Stress-Induced Haematohidrosis: a Case Report

We describe a case of stress-induced haematohidrosis in a 14-year-old boy who responded well to stress management together with sertraline medication.

Search for Subsolar-Mass Binaries in the First Half of Advanced LIGO's and Advanced Virgo's Third Observing Run

We report on a search for compact binary coalescences where at least one binary component has a mass between 0.2  M_{⊙} and 1.0  M_{⊙} in Advanced LIGO and Advanced Virgo data collected between 1 April 2019 1500 UTC and 1 October 2019 1500 UTC. We extend our previous analyses in two main ways: we include data from the Virgo detector and we allow for more unequal mass systems, with mass ratio q≥0.1. We do not report any gravitational-wave candidates. The most significant trigger has a false alarm rate of 0.14  yr^{-1}. This implies an upper limit on the merger rate of subsolar binaries in the range [220-24200]  Gpc^{-3} yr^{-1}, depending on the chirp mass of the binary. We use this upper limit to derive astrophysical constraints on two phenomenological models that could produce subsolar-mass compact objects. One is an isotropic distribution of equal-mass primordial black holes. Using this model, we find that the fraction of dark matter in primordial black holes in the mass range 0.2  M_{⊙}<m_{PBH}<1.0  M_{⊙} is f_{PBH}≡Ω_{PBH}/Ω_{DM}≲6%. This improves existing constraints on primordial black hole abundance by a factor of ∼3. The other is a dissipative dark matter model, in which fermionic dark matter can collapse and form black holes. The upper limit on the fraction of dark matter black holes depends on the minimum mass of the black holes that can be formed: the most constraining result is obtained at M_{min}=1  M_{⊙}, where f_{DBH}≡Ω_{DBH}/Ω_{DM}≲0.003%. These are the first constraints placed on dissipative dark models by subsolar-mass analyses.

The fluctuation-dissipation measurement instrument at the Linac Coherent Light Source

The development of new modes at x-ray free electron lasers has inspired novel methods for studying fluctuations at different energies and timescales. For closely spaced x-ray pulses that can be varied on ultrafast time scales, we have constructed a pair of advanced instruments to conduct studies targeting quantum materials. We first describe a prototype instrument built to test the proof-of-principle of resonant magnetic scattering using ultrafast pulse pairs. This is followed by a description of a new endstation, the so-called fluctuation-dissipation measurement instrument, which was used to carry out studies with a fast area detector. In addition, we describe various types of diagnostics for single-shot contrast measurements, which can be used to normalize data on a pulse-by-pulse basis and calibrate pulse amplitude ratios, both of which are important for the study of fluctuations in materials. Furthermore, we present some new results using the instrument that demonstrates access to higher momentum resolution.

Analysis of entropy production in a bi-convective magnetized and radiative hybrid nanofluid flow using temperature-sensitive base fluid (water) properties

The heat transport characteristics, flow features, and entropy-production of bi-convection buoyancy induced, radiation-assisted hydro-magnetic hybrid nanofluid flow with thermal sink/source effects are inspected in this study. The physical characteristics of hybrid nanofluids (water-hosted) are inherited from the base liquid (water) and none has considered the physical characteristics of base liquid (water) in the study of temperature-sensorial hybrid nanofluid investigations, though the water physical characteristics are not constants in temperature variations. So, the temperature-sensorial attributes of base liquid (water) are taken into account for this hybrid nanofluid ([Formula: see text]) flow analysis. The mathematical forms of the flow configuration (i.e., the set of coupled, nonlinear PDE form of governing equations) are solved by utilizing the subsequent tasks: (i) congenial transformation; (ii) quasilinearization; (iii) methods of finite differences to form block matrix system, and (iv) Varga's iterative algorithm. The preciseness of the whole numerical procedure is ensured by restricting the computation to follow strict convergence conditions. Finally, the numerically extracted results representing the impacts of various salient parameters on different profiles ([Formula: see text]), gradients, and entropy production are exhibited in physical figures for better perception. A few noticeable results are highlighted as: velocity graph shows contrast behaviour under assisting and opposing buoyancy; temperature ([Formula: see text]) is dropping for heightening heat source ([Formula: see text]) surface friction remarkably declines with the outlying magnetic field ([Formula: see text]); thermal transport confronts drastic abatement under radiation ([Formula: see text]), and [Formula: see text]; the characteristics Reynolds and Brinkman numbers promote entropy. Furthermore, the bounding surface acts as a strong source of [Formula: see text]-production. Summarizations are listed at the end to quantify percentage variations.

