POS0653 IMPACT OF UPADACITINIB OR ADALIMUMAB AS INITIAL THERAPY ON THE ACHIEVEMENT OF 48-WEEK TREATMENT GOALS IN PATIENTS WITH RHEUMATOID ARTHRITIS AND INADEQUATE RESPONSE TO METHOTREXATE: POST HOC ANALYSIS OF A PHASE 3 STUDY

Background:

In the randomized, double-blinded, Phase 3 SELECT-COMPARE study, upadacitinib (UPA) + MTX demonstrated greater clinical and functional responses vs adalimumab (ADA) + MTX in patients (pts) with RA and inadequate response to MTX.1,2 Pts with insufficient response to initial therapy were switched from UPA to ADA (and vice versa) according to treat-to-target (T2T) principles.

Objectives:

We analyzed 1-year treatment outcomes in SELECT-COMPARE according to initial randomization group, regardless of whether pts subsequently switched therapy.

Methods:

Pts initially randomized to UPA 15 mg once daily (QD) or ADA 40 mg every other week (EOW; both + MTX) for up to 48 weeks in SELECT-COMPARE were included in the analysis. As per the protocol-directed rescue strategy, pts experiencing <20% improvement in tender or swollen joint counts at Week 14, 18, or 22, or Clinical Disease Activity Index (CDAI) >10 at Week 26, were switched from UPA to ADA or ADA to UPA in a blinded fashion. Efficacy outcomes included CDAI remission (≤2.8) and low disease activity (LDA; ≤10), DAS of 28 joints using CRP (DAS28[CRP]) <2.6 and ≤3.2, and a composite of “deep response” (CDAI remission, HAQ-Disability Index <0.5, and pain score <20). Data are presented and attributed to initial randomized group (UPA or ADA) regardless of any subsequent switch in therapy. Time-averaged response rates were calculated as area under the curve of response rate standardized by 48 weeks. The proportions of pts who maintained Week 26 responses through 6 months of follow-up are also reported.

Results:

This analysis included 651 pts initially randomized to UPA (of whom 245 switched to ADA) and 327 pts initially randomized to ADA (of whom 157 switched to UPA). Baseline characteristics including age, sex, and BMI were generally well balanced between randomized groups. At Week 48, similar proportions of pts initially randomized to UPA or ADA therapy achieved CDAI remission/LDA (27.6%/61.9% vs 24.8%/59.0%) and DAS28(CRP) <2.6/≤3.2 (45.0%/60.2% vs 43.7%/59.0%) (Figure 1). However, a small but significantly greater proportion of pts achieved a deep response with initial UPA vs initial ADA therapy (17.8% vs 12.8%; p<0.05). In addition, time-averaged response rates over 48 weeks were higher for initial UPA vs initial ADA therapy across efficacy outcomes. Similar trends were observed for other outcomes. Additionally, similar proportions of pts maintained Week 26 responses with initial UPA vs initial ADA therapy based on CDAI remission/LDA and DAS28(CRP) <2.6/≤3.2 during 6-month follow-up (Table 1).

Conclusion:

Using a stringent T2T approach to RA management, rates of LDA or remission at 1 year were similar, regardless of whether pts were initially randomized to UPA or ADA. However, initial UPA therapy led to more frequent deep responses and higher time-averaged response rates vs initial ADA therapy.

References:

[1]Fleischmann R, et al. Arthritis Rheumatol 2019;71:1788–800.

[2]Fleischmann R, et al. Ann Rheum Dis 2019;78:1454–62.

Table 1.

Proportion of patients maintaining Week 26 CDAI and DAS28(CRP) responses during 6-month follow-up by initial therapy with UPA or ADA in SELECT-COMPAREa-c

UPA 15 mg QDADA 40 mg EOWCDAI LDA (≤10)43.936.3CDAI Remission (≤2.8)35.022.7DAS28(CRP) ≤3.239.135.3DAS28(CRP) <2.630.530.1

aAs observed.

bBlinded rescue from UPA to ADA or ADA to UPA was permitted at Week 14, 18, and 22 for patients with <20% improvement in TJC or SJC and at Week 26 for patients with a CDAI <10. Data are presented and attributed to original randomized group (UPA or ADA) regardless of any subsequent switch in therapy.

cMaintaining response defined as never losing response at any visit during ~6 months (22–26 weeks) follow up after first achieving response before or at Week 26.

