[Effect of levothyroxine treatment on pregnancy outcomes in euthyroid women with thyroid autoantibody positive: a Meta-analysis]

Objective: To conduct a systematic review of the association of levothyroxine treatment with pregnancy outcomes in euthyroid women who are thyroid autoantibody positive. Methods: Medline, Excerpta Medica (EMBASE), Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), Wanfang data and VIP database were searched from inception until Jan. 28, 2020. All published randomized controlled trials assessing the association of levothyroxine treatment with pregnancy outcomes in euthyroid women with thyroid autoantibody-positive were included. STATA 11.0 and RevMan 5.3 softwares were used to perform this Meta-analysis. Results: A total of 6 studies met the inclusion criteria, with 2 188 women randomized. Meta-analysis showed that there was no significantly association between miscarriage (OR=0.85, 95%CI: 0.65-1.11, P=0.234) and preterm birth (OR=0.79, 95%CI: 0.54-1.16, P=0.224) with levothyroxine treatment. Conclusions: Levothyroxine therapy could not reduce the risk of miscarriage and preterm birth in euthyroid women with thyroid autoantibody-positive. Therefore, levothyroxine should be used with caution for these pregnant women.

Production of renewable oleo-furan surfactants by cross-ketonization of biomass-derived furoic acid and fatty acids

Production of an oleo-furan surfactant precursor from biomass-derived furoic acid and fatty acid via cross-ketonization.

CO2-assisted ethane oxidative dehydrogenation over MoOx catalysts supported on reducible CeO2–TiO2

Supported MoOx catalysts on mixed CeO2–TiO2 were investigated for the oxidative dehydrogenation of ethane (ODHE) using CO2 as a mild oxidant. The reducibility of the support and nature of MoOx affect the relative dehydrogenation pathways.

Differences in erythrocyte phospholipid membrane long-chain polyunsaturated fatty acids and the prevalence of fatty acid desaturase genotype among African Americans and European Americans

Numerous studies have reported an association between genetic variants in fatty acid desaturases (FADS1 and FADS2) and plasma or erythrocyte long chain polyunsaturated fatty acid (PUFA) levels. Increased levels of n-6 PUFAs have been associated with inflammation and several chronic diseases, including diabetes and cancer. We hypothesized that genetic variants of FADS that more efficiently convert precursor n-6 PUFA to arachidonic acid (AA) may explain the higher burden of chronic diseases observed in African Americans. To test this hypothesis, we measured the level of n-6 and n-3 PUFAs in erythrocyte membrane phospholipids and genotyped the rs174537 FADS variants associated with higher AA conversion among African American and European American populations. We included data from 1,733 individuals who participated in the Tennessee Colorectal Polyp Study, a large colonoscopy-based case-control study. Erythrocyte membrane PUFA percentages were measured using gas chromatography. Generalized linear models were used to estimate association of race and genotype on erythrocyte phospholipid membrane PUFA levels while controlling for self-reported dietary intake. We found that African Americans have higher levels of AA and a higher prevalence of GG allele compared to whites, 81% vs 43%, respectively. Homozygous GG genotype was negatively associated with precursor PUFAs (linoleic [LA], di-homo-γ-linolenic [DGLA]), positively associated with both product PUFA (AA, docosahexaenoic acid [DHA]), product to precursor ratio (AA to DGLA), an indirect measure of FADs efficiency and increased urinary isoprostane F2 (F2-IsoP) and isoprostane F3 (F3-IsoP), markers of oxidative stress. Increased consumption of n-6 PUFA and LA resulting in increased AA and subsequent inflammation may be fueling increased prevalence of chronic diseases especially in African descent.

CT phenotypes in mild-to-moderate chronic obstructive pulmonary disease: difference before and after the age of 60 years

AIM

To investigate the pulmonary phenotype of mild-to-moderate chronic obstructive pulmonary disease (COPD) using quantitative computed tomography CT analysis techniques.

MATERIALS AND METHODS

Sixty-three patients with stable-phase mild-to-moderate COPD and 78 healthy controls, categorised as those aged <60 (28 and 40 patients, respectively) and ≥60 years (35 and 38, respectively), underwent chest low-dose respiratory dual-phase CT and pulmonary function test. Automatic software was used to measure the proximal airway parameters, and the emphysema and air-trapping indices were recorded. The intergroup differences in each parameter were assessed by one-way analysis of variance.

