In vitro spermiotoxicity and in vivo adults' biochemical pattern after exposure of the Mediterranean mussel to the sunscreen avobenzone

Avobenzone (AVO) is one of the most frequent ultraviolet (UV) filters in personal care products (PCPs). The Mediterranean mussel Mytilus galloprovincialis is a bioindicator often used for ecotoxicological research. Since UV filters reach higher peaks during summer in aquatic bodies, coincident with mussels' spawning period, and bivalves are sessile, both male gametes and adults of this species were used in this experiment. Therefore, the present study aimed to assess how AVO affects M. galloprovincialis at different biological levels. In vitro experiments on sperms (30 min-exposure) and in vivo experiments on adults (28 days-exposure) were carried out at 0.1, 1.0 and 10.0 μg/L of AVO concentrations. The oxidative and physiological status together with genotoxicity in exposed sperms were assessed. Several biochemical parameters related to enzymatic antioxidant defences, biotransformation enzymes, cell membrane damage, energy reserves, and neurotoxicity were evaluated in adult mussels. Results of in vitro sperm exposure to AVO showed significant overproduction of superoxide anions and DNA damages in all treatments and decrease in sperm viability at 1.0 and 10.0 μg/L. AVO exposure also led to complete inhibition of motility of sperms at the highest concentration, while a significant increase of curvilinear velocity and decrease of wobble occurred at 1.0 μg/L. In vivo exposed adults exhibited a significant decrease in metabolic capacity at 0.1 μg/L, a significant increase in the total protein content and enzymatic turnover as superoxide dismutase (antioxidant defence) at 10 μg/L. This study revealed an ecological concern related to the high sensitivity of sperms respectively to adults under environmentally relevant concentrations of AVO, underpinning an hypothesis of male reproductive function impairments.

Do climate change related factors modify the response of Mytilus galloprovincialis to lanthanum? The case of temperature rise

Most of the electric and electronic waste is not recycled and the release of its components into the environment is expected, including the rare-earth element Lanthanum (La), which has already been reported in the aquatic systems. Furthermore, considering climate change factors such as the predicted increase in temperature, the susceptibility of aquatic organisms to these rare elements may be modified. In light of this, the present study aimed to evaluate the relevance of temperature on La-derived effects in the mussel Mytilus galloprovincialis. Several biomarkers and La bioaccumulation were assessed in organisms exposed to 0 (control) and 10 μg/L of La at two distinct temperatures (17 and 22 °C) for 28 days. Results showed that temperature did not influence La bioaccumulation in mussels. However, exposure to La resulted in a decreased metabolic capacity and an enhancement of biotransformation enzymes activity, as a possible defense behavior of mussels to avoid La accumulation and toxicity. Nevertheless, antioxidant defenses were also inhibited leading to increased lipid peroxidation (LPO) levels. Warming alone seemed to cause a metabolic shutdown seen as reduced enzyme activities and protein carbonylation (PC) levels. Simultaneous La exposure and temperature rise caused combined effects on mussels, as they accused metabolic depression, biotransformation defenses activation, antioxidant capacity reduction, and higher cellular damage. Overall, this study highlights the need to perform environmental risk assessment studies, by considering emerging contaminants exposures at relevant concentrations, both at present and forecasted climate change scenarios.

Micro(nano)plastics and plastic additives effects in marine annelids: A literature review

Plastic debris are dispersed in the marine environment and are consequently available to many organisms of different trophic levels, including sediment-dwelling organisms such as polychaetae. Plastic degradation generates micro (MPs) and nanoplastics (NPs) and as well as releases bounded plastic additives, increasing the ecotoxicological risk for marine organisms. Therefore, this review summarizes current knowledge on the accumulation and effects of MPs and NPs and plastic additives in polychaetes, derived from laboratory and field evidences. Thirty-six papers (from January 2011 to September 2021) were selected and analysed: about 80% of the selected works were published since 2016, confirming the emerging role of this topic in environmental sciences. The majority of the analysed manuscripts (68%) were carried out in the laboratory under controlled conditions. These studies showed that polychaetes accumulate and are responsive to this contaminant class, displaying behavioural, physiological, biochemical and immunological alterations. The polychaetes Hediste diversicolor and Arenicola marina were the most frequent used species to study MPs, NPs and plastic additive effects. The consideration of field studies revealed that MP accumulation was dependent on the plastic type present in the sediments and on the feeding strategy of the species. Polychaetes are known to play an important role in coastal and estuarine food webs and exposure to MPs, NPs and plastic additives may impair their behavioural, physiological, biochemical and immunological responses. Thus, the estimated global increase of these contaminants in the marine environment could affect the health of these benthic organisms, with consequences at population and ecosystem levels.