Role of animal models in biomedical research: a review

The animal model deals with the species other than the human, as it can imitate the disease progression, its’ diagnosis as well as a treatment similar to human. Discovery of a drug and/or component, equipment, their toxicological studies, dose, side effects are in vivo studied for future use in humans considering its’ ethical issues. Here lies the importance of the animal model for its enormous use in biomedical research. Animal models have many facets that mimic various disease conditions in humans like systemic autoimmune diseases, rheumatoid arthritis, epilepsy, Alzheimer’s disease, cardiovascular diseases, Atherosclerosis, diabetes, etc., and many more. Besides, the model has tremendous importance in drug development, development of medical devices, tissue engineering, wound healing, and bone and cartilage regeneration studies, as a model in vascular surgeries as well as the model for vertebral disc regeneration surgery. Though, all the models have some advantages as well as challenges, but, present review has emphasized the importance of various small and large animal models in pharmaceutical drug development, transgenic animal models, models for medical device developments, studies for various human diseases, bone and cartilage regeneration model, diabetic and burn wound model as well as surgical models like vascular surgeries and surgeries for intervertebral disc degeneration considering all the ethical issues of that specific animal model. Despite, the process of using the animal model has facilitated researchers to carry out the researches that would have been impossible to accomplish in human considering the ethical prohibitions.

Hypertriton Production in p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The study of nuclei and antinuclei production has proven to be a powerful tool to investigate the formation mechanism of loosely bound states in high-energy hadronic collisions. The first measurement of the production of _{Λ}^{3}H in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV is presented in this Letter. Its production yield measured in the rapidity interval -1<y<0 for the 40% highest-multiplicity p-Pb collisions is dN/dy=[6.3±1.8(stat)±1.2(syst)]×10^{-7}. The measurement is compared with the expectations of statistical hadronization and coalescence models, which describe the nucleosynthesis in hadronic collisions. These two models predict very different yields of the hypertriton in charged particle multiplicity environments relevant to small collision systems such as p-Pb, and therefore the measurement of dN/dy is crucial to distinguish between them. The precision of this measurement leads to the exclusion with a significance larger than 6.9σ of some configurations of the statistical hadronization model, thus constraining the theory behind the production of loosely bound states at hadron colliders.

Abstract 898: Metformin and ICG-001 act synergistically to abrogate cancer stem cell-mediated chemoresistance in colorectal cancer by promoting apoptosis and autophagy

Background: Colorectal cancer (CRC) remains the third most frequently diagnosed cancers in the United States. Current treatment modalities for patients with CRC include surgery, which is often followed with 5-fluorouracil (5FU) based adjuvant chemotherapy. While such treatment regimens are effective at improving disease outcomes, their clinical usefulness is often hampered due to emergence of chemotherapeutic resistance. Presence of cancer stem cells (CSCs) have been attributed towards 5FU-mediated drug resistance which subsequently leads to poor prognosis in CRC patients. In this study we investigated a novel therapeutic strategy by using metformin along with ICG-001, a Wnt signaling inhibitor, as an approach to abrogate CSC mediated chemoresistance in 5FU resistant (5FUR) and parental CRC cells, as well as CRC patient derived tumor organoids.

Methods: Two 5FU resistant (5FUR)-CRC cell lines previously generated and characterized in our lab were used in this study. First, we performed genome-wide transcriptomic profiling followed by pathway enrichment analysis to identify differentially expressed genes and its associated pathways between parental and 5FUR CRC cells. Next, we determine the anti-tumor effects of metformin and ICG-001 by performing cell viability, colony formation, migration, and invasion analysis. Next, we explore the possible mechanism of action of these two drugs by performing gene and protein expression analysis of CSC, autophagy and apoptotic markers. We also evaluated the anti-tumor activity of metformin and ICG-001 in CRC patient derived tumor organoids.

Results: We observed that 5FUR-CRC cells exhibited increased expression of CSC markers and increased spheroid forming ability. Genome-wide transcriptomic analysis followed by pathway analysis revealed that Wnt signaling pathway, pathways regulating pluripotency of stem cells etc. were enriched between parental and 5FUR CRC cells. These findings prompted us to use ICG-001 which selectively targets Wnt signaling along with metformin in abrogating CSC mediated chemoresistance in CRC. We observed that a combined treatment of metformin and ICG-001 exert anti-tumor activity in by decreasing cell viability (p&lt;0.01), colony formation (p&lt;0.001), migration (p&lt;0.01), and invasion ability (p&lt;0.01) in synergistic manner. We also observed that combined treatment decreases the expression of CSC markers and promote autophagy and apoptosis. In accordance with our in vitro studies, we observed that metformin and ICG-001 exhibited anti-tumor activity in patient derived CRC organoid models in combination (p&lt;0.001).

Conclusion: We conclude that metformin and ICG-001 act synergistically, which can be used as a therapeutic strategy to overcome 5FU mediated therapeutic resistance in CRC.

Citation Format: Souvick Roy, Yinghui Zhao, Yate-Ching Yuan, Ajay Goel. Metformin and ICG-001 act synergistically to abrogate cancer stem cell-mediated chemoresistance in colorectal cancer by promoting apoptosis and autophagy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 898.

