IVIg increases interleukin-11 levels, which in turn contribute to increased platelets, VWF and FVIII in mice and humans

The mechanisms of action of intravenous immunoglobulins (IVIg) in autoimmune diseases are not fully understood. The fixed duration of efficacy and noncumulative effects of IVIg in immune thrombocytopenia (ITP) and acquired von Willebrand disease (AVWD) suggest other mechanisms besides immunological ones. Additionally to the peripheral destruction of platelets in ITP, their medullary hypoproduction emerged as a new paradigm with rescue of thrombopoietin receptor agonists (TPO-RA). In an ITP mouse model, interleukin (IL)-11 blood levels increase following IVIg. IL-11 stimulates the production of platelets and other haemostasis factors; recombinant IL-11 (rIL-11) is thus used as a growth factor in post-chemotherapy thrombocytopenia. We therefore hypothesized that IVIg induces IL-11 over-production, which increases platelets, VWF and factor VIII (FVIII) levels in humans and mice. First, in an ITP mouse model, we show that IVIg or rIL-11 induces a rapid increase (72 h) in platelets, FVIII and VWF levels, whereas anti-IL-11 antibody greatly decreased this effect. Secondly, we quantify for the first time in patients with ITP, AVWD, inflammatory myopathies or Guillain-Barré syndrome the dramatic IL-11 increase following IVIg, regardless of the disease. As observed in mice, platelets, VWF and FVIII levels increased following IVIg. The late evolution (4 weeks) of post-IVIg IL-11 levels overlapped with those of VWF and platelets. These data may explain thrombotic events following IVIg and open perspectives to monitor post-IVIg IL-11/thrombopoietin ratios, and to assess rIL-11 use with or without TPO-RA as megakaryopoiesis co-stimulating factors to overcome the relative hypoproduction of platelets or VWF in corresponding autoimmune diseases, besides immunosuppressant.

Gait in Elderly Glaucoma: Impact of Lighting Conditions, Changes in Lighting, and Fear of Falling

Purpose

The purpose of this study was to characterize the impact of lighting changes on gait in elderly patients with glaucoma and evaluate whether associations are mediated by fear of falling (FOF).

Methods

Gait initiation and parameters measured with the GAITRite Electronic Walkway were captured in normal indoor light, then in dim light, and again in normal light (normal post dim [NPD]). Participants’ right and left eye visual fields (VFs) were merged into integrated VF (IVF) sensitivities. FOF was evaluated using a Rasch-analyzed questionnaire. Multivariable regression models evaluated whether IVF sensitivity was associated with lighting-dependent gait changes and if this relationship was mediated by FOF.

Results

In 213 participants (mean age = 71.4 years), gait initiation in dim light took longer with more VF damage (P = 0.02). Greater VF damage was associated with slower gait in dim (P < 0.001) and NPD (P = 0.003) lighting, as well as shorter strides (P = 0.02), broader stance (P = 0.003), and more variable stride velocity and length in all lighting (all P < 0.03). When moving from normal to dim lighting, those with more VF damage slowed gait and cadence, shortened stride length, and lengthened double support time (all P < 0.001). Velocity, cadence, and double support time did not return to baseline in NPD lighting (all P < 0.05). Fear of falling did not appear to mediate the relationship between IVF sensitivity and lighting-dependent gait changes.

Conclusions

Patients with more VF damage demonstrate gait degradation in extreme or changing lighting, which is not mediated by FOF.

Translational Relevance

Quantitative spatiotemporal gait evaluation reveals lighting-associated impairment, supporting patient-reported difficulty with nonideal lighting and equipping providers to advise patients about limitations.

A systematic review and network meta-analysis of second-line therapy in hepatocellular carcinoma

Background

In patients with advanced hepatocellular carcinoma (hcc) following sorafenib failure, it is unclear which treatment is most efficacious, as treatments in the second-line setting have not been directly compared and no standard therapy exists. This systematic review and network meta-analysis (nma) aimed to compare the clinical benefits and toxicities of these treatments.

Methods

A systematic review of randomized controlled trials (rcts) was conducted to identify phase iii rcts in advanced hcc following sorafenib failure. Baseline characteristics and outcomes of placebo were examined for heterogeneity. Primary outcomes of interest were extracted for results, including overall survival (os), progression-free survival (pfs), objective response rate (orr), grade 3/4 toxicities, and subgroups. An nma was conducted to compare both drugs through the intermediate placebo. Comparisons were expressed as hazard ratios (hrs) for os and pfs, and as risk difference (rd) for orr and toxicities. Subgroup analyses for os and pfs were also performed.