Ecotoxicity of Copper(I) Chloride in Grooved Carpet Shell (Ruditapes decussatus)

Copper (Cu) is a ubiquitous trace element in the aquatic environment, and is usually found at low levels. Copper environmental concentrations can be altered as a result anthropogenic activities. Shellfish are useful bioindicators to ensure adequate environmental monitoring. Thus, the aim of the present study was as follows: (a) determine the LC50 of copper(I) chloride in grooved carpet shell (Ruditapes decussatus) collected in the Santa Gilla lagoon (Sardinia, Italy), and (b) analyze the antioxidant biomarkers in digestive gland and gills of same specimens exposed to different concentrations of the above-mentioned metal (0.045, 0.45, and 0.90 mg/L) for 96 h. A withdrawal period of 96 h was considered for the treated clam, carrying out the same biochemical analyses, superoxide dismutase (SOD), catalase (CAT), selenium-dependent glutathione peroxidase (Se-GPx), glutathione S-transferases (GSTs), and total glutathione (GSH+2GSSG) in the two tissues. Different time and dose responses of the antioxidant biomarkers were recorded in the digestive glands and gills. Oxidative stress biomarkers highlighted the ability of Cu to induce oxidative stress in R. decussatus. Clam, following the withdrawal period of 96 h, has not been able to achieve the control levels of all biochemical markers in the digestive gland and gills. R. decussatus can be a suitable model to assess the ecotoxicity of copper in aquatic ecosystems. These findings may advance knowledge on the role and the effects of copper on oxidative stress biomarkers in grooved carpet shell. The metal ecotoxicity response can be useful to perform accurate biomarker-based monitoring programs using this bivalve species.

Ecotoxicological effects of the UV-filter 4-MBC on sperms and adults of the mussel Mytilus galloprovincialis

Present in an increasing number of products, UV-filters are continuously discharged into aquatic environments. Despite potential risks for inhabiting organisms are recognized, the effects of UV-filter 4-methylbenzylidenecamphor (4-MBC) on marine invertebrates are poorly investigated. By combining in vitro/in vivo exposures through a multi-biomarker approach on sperms and adults, the present study evaluated how 4-MBC affect the mussel species Mytilus galloprovincialis, providing ecologically relevant information on organisms' responses. From the obtained results, considering mortality as endpoint, sperms revealed a greater sensitivity (EC₅₀:347 μg/L) than adults (EC₅₀: not calculable). From an ecotoxicological perspective, this resulted in a derived threshold concentration (LOEC) of 100 μg/L and 72 μg/L, respectively. Effects at the cell/molecular level were provided by general redox-status imbalance and oxidative stress. Sperms showed functional and structural impairments, hyperactivation and DNA damage, while adults showed physiological, metabolic/energetic dysfunctions, DNA damage and activation of oxidative and biotransformation enzymes. High 4-MBC bioaccumulation was also observed in exposed mussels (BCFs:14.0-32.0 L/kg). These findings suggest that 4-MBC may impair fitness and survival of the broadcast spawning mussel M. galloprovincialis, affecting reproduction success and population growth.

The impact of temperature on lithium toxicity in the gastropod Tritia neritea

The most important use of lithium (Li) is in rechargeable batteries. The growing use of Li, incorrect disposal of Li-based applications, and inefficient recycling strategies for their elimination will result in the release of this metal into the aquatic systems. Alongside with the impacts caused by pollutants, organisms in coastal ecosystems are also facing environmental changes as those related with climate change scenarios, namely, seawater temperature rise. In this context, the present study aimed to evaluate the influence of temperature on Li toxicity, using the Nassariid gastropod Tritia neritea as model species. Metabolism and oxidative stress related biomarkers were evaluated after a 28-day exposure period. The results demonstrated that temperature enhanced the toxic impacts of Li, most probably due to snail increased sensitivity when under warming conditions. As a consequence of inefficient antioxidant and biotransformation capacity, lipid peroxidation was observed in Li-contaminated snails at 21 ºC, demonstrating a significant interaction between both factors. Regarding snails' metabolic capacity, Li did not affect snails, but a clear decrease on their metabolism was observed at increased temperature (with or without Li) which may limit snail defense capacity. Overall, the present findings demonstrated the impacts derived from Li towards marine intertidal gastropods, evidencing enhanced threats under predicted warming conditions. Considering the role of T. neritea in the ecosystem functioning, impacts on this species may greatly affect other populations and eventually the entire community.

The effect of ocean warming on accumulation and cellular responsiveness to cobalt in Mytilus galloprovincialis

Cobalt (Co) is among the hazardous substances identified in aquatic environments. Industrialization and population growth have also contributed to climate change, namely in what concerns ocean temperature rise. The aim of the present study was to evaluate the influence of temperature rise on the impacts caused by Co on Mytilus galloprovincialis. To this end, mussels were exposed for 28 days to 17 °C and 21 °C, without and with 200 μg L^-1 of Co. Results showed no significant differences in Co bioaccumulation by the organisms between temperatures. A significant interaction between temperature and Co contamination was observed in terms of oxidative damage, detoxification capacity, and neurotoxicity, with a synergistic effect particularly evident in terms of biotransformation enzymes' activity. The obtained results point out that population survival and distribution may be limited in the long term, highlighting the need for future research on the combined effects of both stressors.