RESULTS

At <60 years of age, the mean Pi10WA (Wall area of a hypothetical airway with an internal perimeter of 10 mm) was greater in the mild-to-moderate COPD group than in the healthy control group (17.04 ± 1.63 versus 16.03 ± 1.16 mm²; p=0.004). Mild or moderate air-trapping was observed in the mild-to-moderate COPD group aged <60 years. There was no significant difference in the proximal airway parameters and inspiratory VI_-950 (percent voxels less than -950 HU) between the two groups at age ≥60 years (all p>0.05); however, the expiratory VI_-856 (percent voxels less than -856 HU) and mean lung density expiratory/inspiratory ratio (MLD_E/I) were higher in the mild-to-moderate COPD group than those in the healthy control group (26.02 [30.23] versus 6.45 [11.16]; 0.88 ± 0.05 versus 0.84 ± 0.04; p<0.001 and p=0.024).

CONCLUSION

For patients with mild-to-moderate COPD, the CT phenotype was predominantly the "airway remodelling" type at <60 years of age, and the "air-trapping" type at ≥60 years of age. Thus, pulmonary CT phenotypes of mild-to-moderate COPD patients of different age groups are different.

ZnO nanorod arrays assembled on activated carbon fibers for photocatalytic degradation: Characteristics and synergistic effects

Well-aligned ZnO nanorod arrays were assembled on activated carbon fibers by a stepwise sequence of sol-gel and hydrothermal synthesis methods. These ZnO nanorod arrays on activated carbon fibers having different characteristics such as surface area, rod concentration, aspect ratio and defect level, were applied as catalysts for the photodegradation of an aqueous methylene blue solution. They showed very promising methylene blue adsorbility in the dark (ca. 0.025-0.031 mg methylene blue m^-2 catalyst, vs. 0.072 mg methylene blue m^-2 activated carbon fibers). Significantly, the defect level of ZnO nanorod arrays has a major effect on the turnover frequency compared to other characteristics. A synergistic effect between activated carbon fibers and ZnO nanocrystals on enhancing turnover frequency was more significant for the well-assembled ZnO nanorod arrays on activated carbon fibers catalysts compared to the mechanically mixed ZnO powder with activated carbon fibers catalyst. Further, turnover frequency for the ZnO nanorod arrays on activated carbon fibers (0.00312 mol_{methylene blue} mol_ZnO^-1 h^-1) was twice higher than that for the corresponding bare ZnO nanorod arrays, and 3 times higher than that for a commercial ZnO powder. In addition, ZnO nanorod arrays on activated carbon fibers show high degradation (77.5%) and mineralization (55.0%) levels for methylene blue, and also good reusability (or stability) as demonstrated by a sequential 5-time recycle routine. These outstanding features indicate that activated carbon fibers supported ZnO nanorod arrays have significant potential to be used as catalysts for photodegradation.

Enhancement of immune responses by co-administration of bacterial ghosts-mediated Neisseria gonorrhoeae DNA vaccines

AIM

Gonorrhoea remains a leading public health burden and the development of vaccine against gonorrhoea becomes more urgent. Here, a novel Neisseria gonorrhoeae DNA vaccine delivered by Salmonella enteritidis ghosts was developed and the immune responses of the vaccine candidate were evaluated.

METHODS AND RESULTS

Neisseria gonorrhoeae nspA gene was cloned into the pVAX1 vector. The constructed recombinant plasmid pVAX1-nspA was loaded into the lyophilized SE ghosts to produce SE ghosts (pVAX1-nspA). Then, the immune responses induced by SE ghosts (pVAX1-nspA) alone and co-administrated with SE ghosts (pVAX1-porB) were evaluated in mouse model. Co-administered SE ghosts (pVAX1-nspA) and SE ghosts (pVAX1-porB) could elicited significantly higher levels of specific IgG antibody responses and lymphocyte proliferative responses than the control groups. Furthermore, the group co-administered SE ghosts (pVAX1-nspA) and SE ghosts (pVAX1-porB) had the highest bactericidal antibody titres.

CONCLUSIONS

Co-administration of SE ghosts (pVAX1-nspA) and SE ghosts (pVAX1-porB) elicited significant specific humoral and cellular immune responses.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study demonstrates the potential of co-administration of SE ghosts (pVAX1-nspA) and SE ghosts (pVAX1-porB) as an attractive vaccination regimen for gonorrhoea.

LncRNA DARS-AS1 regulates microRNA-129 to promote malignant progression of thyroid cancer

OBJECTIVE

To investigate the expression of long non-coding RNA (lncRNA) DARS-AS1 in thyroid cancer, and to further investigate whether it can promote the development of thyroid cancer by regulating microRNA-129.