Results

Two rcts were identified (1280 patients) and compared through an indirect network; celestial (cabozantinib vs. placebo) and resorce (regorafenib vs. placebo). Baseline characteristics of patients in both trials were similar. Both trials also had similar placebo outcomes. Cabozantinib, compared with regorafenib, showed similar os [hazard ratio (hr): 1.21; 95% confidence interval (ci): 0.90 to 1.62], pfs (hr: 1.02; 95% ci: 0.78 to 1.34) and orr (-3.0%; 95% ci: -7.6% to 1.7%). Both treatments showed similar toxicities, but there were marginally higher risks of grade 3/4 hand-foot syndrome (5%; 95% ci: 0.1% to 9.8%), diarrhea (4.8%; 95% ci: 1.1% to 8.5%), and anorexia (4.4%; 95% ci: 0.8% to 8.0%) for cabozantinib. Subgroup results for os and pfs were consistent with overall results.

Conclusions

Overall, this nma determined that cabozantinib and regorafenib have similar clinical benefits and toxicities for second-line hcc.

Abstract PO-242: Viral hepatitis among foreign-born communities in the Washington- Baltimore metropolitan area: 5-year prevalence data and implications for linkage to care follow-up

Background: Viral hepatitis is a major public health problem around the world and in the United States, with significant morbidity and mortality. This research aimed to provide updated prevalence estimates and linkage-to-care rates for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among foreign-born immigrants in the Washington-Baltimore metropolitan area. Methods: This retrospective cohort study analyzed screening data obtained from over 275 community-based outreach events held from 2015 to 2019. Through strategic collaborations and culturally-appropriate programs, the Hepatitis B Initiative of Washington DC was able to provide no-cost HBV and HCV testing, vaccination, and treatment linkage-to-care services to 9,489 and 9,427 individuals, respectively. We examined the prevalence of positive HBV (HBsAg+) and HCV (HCVAb+) infections and linkage-to-care with associated sociodemographic characteristics. Results: Overall, prevalence amongst foreign-born clients screened over the 5-year period was 4.3% for HBV and 1.1% for HCV. The highest HBV prevalence was among participants born in Malaysia (8.5%), Cambodia (7.7%), and Vietnam (6.9%), whereas HCV prevalence was highest among participants born in Mongolia (5.0%), Cameroon (3.2%), and Burma (1.5%). Among the 378 HBV- and 102 HCV-infected individuals who were referred to care, linkage- to-care rates were 87.0% (2016-2019) and 47.1% (2017-2019) respectively. Among those linked to care, an overwhelming proportion reported not having health insurance (74.8%) and/or a usual source of care (75.3%); the majority were also female (52.8%), over 30 years of age (96.6%), and born in Asia (78.0%). Conclusions: Foreign-born individuals from Asia and Africa had the highest prevalence of viral hepatitis. These results underscore the need to disaggregate screening data by country of birth to inform prevention and linkage-to-care programs and their impact. Additionally, optimal HBV and HCV screening and linkage-to-care can be achieved among harder-to-reach at-risk populations through partnerships with community organizations, health centers, and public health departments.

Citation Format: Daisy Le, Annie Coriolan, Jane Pan, Carla Jean Berg, Y. Alicia Hong, Angeline Nguyen, Hai Chi Le, Lorien Cindy Abroms, Hee-Soon Juon, Y. Tony Yang. Viral hepatitis among foreign-born communities in the Washington- Baltimore metropolitan area: 5-year prevalence data and implications for linkage to care follow-up [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-242.

A Challenging Case of A Myeloid Sarcoma Misdiagnosed as High Grade B-Cell Lymphoma

Introduction/Objective

A 46-year-old female presented with severe back pain associated with progressive bilateral lower extremity weakness and paresthesia, urinary retention, and constipation. Computed tomography revealed a retroperitoneal mass encasing the right psoas muscle, obstructing the right kidney, and extending to the thoracolumbar region resulting in severe spinal compression. An epidural tumor resection was subsequently performed at an outside hospital.

Methods

Histological sections showed sheets of blastoid neoplastic cells with intermediate to large nuclei, irregular membranes, fine chromatin, and prominent nucleoli. Immunohistochemical stains showed that these cells were positive for CD43, CD79a (weak, focal), BCL2, C-MYC, and PAX5 (weak, focal) and negative for CD10, CD20, CD30, ALK1, BCL6, MUM1, and Tdt. The Ki-67 proliferation index was 75-80%. With this immunophenotype, this patient was diagnosed with a high grade B-cell lymphoma and transferred to our institution for further work-up. On review of the slides, further immunohistochemical testing was requested which revealed positivity for CD117 and myeloperoxidase (MPO).