UV-filters in marine environments: a review of research trends, meta-analysis, and ecotoxicological impacts of 4-methylbenzylidene-camphor and benzophenone-3 on marine invertebrate communities

The potential adverse effects of UV-filter pollution in marine environments have been the focus of research in recent years. This systematic review aims to determine the extent of this emerging problem, both quantitatively and qualitatively, combining temporal and science mapping analyses to explore the development of the field of UV-filters in the marine environment (from 1990 to 2021), and to outline new research frontiers. The temporal trend analysis revealed an exponential growth of published studies over the last decade (70% since 2016), confirming the emerging role of this topic in environmental science. The meta-analysis determined that 4-methylbenzylidene-camphor (4-MBC) and benzophenone-3 (BP-3) are top-priority environmental pollutants due to their increasing usage and, in turn, a frequent occurrence in marine ecosystems. This meta-analysis determined the focus on these two contaminants for this review. A critical discussion of the applications, regulatory aspects, and environmental occurrences of these selected compounds was provided. The present study also focused on the most recent (2015-2021) field and laboratory studies investigating the ecotoxicological impacts of 4-MBC and BP-3 on marine invertebrates. This review highlights the need for more research efforts to fill the knowledge gaps on the realistic effects these compounds may have when considered individually, in combination, or as subsequent exposures. Overall, this review aims to establish guidelines for further studies to understand the effect of UV-filters on marine ecosystems and marine invertebrate communities.

The influence of salinity on the toxicity of chemical UV-filters to sperms of the free-spawning mussel Mytilus galloprovincialis (Lamark, 1819)

Marine-coastal systems have been increasingly exposed to multiple stressors, including anthropogenic pollution and variations of Climate Change (CC) related factors, whose coexistence could create associated environmental and ecotoxicological risks. Among emergent stressors, 4-methylbenzylidenecamphor (4-MBC) and benzophenone-3 (BP-3) UV-filters are compounds widely used in increasing consumer products, resulting in their ubiquity in aquatic environments and possible pressing challenges on gamete susceptibility. Since most marine invertebrates reproduce by external fertilization, after spawning, gametes may be exposed to several pressures, affecting reproductive success and outcome. The present study focuses on the spermiotoxicity of the environmentally relevant UV-filters 4-MBC and BP-3 combined with salinity shifts, as potential modulators of their harmful effects. For this, Mytilus galloprovincialis male gametes were exposed in vitro to environmentally relevant and slightly higher concentrations (1, 10 and 100 µg/L) of 4-MBC or BP-3 under three different salinities (S 20, 30 and 40). Sperm quality endpoints associated with oxidative status, viability, motility, kinetics, and genotoxicity were evaluated. Similarities and differences in sperm responses among all conditions were highlighted by principal coordinates analysis (PCO). Results showed that salinity acting alone posed greater sperms impairments at the lowest (20) and highest (40) tested levels. When salinity acts as a co-varying stressor, salinity-dominant interactive effects resulted evident, especially for 4-MBC at S 40 and BP-3 at S 20. These findings were pointed out as the worst exposure conditions for M. galloprovincialis sperms, since caused major toxicological effects in terms of: (I) oxidative stress, sperm structural impairments, motility and kinetic alterations in 4-MBC-exposed sperms; (II) DNA damage, compromised mitochondrial activity and hyperactivation in BP-3-exposed ones. Overall, it stands out that salinity influences UV-filter toxicological pathways and, thereby, the potential environmental risk of these contaminants on M. galloprovincialis male gametes, especially in an expected salinity stress scenario.

Biochemical alterations caused by lanthanum and gadolinium in Mytilus galloprovincialis after exposure and recovery periods

The increasing use of rare earth elements (REEs) in electric and electronic equipment has been associated with the presence of these elements in aquatic systems. The present study aimed to evaluate the toxicity of two REEs, Lanthanum (La) and Gadolinium (Gd), towards the mussel species Mytilus galloprovincialis. For this, the toxicity was assessed after a short-term exposure (14 days) to an environmentally relevant concentration of each element (10 μg/L), followed by a recovery period (14 days) in the absence of any contaminant. The measured biomarkers included energy-related parameters, activity of antioxidant and biotransformation enzymes, indicators of oxidative damage, levels of oxidized glutathione and neurotoxicity. After exposure mussels accumulated more La (0.54 μg/g) than Gd (0.15 μg/g). After recovery higher concentration decrease was observed for Gd (≈40% loss) compared to La exposed mussels (≈30% loss) which may be associated with lower detoxification capacity of mussels previously exposed to La. Mussels increased their metabolism (i.e., higher electron transport system activity) only after the exposure to Gd. Exposure to La and Gd resulted into lower energy expenditure, while when both elements were removed glycogen and protein concentrations decreased to values observed in non-contaminated mussels. Antioxidant and biotransformation capacity was mainly increased in the presence of Gd. This defense response avoided the occurrence of cellular damage but still loss of redox balance was found regardless the contaminant, which was re-established after the recovery period. Neurotoxicity was only observed in the presence of Gd with no effects after the recovery period. Results showed that a short-term exposure to La and especially to Gd can exert deleterious effects that may compromise specific biochemical pathways in aquatic species, such as M. galloprovincialis, but under low concentrations organisms can be able to re-establish their biochemical status to control levels after a recovery period.

