SAT0294 IL33 ACTIVATES FIBROBLASTS AND INDUCES SKIN FIBROSIS IN SYSTEMIC SCLEROSIS

Background:

Systemic sclerosis (SSc) is a chronic immune-mediated autoimmune disease that is characterized by fibrotic changes of the skin and internal organs, which in turn leads to distortion of tissue structure and gradual loss of organ function. So far, there is still no treatment allows full recovery from this severe disorder. Therefore, it is of great social significance to study the pathogenesis of this disease and find new targets for treatment. Interleukin 33 (IL-33), which is a potent inducer of type 2 immune response, has been confirmed to be involved in the development and progression of multiple fibrotic diseases. However, the role and mechanism of IL-33 in SSc-related fibrosis remains unclear.

Objectives:

To clarify the role of interleukin 33 (IL-33) and its receptor Suppression of tumorigenicity 2 (ST2) in the skin fibrosis of SSc, so to provides a new target for the treatment of fibrosis in patients with SSc.

Methods:

The levels of IL-33 and ST2 was analysed in human samples, murine models of SSc and in cultured fibroblasts by immunohistochemistry and immunofluorescence. The functional role of IL-33 was evaluated by detecting changes in proliferation, migration, and activation of fibroblasts stimulated with recombinant IL-33 protein. MAPK and NF-κB signallings of fibroblasts were assessed by western blotting and analyses of target genes. The role of IL-33 in skin fibrosis was analysed in IL-33 deficient mice (il33−/−) and wild-type controls injected with bleomycin or NaCl.

Results:

The expression of IL-33 and its receptor ST2 were up-regulated in skin lesions of SSc patients (Fig 1 A-C) and bleomycin-treated mice(Fig1 D-F). Compared to the healthy skin, the skin from SSc patients expressed more ST2 on fibroblasts membrane(Fig 1 B-C). IL33 induces MAPK and IκBα activation in human dermal fibroblast(Fig 2 A), and promote proliferation, migration and production of collagen of human dermal fibroblasts, but not the release of inflammatory factors(IL-6, MCP-1)(Fig2 B-G). Mice deficient for IL33 are protected from bleomycin-induced dermal fibrosis (Fig3).

Fig 1.

Increased expression of IL33, ST2 in SSc patients and bleomycin-treated mice.

Fig 2.

IL33 induces MAPK and IκBα activation in human dermal fibroblast, and and promote proliferation, migration and production of collagen of human dermal fibroblasts.

Fig 3.

Mice deficient for IL33 are protected from bleomycin-induced dermal fibrosis.

Conclusion:

IL33 promotes skin fibrosis by activating fibroblasts, and IL33/ST2 may be an important target for the treatment of fibrosis in patients with SSc.

References:

[1]Ingegnoli F, Ughi N, Mihai C. Update on the epidemiology, risk factors, and disease outcomes of systemic sclerosis. Best practice & research. Clinical rheumatology. 2018;32(2):223-240.

[2]Schmitz J, Owyang A, Oldham E, et al. IL-33, an interleukin-1-like cytokine that signals via the IL-1 receptor-related protein ST2 and induces T helper type 2-associated cytokines. Immunity. 2005;23(5):479-490.

[3]Molofsky AB, Savage AK, Locksley RM. Interleukin-33 in Tissue Homeostasis, Injury, and Inflammation.Immunity.2015;42(6):1005-1019.

Disclosure of Interests:

None declared

[Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province]

Objective: To study the effect of COVID-19 on pregnancy outcomes and neonatal prognosis in Hubei Province. Method: s A retrospective comparison of the pregnancy outcomes was done between 16 women with COVID-19 and 45 women without COVID-19. Also, the results of laboratory tests, imaging examinations, and the 2019 novel coronavirus (2019-nCoV) nucleic acid test were performed in 10 cases of neonatal delivered from women with COVID-19. Result: s (1) Of the 16 pregnant women with COVID-19, 15 cases were ordinary type and 1 case was severe type. No one has progressed to critical pneumonia.The delivery method of the two groups was cesarean section, and the gestational age were (38.7±1.4) and (37.9±1.6) weeks,there was no significant difference between the two groups (P>0.05). Also, there wee no significant differences in the intraoperative blood loss and birth weight of the newborn between the two groups (all P>0.05). (2) Ten cases of neonates delivered from pregnant women with COVID-19 were collected. The 2019-nCoV nucleic acid test were all negative.There were no significant differences in fetal distress, meconium-stained amniotic fluid, preterm birth, and neonatal asphyxia between the two groups (all P>0.05).(3) In the treatment of uterine contraction fatigue, carbetocin or carboprost tromethamine was used more in cesarean section for pregnant women with COVID-19 (1.3±0.6), compared with Non-COVID-19 group (0.5±0.7),the difference was statistically significant (P=0.001). Conclusions: If there is an indication for obstetric surgery or critical illness of COVID-19 in pregnant women, timely termination of pregnancy will not increase the risk of premature birth and asphyxia of the newborn, but it is beneficial to the treatment and rehabilitation of maternal pneumonia. Preventive use of long-acting uterotonic agents could reduce the incidence of postpartum hemorrhage during surgery. 2019-nCoV infection has not been found in neonates delivered from pregnant women with COVID-19.