ADA, adalimumab; CDAI, Clinical Disease Activity Index; DAS28(CRP), DAS of 28 joints using CRP; EOW, every other week; QD, once daily; SJC, swollen joint count; TJC, tender joint count; UPA, upadacitinib.

Acknowledgements:

AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship. Medical writing assistance was provided by Frances Smith, PhD, of 2 the Nth, which was funded by AbbVie.

Disclosure of Interests:

Eduardo Mysler Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Janssen, Pfizer, Roche, and Sandoz., Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Janssen, Pfizer, Roche, and Sandoz., Yoshiya Tanaka Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Eli Lilly, Chugai, Daiichi-Sankyo, Eisai, Gilead, GlaxoSmithKline, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, and YL Biologics, Consultant of: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Eli Lilly, Chugai, Daiichi-Sankyo, Eisai, Gilead, GlaxoSmithKline, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, and YL Biologics, Grant/research support from: AbbVie, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, Takeda, and UCB., Arthur Kavanaugh Consultant of: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Celgene, Janssen, Pfizer, Roche, and UCB., Grant/research support from: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Celgene, Janssen, Pfizer, Roche, and UCB., Daniel Aletaha Consultant of: AbbVie, Amgen, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Roche, Sanofi, and UCB., Grant/research support from: AbbVie, Amgen, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Roche, Sanofi, and UCB., Peter C. Taylor Speakers bureau: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Celltrion, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Fresenius, Nordic Pharma, Pfizer, Roche, Sanofi, and UCB., Consultant of: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Celltrion, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Fresenius, Nordic Pharma, Pfizer, Roche, Sanofi, and UCB., Grant/research support from: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Celltrion, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Fresenius, Nordic Pharma, Pfizer, Roche, Sanofi, and UCB., In-Ho Song Shareholder of: AbbVie, Employee of: AbbVie, Tim Shaw Shareholder of: AbbVie, Employee of: AbbVie, Yanna Song Shareholder of: AbbVie, Employee of: AbbVie, Ryan DeMasi Shareholder of: AbbVie, Employee of: AbbVie, Mira Ali Shareholder of: AbbVie, Employee of: AbbVie, Roy Fleischmann Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sanofi-Aventis, and UCB., Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sanofi-Aventis, and UCB.

Metagenomic analysis revealed the individualized shift in ileal microbiome of neonatal calves in response to delaying the first colostrum feeding

The aim of this study was to explore the effect of colostrum feeding time on the ileal microbiome of neonatal calves. In this study, 22 male Holstein calves were randomly assigned to different colostrum feeding time treatments: after birth (at 45 min, n = 7); at 6 h after birth (n = 8); and at 12 h after birth (TRT12h; n = 7). At 51 h after birth, calves were killed and ileum digesta was collected for microbiome analysis using shotgun metagenomic sequencing. Bacteria, archaea, eukaryotes, and viruses were identified from the ileum microbiome. For the bacteriome, Firmicutes and Proteobacteria were the predominant phyla, and Escherichia, Streptococcus, Lactobacillus were the 3 most abundant genera. For the archaeal community, Euryarchaeota and Crenarchaeota were the 2 major phyla, and Methanosarcina, Methanobrevibacter, and Methanocorpusculum were the 3 most abundant genera. In total, 116 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were identified from the ileal microbiome, with "biosynthesis of vancomycin group antibiotics," "biosynthesis of ansamycins," "valine, leucine, and isoleucine biosynthesis," "ribosome," and "d-alanine metabolism" as the top 5 functions. When the ileal microbiomes were compared among the 3 treatments, the relative abundance of Enterococcus was higher in TRT12h calves, suggesting that calves may have a higher abundance of opportunistic pathogens when the feeding of colostrum is delayed for 12 h. Moreover, among all KEGG pathways, the enriched "taurine and hypotaurine metabolism" (KO00430) pathway was identified in the ileal microbiome of TRT12h calves; however, future studies are needed to understand the effect on the host. Additionally, 2 distinct ileal microbial profiles were identified across all samples, indicating that that host factors may play a significant role in driving varied microbiome changes in response to colostrum feeding time. Whether such microbiome shifts affect long-term gut function and calf performance warrants future studies.

POS0220 INTEGRATED SAFETY PROFILE OF UPADACITINIB WITH UP TO 4.5 YEARS OF EXPOSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

The safety and efficacy of the oral Janus kinase inhibitor upadacitinib (UPA) has been evaluated across a spectrum of patients with rheumatoid arthritis (RA) in the phase 3 SELECT clinical program.1–6

Objectives:

To describe the long-term integrated safety profile of UPA relative to active comparators (cutoff date: June 30, 2020) in patients with RA treated in the SELECT clinical program.