Results

The overall morphological and immunophenotypical features are most compatible with myeloid sarcoma (MS) with aberrant expression of B-cell markers and this patient’s diagnosis was amended. Interestingly, the patient’s bone marrow examination only showed 2% myeloblasts with left shifted granulocytosis and concurrent fluorescence in situ hybridization (FISH) studies were negative.

Conclusion

A literature review showed that 40-50% of MS are misdiagnosed as lymphoma. MS can frequently stain with B-cell or T-cell markers, as seen in this case, which makes it challenging for an accurate diagnosis and sub- classification. In addition, our case is interesting in that there was only extramedullary presentation without bone marrow involvement. Typically, MS develops after the diagnosis of acute myeloid leukemia (AML) with an incidence of 3–5% after AML. It can also manifest de novo in healthy patients, who then go on to develop AML months to years later. Therefore, this patient will require close follow-up.

Robot-assisted ultrasound navigation platform for 3D HIFU treatment planning: Initial evaluation for conformal interstitial ablation

Interstitial Ultrasound-guided High Intensity Focused Ultrasound (USgHIFU) therapy has the potential to deliver ablative treatments which conform to the target tumor. In this study, a robot-assisted US-navigation platform has been developed for 3D US guidance and planning of conformal HIFU ablations. The platform was used to evaluate a conformal therapeutic strategy associated with an interstitial dual-mode USgHIFU catheter prototype (64 elements linear-array, measured central frequency f = 6.5 MHz), developed for the treatment of HepatoCellular Carcinoma (HCC). The platform included a 3D navigation environment communicating in real-time with an open research dual-mode US scanner/HIFU generator and a robotic arm, on which the USgHIFU catheter was mounted. 3D US-navigation was evaluated in vitro for guiding and planning conformal HIFU ablations using a tumor-mimic model in porcine liver. Tumor-mimic volumes were then used as targets for evaluating conformal HIFU treatment planning in simulation. Height tumor-mimics (ovoid- or disc-shaped, sizes: 3-29 cm³) were created and visualized in liver using interstitial 2D US imaging. Robot-assisted spatial manipulation of these images and real-time 3D navigation allowed reconstructions of 3D B-mode US images for accurate tumor-mimic volume estimation (relative error: 4 ± 5%). Sectorial and full-revolution HIFU scanning (angular sectors: 88-360°) could both result in conformal ablations of the tumor volumes, as soon as their radii remained ≤ 24 mm. The presented US navigation-guided HIFU procedure demonstrated advantages for developing conformal interstitial therapies in standard operative rooms. Moreover, the modularity of the developed platform makes it potentially useful for developing other HIFU approaches.

0220 Sleep Deprivation Increases Self-Reported But Not Behavioral Avoidance

Introduction

A common form of emotion regulation is avoidance, in which attention toward negative stimuli results in avoiding (Elliot, 2006). Dysfunctional avoidance is linked to negative outcomes in various forms of psychopathology (Kashdan, Barrios, Forsyth, & Steger, 2006). Sleep challenges have been identified as a mechanism in numerous mental health disorders (Kryger, Roth, & Dement, 2017). These two mechanisms may be related. We hypothesized sleep deprived individuals would demonstrate more avoidance compared to baseline and a sleep as usual group as indexed by lower scores on a behavioral approach task (BAT) and more self-reported avoidance.

Methods

Fifty-two undergraduates (mean age: 18.87, white: 45, female: 35) without mental health disorders, sleep apnea symptoms, or use of medications that may impact sleep or wakefulness were recruited. Participants completed a Cognitive-Behavioral Avoidance Scale (CBAS modified) in which all questions were modified to elucidate present moment avoidance (ex. I would avoid attending social activities) and a BAT in which they were presented with a bedpan made to look and smell dirty. They were asked to complete seven hierarchical levels of engagement ex. (1) touching it with a tissue, (7) touching it with both hands then touching your face. The task ended when a participant declined to complete a step or they completed all seven. They were randomly assigned to 26 hours of sleep deprivation or sleep as usual. Students completed the CBAS modified and the BAT the next morning.

Results

After conducting a mixed ANOVA, there were no significant differences between or within groups in BAT steps completed. There were significant increases in self-reported behavioral social (p &lt; .001) and nonsocial (p &lt; .001), and cognitive nonsocial (p = .006), and social (p = .031) avoidance in the sleep deprivation group.

Conclusion

The study demonstrated a discrepancy between behavioral and self-report avoidance, suggesting a response bias after sleep loss. This investigation illuminates the effects of sleep loss on the transdiagnostic mechanism, avoidance. Note, there are no psychometric data for the modified CBAS. Future work should examine social forms of behavioral avoidance.