On-site testing of multiple drugs of abuse in urine by a miniature dual-LIT mass spectrometer

There is an increasing need for rapid and on-site detection of emerging drugs of abuse. In this work, we developed a method using a miniature dual-LIT (linear ion trap) mass spectrometer recently developed with comprehensive tandem mass spectrometry analysis capability, for qualitative and quantitative analysis of multiple drugs of abuse. Paper-capillary spray cartridges were used with related workflow established to simplify overall analysis procedure. Quantitation of ketamine and methamphetamine was achieved by beam-type collision-induced dissociation on the miniature dual-LIT mass spectrometer and a linear concentration range of 100-5000 ng/mL was obtained. The system has been applied in analysis of real urine samples from individuals addicted to morphine and methamphetamine use. The changes of the ratio of cocaine to its metabolite benzoylecgonine were also explored to estimate the time of cocaine intaking.

Evidence for undoped Weyl semimetal charge transport in Y2Ir2O7

Weyl fermions scattering from a random Coulomb potential are predicted to exhibit resistivity versus temperature [Formula: see text] in a single particle model. Here we show that, in closed-environment-grown polycrystalline samples of Y₂Ir₂O₇, [Formula: see text] over four orders of magnitude in [Formula: see text]. While the measured prefactor, [Formula: see text], is obtained from the model using reasonable materials parameters, the [Formula: see text] behavior extends far beyond the model's range of applicability. In particular, the behavior extends into the low-temperature, high-resistivity region where the Ioffe-Regel parameter, [Formula: see text]. Strong on-site Coulomb correlations, instrumental for predicting a Weyl semimetal state in Y₂Ir₂O₇, are the possible origin of such 'bad' Weyl semimetal behavior.

Effects of early nutritional intervention on oral mucositis in patients with radiotherapy for head and neck cancer

BACKGROUND

To observe the effect of early nutritional intervention on radiation-induced oral mucositis and nutritional status in patients with head and neck cancer (HNC).

METHODS

A total of 54 HNC patients were divided into early (28 cases) and late (26 cases) nutritional intervention groups. The early group received enteral nutrition at the beginning of radiotherapy (RT), while the late group received enteral nutrition after restricted feeding. Operators reported and assessed the timing and extent of oral mucositis and nutritional status during treatment. The nutritional status assessment indicators included body weight; body mass index (BMI); Patient-Generated-Subjective Global Assessment (PG-SGA) score; levels of albumin, hemoglobin and pre-albumin and total lymphocyte count.

RESULTS

The incidence of high-grade oral mucositis was significantly lower in the early group than that in the late group (P < 0.05). Nutritional status assessments showed more significant weight and BMI losses in the late group than in the early group at weeks 4 and 7 after RT (P < 0.01). The albumin decreased in the late group at week 7 after RT was more significant than that in the early group (P < 0.05). Albumin, hemoglobin and pre-albumin levels and total lymphocyte count decreased significantly in both groups (P > 0.05). During therapy, more patients in the early group were well-nourished and fewer were malnourished according to PG-SGA scores (P < 0.05).

CONCLUSION

Early nutritional intervention can reduce the incidence of high-grade oral mucositis during RT in patients with HNC and improve the nutritional status during treatment, which has important clinical significance.