Abstract 3389: An exosomal miRNA-based liquid biopsy signature for the noninvasive early detection of pancreatic ductal adenocarcinoma

Background: Pancreatic ductal adenocarcinoma (PDAC) is projected to become the second leading cause of cancer-related deaths in the United States by 2030. Most of the PDAC patients are diagnosed with advanced disease, and less than 20% of patients are resectable at the time of diagnosis. The current imaging tools and blood markers (e.g. CA 19-9), are inadequate for early disease detection due to their poor specificity and sensitivity. This highlights the need to develop robust, noninvasive biomarkers for early detection of PDAC. While a large body of literature supports the use of cell-free miRNAs (cf-miRNAs) as potential diagnostic biomarkers in cancer, their tumor specificity is often debatable. Given the emerging evidence that exosomal cargo is a more robust representation of individual tumor types, in this study we sought to explore the diagnostic potential of cf-miRNAs along with exosomal miRNAs (exo-miRNAs), to establish a non-invasive miRNA signature for the early detection of PDAC.

Methods: As part of the NCI’s Pancreatic Cancer Detection Consortium (PCDC) funded project, in this study, small RNA-sequencing was performed in exosome and cell-free (cf) samples from a cohort of 57 PDAC cases and 57 non-disease controls. Using rigorous bioinformatic and biostatistical approaches, we prioritized a panel of cf- and exo-miRNAs and evaluated its diagnostic performance in the sequencing-based discovery and validation cohorts. Subsequently, the performance of the discovered miRNA panel was validated using qRT-PCR assays in an independent clinical validation cohort of PDAC patients and non-disease controls (n=48/each group). The results were examined by ROC curve analysis to determine the diagnostic power of the biomarker panel individually and in combination for their ability to discriminate PDAC from controls.

Results: The genomewide transcriptomic analyses led to the identification of a panel of 13 cf-miRNA and 17 exo-miRNA candidates. Sequencing validation in an independent cohort revealed that a combined panel of cf and exo-miRNAs exhibited an area under curve (AUC) of 0.89. Subsequent risk score analysis demonstrated that our biomarker signature was also robust in the identification of PDAC patients with early-stage cancers (stage I & II) vs. controls (p &lt;0.001). Moreover, when we combined the miRNA biomarker panel with CA19-9 values, the diagnostic performance was significantly superior when compared to the biomarker panel alone. Finally, the validation efforts in clinical cohorts by qRT-PCR revealed that the combined miRNA panel yielded an impressive accuracy with an AUC of 0.91, and a sensitivity of 0.88 and specificity of 0.87.

Conclusions: In conclusion, we report a novel, exosome-based miRNA signature for the early detection of patients with PDAC; which could potentially improve early-detection efforts for this fatal malignancy.

Citation Format: Kota Nakamura, Souvick Roy, Zhongxu Zhu, Eunsung Jun, Haiyong Han, Ruben M. Munoz, Satoshi Nishiwada, Geeta Sharma, Derek Cridebring, Frederic Zenhausern, Seungchan Kim, Denise Roe, Sourat Darabi, In Woong Han, Douglas Evans, Suguru Yamada, Michael Demure, Scott A. Celinski, Erkut Borazanci, Susan Tsai, John Bolton, Yasuhiro Kodera, Joon Oh Park, Song Cheol Kim, Xin Wang, Daniel Von Hoff, Ajay Goel. An exosomal miRNA-based liquid biopsy signature for the noninvasive early detection of pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3389.

Abstract 723: Dual inhibition of MDM2 and p38 MAPK signaling is a potential therapeutic strategy in esophageal squamous cell carcinoma

Background: Esophageal squamous cell carcinoma (ESCC) is one of the most common lethal malignancies. Despite recent advances in treatment, the overall 5-year survival rate remains low, primarily due to late diagnosis, acquired resistance to therapy, and distant metastases. Hence, development of novel therapeutic strategies is required to improve patient outcomes. The MDM2 gene is amplified in some patients with ESCC, frequently decreasing the tumor suppressive function of p53. In addition, 40-60% of ESCC tumors exhibit p53 mutations. Missense mutations within the p53 gene cause its overexpression and subsequent activation of p38 MAPK signaling. In this study, we aimed to investigate the effect of combining a p38 MAPK inhibitor and an MDM2 antagonist as a potential therapeutic strategy in ESCC.

Methods: To determine the synergistic anti-tumor activity of the MDM2 antagonist siremadlin (HDM-201) and the p38 MAPK inhibitor Ralimetinib dimesylate (LY2228820), we performed cell viability, colony formation, apoptosis, and cell cycle analysis in ESCC cell lines. Next, we evaluated the anti-tumor activity of HDM-201 and LY2228820 in a xenograft mouse model. Finally, we performed siRNA mediated silencing of p53 to assess its functional role in the MDM2 antagonist-induced activation of p38 MAPK signaling and its ability to modulate the DNA damage response (DDR) by measuring ROS status and phosphorylation of H2AX.