PATIENTS AND METHODS

Real-time quantitative polymerase chain reaction (qPCR) was used to detect the level of DARS-AS1 in tumor tissues and paracancerous tissues of 34 thyroid carcinomas. It was also used to analyze the relationship between the expression of DARS-AS1 and the clinical indicators of thyroid cancer and the prognosis of patients. qPCR was used to further verify the expression of DARS-AS1 in thyroid cancer cell lines. The DARS-AS1 knockdown model was constructed using lentivirus in thyroid cancer cell lines. Cell counting kit-8 (CCK-8), cell clone formation, and transwell migration assays were performed to evaluate the effects of DARS-AS1 on the biological function of thyroid cancer cells. Finally, the potential mechanism was explored by using recovery experiments and the interplay between DARS-AS1 and microRNA-129 was further studied.

RESULTS

qPCR results revealed that the level of DARS-AS1 in tumor tissues of thyroid cancer patients was remarkably higher than that in adjacent tissues, and the difference was statistically significant. Compared with patients with low expression of DARS-AS1, patients with high DARS-AS1 expression had a higher incidence of high tumor stage, distant metastasis, and a lower overall survival rate. Besides, compared with NC group, the proliferation and migration ability of shRNA-AS1 expression knockdown group sh-DARS-AS1 was remarkably decreased. qPCR results indicated that there was a negative correlation between the level of microRNA-129 and DARS-AS1 in thyroid cancer tissues. In addition, cell proliferation and migration ability in the microRNA-129 overexpression group were remarkably decreased. The recovery experiment also found that there was a mutual regulation between DARS-AS1 and microRNA-129, which together affected the malignant progression of thyroid cancer.

CONCLUSIONS

DARS-AS1 level in tumor tissues of thyroid cancer was remarkably increased and was correlated with the pathological stage, distant metastasis, and poor prognosis of thyroid cancer. Moreover, DARS-AS1 could promote the proliferation and migration capabilities of thyroid cancer cells by modulating microRNA-129.

Subolesin vaccination inhibits blood feeding and reproduction of Haemaphysalis longicornis in rabbits

Background

Ticks can transmit numerous tick-borne pathogens and cause a huge economic loss to the livestock industry. Tick vaccines can contribute to the prevention of tick-borne diseases by inhibiting tick infestation or reproduction. Subolesin is an antigenic molecule proven to be a potential tick vaccine against different tick species and even some tick-borne pathogens. However, its effectivity has not been verified in Haemaphysalis longicornis, which is a widely distributed tick species, especially in East Asian countries. Therefore, the purpose of this study was to evaluate the effectivity of subolesin vaccination against H. longicornis in a rabbit model.

Methods

Haemaphysalis longicornis (Okayama strain, female, adult, parthenogenetic strain) and Japanese white rabbits were used as the model tick and animal, respectively. The whole open reading frame of H. longicornis subolesin (HlSu) was identified and expressed as a recombinant protein using E. coli. The expression was verified using sodium dodecyl sulfate polyacrylamide gel electrophoresis, and the immunogenicity of rHlSu against anti-H. longicornis rabbit serum was confirmed using Western blotting. After vaccination of rHlSu in rabbits, experimental infestation of H. longicornis was performed. Variables related to blood-feeding periods, pre-oviposition periods, body weight at engorgement, egg mass, egg mass to body weight ratio, and egg-hatching periods were measured to evaluate the effectiveness of subolesin vaccination.

Results

The whole open reading frame of HlSu was 540 bp, and it was expressed as a recombinant protein. Vaccination with rHlSu stimulated an immune response in rabbits. In the rHlSu-vaccinated group, body weight at engorgement, egg mass, and egg mass to body weight ratio were statistically significantly lower than those in the control group. Besides, egg-hatching periods were extended significantly. Blood-feeding periods and pre-oviposition periods were not different between the two groups. In total, the calculated vaccine efficacy was 37.4%.

Conclusions

Vaccination of rabbits with rHlSu significantly affected the blood-feeding and reproduction in H. longicornis. Combined with findings from previous studies, our findings suggest subolesin has the potential to be used as a universal tick vaccine.

