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

The Roles of Endoplasmic Reticulum in NLRP3 Inflammasome Activation

The NLRP3 (nucleotide-binding domain, leucine-rich-repeat-containing family, pyrin domain-containing 3) inflammasome senses pathogen-associated molecular patterns (PAMPs) and danger-associated molecular patterns (DAMPs), and activates caspase-1, which provokes release of proinflammatory cytokines such as interleukin-1β (IL-1β) and IL-18 as well as pyroptosis to engage in innate immune defense. The endoplasmic reticulum (ER) is a large and dynamic endomembrane compartment, critical to cellular function of organelle networks. Recent studies have unveiled the pivotal roles of the ER in NLRP3 inflammasome activation. ER–mitochondria contact sites provide a location for NLRP3 activation, its association with ligands released from or residing in mitochondria, and rapid Ca²⁺ mobilization from ER stores to mitochondria. ER-stress signaling plays a critical role in NLRP3 inflammasome activation. Lipid perturbation and cholesterol trafficking to the ER activate the NLRP3 inflammasome. These findings emphasize the importance of the ER in initiation and regulation of the NLRP3 inflammasome.

[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.

P-Band Induced Self-Organization and Dynamics with Repulsively Driven Ultracold Atoms in an Optical Cavity

We investigate a Bose-Einstein condensate strongly coupled to an optical cavity via a repulsive optical lattice. We detect a stable self-ordered phase in this regime, and show that the atoms order through an antisymmetric coupling to the P band of the lattice, limiting the extent of the phase and changing the geometry of the emergent density modulation. Furthermore, we find a nonequilibrium phase with repeated intense bursts of the intracavity photon number, indicating nontrivial driven-dissipative dynamics.

Evaluation of common variants in the CNR2 gene and its interaction with abdominal obesity for osteoporosis susceptibility in Chinese post-menopausal females

Objectives

The objective of this study was to investigate the association of four single-nucleotide polymorphisms (SNPs) of the cannabinoid receptor 2 (CNR2) gene, gene-obesity interaction, and haplotype combination with osteoporosis (OP) susceptibility.

Methods

Chinese patients with OP were recruited between March 2011 and December 2015 from our hospital. In this study, a total of 1267 post-menopausal female patients (631 OP patients and 636 control patients) were selected. The mean age of all subjects was 69.2 years (sd 15.8). A generalized multifactor dimensionality reduction (GMDR) model and logistic regression model were used to examine the interaction between SNP and obesity on OP. For OP patient-control haplotype analyses, the SHEsis online haplotype analysis software (http://analysis.bio-x.cn/) was employed.

Results

The logistic regression model revealed that the C allele of rs2501431 and the G allele of rs3003336 were associated with increased OP risk, compared with those with wild genotype. However, no significant correlations were found when analyzing the association of rs4237 and rs2229579 with OP risk. The GMDR analysis suggested that the interaction model composed of two factors, rs3003336 and abdominal obesity (AO), was the best model with statistical significance (p-value from sign test (P_sign) = 0.012), indicating a potential gene-environment interaction between rs3003336 and AO. Overall, the two-locus models had a cross-validation consistency of 10/10 and had a testing accuracy of 0.641. Abdominally obese subjects with the AG or GG genotype have the highest OP risk, compared with subjects with the AA genotype and normal waist circumference (WC) (odds ratio (OR) 2.23, 95% confidence interval (CI) 1.54 to 3.51). Haplotype analysis also indicated that the haplotype containing the rs3003336-G and rs2501431-C alleles was associated with a statistically increased OP risk.

Conclusion

Our results suggested that the C allele of rs2501431 and the G allele of rs3003336 of the CNR2 gene, interaction between rs3003336 and AO, and the haplotype containing the rs3003336-G and rs2501431-C alleles were all associated with increased OP risk.

Cite this article: Bone Joint Res 2019;8:544–549.

CD82/KAI1 inhibits invasion and metastasis of esophageal squamous cell carcinoma via TGF-β1

OBJECTIVE

Previous studies have found that CD82/KAI1 is a tumor suppressor gene. However, the role of CD82/KAI1 in esophageal squamous cell carcinoma (ESCC) has not been reported. This study aims to investigate the specific role of CD82/KAI1 in ESCC, so as to further explore the relationship between CD82/KAI1 expression and clinical characteristics of ESCC.

