview. Autoimmunity reviews 2018;17(8):746-54. doi: 10.1016/j.autrev.2018.01.026 [published Online First: 2018/06/10]

[2]Feng M, Guo H, Zhang C, et al. Absolute reduction of regulatory T cells and regulatory effect of short-term and low-dose IL-2 in polymyositis or dermatomyositis. International immunopharmacology 2019;77:105912. doi: 10.1016/j.intimp.2019.105912 [published Online First: 2019/11/02]

[3]Zhang SX, Wang J, Sun HH, et al. Circulating regulatory T cells were absolutely decreased in dermatomyositis/polymyositis patients and restored by low-dose IL-2. Annals of the rheumatic diseases 2019 doi: 10.1136/annrheumdis-2019-216246 [published Online First: 2019/10/16]

[4]Zhao C, Chu Y, Liang Z, et al. Low dose of IL-2 combined with rapamycin restores and maintains the long-term balance of Th17/Treg cells in refractory SLE patients. BMC immunology 2019;20(1):32. doi: 10.1186/s12865-019-0305-0 [published Online First: 2019/09/06]

Acknowledgments:

None

Disclosure of Interests:

None declared

FRI0261 DIFFERENTIAL EXPRESSION OF PERIPHERAL CD4+ T CELLS IN PATIENTS WITH SYSTEMIC SCLEROSIS AND MIXED CONNECTIVE TISSUE DISEASE

Background:

The CD4+T cell subsets plays an important role in its pathogenesis, and its new research are constantly being published, but its specific changes between SSc and MCTD are still unclear.

Objectives:

The aim of the present study was to explore the absolute numbers of CD4+T subsets in peripheral blood(PB) of patients with SSc and MCTD using our modified flow cryometric method and investigate the role in the pathogenesis of both.

Methods:

The PB samples from 54 patients with SSc, 51 patients with MCTD as well as 30 healthy control subjects were analyzed for lymphocyte subsets using flow cytometry. Of these patients, 19 had pulmonary involvement, including 9 patients with SSc and 10 patients with MCTD. Using directly the percentages from flow cytometry combined with internal standard beads calculated absolute number of peripheral lymphocyte subsets from the subjects in each group.

Results:

Although there were some changes among CD4+T cell subsets in PB from these SSc patients and MCTD patients, the major alteration was the reductions of Treg cells. Compared with the normal controls, the absolute number of CD4+CD25+FOXP3+Treg cells were significantly decreased in SSc patients and MCTD patients, and the absolute number of Th1 cells in MCTD patients is also significantly reduced. Notably, the absolute numbers of Th17 and Th2 cells were not different from those of normal controls, but the ratios of Th17/Treg in SSc patients and MCTD patients were significantly higher, causing by insufficient number of Treg cells (Fig 1). In addition, in patients with pulmonary involvement, we found that the absolute number of Treg cells was significantly reduced in patients with MCTD, while the absolute number of Th2 cells and Th17 cells was significantly reduced in patients with SSc(Fig 2).

Fig 1.

Comparison of the levels of CD4+T lymphocyte subsets in SSc patients, MCTD patients and healthy controls: (A) The absolute number of peripheral Th1 cells in patients with MCTD was significantly reduced; (B and C) There was no significant difference in the absolute number of Th2 cells in peripheral blood of different subjects; (D and E) The ratio of Th17/Treg cells in PB of patients with SSc and MCTD were significantly higher.*P< 0.05; **P< 0.01; ***P< 0.001.

Conclusion:

The number of peripheral Treg cells in patients with SSc and MCTD was significantly reduced, suggesting that that SSc and MCTD progression is associated with the imbalances between pro-inflammation cells to anti-inflammation Treg cells. In addition, we also found that the decrease in peripheral numbers of Treg cells may contribute to the development of MCTD-associated lung disease, whereas in SSc patients who had lung involvement, the reduce in peripheral number of Th17 cells may result in a severe imbalance of Th17/Treg cells, thereby promoting disease progression.

Fig 2.

Comparison of the levels of CD4+T lymphocyte subsets in patients who had pulmonary involvement and healthy controls: (A) There was no significant difference in the absolute number of Th1 cells in peripheral blood of different subjects; (B and C) The absolute number of peripheral Th2 cells and Th17 cells in patients with SSc were significantly reduced; (D and E) The ratio of Th17/Treg cells in PB of patients with MCTD were higher.*P< 0.05; **P< 0.01; ***P< 0.001.

References:

[1]Liu M, Wu W, Sun X, et al. New insights into CD4(+) T cell abnormalities in systemic sclerosis. Cytokine Growth Factor Rev. 2016 Apr; 28:31-6. doi: 10.1016/j.cytogfr.2015.12.002.