Sulfadiazine's photodegradation using a novel magnetic and reusable carbon based photocatalyst: Photocatalytic efficiency and toxic impacts to marine bivalves

In the present study, waste-based biochar functionalized with titanium dioxide (TiO₂) and afterwards magnetized by an ex-situ approach, defined as synthetic photosensitizer (SPS), was explored for the photocatalytic degradation of sulfadiazine (SDZ), an antibiotic widely used in the aquaculture industry, under solar irradiation. The use of the SPS enhanced the photodegradation efficiency, with a half-life time (t_1/2) reduction from 12.2 ± 0.1 h (without SPS) to 5.6 ± 0.4 h. The applied magnetization procedure allowed to obtain a SPS with good reusability for SDZ photodegradation even after five consecutive cycles. To evaluate the effects on marine bivalves of SDZ, before and after photodegradation and in presence or absence of the SPS, a typical bioindicator species, the mussel Mytilus galloprovincialis, was used and different biochemical markers were analysed. Results obtained indicated that the exposure to SDZbefore irradiation, both in absence and presence of SPS, caused an increase in mussels' metabolism and defence mechanisms, evidencing great biochemical impacts. However, after irradiation (in the absence and presence of SPS), biochemical responses were similar to those observed in organisms exposed to control conditions, without SDZ. Therefore, this work provided a promising eco-friendly treatment for the removal of SDZ from aquaculture effluents.

B-esterases characterisation in the digestive tract of the common octopus and the European cuttlefish and their in vitro responses to contaminants of environmental concern

Cephalopods are a group of marine invertebrates that have received little attention as sentinel species in comparison to other molluscs, such as bivalves. Consequently, their physiological and biochemical xenobiotic metabolism responses are poorly understood. Here we undertake a comparative analysis of the enzymatic activities involved in detoxification reactions and neural transmission in the digestive tract of two commercial cephalopods: the Common octopus, Octopus vulgaris, and the European cuttlefish, Sepia officinalis. For methodological purposes, several common B-esterases (five carboxylesterase (CE) substrates and three cholinesterase (ChE) determinations) were assayed as a proxy of metabolic and neuronal activities, respectively. Four components of the digestive tract in each species were considered: salivary glands, the stomach, the digestive gland and the caecum. The in vitro responses of digestive gland homogenates to model chemicals and contaminants of environmental concern were contrasted between both cephalopod species. The baseline biochemical activities in the four digestive tract components were also determined. Moreover, in order to validate the protocol, purified proteins, recombinant human CE (CE1 and CE2) and purified eel acetylcholinesterase (AChE) were included in the analysis. Overall, carboxylesterase activities were higher in octopus than in cuttlefish, with the activity quantified in the digestive tract components in the following order: digestive gland ≈ caecum > stomach ≈ salivary glands, with higher hydrolysis rates reached with naphthyl-derived substrates. In contrast, cuttlefish hydrolysis rates with ChE substrates were higher than in octopus. This trend was also reflected in a higher sensitivity to CE inhibitors in octopus and to AChE inhibitors in cuttlefish. Given the detoxification character of CEs and its protective role preventing AChE inhibition, octopus could be regarded as more efficiently protected than cuttlefish from neurotoxic exposures. A full characterisation of B-esterases in the digestive tract of the two common cephalopods is also provided.

Responses of Ruditapes philippinarum to contamination by pharmaceutical drugs under ocean acidification scenario

In coastal systems, organisms are exposed to a multitude of stressors whose interactions and effects are poorly studied. Pharmaceutical drugs and Climate Change consequences, such as lowered pH, are examples of stressors affecting marine organisms, as bivalves. Although a vast literature is available for the effects of these stressors when acting individually, very limited information exists on the impacts that the combination of both can have on marine bivalves. For this reason, this study aimed to evaluate the impacts of a simulated ocean acidification scenario (control pH, 8.0; lowered pH, pH 7.6) on the effects of the antiepileptic carbamazepine (CBZ, 1 μg/L) and the antihistamine cetirizine (CTZ, 0.6 μg/L), when acting individually and combined (CBZ + CTZ), on the edible clam Ruditapes philippinarum. After 28 days of exposure, drug concentrations, bioconcentration factors and biochemical parameters related to the clams' metabolic capacity and oxidative stress were evaluated. The results showed that R. philippinarum clams responded differently to pharmaceutical drugs depending on the pH tested, influencing both bioconcentration and biological responses. In general, drug combined treatments showed fewer impacts than drugs acting alone, and acidification seemed to activate at a higher extension the elimination processes that were not activated under control pH. Also, lowered pH per se exerted negative impacts (e.g., cellular damage) on R. philippinarum and the combination with pharmaceutical drugs did not enhance the toxicity.

AB0696 Prevalence and clinical associations of different autoantibodies in the Reuma.pt systemic sclerosis cohort: is it all really set in stone?

Background

Different autoantibodies (Ab) have been associated with distinct systemic sclerosis (SSc) phenotypes. Most of these associations have not been confirmed in Portuguese patients.

Objectives

To evaluate SSc immuno-clinical associations in the Rheumatic Diseases Portuguese Register (Reuma.pt) cohort.

Methods

Multicentre open cohort study including adult SSc patients registered in Reuma.pt up to February 2021. The associations between Ab expression and clinical data were established using Chi-Square, Fischer’s Exact or Mann-Whitney U tests. The Bonferroni correction for multiple comparisons was applied to get α≤0.05. Definite associations were defined by p≤0.002, and likely associations by p≤0.05.