Air temperature, carbon dioxide, and ammonia assessment inside a commercial cage layer barn with manure-drying tunnels

Understanding the air temperature distribution, ammonia (NH₃) and carbon dioxide (CO₂) levels in poultry housing systems are crucial to poultry health, welfare, and productivity. In this study, 4 Intelligent Portable Monitoring Units and 7 temperature sensors were installed inside and between the cages and above 2 minimum ventilation fans of a commercial stacked-deck cage laying hen house in the Midwest United States (425,000 laying hens) to continuously monitor the interior environment over a 6-month period. During cold conditions (March 12th–May 22nd), there was a variation noted, with barn center temperatures consistently being highest in the longitudinal and lateral direction (P < 0.001) and the top floor deck warmer than the bottom floor (P < 0.05). During hotter conditions (May 23rd–July 26th), the interior thermal environment was more uniform than during the winter, resulting in a difference only in the longitudinal direction. The daily CO₂ and NH₃ concentrations were 400 to 4,981 ppm and 0 to 42.3 ppm among the 4 sampling locations, respectively. Both CO₂ and NH₃ decreased linearly with increasing outside temperatures. The mean NH₃ and CO₂ concentrations varied with sampling locations and with the outside temperatures (P < 0.001). For CO₂, the minimum ventilation sidewall had lower values than those measured in the barn’s center (P < 0.05) during cold weather, while the barn center and the manure room sidewall consistently measured the highest concentrations during warmer weather (P < 0.05). For NH₃, the tunnel ventilation inlet end consistently had the lowest daily concentrations, whereas the in-cage and manure drying tunnel sidewall locations measured the highest concentrations (P < 0.001). Higher NH₃ and CO₂ concentrations were recorded within the cage than in the cage aisle (P < 0.05). The highest NH₃ concentration of 42 ppm was recorded above the minimum exhaust fan adjacent to the manure drying tunnel, which indicated that higher pressure (back pressure) in the manure drying tunnel allowed air leakage back into the production area through nonoperating sidewall fan shutters.

The Subgingival Microbiome Relationship to Periodontal Disease in Older Women

Understanding of the oral microbiome in relation to periodontal disease in older adults is limited. The composition and diversity of the subgingival microflora and their oligotypes in health and levels of periodontal disease were investigated in this study on older postmenopausal women. The 16S rRNA gene was sequenced using the Illumina MiSeq platform in 1,206 women aged 53 to 81 y. Presence and severity of periodontal disease were defined by Centers for Disease Control and Prevention/American Academy of Periodontology criteria. Composition of the microbiome was determined by 16S rRNA amplicon sequencing and the abundance of taxa described by the centered log₂-ratio (CLR) transformed operational taxonomic unit (OTU) values. Differences according to periodontal disease status were determined by analysis of variance with Bonferroni correction. Bacteria oligotypes associated with periodontal disease and health were determined by minimum entropy decomposition and their functions estimated in silico using PICRUSt. Prevalence of none/mild, moderate, and severe periodontal disease was 25.1%, 58.3%, and 16.6%, respectively. Alpha diversity of the microbiome differed significantly across the 3 periodontal disease categories. β-Diversity differed between no/mild and severe periodontal disease, although considerable overlap was noted. Of the 267 bacterial species identified at ≥0.02% abundance, 56 (20.9%) differed significantly in abundance according to periodontal disease status. Significant linear correlations for pocket depth and clinical attachment level with bacterial amounts were observed for several taxa. Of the taxa differing in abundance according to periodontal disease status, 53% had multiple oligotypes appearing to differ between none/mild and severe periodontal disease. Among older women, taxonomic differences in subgingival microbiome composition and diversity were observed in relation to clinical periodontal disease measures. Potential differences in bacterial subspecies (oligotypes) and their function were also identified in periodontal disease compared with health.

FRI0003 ELEVATED HISTONE H4 IN NEUTROPHIL EXTRACELLULAR TRAPS PROMOTES MACROPHAGE ACTIVATION IN BEHÇET’S DISEASE

Background:

Neutrophil-released neutrophil extracellular traps (NETs) are upregulated and promote autoinflammation and thrombosis in Behçet’s disease (BD), a multi-system inflammatory disease with unknown etiology1,2. However, whether NETs promote macrophage activation in BD remains unclear.

Objectives:

To investigate the potential role of NETs in promoting aberrant macrophage activation in BD.

Methods:

We quantified NETs by measuring dsDNA using ELISA and immunofluorescence. Macrophages were stimulated with BD- and healthy controls (HC)-derived NETs, and IL-8 and TNF-α production were measured by ELISA. NETs-stimulated macrophages were incubated with naive CD4+T cells, and Th1 cell differentiation was examined on day 7 by flow cytometry. Histones H1, H2A, H2B, H3, H4, S100A8 and neutrophil elastase in NETs were analyzed by western blot. Macrophages were stimulated with anti-Histone 4 antibody-treated NETs, and IL-8 production was measured by ELISA.