Acknowledgments:

None

Disclosure of Interests:

None declared

THU0243 HSA_CIRC_0123190 FUNCTIONS AS A COMPETITIVE ENDOGENOUS RNA TO REGULATE APLNR EXPRESSION BY SPONGING HSA-MIR-483-3P IN LUPUS NEPHRITIS

Background:

Lupus nephritis (LN) is one of the most severe complications of systemic lupus erythematosus (SLE). Circular RNAs(circRNAs) can act as competitive endogenous RNAs (ceRNAs) to regulate gene transcription, which is involved in mechanism of many diseases, such as, autoimmunity diseases. However, the role of circRNA in lupus nephritis has been rarely reported.

Objectives:

In this study, we aim to investigate the clinical value of circRNAs and explore the mechanism of circRNA involvement in the pathogenesis of LN.

Methods:

Renal tissues from three untreated LN patients and three normal controls (NCs) were used to identify differently expressed circRNAs by RNA sequencing (RNA-seq). Validated assays were used by quantitative reverse transcription polymerase chain reaction (qRT-PCR). Correlation analysis and receiver operating characteristic (ROC) curve were used to reveal the clinical value of selected circRNA, miRNA and mRNA. The interactions between circRNA and miRNA, or miRNA and mRNA were further determined by luciferase reporter assay. The degrees of renal fibrosis between the two groups were compared by Masson-trichome staining and immunohistochemistry staining.

Results:

159 circRNAs were significantly dysregulated in LN patients compared with NC group. The expression of hsa_circ_0123190 was significantly decreased in renal tissues of patients with LN (p=0.014), as same as the sequencing results. The area under the ROC curve of hsa_circ_0123190 in renal tissues was 0.820. Bio-informatic analysis and luciferase reporter assay illustrated that hsa_circ_0123190 can act as a sponge for hsa-miR-483-3p which was also validated to interact with APLNR mRNA. APLNR mRNA expression was positively related with chronicity index (CI) of LN (R2=0.452,p=0.033). Finally, the factors of renal fibrosis, especially TGF-β (p=0.018), were more pronounced in the LN group.

Conclusion:

Hsa_circ_0123190 could function as a ceRNA to regulate APLNR expression involved in renal fibrosis by sponging hsa-miR-483-3p in LN

References:

[1]Aljaberi N, Bennett M, Brunner HI, Devarajan P. Proteomic profiling of urine: implications for lupus nephritis. Expert review of proteomics. 2019;16(4):303-13.

[2]Zheng ZH, Zhang LJ, Liu WX, Lei YS, Xing GL, Zhang JJ, et al. Predictors of survival in Chinese patients with lupus nephritis. Lupus. 2012;21(10):1049-56.

[3]Chen LL. The biogenesis and emerging roles of circular RNAs. Nature reviews Molecular cell biology. 2016;17(4):205-11.

[4]Mahmoudi E, Cairns MJ. Circular RNAs are temporospatially regulated throughout development and ageing in the rat. Scientific reports. 2019;9(1):2564.

[5]Liang D, Wilusz JE. Short intronic repeat sequences facilitate circular RNA production. Genes & development. 2014;28(20):2233-47.

[6]Tan WL, Lim BT, Anene-Nzelu CG, Ackers-Johnson M, Dashi A, See K, et al. A landscape of circular RNA expression in the human heart. Cardiovascular research. 2017;113(3):298-309.

[7]Zhao Z, Li X, Jian D, Hao P, Rao L, Li M. Hsa_circ_0054633 in peripheral blood can be used as a diagnostic biomarker of pre-diabetes and type 2 diabetes mellitus. Acta diabetologica. 2017;54(3):237-45.

[8]Ouyang Q, Huang Q, Jiang Z, Zhao J, Shi GP, Yang M. Using plasma circRNA_002453 as a novel biomarker in the diagnosis of lupus nephritis. Molecular immunology. 2018;101(undefined):531-8.

[9]Luan J, Jiao C, Kong W, Fu J, Qu W, Chen Y, et al. CircHLA-C Plays an Important Role in Lupus Nephritis by Sponging miR-150. Molecular therapy Nucleic acids. 2018;10(undefined):245-53.

[10]Kuschnerus K, Straessler ET, Müller MF, Lüscher TF, Landmesser U, Kränkel N. Increased Expression of miR-483-3p Impairs the Vascular Response to Injury in Type 2 Diabetes. Diabetes. 2019;68(2):349-60.

[11]Huang Z, Wu L and Chen L. Apelin/APJ system: A novel potential therapy target for kidney disease. Journal of cellular physiology. 2018;233(5): 3892-900.