PATIENTS AND METHODS

The expression of CD82/KAI1 in 96 pairs of ESCC tissues and adjacent normal tissues was detected by Real-time quantitative polymerase chain reaction (qRT-PCR). The relationship between CD82/KAI1 expression and the pathological indicators of ESCC patients was analyzed by Kaplan-Meier method. QRT-PCR further validated the expression level of CD82/KAI1 in ESCC cells. In addition, the CD82/KAI1 knockdown expression model was constructed using small interfering RNA in ESCC cell lines TE-1 and EC-109 cells. Cell counting kit-8 (CCK-8) and transwell assay were performed to detect cell viability, invasion and migration. Finally, the potential mechanism of CD82/KAI1 in regulating ESCC was explored using Western blot.

RESULTS

QRT-PCR results showed that the expression level of CD82/KAI1 in ESCC was significantly lower than that of normal tissues, and the difference was statistically significant. Higher rates of lymph node metastasis and distant metastasis, as well as shorter overall survival were observed in ESCC patients with lower expression of CD82/KAI1 compared with those with higher expression. CD82/KAI1 overexpression decreased cell proliferation, invasion and metastasis in ESCC cells. Western blot results showed that the expressions of TGF-β1, Smad2/3, MMP-2 and MMP-9 were regulated by CD82/KAI1. In addition, rescue experiments demonstrated an interaction between CD82/KAI1 and TGF-β1, indicating that CD82/KAI1 inhibits the malignant progression of ESCC via regulating TGF-β1.

CONCLUSIONS

Lowly expressed CD82/KAI1 in ESCC was significantly associated with the pathological stage, distant metastasis and poor prognosis of ESCC patients. CD82/KAI1 may inhibit the malignant progression of ESCC by interacting with TGF-β1.

MiR-34a-5p/PD-L1 axis regulates cisplatin chemoresistance of ovarian cancer cells

Ovarian cancer is the most lethal gynecologic malignancy in women with an increasing number of cases worldwide. Chemoresistance is the main obstacle for ovarian cancer treatment during clinical therapy. Previous studies found that programmed cell death 1 ligand 1 (PD-L1) was associated with chemoresistance of cancer. However, there were little reports about the function of PD-L1 involved in chemoresistance of ovarian cancer. In our study, cisplatin (DDP)-resistant SKOV3 and A2780 ovarian cancer cell lines (SKOV3/DDP and A2780/DDP) were established. We found that the expression of PD-L1 was increased and miR-34a-5p was decreased in DDP-resistant cells. PD-L1 silencing inhibited chemoresistance of DDP-resistant ovarian cancer cells to DDP, as evidenced by decreased proliferation, G1-phase cell cycle arrest and increased apoptosis. Western blot assay showed that in the presence of DDP, PD-L1 silencing decreased multidrug resistance protein 1 and Cyclin D1 protein levels, whereas increased cleaved-caspase-3 and cleaved-PARP protein levels in these cells. Moreover, we demonstrated that miR-34a-5p negatively regulated the expression of PD-L1 by targeting its 3'-untranslated region. The effects of miR-34a-5p mimic on DDP-treated SKOV3/DDP cells were reversed by the overexpression of PD-L1. Moreover, the tumorigenicity of DDP-resistant ovarian cancer cells in nude mice treated with DDP was attenuated by miR-34a-5p in vivo. The combined data indicate that miR-34a-5p/PD-L1 axis regulates DDP chemoresistance of ovarian cancer cells, providing a deeper insight into the treatment for ovarian cancer.

Association between depression subtypes and response to repeated-dose intravenous ketamine

OBJECTIVE

About half or more of treatment-resistant depressed patients do not respond to ketamine, and few clinical predictors to gauge the most likely antidepressant response have been proposed. We explored whether depression subtypes are associated with response to ketamine.

METHOD

Ninety-seven participants with depression were administered six repeated-dose intravenous ketamine and assessed for depression (Montgomery-Åsberg Depression Rating Scale, MADRS), anxiety (Hamilton Anxiety Rating Scale, HAMA), and suicidal ideation (Beck Scale for Suicidal Ideation, SSI) at baseline, 24 h after each infusion, and 2 weeks after the whole treatment. Participants were classified by melancholic/anxious subtype. Individuals who met criteria for neither or both subtypes were classified separately, resulting in four mutually exclusive groups.

RESULTS

Patients with melancholic or melancholic-anxious features were less likely to respond (e.g., day 13, melancholic-anxious vs. anxious, OR 0.138, 95% CI 0.032-0.584, P = 0.007) or remit (e.g., day 26, melancholic vs. no subtype, OR 0.182, 95% CI 0.035-0.960, P = 0.045) and took longer to achieve response/remission than those with anxious or no subtype features. Faster HAMA score reductions were observed in patients with anxious or melancholic-anxious features, and faster SSI score reductions were observed among those with melancholic-anxious features.

