Alteration of Exon Definition Causes Amelogenesis Imperfecta

Amelogenesis imperfecta (AI) is a collection of genetic disorders affecting the quality and/or quantity of tooth enamel. More than 20 genes are, so far, known to be responsible for this condition. In this study, we recruited 3 Turkish families with hypomaturation AI. Whole-exome sequence analyses identified disease-causing mutations in each proband, and these mutations cosegregated with the AI phenotype in all recruited members of each family. The AI-causing mutations in family 1 were a novel AMELX mutation [NM_182680.1:c.143T>C, p.(Leu48Ser)] in the proband and a novel homozygous MMP20 mutation [NM_004771.3:c.616G>A, p.(Asp206Asn)] in the mother of the proband. Previously reported compound heterozygous MMP20 mutations [NM_004771.3:c.103A>C, p.(Arg35=) and c.389C>T, p.(Thr130Ile)] caused the AI in family 2 and family 3. Minigene splicing analyses revealed that the AMELX missense mutation increased exonic definition of exon 4 and the MMP20 synonymous mutation decreased exonic definition of exon 1. These mutations would trigger an alteration of exon usage during RNA splicing, causing the enamel malformations. These results broaden our understanding of molecular genetic pathology of tooth enamel formation.

Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial

BACKGROUND

The INBUILD trial investigated the efficacy and safety of nintedanib versus placebo in patients with progressive fibrosing interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF). We aimed to establish the effects of nintedanib in subgroups based on ILD diagnosis.

METHODS

The INBUILD trial was a randomised, double-blind, placebo-controlled, parallel group trial done at 153 sites in 15 countries. Participants had an investigator-diagnosed fibrosing ILD other than IPF, with chest imaging features of fibrosis of more than 10% extent on high resolution CT (HRCT), forced vital capacity (FVC) of 45% or more predicted, and diffusing capacity of the lung for carbon monoxide (DLco) of at least 30% and less than 80% predicted. Participants fulfilled protocol-defined criteria for ILD progression in the 24 months before screening, despite management considered appropriate in clinical practice for the individual ILD. Participants were randomly assigned 1:1 by means of a pseudo-random number generator to receive nintedanib 150 mg twice daily or placebo for at least 52 weeks. Participants, investigators, and other personnel involved in the trial and analysis were masked to treatment assignment until after database lock. In this subgroup analysis, we assessed the rate of decline in FVC (mL/year) over 52 weeks in patients who received at least one dose of nintedanib or placebo in five prespecified subgroups based on the ILD diagnoses documented by the investigators: hypersensitivity pneumonitis, autoimmune ILDs, idiopathic non-specific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, and other ILDs. The trial has been completed and is registered with ClinicalTrials.gov, number NCT02999178.

FINDINGS

Participants were recruited between Feb 23, 2017, and April 27, 2018. Of 663 participants who received at least one dose of nintedanib or placebo, 173 (26%) had chronic hypersensitivity pneumonitis, 170 (26%) an autoimmune ILD, 125 (19%) idiopathic non-specific interstitial pneumonia, 114 (17%) unclassifiable idiopathic interstitial pneumonia, and 81 (12%) other ILDs. The effect of nintedanib versus placebo on reducing the rate of FVC decline (mL/year) was consistent across the five subgroups by ILD diagnosis in the overall population (hypersensitivity pneumonitis 73·1 [95% CI -8·6 to 154·8]; autoimmune ILDs 104·0 [21·1 to 186·9]; idiopathic non-specific interstitial pneumonia 141·6 [46·0 to 237·2]; unclassifiable idiopathic interstitial pneumonia 68·3 [-31·4 to 168·1]; and other ILDs 197·1 [77·6 to 316·7]; p=0·41 for treatment by subgroup by time interaction). Adverse events reported in the subgroups were consistent with those reported in the overall population.

INTERPRETATION

The INBUILD trial was not designed or powered to provide evidence for a benefit of nintedanib in specific diagnostic subgroups. However, its results suggest that nintedanib reduces the rate of ILD progression, as measured by FVC decline, in patients who have a chronic fibrosing ILD and progressive phenotype, irrespective of the underlying ILD diagnosis.

FUNDING

Boehringer Ingelheim.