Disclosure of Interests:

None declared

AB0588 INFECTION AGGRAVATED DECREASE OF THE LEVEL OF TH17 AND TREG CELLS AND LOW-DOSE IL-2 REBALANCED TH17/TREG IN THE PERIPHERAL BLOOD OF PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHY

Background:

Idiopathic inflammatory myopathies (IIM) are featured by a series of clinical presentation such as proximal muscle weakness, increased serum levels of creatine kinase and other muscle enzymes and involvement of other organs and systems[1, 2], which results in high morbidity and early mortality[3]. We have known the changes of the level of Th17 and Treg cells in IIM in previous studies[4-6]. However, whether infection affects lymphocyte subsets or not and whether the effect of low-dose interleukin-2 (IL-2) can be influenced by the use of immunosuppressants or not are still unclear.

Objectives:

The study aimed to explore the changes of lymphocyte subsets in patients of IIM with or without important organ infection, and the restoration of Th17/Treg after receiving low-dose IL-2.

Methods:

A total of 118 IIM patients were enrolled and classified into infection group and non-infection group based on the important organ infection. Of them, 48 cases were treated with low dose IL-2 (5.0*105IU for 5 days). The absolute number of peripheral total T, B, CD4+T, CD8+T, NK, Th1, Th2, Th17 and Treg cell subsets were analyzed by flow cytometry combined with absolute counting beads. Clinical data, laboratory examinations and the levels of peripheral lymphocyte subsets were analyzed retrospectively.

Results:

In these patients, especially in the infection group, the absolute number of T, CD4+T, CD8+T, NK, Th1, Th2, Th17 and Treg cells were significantly decreased as compared with that in the healthy controls, which were significantly increased by low dose IL-2 (especially Treg cells) treatment. The levels of ESR, LDH and HBDH and the ratio of Th17/Treg were significantly lower than those before IL-2 treatment (Z=-2.237, -2.083, -2.140, -3.663,P=0.025, 0.037, 0.032, 0.000). The 48 cases who received IL-2 treatment were divided into 2 groups according to whether they used immunosuppressants. There was no significant difference in the absolute number of T, B, CD4+T, CD8+T, Th1, Th2, Th17 and Treg cells, the proportion of Th17 and Treg cells and the ratio of Th17/Treg between the 2 groups (P>0.05).

Conclusion:

Global decrease in lymphocyte subsets was found in IIM patients, especially those who had important organ infection. A significant re-balance of Th17/Treg was observed after receiving treatment with low-dose IL-2. Furthermore, the restoration of lymphocyte subsets showed similar degree after treatment with or without immunosuppressants. Low-dose IL-2 may become a potential therapy for IIM patients. The mechanism of lymphocyte decrease in IIM is required further to study.

References:

[1]Clark K E N, Isenberg D A. A review of inflammatory idiopathic myopathy focusing on polymyositis[J]. European Journal of Neurology, 2017.

[2]Tieu J, Lundberg IE, Limaye V. Idiopathic inflammatory myositis. Best Pract Res Clin Rheumatol. 2016. 30(1): 149-68.

[3]Mandel DE, Malemud CJ, Askari AD. Idiopathic Inflammatory Myopathies: A Review of the Classification and Impact of Pathogenesis. Int J Mol Sci. 2017. 18(5).

[4]Zhang SX, Wang J, Sun HH, et al. Circulating regulatory T cells were absolutely decreased in dermatomyositis/polymyositis patients and restored by low-dose IL-2. Ann Rheum Dis. 2019 .

[5]Espinosa-Ortega F, Gómez-Martin D, Santana-De Anda K, Romo-Tena J, Villaseñor-Ovies P, Alcocer-Varela J. Quantitative T cell subsets profile in peripheral blood from patients with idiopathic inflammatory myopathies: tilting the balance towards proinflammatory and pro-apoptotic subsets. Clin Exp Immunol. 2015. 179(3): 520-8.

[6]Feng M, Guo H, Zhang C, et al. Absolute reduction of regulatory T cells and regulatory effect of short-term and low-dose IL-2 in polymyositis or dermatomyositis. Int Immunopharmacol. 2019. 77: 105912.

Acknowledgments:

Thanks for the support of my teachers, classmates and my family.

Disclosure of Interests:

None declared

AB0795 ABNORMAL LEVELS OF PERIPHERAL LYMPHOCYTES SUBSETS IN PATIENTS WITH PSORIATIC ARTHRITIS AND RESTORATION AFTER RECEIVING OUR NEW IMMUNOREGULATORY COMBINATION THERAPIES: A CROSS-SECTIONAL STUDY

Background:

Psoriatic arthritis (PsA) is a chronic autoimmune disease characterized by skin and joint inflammation with lymphocytes disturbance[1,2]. However, the statuses of immune cell subsets are unclear. In addition, although, during the past 20 years, the treatment of the PsA has progressed rapidly, it still remains an unmet need[3].

Objectives:

To compare the lymphocyte subsets in peripheral blood of PsA patients and healthy controls and, evaluate effects of immunoregulatory combination therapies, such as low-dose interleukin-2, rapamycin, metformin, and retinoic acid, on the proliferation and functional recovery of lymphocyte subsets in PsA patients.