Results: HDM-201 exerted cytotoxic effects in p53-mutated ESCC cells in a dose-dependent manner and activated the p38 MAPK signaling pathway. These results prompted us to combine the p38 MAPK inhibitor LY2228820 with HDM-201 and evaluate this novel treatment strategy in a p53-mutant pre-clinical model of ESCC. We observed that HDM-201 and LY2228820 acted synergistically to decrease cell viability (p&lt;0.01) and colony formation (p&lt;0.01), as well as induction of apoptosis (p&lt;0.01) and G2/M phase cell cycle arrest (p&lt;0.01). The xenograft animal model confirmed our in vitro findings wherein the combined treatment exerted more potent anti-tumor activity (p&lt;0.05). We also observed that silencing of p53 promoted resistance towards the MDM2 antagonist and did not induce apoptosis, highlighting that a functional p53 is required for inducing apoptosis after combined treatment. Furthermore, we observed that the combined treatment promoted ROS induced oxidative stress (p&lt;0.01) and promoted DNA double strand breaks (DSBs) as evidenced by increased phosphorylation of H2AX (p&lt;0.01), highlighting its potential as an effective therapeutic strategy.

Conclusion: We provide novel pre-clinical evidence that inhibition of p38 MAPK signaling can augment the anti-tumor activity of an MDM2 antagonist in p53-mutant human tumor models of ESCC.

Citation Format: Souvick Roy, Rachana Garg, David Wang, Ajay Goel. Dual inhibition of MDM2 and p38 MAPK signaling is a potential therapeutic strategy in esophageal squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 723.

AB0444 ENPATORAN: PRECLINICAL EVIDENCE SUPPORTING GLUCOCORTICOID DOSE REDUCTION AND PHASE II STUDY DESIGN IN PATIENTS WITH SLE AND/OR CLE (WILLOW)

Background

Enpatoran is a potent selective dual inhibitor of toll-like receptor (TLR) 7 and TLR8, aberrant activation of which may be involved in systemic lupus erythematosus (SLE) pathogenesis and glucocorticoid resistance.1,2,3 Enpatoran suppressed disease development in lupus mouse models, improving survival and reducing proteinuria, autoantibodies, and the interferon (IFN) gene signature.1 In healthy participants and patients hospitalized with COVID-19 pneumonia, enpatoran was well tolerated and demonstrated effective TLR7/8 engagement.4 Enpatoran is potentially glucocorticoid sparing and may help avoid the detrimental effects of long-term corticosteroid use in SLE management.5,6

Objectives

To evaluate the glucocorticoid-sparing effect of enpatoran and design a basket trial to assess its efficacy and safety in patients with SLE and/or cutaneous lupus erythematosus (CLE).

Methods

Cytokine concentrations and gene expression changes were measured in stimulated human peripheral blood mononuclear cells (PBMCs) from healthy donors after treatment with dexamethasone, TLR7/8 inhibitor, or both. A Phase II, basket design proof-of-concept, dose-finding study in patients with SLE and/or CLE (WILLOW) was designed.

Results

In healthy donor PBMCs, synergy was observed between TLR7/8 inhibitor and dexamethasone. Combination treatment inhibited cytokine release (IL-6) with greater potency than either treatment alone and reduced the expression of nuclear factor-kappa B and IFN-regulated genes. WILLOW is a Phase II, basket proof-of-concept, dose-finding, randomized, double-blind, placebo (PBO)-controlled 24-week study with two cohorts (NCT05162586, Figure 1). The primary objectives of WILLOW are to evaluate the dose–response relationship of enpatoran in reducing disease activity based on Cutaneous Lupus Erythematosus Disease Area and Severity Index-A (CLASI-A) or BILAG-Based Composite Lupus Assessment (BICLA) response rate. The secondary objectives are to investigate effects on both BICLA response and clinically meaningful corticosteroid reduction and evaluate disease control (including clinically meaningful corticosteroid reduction) in patients with predominantly active CLE or SLE. Cohort A will enroll patients with CLE (active subacute CLE and/or discoid LE) or SLE with predominantly active lupus rash. Cohort B, in two parts, will enroll SLE patients with moderate to severe systemic disease activity. Part 1 will assess clinical signal and Part 2 may be adapted to improve dose finding. Glucocorticoid-sparing will be evaluated by mandatory tapering to a prednisone-equivalent dose of ≤5 mg/day.

Figure 1.

WILLOW study design.

Cohort A and Cohort B Part 1 will start in parallel.