Rapid selection of analytical lines for SAF-LIBS based on the doublet intensity ratios at the initial and final stages of plasma

Self-absorption-free laser-induced breakdown spectroscopy (SAF-LIBS) can directly obtain the applicable quasi-optically thin lines by determining the optimal acquisition delay time according to the intensity ratio of doublet lines at specific transition wavelength of the analyzed elements, thus eliminating the influence of self-absorption on quantitative results. In quantitative analysis of samples with a certain content range, the key to the convenient application of this technique is to rapidly select the suitable doublet lines for the element to be analyzed. The theoretical analysis shows that the evolution trend of doublet intensity ratio is monotonous under the assumptions that the plasma is uniform and in local thermal equilibrium (LTE) and the area density (Nl) is a constant, which is also confirmed by the experimental results of Cu and Al. Thus, a rapid spectral line selection criterion for SAF-LIBS applications is derived: only when the doublet intensity ratios measured at the initial and final stages of plasma induced by the boundary sample with the highest element content lie on both sides of the theoretical ratio, the doublet lines can reach quasi-optically thin during plasma evolution and are suitable for SAF-LIBS measurements. This new criterion is helpful to promote the practicality and industrial application of SAF-LIBS technology.

Kidney injury enhances renal G-CSF expression and modulates granulopoiesis and human neutrophil CD177 in vivo

Kidney injury significantly increases overall mortality. Neutrophilic granulocytes (neutrophils) are the most abundant human blood leukocytes. They are characterized by a high turnover rate, chiefly controlled by granulocyte colony stimulating factor (G‐CSF). The role of kidney injury and uremia in regulation of granulopoiesis has not been reported. Kidney transplantation, which inherently causes ischemia–reperfusion injury of the graft, elevated human neutrophil expression of the surface glycoprotein CD177. CD177 is among the most G‐CSF‐responsive neutrophil genes and reversibly increased on neutrophils of healthy donors who received recombinant G‐CSF. In kidney graft recipients, a transient rise in neutrophil CD177 correlated with renal tubular epithelial G‐CSF expression. In contrast, CD177 was unaltered in patients with chronic renal impairment and independent of renal replacement therapy. Under controlled conditions of experimental ischemia–reperfusion and unilateral ureteral obstruction injuries in mice, renal G‐CSF mRNA and protein expression significantly increased and systemic neutrophilia developed. Human renal tubular epithelial cell G‐CSF expression was promoted by hypoxia and proinflammatory cytokine interleukin 17A in vitro. Clinically, recipients of ABO blood group‐incompatible kidney grafts developed a larger rise in neutrophil CD177. Their grafts are characterized by complement C4d deposition on the renal endothelium, even in the absence of rejection. Indeed, complement activation, but not hypoxia, induced primary human endothelial cell G‐CSF expression. Our data demonstrate that kidney injury induces renal G‐CSF expression and modulates granulopoiesis. They delineate differential G‐CSF regulation in renal epithelium and endothelium. Altered granulopoiesis may contribute to the systemic impact of kidney injury.

[Clinical features and reasons for missed diagnosis of allergic bronchopulmonary aspergillosis]

Objective: To summarize the clinical features of allergic bronchopulmonary aspergillosis (ABPA) and analyze the common causes of missed diagnosis. Methods: The clinical data of patients with ABPA who were admitted into Qilu Hospital of Shandong University from October 2014 to November 2017 were retrospectively analyzed, including baseline data, eosinophil count in peripheral blood, serum total IgE, A. fumigates-specific antibody (sIgE, sIgG and sIgM), pulmonary function tests and chest CT, etc. Then the correlations between serum total IgE, sIgE and forced expiratory volume in one second (FEV₁) as percentage of predicted value (FEV₁%pred) was conducted, as well as that between serum total IgE, sIgE and FEV₁/forced vital capacity (FEV₁/FVC). The clinical features of the patients were summarized and the causes of missed diagnosis were analyzed. Results: There were 46 patients with ABPA (21 males and 25 females, 48.3±13.2 years old) in total. Only 2 cases (4.3%) were diagnosed after the first symptom onset, and 44 cases (95.7%) were treated repeatedly for many years before being diagnosed. The misdiagnoses were asthma (26 cases, 56.5%), bronchiectasis (13 cases, 28.3%), pneumonia (4 cases, 8.7%), pulmonary tuberculosis (3 cases, 6.5%), and lung cancer (4 cases, 8.7%). Common symptoms of ABPA included cough, expectoration, wheezing, chest tightness, fever, weight loss, chest pain, etc. Peripheral blood eosinophil count increased in 37 patients (80.4%). Serum total IgE in 37 patients (80.4%) were higher than 1 000 U/ml, and 9 cases (19.6%) were less than 1 000 U/ml. The positive rate of sIgE, sIgG and sIgM was 100.0%, 89.1% and 54.3%, respectively. All patients underwent pulmonary function tests and 35 cases (76.1%) had obstructive ventilation dysfunction, 5 cases (10.9%) with mixed ventilation dysfunction, 5 cases (10.9%) were normal and 1 case (2.2%) with restrictive ventilation dysfunction. All patients underwent Chest CT examination, 28 cases (60.9%) showed bronchiectasis, 8 cases (17.4%) manifested mucus plugs (among them, 4 cases with high-attenuation mucus) and 10 cases (21.7%) had other atypical imaging. Serum total IgE and sIgE had no correlations with FEV₁%pred and FEV₁/FVC. Conclusions: ABPA is characterized by recurrent episodes of wheezing, fleeting pulmonary opacities and bronchiectasis. The main reasons of misdiagnosis in ABPA patients were: atypical symptoms, variety of predisposing diseases, early atypical imaging changes, limitations and misunderstandings of screening indicators, interference with tumor markers, and the presence of pulmonary aspergillus overlap syndrome. The severity of asthma attacks is not related to the degree of fungal sensitization.