[The efficacy and safety of tiotropium/olodaterol fixed-dose combination in Chinese patients with chronic obstructive pulmonary disease: a pooled subgroup analysis of TONADO 1+2]

Objective: To compare the efficacy and safety profiles of tiotropium/olodaterol with the mono-components in Chinese and total study population from TONADO trial. Methods: In the replicate, double-blind, parallel-group, active-controlled, randomized, 52-week, Phase Ⅲ TONADO studies (TONADO 1+2), patients received tiotropium/olodaterol, tiotropium, or olodaterol via the Respimat(®) Inhaler (Boehringer Ingelheim, Germany). Primary end points were forced expiratory volume in 1 second (FEV(1)) area under the curve from 0 to 3 hours (AUC(0-3h)) response and trough FEV(1) response, and St George's respiratory questionnaire (SGRQ) total score at 24 weeks. Adverse events were also collected. This subgroup analysis only focused on the efficacy and safety of the drug at the approved dose in China. Results: 548 Chinese patients were randomized, aged 41 to 82 years [mean age, (63±8) years] and most were male (526, 96%), 111 received tiotropium/olodaterol 5/5 μg, and 127 received tiotropium 5 μg and 95 received olodaterol 5 μg. The baseline characteristics of these groups were similar. After 24 weeks, treatment with tiotropium/olodaterol 5/5 μg, tiotropium 5 μg and olodaterol 5 μg resulted in an adjusted mean FEV(1) AUC(0-3h) response of 0.240, 0.157 and 0.079 L, and trough FEV(1) response of 0.117, 0.068 and-0.001 L, respectively. Tiotropium/olodaterol 5/5 μg significantly improved SGRQ scores in Chinese patients compared with olodaterol 5 μg (32.729 and 37.202, respectively). Generally, the safety profile of tiotropium/olodaterol was comparable with mono-components in 52 weeks. Conclusion: Compared with tiotropium or olodaterol, tiotropium/olodaterol in Chinese patients provided significant improvement in lung function and quality of life, and the safety profiles were similar.

P6534Prognostic implication of serum cystatin C and creatinine-based glomerular filtration rate ratio in coronary disease patients receiving PCI: a surrogate of low muscle mass and a predictor of mortality

Background

Low muscle mass results in impaired exercise capacity and is related with poor prognosis in chronic diseases. Although the ratio of serum creatinine (Scr) to cystatin C (Scys) is known as a surrogate marker of body muscle mass, the value of this marker is unclear in the patients with coronary artery disease (CAD).

Purpose

We assessed the clinical significance of two markers representing body muscle mass, the ratio of Scr to Scys (Scr/Scys), and ratio of estimated glomerular filtration rate by Scys to Scr (eGFRcys/eGFRcr).

Methods

We analyzed patients enrolled in a single tertiary center prospective percutaneous coronary intervention (PCI) registry that had Scr and Scys levels simultaneously measured before PCI. Optimal cut-off values of Scr/Scys and eGFRcys/eGFRcr, and their prognostic impact on 3-year mortality after PCI were analyzed. Subgroup analysis according to various demographics and risk factors was performed.

Results

A total of 1,928 patients who underwent PCI for significant CAD were analyzed (age 65.2±9.9 years, 70.8% men). Both Scr/Scys and eGFRcys/eGFRcr showed strong correlation with estimated proportion of muscle mass. Cut-off values of Scr/Scys discriminating 3-year death were 1.0 for men and 0.8 for women, while those of eGFRcys/eGFRcr were 1.1 for men and 1.0 for women. Both Scr/Scys- and eGFRcys/eGFRcr-based low muscle mass groups showed significantly higher risk of death, after adjusting for 7 selected covariates including age. The additional discriminative power of low muscle mass group on the predictive model was greater in the group determined by eGFRcys/eGFRcr than Scr/Scys. Low eGFRcys/eGFRcr values showed additional prognostic impact especially in patients older than 65 years, non-obese, men, chronic kidney disease, and current smokers.

Conclusions

Low muscle mass was an independent prognostic indicator in the patients who underwent coronary stenting. eGFRcys/eGFRcr was identified as a useful surrogate of muscle mass, which may be used to detect vulnerable patients with low muscle mass at high risk for future events.

Acknowledgement/Funding

None

The use of a pin-screw-wire tie-in configuration for ventral stabilization of congenital atlantoaxial instability in a Yorkshire terrier

A one-year-old Yorkshire terrier of 1.2 kg was presented with an eight-month-old history of non-ambulatory tetraparesis. The dog was diagnosed on right-lateral radiography with atlantoaxial instability (AAI). Ventral stabilization was achieved with a tie-in configuration. Two 0.9-mm-positive-profile-threaded pins and four 1.2-mm-locking screws were inserted into the atlas and the axis, respectively. The pin shafts were bent caudally and tied in with the screws using cerclage wire. Polymethylmethacrylate (PMMA) was applied to the entire construct. The dog showed rapid improvement after surgery, walking on his own on day three, postoperatively. There were no complications related to the surgery. This adjusted multiple implant fixation technique using pins, screws and cerclage wire embedded in PMMA in a tie-in configuration can be a feasible option to provide rigid fixation for AAI in toy breed dogs.