Results

1080 patients were included, with a mean age and disease duration of 60.2±14.6 and 12.4±10.0 years, respectively. Most were females (87.5%) and had white European ancestry (WEA, 93.2%). The most common disease subtypes were limited cutaneous (lcSSc, 57.4%), diffuse cutaneous (dcSSc, 17.7%), and very early diagnosis of SSc (VEDOSS, 12.3%). Most patients expressed antinuclear Ab (ANA, 93.4%), and the most frequent were anti-centromere (ACA, 54.6%), anti-topoisomerase I (Scl70, 21.8%), and anti-Pm/Scl Ab (PmScl, 4.7%).

ACA had definite positive associations with female sex, older age at diagnosis, lcSSc, lower modified Rodnan skin score (mRSS, median 0 vs 4), and isolated sclerodactyly, and likely associations with a higher diagnosis delay, WEA and VEDOSS. ACA had definite inverse associations with flexion contractures (FC), myositis, digital ulcers (DU), and interstitial lung disease (ILD), and likely inverse associations with pitting scars (PS) and oesophageal involvement (OI).

Scl70 had definite positive associations with male sex, dcSSc, higher mRSS, FC, DU, PS, ILD, and OI, and likely associations with younger age at diagnosis, tendon friction rubs, active scleroderma pattern in capillaroscopy, and heart involvement.

PmScl had a definite association with myositis and likely associations with male sex, calcinosis, joints involvement, and ILD. Anti-U1RNP Ab had definite associations with younger age at diagnosis, MCTD and myositis, and likely associations with a lower diagnosis delay, African ancestry and joint involvement. Anti-RNA polymerase III Ab (RP3) had likely associations with higher mRSS and renal involvement. Anti-U3RNP Ab had a definite association with dcSSc and likely associations with calcinosis and renal involvement. Anti-Th/To Ab had likely associations with male sex and myositis. Anti-Ku Ab had likely associations with systemic lupus erythematosus and mixed connective tissue disease (MCTD) overlap syndromes.

Conclusion

There was a higher prevalence of ACA and PmScl compared to other cohorts, most likely due to the high proportion of WEA patients. Most immuno-clinical associations described in the literature apply, including ACA with lcSSc and Scl70 with dcSSc, DU, PS and ILD. However, Scl70+ patients did not have an increased risk of renal involvement, and ACA+ patients did not have an increased risk for calcinosis, PAH or OI, contrary to what was described in the literature. New findings included the association of PmScl with ILD and Scl70 with an active pattern in capillaroscopy. Also, anti-U3RNP+ and Th/To+ patients did not have an increased risk of ILD or PAH, contrarily to what was previously reported. These nuances may be specific to the Portuguese SSc population or signal previously reported associations as geographically specific.

Disclosure of Interests

None declared

Dual Diagnosis, Double Trouble

Introduction

Many individuals with severe mental illness (SMI) have substance use disorder comorbidity. Dual diagnosis makes the approach and management of these patients even more challenging since the lack of improvement in either pathologies can lead to a deterioration of both.

Objectives

To illustrate, through the presentation of two cases, the clinical challenges in managing a patient with dual diagnosis

Methods

Clinical case presentation through retrospective review of clinical notes and non-systematic literature review on this topic

Results

We present the clinical cases of two women diagnosed with Bipolar Disorder and (poly)Substance Use Disorder since adolescence, who have a history of multiple hospitalizations due to mostly maniform symptoms. The complexity of case management is evident, both at the pharmacological level and in psychosocial intervention. This is aggravated by the difficulty in maintaining adherence to the therapeutic project and frequent relapses.

Conclusions

Current evidence points to the beneficial effect of a combined pharmacological and psychosocial approach, which must be comprehensive, individualized and require differentiation at various levels that are difficult to achieve and make the treatment of these situations an even greater challenge.

Using illustrative examples, this review draws attention to the practical difficulties in managing situations where substance use is associated with SMI.

Disclosure

No significant relationships.

POS0564 SHOULD WE USE PHYSICIAN’S GLOBAL TO DEFINE REMISSION IN RHEUMATOID ARTHRITIS AND CONSIDER A SEPARATE PATIENT-CENTRED TARGET?

Background

The definitions of remission play a crucial role in the treat-to-target strategy in rheumatoid arthritis.The patient’s and physician’s global assessment (PGA|PhGA) of disease activity are considered in current definitions, but PGA has been criticized for its poor relationship with actual disease activity. This leads to a considerable risk of overtreatment in patients who are otherwise in remission but fail this target solely because of PGA: PGA-near-remission. A dual-target strategy, excluding PGA from the definition of biological remission and the creation of a second target focused on disease impact has been proposed.1 Another proposal is to substitute PGA by PhGA with the purpose of strengthening the definition with a fourth variable capable of conveying relevant unaccounted factors, such as comorbidity.2

Objectives

To assess the relationship of PGA and PhGA with objective measures of disease activity (DAS3v) and their impact upon near-remission and risk of overtreatment.