Methods:

This analysis included updated data from 6 randomized controlled UPA RA trials.1–6 Treatment-emergent adverse events (TEAEs; onset after first dose and ≤30 days after last dose of study drug or ≤70 days for adalimumab [ADA]) including AEs of special interest were summarized as follows: pooled UPA 15 mg once daily (QD; UPA15, 6 trials); pooled UPA 30 mg QD (UPA30, 4 trials); methotrexate (MTX, 1 trial), and ADA (1 trial). TEAEs were reported as exposure-adjusted adverse event rates (EAERs; events/100 patient-years [E/100 PY]), which included both incident and recurrent events.

Results:

4413 patients (UPA15, n=3209; UPA30, n=1204) received ≥1 dose of UPA, providing 10,115.4 PY of exposure. EAERs for AEs, serious AEs (SAEs), and AEs leading to discontinuation were similar for UPA15, MTX, and ADA; rates for UPA30 were numerically higher than UPA15 (Table 1). The most common AEs were upper respiratory tract infection, nasopharyngitis, and urinary tract infection for both UPA doses, and for UPA30 only, increased creatine phosphokinase (CPK). Pneumonia was the most common SAE for both UPA15 and UPA30. Serious infection rates were similar for UPA15, MTX, and ADA but higher for UPA30 (Figure 1). Rates of herpes zoster (HZ) were higher for both UPA groups (dose-dependent) vs MTX and ADA. Most HZ cases with UPA were non-serious (94%) and involved a single dermatome (74%). CPK elevations, which were mostly asymptomatic, were more common for both UPA groups (dose-dependent) vs MTX and ADA. EAERs of adjudicated gastrointestinal perforations were <0.1 and 0.2 E/100 PY for UPA15 and UPA30, respectively. Rates of non-melanoma skin cancer (due in part to more recurrent events with UPA30), anemia, and neutropenia were higher with UPA30 vs other treatment groups. Events of anemia and neutropenia were generally mild/moderate and treatment discontinuation due to these events was uncommon (<0.4%). Rates of other AEs of special interest, including major adverse cardiovascular and venous thromboembolic events, were broadly similar across treatment groups. The rate of deaths in UPA-treated patients with RA was not higher than expected for the general population (standardized mortality ratio [95% confidence interval (CI)]: UPA15, 0.43 [0.29, 0.63]; UPA30, 0.68 [0.40, 1.08]).

Table 1.

TEAEs in patients treated with UPA, MTX, and ADA

UPA 15 mg QDUPA 30 mg QDADA 40 mg EOWMTXn32091204579314ExposureTotal, PY7023.83091.61051.8637.4Mean (SD), weeks114 (64)134 (66)95 (70)106 (67)Median (range), weeks136 (0, 232)160 (0, 231)118 (2, 231)144 (1, 221)E/100 PY (95% CI)Any AE230.7 (227.2, 234.3)283.6 (277.7, 289.6)216.6 (207.8, 225.7)227.8 (216.2, 239.8)Any SAE13.0 (12.2, 13.9)18.8 (17.3, 20.4)13.3 (11.2, 15.7)10.4 (8.0, 13.2)Any AE leading to discontinuation of study drug5.6 (5.0, 6.1)8.5 (7.5, 9.6)6.8 (5.3, 8.5)6.3 (4.5, 8.5)Deathsa0.4 (0.3, 0.6)0.6 (0.3, 0.9)0.9 (0.4, 1.6)0.5 (0.1, 1.4)

aBoth treatment and non-treatment-emergent deaths

EOW, every other week

Conclusion:

The updated safety profile of UPA with up to 4.5 years of exposure in patients with RA was comparable to previous analyses,7 with no new safety signals reported. With the exception of HZ and elevated CPK, the safety profile of UPA15, the approved dose for RA, was similar to that observed for ADA.

References:

[1]Burmester GR, et al. Lancet 2018;391:2503–12;

[2]Smolen JS, et al. Lancet 2019;393:2303–11;

[3]Fleischmann R, et al. Arthritis Rheumatol 2019;71:1788–800;

[4]Genovese MC, et al. Lancet 2018;391:2513–24;

[5]van Vollenhoven R, et al. Arthritis Rheumatol 2020;72:1607–20;

[6]Rubbert-Roth A, et al. N Engl J Med 2020;383:1511–21;

[7]Cohen SB, et al. Ann Rheum Dis 2020;79(Suppl 1):319–20.