Results:

Circulating NETs (2336±534 ng/ml vs. 1472±549 ng/ml,P=0.0008) and neutrophil-derived NETs (909.2±485.2 ng/ml vs. 582.4±199.2 ng/ml,P=0.0108) were significantly higher in BD patients compared with those in HC. BD NETs stimulated macrophages to produce a higher level of IL-8 (17±4 ng/ml vs. 13±4 ng/ml,P=0.0474) and TNF-α (166±61 pg/ml vs. 102±48 pg/ml,P=0.0132) than HC NETs. Moreover, BD NETs promoted macrophages to facilitate Th1 differentiation than HC NETs (33±10% vs. 24±7%,P=0.0398). Western blot analysis revealed more Histone H4 (289076 (144365, 544038) IOD values vs. 42121 (6958, 129625) IOD values,P=0.0286), but not Histones H1, H2A, H2B, H3, S100A8 or neutrophil elastase in BD NETs compared to HC NETs. Importantly, neutralizing Histone H4 abrogated the BD NETs-stimulated IL-8 overproduction by macrophages (9.99±2.07 ng/ml vs. 13.95±2.91 ng/ml,P=0.021).

Conclusion:

BD NETs promoted macrophages activation, which might be mediated by a higher level of Histone H4.

References:

[1]Safi R., Kallas R., Bardawil T., et al. Neutrophils contribute to vasculitis by increased release of neutrophil extracellular traps in Behçet’s disease. J. Dermatol. Sci. 2018;92:143–150.

[2]Le Joncour a, Martos r, Loyau s, et al. Critical role of neutrophil extracellular traps (NETs) in patients with Behcet’s disease. Ann Rheum Dis 2019;78:1274–1282.

Disclosure of Interests:

None declared

FRI0225 THE CLINICAL FEATURES AND OUTCOME OF VENA CAVA INVOLVEMENT IN BEHCET’S DISEASE

Background:

Behcet’s disease (BD) is a systemic disease that can affect vessels of any size and type. However, only limited cases of BD patients with vena cava involvement have been reported.

Objectives:

To investigate the clinical features and outcome of vena cava involvement in BD patients.

Methods:

We retrospectively reviewed the clinical data of BD patients with vena cava involvement in our institute from August 2001 to October 2019. The treatment and outcome of these patients were also analyzed.

Results:

Fifty BD patients with vena cava involvement were included. The median interval between BD onset and diagnosis of vena cava involvement was 2.8 (range 0-19.4) years. Superior vena cava (SVC) involvement was detected in 22 (44.0%) patients, and 21 patients had typical manifestations of SVC syndrome. Inferior vena cava (IVC) was detected in 35 (70.0%) patients, including 7 patients diagnosed with Budd-Chiari syndrome. Seven patients had both superior and inferior vena cava involvement. Forty-five (90.0%) patients had venous involvement other than vena cava, including 19 patients with common iliac thrombosis, 12 patients with common femoral vein thrombosis, 11 patients with external iliac vein thrombosis, etc. For the other BD manifestations, oral ulceration was presented in all patients, followed by genital ulceration (35, 70.0%), Erythema nodosum (27, 54.0%) and pathergy reaction (25, 50.0%). Thirteen (26%) patients had eye involvement. Ten (20%) patients had pleural and/or pericardial effusions. Eleven (22.0%) patients had pulmonary thromboembolism, and 4 (8.0%) patients had arterial involvement. Inflammatory markers were significantly elevated in 41 (82.0%) patients when the vena cava involvement developed, the mean ESR was 34.0±29.2mm/hr, and the median CRP level was 19.9(0.2-177.0) mg/L. The mean BDCAF2006 score of all patients was 4.6±1.6. Glucocorticoid was used in 47 (94.0%) patients after vena cava involvement was diagnosed, and cyclophosphamide was the first-choice immunosuppressant. Forty-one (82.0%) patients received anticoagulation treatment. Five patients had received placement of IVC filter, and 3 patients had taken balloon dilation of IVC. With a mean follow up of 4.1±3.8 years, 45 patients (90.0%) achieved clinical improvements, 6 patients (12.0%) had relapse of vascular involvement, 5 patients (10.0%) died. The respective estimated cumulative 1- and 5- years relapse-free rates were 90.9% and 83.1%, and the respective estimated 1- and 5- years survival rates were 95.9% and 90.1%.