Methods:

From September 2014 to December 2019, 218 PsA patients (107 male and 111 female) and 206 healthy controls (78 male and 128 female) were enrolled, including 112 patients (50 male and 62 female) who received immunoregulatory combination treatments (low-dose interleukin-2, rapamycin, metformin, retinoic acid and coenzyme Q10, ect). The absolute numbers and ratio of T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and Tregs in peripheral blood were measured by flow cytometry with absolute counting beads. The data were subject to normal distribution, which was expressed as the mean ± standard deviation. Independent-samples T test and paired-samples T test were applied. P value <0.05 were considered statistically significant.

Results:

The absolute numbers of B, CD4+T and Th17 in PsA patients were significantly higher than those of healthy controls (P<0.01), while the absolute numbers of NK and the percentage of Th1 and Tregs were decreased significantly (P<0.01). The ratio of Th17/Tregs was significantly increase (P<0.001) (Figure 1). After receiving our new immunoregulatory combination therapies, the percentage of B, Th2 and Th17 were lower than before (P<0.05) and the absolute numbers of T, CD8+T, NK, Th1 and Tregs in PsA patients were increased (P<0.05). Further, the ratios of Teffs/Tregs had a tendency to decrease (rebalance of them): Th2/Tregs (P<0.01) and Th17/Tregs (P=0.095) (Figure 2).

Conclusion:

The abnormal levels of peripheral lymphocyte subpopulations resulted in an imbalance of Teffs/Tregs, which might play an important role in PsA pathogenesis. Our new immunoregulatory combination therapies could promote the proliferation of Tregs and may help for PsA patients’ symptom remission.

References:

[1]Gladman DD, Antoni C, Mease P, et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005;64 Suppl 2:ii14-7. doi: 10.1136/ard.2004.032482 [published Online First: 2005/02/15]

[2]Ritchlin CT, Colbert RA, Gladman DD. Psoriatic Arthritis. N Engl J Med 2017;376(10):957-70. doi: 10.1056/NEJMra1505557 [published Online First: 2017/03/09]

[3]Winthrop KL, Weinblatt ME, Crow MK, et al. Unmet need in rheumatology: reports from the Targeted Therapies meeting 2018. Ann Rheum Dis 2019;78(7):872-78. doi: 10.1136/annrheumdis-2018-214280 [published Online First: 2019/02/04]

Figure 1.

Article selection

Acknowledgments:

None.

Disclosure of Interests:

None declared

SAT0195 ABNORMITY TFH SUBSETS INDICATE DISEASE ACTIVITY WHILE SIROLIMUS THERAPY RESTORES THE PD-1+ICOS+TFH/ACTIVATED TFR BALANCE IN PRIMARY SJOGREN’S SYNDROME PATIENTS

Background:

Immune imbalance between follicular helper T (Tfh) cells and follicular regulatory T (Tfr) cells is a characteristic of primary Sjogren’s syndrome (pSS) [1]. The heterogeneity among Tfh and Tfr can be elucidated by separating them into different subsets based on the expression molecular characteristics.

Objectives:

The aim of this study was to investigate the role of Tfh and Tfr subsets, and to evaluate the effects of sirolimus on these cells.

Methods:

In this study, we enrolled 51 pSS patient and 26 healthy controls (HCs), and analyzed the frequencies and absolute counts of circulating Tfh and Tfr subsets, and serum levels of cytokines. Within these patients, analyses of above T cells in twelve patients before and after treatment with sirolimus. Clinical indicators and correlations with follicular T cells were systematically analyzed. The diagnostic value for CD4+CXCR5+T cells was evaluated by the areas under the receiver operating characteristic curves (AUC).

Results:

Patients with pSS had higher frequencies and absolute numbers of PD-1+ICOS+Tfh cells, but lower levels of activated Tfr cells cells, thereby resulting in elevated ratios of PD-1+ICOS+Tfh/activated Tfr. In addition, PD-1+Tfh cells levels were lower in pSS patients than in HCs. Interestingly, the ratio of PD-1+ICOS+Tfh/activated Tfr was a strong predictor of pSS diagnosis. However, sirolimus therapy resulted in significant reductions in PD-1+ICOS+Tfh cells and the PD-1+ICOS+Tfh/activated Tfr ratio in pSS patients. We also found increased numbers of PD-1+ICOS+Tfh cells were associated with B cells, while decreased numbers of Tfr and their subsets were strongly associated with aTreg cells in pSS patients. The ESSDAI [2] was positively correlated with PD-1+ICOS+Tfh cell frequency, but was negatively correlated with PD-1+Tfh cell count.