*Part 2 will be initiated after a pre-specified number of patients are enrolled in Part 1; enpatoran doses in Part 2 may be adapted to improve dose finding (dashed boxes).

BILAG, British Isles Lupus Assessment Group; CLASI-A, Cutaneous Lupus Erythematosus Disease Area and Severity Index-A; CLE, cutaneous lupus erythematosus; CS, corticosteroid; DBPC, double-blind placebo-controlled; DLE, discoid lupus erythematosus; PBO, placebo; SCLE, Subacute cutaneous lupus erythematosus; SLE, systemic lupus erythematosus; SLEDAI, Systemic Lupus Erythematosus Disease Activity Index.

Conclusion

Enpatoran is a novel TLR7/8 inhibitor and may enable glucocorticoid dose reduction in patients with SLE and CLE. The WILLOW study incorporates multiple novel elements including a basket design and evaluation of glucocorticoid-sparing.

References

[1]Vlach, et al. J Pharmacol Exp Ther. 2021;376:397–409;

[2]Northcott, et al. Lancet Rheumatol. 2021;5:e357–e370;

[3]Guiducci, et al. Nature. 2010;465:937–941;

[4]Port, et al. Pharmacol Res Perspect. 2021;9:e00842;

[5]Thamer, et al. J Rheumatol. 2009;36:560–564;

[6]Ruiz-Irastorza, et al. Rheumatology. 2012;51:1145–1153.

Acknowledgements

This study was sponsored by the healthcare business of Merck KGaA, Darmstadt, Germany (CrossRef Funder ID: 10.13039/100009945), who funded medical writing support by Bioscript Stirling Ltd.

Disclosure of Interests

Eric F. Morand: None declared, Andrew Bender Shareholder of: Shares in Merck KGaA, Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA), Aditee Deshpande Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA), Bharat Vaidyanathan Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA), cristina vazquez mateo Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA), Melinda Przetak Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA), Flavie Moreau Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA), Mukhy Khursheed Employee of: Merck Serono Ltd (an affiliate of Merck KGaA), Sanjeev Roy Employee of: Ares Trading SA (an affiliate of Merck KGaA), David Pearson Consultant of: Biogen Inc.

Expression profile, transcriptional and post-transcriptional regulation of genes involved in hydrogen sulphide metabolism connecting the balance between development and stress adaptation in plants: a data-mining bioinformatics approach

Recent research focused on novel aspects of sulphur and sulphur-containing molecules in fundamental plant processes has highlighted the importance of these compounds. Currently, the focus has shifted to the efficacy of hydrogen sulphide (H₂ S) as signalling compounds that regulate different development and stress mitigation in plants. Accordingly, we used an in silico approach to study the differential expression patterns of H₂ S metabolic genes at different growth/development stages and their tissue-specific expression patterns under a range of abiotic stresses. Moreover, to understand the multilevel regulation of genes involved in H₂ S metabolism, we performed computation-based promoter analysis, alternative splice variant analysis, prediction of putative miRNA targets and co-expression network analysis. Gene expression analysis suggests that H₂ S biosynthesis is highly influenced by developmental and stress stimuli. The functional annotation of promoter structures reveales a wide range of plant hormone and stress responsive cis-regulatory elements (CREs) that regulate H₂ S metabolism. Co-expression analysis suggested that genes involved in H₂ S metabolism are also associated with different metabolic processes. In this data-mining study, the primary focus was to understand the genetic architecture governing pathways of H₂ S metabolism in different cell compartments under various developmental and stress signalling cascades. The present study will help to understand the genetic architecture of H₂ S metabolism via cysteine metabolism and the functional roles of these genes in development and stress tolerance mechanisms.

POS1268 PHASE II TRIAL OF ENPATORAN IN PATIENTS HOSPITALIZED WITH COVID-19 PNEUMONIA

Background

Enpatoran is a selective and potent dual toll-like receptor (TLR) 7/8 inhibitor in development for the treatment of cutaneous and systemic lupus erythematosus (CLE/SLE). Enpatoran inhibits TLR7/8 activation in vitro and suppresses disease activity in lupus mouse models.1 Enpatoran was well tolerated and had linear pharmacokinetic (PK) parameters in healthy volunteers.2 As TLR7/8 mediate immune responses to single-stranded RNA viruses, including SARS-CoV-2, it was postulated that enpatoran may prevent hyperinflammation and cytokine storm in COVID-19.

Objectives

In response to the COVID-19 pandemic, we conducted an exploratory Phase II trial to assess safety and determine whether enpatoran prevents clinical deterioration in patients (pts) hospitalized with COVID-19 pneumonia. PK and pharmacodynamics (PD) of enpatoran were also evaluated.