Conclusion:

Vena cava involvement is a rare complication in BD patients. The prognosis of these patients is relatively optimistic after proper treatment. To the best of our knowledge, our study is the largest cohort of BD patients with vena cava involvement.

References:

[1]Y. Fei, X. Li, S. Lin et al. Major vascular involvement in Behçet’s disease: a retrospective study of 796 patients. Clinical Rheumatology, 2013, 32 (6): 845–852.

[2]Seyahi E, Caglar E, Ugurlu S et al. An outcome survey of 43 patients with Budd-Chiari syndrome due to Behçet’s syndrome followed up at a single, dedicated center. Semin Arthritis Rheum, 2015, 44(5):602-609.

Acknowledgments:

We gratefully thank all the patients who participated in our study.

Disclosure of Interests:

None declared

AB0531 GOLIMUMAB IN THE TREATMENT OF SEVERE AND/OR REFRACTORY VASCULO-BEHÇET’S DISEASE: A SINGLE-CENTRE EXPERIENCE IN CHINA

Background:

Vascular involvement is one of the leading causes of mortality and morbidity in Behcet’s Disease (BD)1. Surgical treatments are difficult for Vaculo-BD (VBD) patients due to the high risk of serious postoperative complications without effective and promptly perioperative immunotherapy2, 3. Anti-tumor necrosis factor alpha (TNF-α) therapy has been reported as a potential treatment in severe VBD, e.g. infliximab (IFX) and adalimumab (ADA). However, only few case reports are available regarding the fully humanized monoclonal antibody to TNF-α, golimumab (GOL), in the management of VBD4.

Objectives:

The objective of this study was to report the efficacy and safety of GOL for the treatment of severe and/or refractory VBD.

Methods:

We retrospectively analyzed the efficacy and safety profile of patients with severe and/or refractory VBD treated with GOL in our medical center between 2018 to 2020.

Results:

Nine VBD patients (8 male and 1 female) were enrolled, with a mean age and median course of 37±8.6 years and 72 months (range 12 to 300), respectively. Cardiac involvements (severe aortic regurgitation secondary to BD) were presented in 7 patients, including 2 patients with post-operative paravalvular leakage (PVL) after aortic valve replacement surgery. Multiple vascular lesions were documented in the other 2 patients, including one patient with life-threatening multiple pulmonary aneurysms, pulmonary thromboembolism and recurrent deep vein thrombosis, and another patient with abdominal aortic pseudoaneurysm and multiple artery stenosis and occlusion. Prior to GOL therapy, all patients experienced disease progression despite high-dose glucocorticoids combined with multiple immunosuppressants. Moreover, seven patients required effective and fast control of inflammation and a decrease of glucocorticoid dose during the perioperative period. They were treated with GOL, 50mg every 4 weeks, in combination with background low-or medium-dose glucocorticoids and immunosuppressants, for a median of 6 (range 3-15) months. After a mean duration of follow-up of 10 (range 2-6) months, all patients achieved improvement both in clinical symptoms and serum inflammation markers. The ESR level [4.88±4.94 mm/h vs 31.13±31.78mm/h, P<0.01] and CRP level [1.9 (0.11-3.73)mg/L vs 24.3 (0.4-85.57)mg/L, P<0.01] significantly decreased. The dosage of glucocorticoid[10 (0-15) vs 40 (0-100)mg/d, P<0.01] effectively tapered, indicating a potential steroid-sparing effect. No newly-onset aneurysm and recurrent venous thrombosis were observed. Also, one patient had a marked reduction in size and number of pulmonary aneurysms. No post-operative PVL was observed in the five patients after Bentall operation with a median follow-up of 10 months. One patient with severe aortic regurgitation remained stable and without surgical intervention with the treatment of GOL for 16 months. No severe complication occurred in one patient after underwent endovascular repair of abdominal aorta for 8 months. GOL was well-tolerated, and no serious adverse event was observed.

Conclusion:

Our results suggested that GOL is safe and effective for the treatment of patients with severe and / or refractory VBD. Further controlled studies are warranted to confirm the therapeutic potential of GOL in VBD patients.

Disclosure of Interests:

None declared

THU0326 TOFACITINIB IN THE TREATMENT OF SEVERE AND REFRACTORY BEHÇET’S DISEASE: A SINGLE-CENTRE EXPERIENCE IN CHINA

Background:

Small-molecule JAK inhibitors have succeeded in the treatment of rheumatoid arthritis, psoriasis, and inflammatory bowel disease1. Tofacitinib is under investigation for various autoimmune diseases2, but its effectiveness on Behçet’s disease(BD) has not been demonstrated.