Methylation and expression analysis of mismatch repair genes in extramammary Paget's disease

BACKGROUND

Extramammary Paget's disease (EMPD) is a rare skin cancer with relative high frequencies of germline and somatic mismatch repair (MMR) genes mutations. However, the methylation and expression of these genes have not been validated in EMPD.

OBJECTIVE

This study aims to confirm the methylation and expression of MMR genes in EMPD.

METHODS

Immunohistochemical (IHC) staining detection and Methylation-specific PCR (MSP) were used to analyse MLH1, MSH2, MSH6 and PMS2 proteins' expression and promoters' methylation in 57 EMMD samples, and pyro-sequence was used to find highly methylated CpG sites in MSH2 promoter.

RESULTS

Immunohistochemical detection displayed reduced expression of MSH2 in 38.6% EMPD cases but normal expression of MLH1, MSH6 and PMS2 in all tumour tissues. Hypermethylation also was found in the promoter of MSH2 but not in other MMR genes. Pyrosequencing of MSH2 promoter showed CpG6 (-87) and CpG3 (-98) were the most common two methylated CpG dinucleotides. There is a significant correlation between reduced MSH2 expression and MSH2 methylation.

CONCLUSION

Reduced MSH2 expression and hypermethylation in this gene promoter were common genetic changes in EMPD, which expands our understanding of the role of MMR function in this skin cancer.

Regulatory T-cell levels in systemic lupus erythematosus patients: a meta-analysis

Background

The contribution of regulatory T-cells (Tregs) to systemic lupus erythematosus (SLE) pathogenesis remains a matter of debate. The objective of this study was to quantify the association between peripheral blood Tregs and disease status in SLE patients.

Method

EMBASE and PubMed databases were searched using ‘systemic lupus erythematosus’ and ‘regulatory T-cells’ as relevant key terms. A meta-analysis of studies that examined the proportion of Tregs among peripheral blood mononuclear cells (PBMCs) and CD4+T-cells was performed using Stata software. Subgroup analysis was performed based on ethnic groups and Treg definition markers.

Results

The Treg/PBMC and Treg/CD4+T-cell ratios were significantly lower in SLE patients than in healthy controls (HCs), whereas patients with active and inactive SLE showed no difference in these indicators. A subgroup analysis indicated that Asian SLE patients had a substantially lower proportion of Tregs/PBMCs than HCs, but this difference was not seen for white and Latin American SLE patients. Patients defined by CD4+CD25+Foxp3+, CD4+CD25+ and CD4+Foxp3+ had a much lower Treg/PBMC ratio compared with HCs. Ethnic groups and choice of Treg definition markers had no influence on the proportion of Tregs/CD4+T-cells.

Conclusion

The proportion of Tregs among both PBMCs and CD4+T-cells was significantly decreased in SLE patients. Ethnic group and Treg definition markers may influence the proportion of Tregs among PBMCs. Further study of the correlation between SLE disease activity and the proportion of Tregs in peripheral blood is needed to determine the physiological role of this association.

Association between IL-10 polymorphisms rs1800896 and rs1800871 and risk of acute pancreatitis in Chinese Han population: An update systemic review and meta-analysis

The association between interleukin-10 (IL-10) promoter region (1082 A/G (rs1800896), 819 C/T (rs1800871)) polymorphisms, and acute pancreatitis (AP) is inconclusive in Chinese Han population. In this study, six eligible studies extracted from the databases of PubMed, Web of Science, and Cochrane Library were evaluated. The results revealed a significant association between 1082 A/G (rs1800896) polymorphism and AP risk in all these five models (AG/AA: OR = 1.19, 95% Cl = 1.02-1.40, P = 0.03; GG/AA: OR = 1.80, 95% Cl = 1.38-2.23, P = 0.01; AG+GG/AA: OR = 1.29, 95% Cl = 1.11-1.50, P = 0.01; GG/AG+AA: OR = 1.62, 95% Cl = 1.27-2.08, P = 0.01; G/A: OR = 1.29, 95% Cl = 1.15-1.45, P = 0.01). In contrast, no statistically significant association was found in all these five models for 819 C/T (rs1800871) polymorphism. In summary, IL-10 polymorphism 1082 A/G (rs1800896) could increase the risk of AP in Chinese Han population.