Support

This study was conducted using the University of Arkansas SONA system.

Nell-1 Is a Key Functional Modulator in Osteochondrogenesis and Beyond

Neural EGFL-like 1 (Nell-1) is a well-studied osteogenic factor that has comparable osteogenic potency with the Food and Drug Administration-approved bone morphogenic protein 2 (BMP-2). In this review, which aims to summarize the advanced Nell-1 research in the past 10 y, we start with the correlation of structural and functional relevance of the Nell-1 protein with the identification of a specific receptor of Nell-1, contactin-associated protein-like 4 (Cntnap4), for osteogenesis. The indispensable role of Nell-1 in normal craniofacial and appendicular skeletal development and growth was also defined by using the newly developed tissue-specific Nell-1 knockout mouse lines in addition to the existing transgenic mouse models. With the achievements on Nell-1's osteogenic therapeutic evaluations from multiple preclinical animal models for local and systemic bone regeneration, the synergistic effect of Nell-1 with BMP-2 on osteogenesis, as well as the advantages of Nell-1 as an osteogenic protein with antiadipogenic, anti-inflammatory, and provascularized characteristics over BMP-2 in bone tissue engineering, is highlighted, which lays the groundwork for the clinical trial approval of Nell-1. At the molecular level, besides the mitogen-activated protein kinase (MAPK) signaling pathway, we emphasize the significant involvement of the Wnt/β-catenin pathway as well as the key regulatory molecules Runt-related transcription factor 2 (Runx2) in Nell-1-induced osteogenesis. In addition, the involvement of Nell-1 in chondrogenesis and its relevant pathologies have been revealed with the participation of the nuclear factor of activated T cells 1 (Nfatc1), Runx3, and Indian hedgehog (Ihh) signaling pathways, although the mechanistic insights of Nell-1's osteochondrogenic property will be continuously evolving. With this perspective, we elucidate some emerging and novel functional properties of Nell-1 in oral-dental and neural tissues that will be the frontiers of future Nell-1 studies beyond the context of bone and cartilage. As such, the therapeutic potential of Nell-1 continues to evolve and grow with continuous pursuit.

P2436Preliminary data from “LAA-Print French registry”: a large national multi-centric prospective registry evaluating a new preoperative approach based on 3Dprinted simulation in LAAC procedures

Aim

To demonstrate efficiency of 3D-printing simulation to predict LAAC procedural risk (failure, long procedure time, pericardial effusion or others serious adverse events (SAES) or inappropriate implantations)

Methods

Open study: Prospective and Consecutive.

Recruiting 150 patients in 16 centres (of 300 patients expected).

Start: Jan 18th, 2018.

Study Completion: Nov 1st, 2019.

ClinicalTrials ID: NCT03330210.

1. Cardiac CT prior to LAAC.

2. Industrial manufacture, laser sintering, of 3D-printed models including the whole LA cavity including interatrial thin septum and vena cava (using material TPU with adequat elasticity: shore 50).

3. LAAC Simulation based on 3Dprinted models using specific sheaths and prosthesis.

Prior to LAAC procedure each operator asses a risk score for procedural failure (low/moderate/high) based on real 3D printed LAAC simulation taking into account: trans-septal puncture site/sheath alignment with LAA ostium/device deployment and stability.

4. LAAC procedure TEE guided.

5. CT or TEE control M3 or M6.

Procedural outcomes according to risk Sc Low risk (N=63) Moderate risk (N=50) High risk (N=37) p<0.05 vs High risk Failure 1 (1.6%) 1 (2%) 10 (27%) * Recaptures ≥2 4 (6%) 5 (10%) 12 (32%) * Prosthesis ≥2 2 (3%) 1 (2%) 9 (24%) * Inappropriate implantation 0 6 (12%) 7 (19%) * SAES 2 (3%) 6 (12%) 12 (32%) * Pericardial effusion (pericardiocentesis) 2 (3%) 1 (2%) 4 (11%) * Haemorrhage (≥2 points) 0 2 (4%) 5 (13%) * Coronary syndrome 0 0 4 (11%) * Time (intra left atrium) min 21±10 29±16 50±25 * *p<0.05 vs High risk group according to prospective risk score.

LAAC simulation on 3D printed model

Conclusion

3D printing simulation accurately stratifies the risk of procedure according to LA anatomy. 3D printing may guide the procedure through verification of the transseptal puncture site and/or using a specific catheter shape and device. In case of high risk, a careful assessment of risk/benefice ratio is mandatory

Acknowledgement/Funding

AG2RFondation and Boston Scientific