Methods

This is a cross-sectional analysis of data from RAID.PT, an observational, prospective and multicenter study, including adult patients fulfilling RA classification criteria. Tender (TJC28) and swollen (SJC28) 28 joint counts, C-Reactive Protein (CRP), Pain score, Health Assessment Questionnaire (HAQ), the Rheumatoid Arthritis Impact of Disease (RAID) total score, Hospital Anxiety and Depression Scale (HADS) scores, PGA and PhGA were collected. Disease Activity Score (DAS28-3v-CRP) was calculated and taken as the reference measure of current disease activity. Correlation between PGA and PhGA with other continuous variables was evaluated through Pearson´s Correlation Coefficient and variables with p<0.10 in univariate analysis were included in multivariable linear regression models.

Results

We included 299 patients, 81.3% women, mean age of 57.4±12.0 years and disease duration 9.4±9.5 years. Average DAS28-3v-PCR 2.4 (±1.9).

DAS3v-CRP is the strongest factor associated with PhGA, explaining 45% of its variance. Inversely, it only explains 2% of the variance of PGA, which is more affected by disease impact.

In this clinical cohort, 13% of patients were in full Boolean remission and 41% in PGA-near-remission. Only 49 of 123 patients in the latter group had a PhGA >1.

Considering PhGA instead of PGA in the Boolean definition of remission would increase the proportion of remission from 13 to 37.5% of the whole cohort.

Table 1.

Factors Associated with PGA and PhGA in multivariate regression analysis

PGAPhGA(β, 95% CI)(β, 95% CI)(β, 95% CI)ΔR2ΔR2DAS28-3v-CRP3.7 (1.9-5.5)10.9 (9.4 to12.5)0.020.45RAID7.7 (6.7-8.8)3.4 (2.5 to 4.3)0.610.09HAQ5.6 (1.0-8.1)-3.4 (-6.4 to -0.4)0.010.01R20.64*0.55*

DAS28-3v-CRP: Disease Activity Score-3 variables C-Reactive Protein. PGA: Patient global assessment; PhGA: Physician Global Assessment; HAQ (health assessment questionnaire); RAID: Rheumatoid Arthritis Impact Disease score. ΔR2 change of R2associated with the inclusion of the variable in the model. *p<0,01

Conclusion

PhGA is a closer representation of actual disease activity than PGA, thus providing a more valid basis for treatment decisions aimed at disease activity. These observations support the substitution of PGA by PhGA in the Boolean definition of remission as it would strengthen the representation of disease activity and significantly reduce the risk of overtreatment in comparison to current definitions. The consequences of this change upon the prediction of long-term function and structural stability warrant evaluation. The patient’s perspective will remain central to disease management in the form of a distinct target.

References

[1]Ferreira et al. Ann Rheum Dis 2019 Oct;78(10):e109.doi: 10.1136/annrheumdis-2018-214199

[2]Pazmino et al. J Rheumatol. 2021 Feb;48(2):174-178.doi: 10.3899/jrheum.200758

Disclosure of Interests

None declared.

Will extreme weather events influence the toxic impacts of caffeine in coastal systems? Comparison between two widely used bioindicator species

In the recent years, marine heatwaves (MHWs) have caused devastating impacts on marine life. The understanding of the combined effects of these extreme events and anthropogenic pollution is a vital challenge. In particular, the combined effect of MHWs on the toxicity of pharmaceuticals to aquatic life remains unclear. To contribute to these issues, the main goal of the present investigation was to evaluate how MHWs may increase caffeine (CAF) toxicity on the clam Ruditapes philippinarum and the mussel Mytilus galloprovincialis. Bioaccumulation levels and changes on oxidative stress, metabolic capacity and neurotoxic status related biomarkers were investigated. The obtained results revealed the absence of CAF accumulation in both species. However, the used contaminant generated in both bivalve species alteration on neurotransmission, detoxification mechanisms induction as well as cellular damage. The increase of antioxidant defence mechanisms was complemented by an increase of metabolic activity and decrease of energy reserves. The obtained results seemed magnified under a simulated MHWs, suggesting to a climate-induced toxicant sensitivities' response. On this perspective, understanding of how toxicological mechanisms interact with climate-induced stressors will provide a solid platform to improve effect assessments for both humans and wildlife.

POS0861 ANTI-Ku ANTIBODY SYNDROME: IS IT A DISTINCT CLINICAL ENTITY? A CLUSTER ANALYSIS OF 75 PATIENTS

Background

Anti-Ku antibodies are rare among patients with Connective Tissue Diseases (CTD) (1). Their potential role as a disease biomarker is not well established.

Objectives

To identify subgroups of anti-Ku positive patients according to their spectrum of anti-nuclear antibody (ANA) specificities and analyze their clinical and analytical features.

Methods

Multicenter, cross-sectional study of anti-Ku positive patients, irrespective of their diagnosis, followed at eight Rheumatology outpatient clinics. Patients were spontaneously identified according to the local work-out for suspected autoimmune diseases. Anti-Ku and other ANA specificities were determined at each hospital’s Immunology lab according to the local methodology and strategy to decide on which auto-antibodies to check when faced with a positive ANA immunofluorescence. Clinical, analytical and treatment cumulative features were identified following a dedicated structured questionnaire. Hierarchical cluster analysis (method: between-groups linkage, squared Euclidian distance) for ANA specificity variables was performed to identify subgroups.