Conclusion:

These findings suggest that the PD-1+ICOS+Tfh cell:activated Tfr cell ratio and PD-1+Tfh cells constitute potential novel biomarkers for pSS, and Tfr cells and subsets resemble derived aTreg cells. Furthermore, the PD-1+ICOS+Tfh cells as a biomarker of disease activity and provide new ground to verify the therapeutic implications of sirolimus as an innovative drug in pSS.

References:

[1]Fonseca VR, Romão VC, Agua-Doce A, Santos M, López-Presa D, Ferreira AC, et al. The Ratio of Blood T Follicular Regulatory Cells to T Follicular Helper Cells Marks Ectopic Lymphoid Structure Formation While Activated Follicular Helper T Cells Indicate Disease Activity in Primary Sjogren’s Syndrome. Arthritis Rheumatol 2018; 70:774-784.

[2]Seror R, Ravaud P, Bowman SJ, Baron G, Tzioufas A, Theander E, et al. EULAR Sjogren’s syndrome disease activity index: development of a consensus systemic disease activity index for primary Sjogren’s syndrome. Ann Rheum Dis 2010; 69:1103–9.

Disclosure of Interests:

None declared

AB0346 THE NUMERAL CHANGES OF PERIPHERAL LYMPHOCYTE SUBSETS IN PATIENTS WITH RHEUMATOID ATHRITIS AND THEIR RESTORATIONS AFTER RECEIVED COMBINED IMMUNOMODULATORY THERAPY

Background:

Rheumatoid arthritis (RA) is an aggressive immune-mediated joint disease with synovial inflammation and joint destruction characterized by abnormal immune responses to self-antigens1. An imbalance in pro- and anti-inflammatory lymphocyte subsets has been considered to contribute to the pathogenesis of RA2. However, the detailed lymphocyte statuses of RA patients are required clarified and the effect of immunomodulatory therapy on the lymphocyte subsets is unclear3.

Objectives:

To investigate the status of lymphocyte subsets in peripheral blood (PB) of RA patients at relatively large-sample size and the changes of them after our immune regulatory combination treatment.

Methods:

This cross-sectional study enrolled 3016 patients with RA who met the ACR’s revised RA diagnostic classification in 1987 as well as 206 healthy controls (HCs). Among these participations, 1415 patients have received the treatment of immunomodulatory drugs (IMiDs) such as low-dose interleukin-2, rapamycin, metformin, retinoic acid etc. Flow cytometry (FCM) was used to measure the levels of PB lymphocyte subgroups and CD4+T subsets in RA patients before and after the treatments and HCs. Data were expressed as mean ± standard deviation to the distribution. Independent-samples T test and paired-samples T test were applied.Pvalue <0.05 were considered statistically significant.

Results:

Compared with HCs, patients with RA had a lower absolute numbers of total T, CD8+T, NK and Tregs (P<0.05), decreased percentages of NK, Th1, Th2 and Th17 (P<0.05), but higher ratios of Teffs/Tregs such as Th1/Tregs and Th17/Tregs (P<0.05), indicating a disturbance of immune systems (Figure 1). After receiving combined immunomodulatory therapy, the absolute numbers of T, B, CD4+T, CD8+T, NK, Th1, Th17 and Tregs were dramatically increased (P<0.05) and the percentages of B, Th1, CD4+T and Tregs were also increased (P<0.05). Although these subsets increased globally, the ratio of Teffs/Tregs such as Th2/Tregs and Th17/Tregs tended to decrease, suggesting a rebalance of immune systems(Figure 2).

Conclusion:

Impaired peripheral lymphocytes especially insufficiency of Tregs might played an important role in pathogenesis of RA. Immunoregulatory combination therapies could promote the proliferation and functional recovery of Tregs in patients and help to alleviate disease activity.

References:

[1]Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. (1474-547X (Electronic))

[2]Kondo Y, Yokosawa M, Kaneko S, et al. Review: Transcriptional Regulation of CD4+ T Cell Differentiation in Experimentally Induced Arthritis and Rheumatoid Arthritis. (2326-5205 (Electronic))

[3]Fonseka CY, Rao DA, Raychaudhuri S. Leveraging blood and tissue CD4+ T cell heterogeneity at the single cell level to identify mechanisms of disease in rheumatoid arthritis. (1879-0372 (Electronic))

Acknowledgments:

None.

Disclosure of Interests:

None declared

SAT0183 STATUS OF LYMPHOCYTE SUBSETS IN PERIPHERAL BLOOD OF PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME AND THEIR CHANGES AFTER RECEIVING OUR NEW IMMUNOREGULATORY COMBINATION THERAPY: A RETROSPECTIVE CROSS-SECTIONAL STUDY

Background:

Primary Sjögren’s syndrome (pSS) is a chronic inflammatory autoimmune disease mainly involving exocrine glands and involving multiple organs and systems1. Recent studies have reported that peripheral lymphocyte subsets such as Th1, Th2, Th17, and regulatory cells (Tregs), have been implicated in the pathogenesis of pSS2. However, the detailed statuses of lymphocyte subsets of pSS patients remain to be clearly evaluate and effects of immunomodulatory therapies on the lymphocyte subsets are unknown.