[Effect of transcutaneous oximetry on prognosis of patients with severe acute respiratory failure receiving extracorporeal membrane oxygenation]

Objective: To investigate the prognostic value of transcutaneous oximetry in patients with severe acute respiratory failure receiving extracorporeal membrane oxygenation(ECMO). Methods: Forty-nine patients diagnosed as severe acute respiratory failure receiving Venous-Venous(V-V)ECMO were enrolled from January 2013 to December 2015 in intensive care unit(ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University.The 10-min oxygen challenge test was performed using transcutaneous oximetry 6 h after the initiation of ECMO, and the 10-min oxygen challenge test value(OCT(10)) and oxygen challenge index(OCI) were calculated.The following data were collected: patients' baseline characteristics, results of arterial blood gas analysis, ventilator settings, APACHEⅡ, SOFA and Murray lung injury score. Patients were stratified into the survival group and the death group based on their mortality status at 60 d after initiation of ECMO.Patients' characteristics and clinical data were analyzed with SPSS 22.0 software. Receiver operating characteristics (ROC) analysis for predicting 60 d mortality was carried out to find area under curve (AUC) and threshold levels of OCT(10) and OCI. Analysis of survival probability was carried out by Kaplan-Meier method and log-rank test. Multivariable logistic regression was used to identify factors associated with outcomes. Results: There were 25 patients in the survival group and 24 patients in the death group. The characteristics(i.e., age, sex, primary disease) and clinical data(i.e., results of arterial blood gas, ventilator settings) of the 2 groups were similar (P>0.05). The survival group had a significant higher OCT(10) and OCI [(77±11) mmHg(1 mmHg=0.133 kPa), 0.77±0.17] than the death group [(57±12) mmHg, 0.55±0.13, all P<0.05]. The AUC value of OCT(10) and OCI for predicting 60 d mortality were 0.87±0.07(95%CI: 0.69-0.96, P<0.05) and 0.83±0.18(95%CI: 0.64-0.94, P<0.05) respectively, and the cutoff points for OCT(10) and OCI were 72.00 mmHg and 0.80. Kaplan-Meier survival analysis showed that a OCT(10)≥72 mmHg (81.3% vs 15.4%, χ(2)=7.04, P<0.01) and a OCI≥0.8(77.8% vs 21.7%, χ(2)=13.15, P<0.01) were related to better outcome. Multivariate logistic regression analysis showed that OCT(10)(OR=0.88, 95%CI: 0.80-0.96, P<0.01) and OCI (OR=0.01, 95%CI: 0.001-0.086, P<0.01) were both risk factors associated with 60 d mortality. Conclusion: The OCT(10) and OCI are predictive of mortality for patients with severe acute respiratory failure receiving ECMO support.

Resonance/non-resonance doublet-based self-absorption-free LIBS for quantitative analysis with a wide measurement range

A resonance/non-resonance, doublet-based, self-absorption-free, laser-induced breakdown spectroscopy (SAF-LIBS) technique is proposed for greatly expanding the measurement range of quantitative elemental analysis by using a quasi-optically thin line. The quasi-optically thin spectral line is obtained by matching the measured doublet atomic lines' intensity ratios with the theoretical one, and the applicable measurement range is expanded by utilizing the resonance and non-resonance lines. The specific calibration process consists of two parts: the nonlinear LIBS calibration and the linear SAF-LIBS calibration. For quantitative measurements, the approximate content of the unknown sample is determined first by using the LIBS calibration curve, and then the SAF-LIBS spectra and the resonance or non-resonance calibration curve that corresponds to the predetermined content are used for further implementing the quantitative analysis. Univariate quantitative analysis results of Cu show that this resonance/non-resonance doublet-based SAF-LIBS technique not only captures the quasi-optically thin spectral line in a wide range of elemental content, but also possesses high correlation coefficients of calibration curves, small relative errors of measurement and low limits of detection. The applicability and limitations of this technique are also discussed, and the evolution as well as the related major determinants of self-absorption are analyzed by taking advantage of the spatial-temporal evolution images of plasma emissivity.