Results

Seventy-five anti-Ku positive patients were included (female: 73.3%, mean age at diagnosis: 50.5±17.9 years, mean disease duration: 4.7±5.4 years). Their clinical diagnosis were undifferentiated connective tissue disease (UCTD) (21.3%), systemic lupus erythematosus (17.3%), Sjögren’s syndrome (16.0%), inflammatory myositis (14.7%), systemic sclerosis (10.7%), overlap CTD syndrome (8.0%), other connective tissue diseases (17.3%), healthy anti-Ku carrier (17.3%).

Six autoantibody clusters were identified and included most patients (Figure 1): Cluster 1 - anti-Ku without any other ANA specificities (36.0%); cluster 2 - Anti-nor90 and anti-fibrillarin (8.0%); cluster 3 - anti-Jo1, PL-7, PL-12, and PM-Scl100 (9.3%); cluster 4 - anti-Scl70 (4.0%); cluster 5 - anti-Sm, anti-ribosome, and anti-dsDNA (13.3%); cluster 6 - anti-centromere, Th/To, PM-Scl75 (8.0%). The remaining patients were outliers (21.3%) not fitting in any cluster.

Figure 1.

Hierarchical cluster analysis of ANA specificities in anti-Ku+ patients

Detailed clinical analysis of patients in cluster 1, the most numerous, presenting anti-Ku antibodies without any other ANA specificities, the most frequent clinical manifestations were: Raynaud’s phenomenon (40.7%), arthritis (25.9%), sicca syndrome (25.9%), myositis (14.8%), and interstitial lung disease (ILD) (14.8%); 25.9% were healthy anti-Ku carriers. Patients from cluster 1 were most frequently treated with low dose glucocorticoids (51.9%), hydroxychloroquine (37.0%), or methotrexate (18.5%).

Among the whole study population (n=75), major organ involvement was present in 18.7%, with ILD in 10.7% and renal involvement in 8.0%. None of the patients in cluster 1 presented nephritis.

Conclusion

Anti-Ku positive patients without any other ANA specificities is the largest subset and may represent a distinct entity among the differentiated CTD (2). Patients with this anti-Ku syndrome may develop ILD. In addition, anti-Ku antibodies can be found in patients with a diversity of other ANA specificities and heterogeneous CTD diagnosis.

References

[1]Lakota K, et al. International cohort study of 73 anti-Ku-positive patients: association of p70/p80 anti-Ku antibodies with joint/bone features and differentiation of disease populations by using principal-components analysis. Arthritis Res Ther. 2012 Jan 6;14(1):R2. doi: 10.1186/ar3550. PMID: 22226402; PMCID: PMC3392788.

[2]Spielmann L, et al. Anti-Ku syndrome with elevated CK and anti-Ku syndrome with anti-dsDNA are two distinct entities with different outcomes. Ann Rheum Dis. 2019 Aug;78(8):1101-1106. doi: 10.1136/annrheumdis-2018-214439. Epub 2019 May 24. PMID: 31126956.

Disclosure of Interests

None declared

The influence of salinity on the toxicity of remediated seawater

Mercury (Hg) is one of the most hazardous pollutants, due to its toxicity, biological magnification and worldwide persistence in aquatic systems. Thus, new efficient nanotechnologies (e.g. graphene oxide functionalized with polyethyleneimine (GO-PEI)) have been developed to remove this metal from the water. Aquatic environments, in particular transitional systems, are also subjected to disturbances resulting from climate change, such as salinity shifts. Salinity is one of the most relevant factors that influences the distribution and survival of aquatic species such as mussels. To our knowledge, no studies assessed the ecotoxicological impairments induced in marine organisms exposed to remediate seawater (RSW) under different salinity levels. For this, the focus of the present study was to evaluate the effects of seawater previously contaminated with Hg and remediated with GO-PEI, using the species Mytilus galloprovincialis, maintained at three different salinities (30, 20 and 40). The results obtained demonstrated similar histopathological and metabolic alterations, oxidative stress and neurotoxicity in mussels under RSW treatment at stressful salinity conditions (20 and 40) in comparison to control salinity (30). On the other hand, the present findings revealed toxicological effects including cellular damage and histopathological impairments in mussels exposed to Hg contaminated seawater in comparison to non-contaminated ones, at each salinity level. Overall, these results confirm the high efficiency of GO-PEI to sorb Hg from water with no noticeable toxic effects even under different salinities, leading to consider it a promising eco-friendly approach to remediate contaminated water.