Objectives:

To explore the pathogenesis and evaluate the therapeutic effect of immunomodulatory drugs (IMiDs) by comparing the changes of lymphocyte subsets in peripheral blood (PB) before and after treatment.

Methods:

This study included 1,221 pSS patients and 206 healthy controls (HCs). Among these patient, 759 patients were received our new immunoregulatory therapies such as low-dose interleukin-2, rapamycin, metformin, retinoic acid etc. The absolute numbers of T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and Tregs in PB of these subjects were detected by flow cytometry combined with standard absolute counting beads. Data were expressed as mean ± standard deviation to the distribution. Independent-samples T test and paired-samples T test were applied.Pvalue <0.05 were considered statistically significant.

Results:

The absolute numbers of circulating Tregs as well as T, NK cells in pSS patients were significantly lower than those of HCs (P<0.05). After immunoregulatory combination treatments, the number of Tregs was significantly increased (P<0.05). Though the absolute numbers of T, NK, CD4+T, CD8+T, Th1, and Th17 cells were also increased to some degree (P<0.05), the increased amount of Tregs was much more than other cells, resulting a new balance between pro- and anti- inflammatory lymphocyte homeostasis.

Conclusion:

The decrease of peripheral Tregs played an important role in the pathogenesis of primary Sjögren’s syndrome. Immunoregulatory combination therapies promoted the increase of Tregs and might help for the recovery of pSS.

References:

[1]Mariette X, Criswell LA. Primary Sjogren’s Syndrome. N Engl J Med 2018;378(10):931-39. doi: 10.1056/NEJMcp1702514 [published Online First: 2018/03/08]

[2]Miao M, Hao Z, Guo Y, et al. Short-term and low-dose IL-2 therapy restores the Th17/Treg balance in the peripheral blood of patients with primary Sjogren’s syndrome. Ann Rheum Dis 2018;77(12):1838-40. doi: 10.1136/annrheumdis-2018-213036 [published Online First: 2018/06/25]

Acknowledgments :

None.

Disclosure of Interests:

None declared

AB0499 ABNORMALITY OF PERIPHERAL LYMPHOCYTE SUBSETS IN BECHET’S DISEASE AND EFFECTS OF NEW IMMUNOREGULATORY COMBINATION THERAPIES ON THESE CELLS

Background:

Bechet’s disease (BD) is a chronic multisystemic vasculitis. Although its exact etiopathology is unknown, both autoimmune imbalances associated with genetic and abnormal immune response of effector lymphocytes promoted by infectious factors are suggested1. The increase of effector T cells (Teffs) and the decrease of regulatory T cells (Tregs) are possibly the involving factors in the pathogenesis of BD2. Importantly, we have developed new immunoregulatory combination therapies trying to restore the reduction of Tregs in rheumatic patients.

Objectives:

To examine abnormal levels of lymphocyte subsets in BD patients at a relatively large-sample size and to investigate whether the immunoregulatory combination therapies have therapeutic efficacy in BD.

Methods:

Total 384 BD patients and 206 healthy controls (HCs) were enrolled in this cross-sectional study. Proportions and absolute numbers of peripheral T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and Treg subsets were analyzed by flow cytometry (FCM) for all participants. Among these patients,183 cases of BD patients were treated with immunoregulatory combination drugs (IMiDs) such as low-dose interleukin-2, rapamycin, metformin, retinoic acid and coenzyme Q10. The levels of peripheral lymphocyte subsets were measured before and after the treatment. Compared-T test was used to compare continuous measures and to assess effect of these drugs.

Results:

Compared to HCs, the absolute numbers of various Teffs such as T, B, CD4+T, CD8+T, Th1 and Th17 cells were significantly increased in BD group (P<0.01), while the level of Tregs in patients with BD was severely decreased (P< 0.05), resulting in increased ratios (imbalance) of Th1/Tregs, Th2/Tregs and Th17/Tregs (P< 0.05) (Figure 1). After the IMiDs treatment, the levels of NK, CD4+T, CD8+T, Th1, Th17 cells as well as Tregs were significantly increased (P<0.05). But the increased Tregs was much more dramatical than those of Teffs, resulting in a decrease in ratios of Teffs/Tregs such as Th2/Tregs (P< 0.001) (Figure 2).

Conclusion:

Impaired balance of pro- and anti-inflammatory immune cells, especially insufficiency of Tregs, might be a cornerstone of the pathogenesis of BD. Immunoregulatory combination therapies could promote the proliferation and functional recovery of Tregs in patients with BD and might help to alleviate disease activity.