Objectives:

We aimed to investigate the efficacy and safety of Tofacitinib in the treatment of severe and refractory BD.

Methods:

We retrospectively analyzed the efficacy and safety profile of Tofacitinib in treating severe and refractory BD patients in our hospital from 2017 to 2020.

Results:

Thirteen BD patients (7 males and 6 females) were enrolled, with a mean age and median course of 40.6±14.7 years and 84 months (60, 132). Vascular/cardiac, gastrointestinal, and articular involvement were presented in 5, 6, and 2 patients, respectively. Three patients had multiple arterial stenosis or occlusion, two presented with aortic root dilation with aortic valve regurgitation, and one experienced perivalvular leakage (PVL). All the six patients with gastrointestinal involvement had multiple episodes of ileocecal and colon ulcers, intestinal bleed, and three had anastomotic ulcers or leaks.

All the patients had received high-dose glucocorticoids and immunosuppressants before tofacitinib therapy, they displayed poor response with evidence of disease progression; furthermore, three patients with gastrointestinal involvement and one patient with polyarthritis had failed anti-TNF antibody treatment. They were then treated with Tofacitinib, 5mg twice daily, with background glucocorticoids and immunosuppressants, for a median of 6 months (range 4 to 19).

After a median follow-up of 7 (5, 19) months, the ESR and CRP level decreased significantly (21(8, 50) mm/h vs 8(3, 19.5) mm/h, P<0.01, and 25(5.85, 49.5) mg/L vs 1.89(0.44, 6.65) mg/L, P<0.01, respectively). All patients with vascular/cardiac and articular involvement achieved clinical improvement. Vascular lesions of three patients were radiologically stable, no progressive aneurysm or PVL was observed. Two patients with intestinal ulcers revealed complete mucosal healing; the other three had sustained elevation of ESR and CRP, active mucosal ulcers, recurrent bleeding, or fistula formation. The dose of corticosteroids was tapered in six cases (46.2%), furthermore, the number of immunosuppressants lessened in seven cases. However, two patients had herpes zoster infection during follow up, while being treated with five to six immunosuppressants in addition to Tofacitinib for refractory intestinal ulcers.

Conclusion:

Our study suggests that Tofacitinib is effective for the treatment of vascular and articular BD; given the limited data, its therapeutic effect on gastrointestinal BD could not be validated. We have to be cautious of infectious risk for severely immunocompromised patients. Further large-scale prospective studies are warranted to confirm the therapeutic potential of JAK inhibitors in BD patients.

References:

[1]Banerjee, S., Biehl, A., Gadina, M., Hasni, S. & Schwartz, D. M. JAK–STAT Signaling as a Target for Inflammatory and Autoimmune Diseases: Current and Future Prospects. Drugs 77, 521–546 (2017).

[2]Fragoulis, G. E., Mcinnes, I. B. & Siebert, S. JAK-inhibitors. New players in the field of immune-mediated diseases, beyond rheumatoid arthritis. Rheumatol. (United Kingdom) 58, i43–i54 (2019).

Disclosure of Interests:

None declared

Porin Expression Profiles in Haemaphysalis longicornis Infected With Babesia microti

The porin gene is widely disseminated in various organisms and has a pivotal role in the regulation of pathogen infection in blood-sucking arthropods. However, to date, information on the porin gene from the Haemaphysalis longicornis tick, an important vector of human and animal diseases, remains unknown. In this study, we identified the porin gene from H. longicornis and evaluated its expression levels in Babesia microti-infected and -uninfected H. longicornis ticks at developmental stages. We also analyzed porin functions in relation to both tick blood feeding and Babesia infection and the relationship between porin and porin-related apoptosis genes such as B-cell lymphoma (Bcl), cytochrome complex (Cytc), caspase 2 (Cas2), and caspase 8 (Cas8). The coding nucleotide sequence of H. longicornis porin cDNA was found to be 849 bp in length and encoded 282 amino acids. Domain analysis showed the protein to contain six determinants of voltage gating and two polypeptide binding sites. Porin mRNA levels were not significantly different between 1-day-laid and 7-day-laid eggs. In the nymphal stage, higher porin expression levels were found in unfed, 12-h-partially-fed (12 hPF), 1-day-partially-fed (1 dPF), 2 dPF nymphs and nymphs at 0 day post-engorgement (0 dAE) vs. nymphs at 2 dAE. Cytc and Cas2 mRNA levels were higher in 2 dPF nymphs in contrast to nymphs at 2 dAE. Porin expression levels appeared to be higher in the infected vs. uninfected nymphs during blood feeding except at 1 dPF and 0–1 dAE. Especially, the highest B. microti burden negatively affected porin mRNA levels in both nymphs and female adults. Porin knockdown affected body weight and Babesia infection levels and significantly downregulated the expression levels of Cytc and Bcl in H. longicornis female ticks. In addition, this study showed that infection levels of the B. microti Gray strain in nymphal and female H. longicornis peaked at or around engorgement from blood feeding to post engorgement. Taken together, the research conducted in this study suggests that H. longicornis porin might interfere with blood feeding and B. microti infection.