Methods

ANEMONE was a randomized, double-blind, placebo (PBO)-controlled study conducted in Brazil, the Philippines, and the USA (NCT04448756). Pts aged 18–75 years, hospitalized with COVID-19 pneumonia (WHO 9-point scale score =4) but not mechanically ventilated, with SpO2 <94% and PaO2/FiO2 ≥150 (FiO2 maximum 0.4) were eligible. Those with a history of uncontrolled illness, active/unstable cardiovascular disease and SARS-CoV-2 vaccination were excluded. Pts received PBO or enpatoran (50 or 100 mg twice daily [BID]) for 14 days, with monitoring to Day 28 and safety follow-up to Day 60. Primary outcomes were safety and time to recovery (WHO 9-point scale ≤3). Clinical deterioration (time to clinical status >4, WHO 9-point scale) was a secondary outcome. Exploratory endpoints were enpatoran and biomarker concentrations (cytokines, C-reactive protein [CRP], D-dimer and interferon gene signature [IFN-GS] scores) assessed over time.

Results

149 pts received either PBO (n=49), or enpatoran 50 mg (n=54) or 100 mg (n=46) BID; 88% completed treatment and 86% received concomitant steroids. Median age was 50 years (77% <60 years old), 66% were male, and 50% had ≥1 comorbidity (40% hypertension, 24% diabetes). Overall, 59% pts reported a treatment-emergent adverse event (TEAE) with three non-treatment-related deaths; 11% reported a treatment-related TEAE. The proportion of pts in the enpatoran group reporting serious TEAEs was low (50 mg BID 9%; 100 mg BID 2%) vs PBO (18%). Gastrointestinal disorders were most common (PBO 8%; 50 mg BID 28%; 100 mg BID 9%). The primary outcome of time to recovery with enpatoran vs PBO was not met; medians were 3.4–3.9 days. A positive signal in time to clinical deterioration from Day 1 through Day 28 was observed; hazard ratios [95% CI] for enpatoran vs PBO were 0.39 [0.13, 1.15] (50 mg BID) and 0.30 [0.08, 1.08] (100 mg BID). Mean enpatoran exposure was dose-proportional, and PK properties were within expectations. The median (quartile [Q]1– Q3) interleukin 6 (IL-6), CRP and D-dimer baseline concentration across the groups were 5.7 (4.0–13.5) pg/mL, 30.04 (11.40–98.02) and 0.62 (0.39–1.01) mg/L, respectively. Baseline IFN-GS scores were similar across groups.

Conclusion

The ANEMONE trial was the first to evaluate the safety and efficacy of a TLR7/8 inhibitor in an infectious disease for preventing cytokine storm. Enpatoran up to 100 mg BID for 14 days was well tolerated by patients acutely ill with COVID-19 pneumonia. Time to recovery was not improved with enpatoran, perhaps due to the younger age of patients who had fewer comorbidities compared to those in similar COVID-19 trials. However, there was less likelihood for clinical deterioration with enpatoran than placebo. This trial provides important safety, tolerability, PK and PD data supporting continued development of enpatoran in SLE and CLE (NCT04647708, NCT05162586).

References

[1]Vlach, et al. J Pharmacol Exp Ther 2021;376:397–409;

[2]Port, et al. Pharmacol Res Perspect 2021;9:e00842.

Acknowledgements

We would like to thank those who took part in the the ANEMONE trial. This study was sponsored by the healthcare business of Merck KGaA, Darmstadt, Germany (CrossRef Funder ID: 10.13039/100009945), who funded medical writing support by Bioscript Stirling Ltd.

Disclosure of Interests

John E. McKinnon Consultant of: EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA, Joel Santiaguel Speakers bureau: Merck Healthcare KGaA, Claudia Murta Speakers bureau: Pfizer/Wyeth, Dongzi Yu Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA), Mukhy Khursheed Employee of: Merck Serono Ltd (an affiliate of Merck KGaA), Flavie Moreau Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA), Lena Klopp-Schulze Employee of: Merck Healthcare KGaA, Jamie Shaw Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA), Sanjeev Roy Employee of: Ares Trading SA (an affiliate of Merck KGaA), Amy Kao Employee of: EMD Serono Research & Development institute (an affiliate of Merck KGaA)

POS1411 ARTIFICIAL INTELLIGENCE FOR IDENTIFYING NEW DISEASE CLUSTERS IN PATIENTS WITH PSORIATIC ARTHRITIS/PSORIASIS: A PROOF-OF-CONCEPT STUDY

Background

Psoriatic arthritis (PsA)/Psoriasis (PsO) patients present with multiple long-term conditions (MLTCs), and more than half of PsA patients have ≥1 LTC, which have an impact on the quality of life. We used the Clinical Practice Research Datalink (CPRD) in the UK to determine multimorbidity in patients with PsA/PsO. CPRD is a database of routinely collected UK patient data that can be used to examine multimorbidity over the life course of the disease. A understanding of clusters and timing may allow the development of tailored programmes for surveillance and early interventions to reduce MLTcs in PSA/PO.