Acknowledgements:

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Hilary Wong, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.

Disclosure of Interests:

Stanley B. Cohen Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Gilead, Pfizer, Roche, and Sandoz, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Gilead, Pfizer, Roche, and Sandoz, Ronald van Vollenhoven Consultant of: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, Eli Lilly, GSK, Janssen, Medac, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Arthrogen, Bristol-Myers Squibb, Eli Lilly, GSK, Pfizer, and UCB, Jeffrey R. Curtis Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Crescendo, Janssen, Pfizer, Sanofi/Regeneron, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Crescendo, Janssen, Pfizer, Sanofi/Regeneron, and UCB, Leonard Calabrese Speakers bureau: AbbVie, Crescendo, Genentech, Horizon, Janssen, Novartis, and Sanofi, Consultant of: AbbVie, Bristol-Myers Squibb, Crescendo, Genentech, Gilead, GSK, Horizon, Janssen, Novartis, and Sanofi, Cristiano Zerbini Speakers bureau: MSD, Pfizer, and Sanofi, Consultant of: MSD, Pfizer, and Sanofi, Grant/research support from: Amgen, Eli Lilly, GSK, MSD, Novartis, Pfizer, Roche, Sanofi, and Servier, Yoshiya Tanaka Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, Gilead, GSK, Janssen, Mitsubishi Tanabe, Novartis, Pfizer, Sanofi, and YL Biologics, Grant/research support from: Asahi Kasei, Chugai, Daiichi Sankyo, Eisai, Mitsubishi Tanabe, Takeda, and UCB, Louis Bessette Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Christophe Richez Speakers bureau: AbbVie, Amgen, AstraZeneca, Biogen, Bristol-Myers Squibb, Eli Lilly, GSK, MSD, and Pfizer, Consultant of: AbbVie, Amgen, AstraZeneca, Biogen, Bristol-Myers Squibb, Eli Lilly, GSK, MSD, and Pfizer, Ivan Lagunes-Galindo Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Jianzhong Liu Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Heidi Camp Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Yanna Song Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Samuel Anyanwu Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Gerd Rüdiger Burmester Speakers bureau: AbbVie, Eli Lilly, Gilead, Janssen, MSD, Pfizer, Roche, and UCB, Consultant of: AbbVie, Eli Lilly, Gilead, Janssen, MSD, Pfizer, Roche, and UCB

Constraints on the Ecomorphological Convergence of Zooplanktivorous Butterflyfishes

Whether distantly related organisms evolve similar strategies to meet the demands of a shared ecological niche depends on their evolutionary history and the nature of form-function relationships. In fishes, the visual identification and consumption of microscopic zooplankters, selective zooplanktivory, is a distinct type of foraging often associated with a suite of morphological specializations. Previous work has identified inconsistencies in the trajectory and magnitude of morphological change following transitions to selective zooplanktivory, alluding to the diversity and importance of ancestral effects. Here we investigate whether transitions to selective zooplanktivory have influenced the morphological evolution of marine butterflyfishes (family Chaetodontidae), a group of small-prey specialists well known for several types of high-precision benthivory. Using Bayesian ancestral state estimation, we inferred the recent evolution of zooplanktivory among benthivorous ancestors that hunted small invertebrates and browsed by picking or scraping coral polyps. Traits related to the capture of prey appear to be functionally versatile, with little morphological distinction between species with benthivorous and planktivorous foraging modes. In contrast, multiple traits related to prey detection or swimming performance are evolving toward novel, zooplanktivore-specific optima. Despite a relatively short evolutionary history, general morphological indistinctiveness, and evidence of constraint on the evolution of body size, convergent evolution has closed a near significant amount of the morphological distance between zooplanktivorous species. Overall, our findings describe the extent to which the functional demands associated with selective zooplanktivory have led to generalizable morphological features among butterflyfishes and highlight the importance of ancestral effects in shaping patterns of morphological convergence.