Marine heatwaves hamper neuro-immune and oxidative tolerance toward carbamazepine in Mytilus galloprovincialis

The increased frequency and intensity of short-term extreme warming phenomena have been associated to harsh biological and ecosystem outcomes (i.e., mass mortalities in marine organisms). Marine heatwaves (MHWs), occurring when seasonal temperature threshold is exceeded for at least 5 consecutive days, may reduce the tolerance of coastal species toward additional pressures, but interactions between such multiple stressors are virtually unexplored. The present study aimed to characterize in Mytilus galloprovincialis the influence of a simulated MHW scenario on the toxicological effects of the pharmaceutical carbamazepine (CBZ), ubiquitously detected in the marine environment and chosen as model compound for this relevant class of emerging contaminants. The bioaccumulation of CBZ and responsiveness of various biological parameters, including immune system, antioxidant status, lipid metabolism and cellular integrity, were analyzed in exposed mussels both during and after the end of the heatwave. MHW appeared to strongly modulate accumulation of CBZ, paralleled by weakened immunocompetence and onset of oxidative disturbance that finally evolved to cellular damages and lipid metabolism disorders. Elaboration of the overall results through a quantitative Weight of Evidence model, revealed the highest hazard in organisms exposed to both the stressors 10 days after the end of the heatwave, suggesting that MHWs could leave a footprint on the capability of mussels to counteract CBZ toxicity, thus affecting their vulnerability and predisposition to adverse effects toward multiple stressors.

Biochemical response of Ficopomatus enigmaticus adults after exposure to organic and inorganic UV filters

With the increase of UV filters usage and consequent release into aquatic environments, the concerns about their potential ecological risks are also increasing. According to this, in the present study, adult polychaetes of the species Ficopomatus enigmaticus were chronically exposed to three concentrations (0.01, 0.1 and 0.5 mg/L) of organic and inorganic filters (Ethylhexyl methoxycinnamate (EHMC) and nanoparticulate Zinc oxide (nZnO), respectively) in order to analyse biochemical responses related to cellular damage, antioxidant defence, biotransformation mechanisms and, lastly, neurotoxicity. Despite major lipid peroxidation caused by EHMC was observed, both UV filters have produced the same response patterns. In details, a clear concentration-dependent activation of glutathione S-transferases and a significant decrease of acetylcholinesterase levels defined an important neurotoxic effect was observed for both contaminants. These results become important to expand the limited scientific literature on biochemical responses of marine and brackish water invertebrates to organic and inorganic UV filters.

Behavioral, physiological and biochemical responses and differential gene expression in Mytilus galloprovincialis exposed to 17 alpha-ethinylestradiol and sodium lauryl sulfate

Mixture of contaminants often determine biological responses of marine species, making difficult the interpretation of toxicological data. The pharmaceutical 17 alpha-ethinylestradiol (EE2) and the surfactant Sodium Lauryl Sulfate (SLS) commonly co-occur in the marine environment. This study evaluated the effects of EE2 (125.0 ng/L) and SLS (4 mg/L), acting individually and combined, in the mussel Mytilus galloprovincialis. Contaminated mussels closed their valves for longer periods than control ones, especially in the presence of both contaminants, with longer closure periods immediately after spiking compared to values obtained one day after spiking. Nevertheless, males and females increased their metabolism when in the presence of both contaminants (males) and SLS (females), and independently on the treatment males and females were able to activate their antioxidant and biotransformation defences. Although enhancing defences mussels still presented cellular damage and loss of redox balance, especially noticed in the presence of EE2 for males and SLS for females. Histopathological damage was found at mussel's gills in single and mixture exposure, and qPCR analysis revealed a clear estrogen receptor expression with no additive effect due to combined stressors. The results obtained highlight the harmful capacity of both contaminants but further research on this matter is needed, namely considering different climate change scenarios.

How temperature rise will influence the toxic impacts of 17 α-ethinylestradiol in Mytilus galloprovincialis?

Pharmaceutical drugs are Contaminants of Emerging Concern (CECs) and are continuously discharged into the environment. As a result of human and veterinary use, these substances are reaching aquatic coastal systems, with limited information regarding the toxic effects of these compounds towards inhabiting organisms. Among CECs are pharmaceuticals like 17 α-ethinylestradiol (EE2), which is a synthetic hormone with high estrogenic potency. EE2 has been increasingly found in different aquatic systems but few studies addressed its potential toxicity to marine wildlife, in particular to bivalves. Therefore, the aim of the present study was to evaluate the influence of temperature (17 °C-control and 21 °C) on the potential effects of EE2 on the mussel Mytilus galloprovincialis. For this purpose, mussels were exposed to different concentrations of EE2 (5.0; 25.0; 125.0 and 625 ng/L), resembling low to highly polluted sites. Mussels exposed to each concentration were maintained under two temperatures, 17 and 21 °C, which represent actual and predicted warming conditions, respectively. After 28 days, oxidative stress status, metabolism related parameters, neurotoxicity and histopathological alterations were measured. The results obtained clearly showed an interactive effect of increased temperature and EE2, with limited antioxidant and biotransformation capacity when both stressors were acting together, leading to higher cellular damage. The combination of both stressors also enhanced mussels' metabolic capacity and neurotoxic effects. Nevertheless, loss of redox balance was confirmed by the strong decrease of the ratio between reduce glutathione (GSH) and oxidized glutathione (GSSG) in contaminated mussels, regardless the temperature. Histopathological indexes in contaminated mussels were significantly different from the control group, indicating impacts in gills and digestive glands of mussels due to EE2, with higher values observed at 21 °C. Overall, this study demonstrates that of EE2 represents a threat to mussels and predicted warming conditions will enhance the impacts, which in a near future might result in impairments at the population and community levels.

Metabolic and oxidative status alterations induced in Ruditapes philippinarum exposed chronically to estrogen 17α-ethinylestradiol under a warming scenario

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