Identification of Haemaphysalis longicornis Genes Differentially Expressed in Response to Babesia microti Infection

Haemaphysalis longicornis is a tick and a vector of various pathogens, including the human pathogenetic Babesia microti. The objective of this study was to identify female H. longicornis genes differentially expressed in response to infection with B. microti Gray strain by using a suppression subtractive hybridization (SSH) procedure. A total of 302 randomly selected clones were sequenced and analyzed in the forward subtracted SSH cDNA library related to Babesia infection, and 110 clones in the reverse cDNA library. Gene ontology assignments and sequence analyses of tick sequences in the forward cDNA library showed that 14 genes were related to response to stimulus or/and immune system process, and 7 genes had the higher number of standardized sequences per kilobase (SPK). Subsequent real-time PCR detection showed that eight genes including those encoding for Obg-like ATPase 1 (ola1), Calreticulin (crt), vitellogenin 1 (Vg1) and Vg2 were up-regulated in fed ticks. Compared to uninfected ticks, infected ticks had six up-regulated genes, including ola1, crt and Vg2. Functional analysis of up-regulated genes in fed or Babesia-infected ticks by RNA interference showed that knockdown of crt and Vg2 in infected ticks and knockdown of ola1 in uninfected ticks accelerated engorgement. In contrast, Vg1 knockdown in infected ticks had delayed engorgement. Knockdown of crt and Vg1 in infected ticks decreased engorged female weight. Vg2 knockdown reduced B. microti infection levels by 51% when compared with controls. The results reported here increase our understanding of roles of H. longicornis genes in blood feeding and B. microti infection.

[Analysis of population attributable risk of large for gestational age]

Objective: To examine the association of pre-pregnancy obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with the risk of large for gestational age (LGA), and assess the dynamic changes in population attributable risk percent (PAR%) for having these exposures. Methods: A retrospective cohort study was conducted to collect data on pregnant women who received regular health care and delivered in Beijing Obstetrics and Gynecology Hospital from January to December in 2011, 2014 and 2017, respectively. Information including baseline characteristics, metabolic indicators during pregnancy, pregnancy complications, and pregnancy outcomes were collected. Multivariate logistic regression model was constructed to assess their association with LGA delivery. Adjusted relative risk and prevalence of these factors were used to calculate PAR%and evaluate the comprehensive risk. Results: (1)The number of participants were 11 132, 13 167 and 4 973 in 2011, 2014 and 2017, respectively. Corresponding prevalence of LGA were 15.19% (1 691/11 132), 14.98% (1 973/13 167) and 16.21% (806/4 973). No significant change in the prevalence of LGA was observed across all years investigated (all P>0.05). (2)According to results from multivariate logistic regression model, advanced maternal age, multiparity, pre-pregnancy overweight or obesity, GWG,GDM and serum triglyceride level≥1.7 mmol/L in the first trimester were associated with high risk of LGA (all P<0.05). Among these factors, pre-pregnancy overweight or obesity, excessive GWG and multiparity were common risk factors of LGA. GDM was not associated with risk of LGA in 2017 database. (3) Dynamic change of PAR% in these years were notable. PAR% of GWG for LGA decreased (32.6%, 27.2% and 22.2% in 2011, 2014 and 2017, respectively), while PAR% of pre-pregnancy overweight or obesity showed an upward trend (4.2%, 3.3% and 8.4%). In addition, PAR% of multiparity increased as well (3.5%, 6.3% and 15.9%). (4) Further analysis showed that excessive GWG in the first and second trimesters contributed the most (20.2% and 19.0% in 2014 and 2017). Conclusions: Excessive GWG, pre-pregnancy overweight or obesity and multiparity are the important risk factors what contribute to LGA. PAR% of excessive GWG for LGA decrease in recent years. However, GWG in the first and second trimesters is a critical factor of LGA. Appropriate weight management in pre-pregnancy, the first or second trimester is the key point to reduce the risk of LGA.