References:

[1]Yazici H, Seyahi E, Hatemi G, et al. Behcet syndrome: a contemporary view. Nat Rev Rheumatol 2018;14(2):107-19. doi: 10.1038/nrrheum.2017.208 [published Online First: 2018/01/04]

[2]Rosenzwajg M, Lorenzon R, Cacoub P, et al. Immunological and clinical effects of low-dose interleukin-2 across 11 autoimmune diseases in a single, open clinical trial. Ann Rheum Dis 2019;78(2):209-17. doi: 10.1136/annrheumdis-2018-214229 [published Online First: 2018/11/26]

Acknowledgments:

None

Disclosure of Interests:

None declared

AB0032 ABNORMAL STATUSES OF PERIPHERAL CD4+T CELL SUBSETS IN PATIENTS WITH GOUT AND THEIR CHANGES AFTER RECEIVING COMBINED IMMUNOMODULATORY THERAPY

Background:

Gout is a chronic systemic inflammatory disease that results from the deposition of monosodium urate crystals in joints and the associated activation of the innate immune system associated with hyperuricemia1. As the pathogenesis of gout is still a matter of speculation and debate, accumulating evidence converges on inflammasome activation and immunological dysregulation2. However, the detailed statuses of lymphocyte subsets in patients with gout are unknown and influence of immunomodulatory combination therapies on the lymphocyte subsets remain to be clearly evaluate3.

Objectives:

To evaluate the quantitative statuses of peripheral CD4+T subpopulations in patients with gout and further investigate the effects of immunomodulatory combination therapies on those cells.

Methods:

Total 247 patients who met the clinical criteria of gout from the American College of Rheumatology and 206 healthy controls (HCs) were enrolled in this retrospective cross-sectional study. Among those patients, 70 follow-up patients donated their peripheral blood after receiving immunomodulatory drugs (e.g., low-dose interleukin-2, rapamycin, metformin, retinoic acid, etc). The absolute numbers of Th1, Th2, Th17 and Tregs in peripheral CD4+T subsets were detected by flow cytometry combined with standard absolute counting beads.

Results:

Compared with HCs, the absolute numbers of Th1 and Th17 were evidently increased in gout patients (P<0.001), while the level of Tregs was significantly decreased (P<0.05) (Figure 1). After immunomodulatory combination treatments, there were dramatical increases in a wide variety of CD4+T subsets such as Th1, Th17 and Tregs (P<0.05). Interestingly, the increased amount of Tregs was much more than that of other Teffs, leading to the decrease ratios of Teffs/Tregs such as Th2/Tregs, restoring immune homeostasis (Figure 2).

Conclusion:

This cross-sectional study clarified the abnormal statuses of CD4+T subsets in gout patients, suggesting that CD4+T subsets, especially Tregs, might be relevant and play a crucial role in the pathogenesis of gout, thus providing a potential therapeutic target for gout patients. Immunomodulatory combination therapies effectively increase the number of Tregs and may help for gout patients’ symptom remission.

References:

[1]Ramsubeik K, Ramrattan LA, Kaeley GS, et al. Effectiveness of healthcare educational and behavioral interventions to improve gout outcomes: a systematic review and meta-analysis. Therapeutic advances in musculoskeletal disease 2018;10(12):235-52. doi: 10.1177/1759720x18807117 [published Online First: 2018/12/06]

[2]Stiburkova B, Pavelcova K, Pavlikova M, et al. The impact of dysfunctional variants of ABCG2 on hyperuricemia and gout in pediatric-onset patients. Arthritis Res Ther 2019;21(1):77. doi: 10.1186/s13075-019-1860-8 [published Online First: 2019/03/22]

[3]Raucci F, Iqbal AJ, Saviano A, et al. In-depth immunophenotyping data relating to IL-17Ab modulation of circulating Treg/Th17 cells and of in situ infiltrated inflammatory monocytes in the onset of gouty inflammation. Data Brief 2019;25:104381. doi: 10.1016/j.dib.2019.104381 [published Online First: 2019/09/07]

Acknowledgments:

None.

Disclosure of Interests:

None declared

0344 Age-Related Longitudinal Trajectories in NREM and REM Spectral Power

Introduction

Knowledge of how aging impacts sleep physiology is based almost exclusively on cross-sectional studies. Longitudinal studies, by contrast, can inform how macro- and micro-features of NREM and REM sleep change dynamically across time in individual trajectories. For the current work, we conducted quantitative EEG analyses from a longitudinal polysomnography study to inform age-related trajectories in sleep macro- and micro-architecture.

Methods

We conducted a secondary data analysis on 2208 participants in the Sleep Heart Health Study (mean age =62.47, SD=10.46, 55.30% females). Participants underwent one night of in-home polysomnography recording during two study visits (M=5.21 years apart, SD=0.53). Spectral power density was calculated for each 0.5 Hz frequency bin for NREM and REM sleep separately.