Objectives

The overall objective of our study was to use CPRD to identify and interpret new and frequently-occurring disease clusters in the PsA/PsO population.

Methods

We identified PsA/PsO patients from the CPRD GOLD for the UK from 2009 to 2018 with at least one year of follow up but excluded patients in practices that had migrated to Aurum, a different electronic health record system held by CPRD. All patients were matched to controls at a 1: 4 ratio by age, sex, practice. We analysed 40 common MLTCs outlined by Barnett et al. to identify and interpret multimorbidity clusters. Multimorbidity clusters were identified using the network bi-clustering. Our methodology can be divided into three steps- (a) Separate the “case” and the “control” population, (b) Create a patient-condition matrix for each of “case” and “control” population and (c) From the patient-condition matrix in each case use a the Euclidean distance criterion to compute a similarity matrix of all the possible conditions among those patients.

Results

We identified 67,827 incident or prevalent PsA/PsO patients aged 20 years and above who were matched to 271,308 controls by age, sex and practice (Table 1). The median number of long-term conditions (LTCs) was higher in the cases than in the controls.

Table 1.CharacteristicCASE, N = 67,827CONTROL, N = 271,308Age Group, n (%)<206,491 (9.6%)27,897 (10%)20-5442,357 (62.4%)169,008(62.3%)55 and above19,148 (28.2%)74,403 (27.4%)Ethnicity, n (%)White28,200 (41.6%)93,485 (34.5%)Black, S.Asian and other956 (1.4%)3,735 (1.4%)Unknown38,671 (57%)174,088(64.2%)Sex, n (%)F35,431 (52%)141,724 (52%)BMI category, n (%)20 to <2511,183 (16.5%)43,240 (15.9%)25 to <3013,565 (20%)45,783 (16.9%)30 to <357,584 (11.2%)22,690 (8.4%)35 to 403,048 (4.5%)8,172 (3.0%)Alcohol status, n (%)Non-drinker/ Ex-drinker8,649/2,159 (15.9%)33,983/7,579 (15.3%)Drinker/Heavy drinker47,316/3,030 (74.2%)180,888/8,831 (69.9%)Smoking status, n (%)Ex-smoker/Non-smoker14,137/29,289 (64%)48,110/142,295 (70.2%)Smoker24,018 (35%)71,779 (26%)Long term condition, Median (IQR)1.00 (0.00, 3.00)1.00 (0.00, 2.00)

We present the results obtained via spectral clustering on the similarity matrix obtained in each “case” and “control” population via Euclidean distance. There are 40 LTCs which are represented via two clusters in the “case” and the “control” population network (Figure 1). The LTCs in the same cluster are strongly connected within themselves compared to those in the other cluster. The noticeable part was clustering of diabetes, hypertension and chronic heart diseases in one group, especially in the “case” population over the “control” population. Interestingly depression, dementia and chronic heart diseases were in the same group in the clustering results for both the “case” and the “control” population. There are a central group of diseases (HYP, DEM, DIV, CHD etc.) in Figure 1, which seems to be connected with both sets of clusters. As mentioned earlier, diabetes has connections with these central groups of diseases, and it tends to be more pronounced in the “case” population.

Figure 1.

Conclusion

MLTCs including diabetes, hypertension, chronic kidney disease and heart disease occurred together more commonly in patients with PsA/PsO than those without PsA/PsO.

The future goal is to identify frequently occurring clusters of MLTCs in the immune-mediated inflammatory disease population.

Disclosure of Interests

Prasad Nishtala: None declared, Neil McHugh: None declared, William Tillett Speakers bureau: Abbvie, Amgen, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Pfizer and UCB, Consultant of: Abbvie, Amgen, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Pfizer and UCB, Grant/research support from: Abbvie, Celgene, Eli-Lilly, Janssen, and UCB, Sarah Skeoch: None declared, Jenny Humphreys: None declared, John Pauling: None declared, Olga Isupova: None declared, Anita McGROGAN: None declared, Julia Snowball: None declared, Sandipan Roy: None declared

Hydrogen sulphide (H2 S) in the hidden half: Role in root growth, stress signalling and rhizospheric interactions