CONCLUSION

Our study shows promising results for ketamine as a novel antidepressant preferentially for the treatment of non-melancholic or anxious depression.

Lipopolysaccharide induces epithelial-mesenchymal transition of alveolar epithelial cells cocultured with macrophages possibly via the JAK2/STAT3 signaling pathway

Epithelial-mesenchymal transition (EMT) plays a key role in the process of pulmonary fibrosis (PF). Increasing evidences have shown that exaggerated EMT in recurrent pulmonary injury mediates the early pathogenesis of PF. This study aimed to evaluate EMT of human alveolar epithelial cells (A549) when cocultured with human macrophages Tohoku hospital pediatrics-1 (THP-1) induced by lipopolysaccharide (LPS) and investigate the role of Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) signaling pathway. Firstly, we detected the inflammatory and EMT biomarkers in A549 cells monoculture and A549/THP-1 cells coculture in the presence or absence of LPS. Then, the activation of JAK2/STAT3 signaling pathway was determined in coculture. Interestingly, inflammatory markers, such as interleukin (IL)-6, matrix metalloproteinase (MMP)-9, transforming growth factor (TGF)-β, and collagen type 1 (COL-1), were enhanced in LPS treated coculture. Besides, the expression of E-cadherin decreased but α-smooth muscle actin expression increased, indicating the presence of EMT in A549 cells when cocultured with THP-1 macrophages. However, these phenotypes could not be observed in LPS-treated A549 cells monoculture. Meanwhile, JAK2/STAT3 signaling pathway was activated, and the STAT3 DNA-binding and inflammatory markers were inhibited by Stattic. Together, these findings demonstrate the key role of JAK2/STAT3 signaling pathway in LPS promoted EMT of A549 in the presence of THP-1 macrophages as an in vitro PF model.

Timing of HPV16-E6 antibody seroconversion before OPSCC: findings from the HPVC3 consortium

BACKGROUND

Human papillomavirus type 16 (HPV16)-E6 antibodies are detectable in peripheral blood before diagnosis in the majority of HPV16-driven oropharyngeal squamous cell carcinoma (OPSCC), but the timing of seroconversion is unknown.

PATIENTS AND METHODS

We formed the HPV Cancer Cohort Consortium which comprises nine population cohorts from Europe, North America and Australia. In total, 743 incident OPSCC cases and 5814 controls provided at least one pre-diagnostic blood sample, including 111 cases with multiple samples. Median time between first blood collection and OPSCC diagnosis was 11.4 years (IQR = 6-11 years, range = 0-40 years). Antibodies against HPV16-E6 were measured by multiplex serology (GST fusion protein based Luminex assay).

RESULTS

HPV16-E6 seropositivity was present in 0.4% of controls (22/5814; 95% CI 0.2% to 0.6%) and 26.2% (195/743; 95% CI 23.1% to 29.6%) of OPSCC cases. HPV16-E6 seropositivity increased the odds of OPSCC 98.2-fold (95% CI 62.1-155.4) in whites and 17.2-fold (95% CI 1.7-170.5) in blacks. Seropositivity in cases was more frequent in recent calendar periods, ranging from 21.9% pre-1996 to 68.4% in 2005 onwards, in those with blood collection near diagnosis (lead time <5 years). HPV16-E6 seropositivity increased with lead time: 0.0%, 13.5%, 23.7%, and 38.9% with lead times of >30 years (N = 24), 20-30 years (N = 148), 10-20 years (N = 228), and <10 years (N = 301 cases) (p-trend < 0.001). Of the 47 HPV16-E6 seropositive cases with serially-collected blood samples, 17 cases seroconverted during follow-up, with timing ranging from 6 to 28 years before diagnosis. For the remaining 30 cases, robust seropositivity was observed up to 25 years before diagnosis.

CONCLUSIONS

The immune response to HPV16-driven tumorigenesis is most often detectable several decades before OPSCC diagnosis. HPV16-E6 seropositive individuals face increased risk of OPSCC over several decades.

Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated 9-mediated mutagenesis of the multiple edematous wings gene induces muscle weakness and flightlessness in Bactrocera dorsalis (Diptera: Tephritidae)

The clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated 9 (Cas9) system is a versatile, efficient and heritable gene editing tool that can be useful for genome engineering. Bactrocera dorsalis (Hendel) is a major pest of agriculture that causes great economic losses. We used the B. dorsalis multiple edematous wings (Bdmew) gene as the target gene to explore the effectiveness of CRISPR/Cas9 for B. dorsalis genome manipulation. We studied the physiological functions of the Bdmew gene, particularly those related to muscle development. Site-specific genome editing was feasible using direct microinjection of specific guide RNA and the Cas9-plasmid into B. dorsalis embryos. Mutation frequencies ranged from 12.1 to 30.2% in the injected generation. Mosaic G0, with the mew mutation, was heritable to the next generation. The G1 displayed a series of defective phenotypes including muscle weakness, flightlessness, failure to eclose, wing folds and unbalanced movement. These results demonstrated that CRISPR/Cas9 can act as a highly specific, efficient, heritable tool for genome manipulation in B. dorsalis and this has significance for gene function research and genetic control of pests. The Bdmew gene possesses key functions in muscle development of B. dorsalis. Bdmew mutations cause a series of serious defects by interfering with muscle development and may provide a means for controlling B. dorsalis via a gene-based method such as gene drive.

Vitamin B6 catabolism and lung cancer risk: results from the Lung Cancer Cohort Consortium (LC3)

BACKGROUND

Increased vitamin B6 catabolism related to inflammation, as measured by the PAr index (the ratio of 4-pyridoxic acid over the sum of pyridoxal and pyridoxal-5'-phosphate), has been positively associated with lung cancer risk in two prospective European studies. However, the extent to which this association translates to more diverse populations is not known.

MATERIALS AND METHODS

For this study, we included 5323 incident lung cancer cases and 5323 controls individually matched by age, sex, and smoking status within each of 20 prospective cohorts from the Lung Cancer Cohort Consortium. Cohort-specific odds ratios (ORs) and 95% confidence intervals (CIs) for the association between PAr and lung cancer risk were calculated using conditional logistic regression and pooled using random-effects models.

RESULTS

PAr was positively associated with lung cancer risk in a dose-response fashion. Comparing the fourth versus first quartiles of PAr resulted in an OR of 1.38 (95% CI: 1.19-1.59) for overall lung cancer risk. The association between PAr and lung cancer risk was most prominent in former smokers (OR: 1.69, 95% CI: 1.36-2.10), men (OR: 1.60, 95% CI: 1.28-2.00), and for cancers diagnosed within 3 years of blood draw (OR: 1.73, 95% CI: 1.34-2.23).

CONCLUSION

Based on pre-diagnostic data from 20 cohorts across 4 continents, this study confirms that increased vitamin B6 catabolism related to inflammation and immune activation is associated with a higher risk of developing lung cancer. Moreover, PAr may be a pre-diagnostic marker of lung cancer rather than a causal factor.

Clinical diagnostic significance of prealbumin, cholinesterase and retinol binding protein in liver cirrhosis combined with encephalopathy

OBJECTIVE

Hepatic encephalopathy is a common consequence of liver cirrhosis, but diagnosis can be difficult as it is based on clinical criteria alone. We hypothesised that serum prealbumin, cholinesterase and retinol binding protein (RBP) can help support the diagnosis of hepatic encephalopathy.

METHODS

We enrolled 306 cirrhotic patients (110 with encephalopathy), 100 chronic hepatitis B patients and 50 healthy controls, measuring routine liver function tests (ALT, AST, GGT, ALP, and bilirubin), albumin, prothrombin time, prealbumin, cholinesterase and RBP by routine methods. Logistic regression analysis and areas under the receiver operating characteristic curves (AUCs) were used to find predictive factors for hepatic encephalopathy.

RESULTS

There were differences in all laboratory indices between the three groups (all p < 0.001). In univariate analysis, albumin, prothrombin time, prealbumin, cholinesterase and RBP were significantly altered in those with encephalopathy (p < 0.01), but only prealbumin, cholinesterase and RBP levels were significant predictors in multivariate analysis, and each was linked to the severity of liver fibrosis defined by the Child-Pugh score (all p < 0.001). The AUCs (95% CI) of prealbumin, cholinesterase and RBP for diagnosing liver cirrhosis with hepatic encephalopathy were comparable at 0.85 (81-90), 0.81 (0.76-0.85) and 0.81 (0.76-0.86), respectively (all p < 0.01).

CONCLUSIONS

Serum prealbumin, cholinesterase and RBP levels are of potential clinical value in diagnosis of liver cirrhosis complicated by encephalopathy.