Results

In cross-sectional analyses, older chronological age was significantly associated with worse sleep macro-architecture. Plots of the individual trajectories over 5 years, however, revealed considerable inter-individual variability in whether sleep physiology was preserved or declined. Interestingly, there were strong associations between the longitudinal changes in power density in NREM and REM sleep (slow oscillations: r=.53 [.50-.56]; delta: r=.58 [.55-.60]; alpha: r=.69 [.67-.71]; sigma: r=.74 [.73-.76]; beta: r=.82 [.80-.83]; ps&lt;.001). The strongest NREM-REM association was for theta band power (r=.85 [.83-.86]), particularly in the 5.5-6.0 Hz bin (r=.94, [.94, .95]).

Conclusion

There is substantial inter-individual variability in how aging impacts sleep physiology. Nevertheless, within individuals, power density declines similarly across NREM and REM stages, with nearly perfect convergence for theta activity, indicating a common age-related neurobiological mechanism.

Support

The National Sleep Research Resource is supported by NIH HL114473.

0212 Questionnaire Assessment of Intraindividual Variability in Sleep: Inconsistent Sleep Can Be Worse Than Short Average Sleep

Introduction

The consequences of short sleep are well-documented, but recent evidence indicates that night-to-night consistency in sleep may be just as important. For the current work, we developed an intraindividual variability in sleep (IIV) questionnaire to make IIV measurement possible in single-time-point studies. We investigated whether self-reported IIV explained unique variance in sleep quality and health beyond average total sleep time (TST), focusing on a critical transition period (first semester of college) in which high variability was predicted.

Methods

First-semester college students (N=126, Mage=18.28, 75.40% females) completed an IIV questionnaire in which participants indicated their average sleep duration, then estimated how much their sleep duration deviated from their average duration for each day of a typical week. We quantified IIV as the mean day-to-day change in sleep. Participants also completed standard questionnaires on global sleep quality, social jetlag, daytime sleepiness, depression, and stress.

Results

Participants reported substantial IIV in their sleep durations (M=1.77 hours, SD=0.86) that was largely distinguishable from measures of social jetlag (r=.25) and average TST (r=-.18). Patterns of IIV differed across race/ethnicities: in white/Asian students, IIV was strongly associated with social jetlag (r=-.44) whereas in underrepresented minority students, IIV and social jetlag were separate constructs (r=-.03), suggesting that fluctuations in the latter group occur across all days of the week. Greater IIV was associated with significantly worse global sleep quality (r=.24, p=.01), stress (r=.20, p=.03), and depression, r=.20, p=.03). These associations were significant after adjusting for average TST, and only marginally reduced when controlling for social jetlag.

Conclusion

IIV in sleep/wake patterns can be captured using a questionnaire, and such measurement provides unique explanatory power to understanding sleep quality and mental health. Future research is needed to compare IIV questionnaire data to actigraphy data and to understand the underlying mechanisms by which inconsistent sleep detrimentally affects individuals.

Support

National Science Foundation (NSF 1920730)

0197 Chronotype is Influenced by Behavioral Choices and Can Fluctuate Across the Semester in STEM Students

Introduction

A delay in endogenous biological rhythms is assumed to cause undergraduate students to be “night owls,” but neurodevelopmental effects may only partially explain chronotype (circadian preference). Instead, perceived chronotype in students may result from poor sleep hygiene practices including bedtime social media use, afternoon caffeine consumption, and daytime napping. If so, then chronotype should be malleable in students to the extent that behavioral choices change.

Methods

We surveyed 1,120 undergraduate students who were enrolled in STEM courses across up to 3 time points during the semester. The survey assessed perceived chronotype (morning/evening type), global sleep quality, and daily habits that impact alertness and sleep hygiene (e.g., social media usage and timing, caffeine consumption and timing, and napping behavior).

Results

Relative to Morning Types, students who perceived themselves as being Evening Types showed 23.1% greater bedtime social media usage (t=3.14, p=.002), 35.1% greater daytime napping duration (t=4.44, p&lt;.001), and a 44 minute later average time of caffeine consumption (even though total caffeine consumption was reduced; t=2.30, p=.022). Evening Types also reported lower subjective health (t=3.55, p&lt;.001), with 14.2% of the association between chronotype and subjective health being mediated by bedtime social media use (direct effect: b=0.050, p=.002; indirect effect: b=0.009, p&lt;.05). Ninety-one students reported switching from being Evening Types at baseline to Morning Types at a later survey; those who switched to Morning Types used less social media and consumed less caffeine after 5pm and they showed significant improvements across the semester in sleep duration, sleep quality, and exam scores (ps&lt;.05).

Conclusion

Perceived chronotype is related to social media and caffeine consumption behaviors and is modifiable. Students who perceive themselves as night owls may find better health and academic success if they behave like morning larks.

Support

National Science Foundation (DRL 1920730)