Apart from nitric oxide (NO) and carbon monoxide (CO), hydrogen sulphide (H₂ S) has emerged as a potential gasotransmitter that has regulatory roles in root differentiation, proliferation and stress signalling. H₂ S metabolism in plants exhibits spatio-temporal differences that are intimately associated with sulphide signalling in the cytosol and other subcellular components, e.g. chloroplast and mitochondria. H₂ S biosynthesis in plant organs uses both enzymatic and non-enzymatic pathways. H₂ S generation in roots and aerial organs is modulated by developmental phase and changes in environmental stimuli. H₂ S has an influential role in root development and in the nodulation process. Studies have revealed that H₂ S is a part of the auxin and NO signalling pathways in roots, which induce lateral root formation. At the molecular level, exogenous application of H₂ S regulates expression of several transcription factors, viz. LBD (Lateral organ Boundaries Domain), MYB (myeloblastosis) and AP2/ERF (Apetala 2/ Ethylene Response Factor), which stimulate upregulation of PpLBD16 (Lateral organ boundaries domain 16), thereby significantly increasing the number of lateral roots. Concomitantly, H₂ S acts as a crucial signalling molecule in roots during various abiotic stresses, e.g. drought, salinity heavy metals (HMs), etc., and augments stress tolerance in plants. Interestingly, extensive crosstalk exists between H₂ S, NO, ABA, calcium and ethylene during stress, which escalate plant defence and regulate plant growth and productivity. Hence, the present review will elaborate the role of H₂ S in root development, stress alleviation, legume-Rhizobium symbiosis and rhizosphere signalling. The review also examines the mechanism of H₂ S-mediated abiotic stress mitigation and cross-talk with other signaling molecules.

Polarization of Λ and Λ[over ¯] Hyperons along the Beam Direction in Pb-Pb Collisions at sqrt[s]_{NN}=5.02 TeV

The polarization of the Λ and Λ[over ¯] hyperons along the beam (z) direction, P_{z}, has been measured in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV recorded with ALICE at the Large Hadron Collider (LHC). The main contribution to P_{z} comes from elliptic flow-induced vorticity and can be characterized by the second Fourier sine coefficient P_{z,s2}=⟨P_{z}sin(2φ-2Ψ_{2})⟩, where φ is the hyperon azimuthal emission angle and Ψ_{2} is the elliptic flow plane angle. We report the measurement of P_{z,s2} for different collision centralities and in the 30%-50% centrality interval as a function of the hyperon transverse momentum and rapidity. The P_{z,s2} is positive similarly as measured by the STAR Collaboration in Au-Au collisions at sqrt[s_{NN}]=200  GeV, with somewhat smaller amplitude in the semicentral collisions. This is the first experimental evidence of a nonzero hyperon P_{z} in Pb-Pb collisions at the LHC. The comparison of the measured P_{z,s2} with the hydrodynamic model calculations shows sensitivity to the competing contributions from thermal and the recently found shear-induced vorticity, as well as to whether the polarization is acquired at the quark-gluon plasma or the hadronic phase.

Post-Acute Covid Neurological Symptoms among Doctors and Nurses in A Tertiary Care Hospital: An Observational Study from Bangladesh

A good number of patients experience post-Covid complications. Doctors and nurses are the front liners who are at greater risk of having this disease. Neurological symptoms are frequent in patients with post-COVID-19 infection. The study aims to observe the post-acute neurological symptoms among doctors and nurses of Mymensingh Medical College Hospital, a tertiary care hospital in Bangladesh, after they recover from initial infection or among the asymptomatic cases. It was a retrospective observational study among the doctors and nurses who became RT PCR positive from late April to mid-September 2020. A total of 100 subjects were interviewed over the phone for the presence or absence of neurological symptoms four weeks post Covid-19 infection. Total 54 doctors and 46 nurses were evaluated; the male-female ratio was 1:1.77, the mean age was 35.6±7.6 years. Post-acute COVID neurological symptoms (PACNS) were present in 60% of respondents. Fatigue (51%) was the most common symptom, followed by sleep disturbance, headache, myalgia, loss of taste and smell. PACNS were more in symptomatic patients at the initial Covid infection than asymptomatic cases.

Measurement of the Groomed Jet Radius and Momentum Splitting Fraction in pp and Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

This article presents groomed jet substructure measurements in pp and Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV with the ALICE detector. The soft drop grooming algorithm provides access to the hard parton splittings inside a jet by removing soft wide-angle radiation. We report the groomed jet momentum splitting fraction, z_{g}, and the (scaled) groomed jet radius, θ_{g}. Charged-particle jets are reconstructed at midrapidity using the anti-k_{T} algorithm with resolution parameters R=0.2 and R=0.4. In heavy-ion collisions, the large underlying event poses a challenge for the reconstruction of groomed jet observables, since fluctuations in the background can cause groomed parton splittings to be misidentified. By using strong grooming conditions to reduce this background, we report these observables fully corrected for detector effects and background fluctuations for the first time. A narrowing of the θ_{g} distribution in Pb-Pb collisions compared to pp collisions is seen, which provides direct evidence of the modification of the angular structure of jets in the quark-gluon plasma. No significant modification of the z_{g} distribution in Pb-Pb collisions compared to pp collisions is observed. These results are compared with a variety of theoretical models of jet quenching, and provide constraints on jet energy-loss mechanisms and coherence effects in the quark-gluon plasma.