[Using energy spectrum CT to evaluate the characteristics of adult abdominal fat distribution and analyze its influencing factors]

Objective: To evaluate the characteristics of adult abdominal fat distribution and analyze its influencing factors by energy spectrum CT scan. Methods: The body height, weight, waist circumference, and hip circumference of 105 adults were measured, and the characteristics of abdominal fat distribution were evaluated by energy spectrum CT scan. Results: Compared with non-obese individuals, the contents of abdominal subcutaneous fat, abdominal cavity and liver ectopic fat were higher in obese patients (P<0.05), and the intramuscular fat (IMAT) content did not increase with the increase of BMI. In middle-aged group, the waist circumference, waist-to-hip ratio (WHR) abdominal cavity area and IMAT content were higher than those in the youth group, and the muscle content of the middle-aged group was lower than that of the youth group, the difference between the two groups was significant (P<0.05); the male group had higher abdominal cavity area and muscle content than the female group, while the female group had higher the subcutaneous fat area, abdominal subcutaneous fat thickness and erector spinae fat content than the male group, the differences were significant (P<0.05). Conclusions: The characteristics of abdominal fat distribution of subjects with different BMI, age and gender were different. Therefore, we should pay attention to the individual assessment of ectopic fat distribution in obese patients. Energy spectrum CT can be used as an important approach for the assessment of ectopic fat to provide evidence for developing individualized weight loss programs.

[Gender difference in secular trends of body height in Chinese Han adolescents aged 18 years, 1985-2014]

Objective: To analyze the gender difference in secular trends of body height in Chinese Han adolescents aged 18 years from 1985 to 2014. Methods: Data were extracted from 1985, 1995, 2000, 2005, 2010 and 2014 Chinese National Surveys in Students' Constitution and Health. A total of 124 099 Chinese Han adolescents aged 18 years were included in the analysis. ANOVA test was used to compare the body height between different subgroups stratified by gender and the mean difference and ratio in body height were calculated. Quantile regression model was used to assess the association between body height and gender over time in the adolescents stratified by region or area. Results: The mean body height of adolescents aged 18 years increased significantly from 1985 to 2014 with the rate of 1.3 cm/decade in male adolescents and 0.8 cm/decade in female adolescents, and the highest increment occurred from 1995 to 2005 in both groups. Male adolescents were taller than female adolescents at each subgroup (P<0.05). Gender difference in body height increased from 11.1 cm in 1985 to 12.6 cm in 2014 and ratio remained to be 1.07-1.08. The body height was taller in adolescents in urban area than in rural area (P<0.05) and in northeastern China than in other regions (P<0.05) in both male and female adolescents. The body height of obese male adolescents had been taller since 2000 and the body height of obese female adolescents had been taller since 2010 than other groups. When adjusted for urban-rural areas, region, socioeconomic status and nutritional status, the body height increased over time at P₅, P₂₅, P₅₀, P₇₅ and P₉₅ in both male and female adolescents, and the increments of gender difference in body height at different percentile ranged from 0.45 cm/decade to 0.57 cm/decade. When stratified by region, the gender difference in body height showed similar trend with total sample except P₅ and P₉₅ in northeastern China, the difference of increments were not significant. Conclusions: From 1985 to 2014, the gender difference in body height of Chinese Han adolescents aged 18 years increased, and male adolescents showed greater increase than female adolescents. Moreover, the adolescents in northeastern and eastern China had larger increment in body height. It is necessary to paid more attention to the adolescents in central and western China to promote their physical development.

[Metabolic-associated fatty liver disease-related liver cirrhosis and cryptogenic liver cirrhosis]

Metabolic-associated fatty liver disease (MAFLD) is currently the most common chronic liver disease in the world, which may eventually progress to cirrhosis, hepatocellular carcinoma and liver failure. Fatty liver disease was once considered to be the most common cause of cryptogenic cirrhosis. Recently, a new definition of MAFLD suggests that MAFLD-related liver cirrhosis is no longer a kind of cryptogenic cirrhosis, and it belong to two different concepts and may have different liver and extrahepatic adverse outcomes. In this paper, the definition, epidemiology, diagnosis, treatment and other aspects of MALFD-related liver cirrhosis and cryptogenic liver cirrhosis are described in order to facilitate clinical practice, improve the efficiency of clinical research, and benefit clinicians and patients.

[Sleep-disordered breathing in patients with chronic heart failure before and after heart transplantation]

Objective: To explore the characteristics of sleep-disordered breathing (SDB) in chronic heart failure patients waiting for heart transplantation and the changes of SDB after transplantation. Methods: From September 2018 to December 2019, 34 patients with chronic heart failure were prospectively enrolled into this study, who were hospitalized for waiting for heart transplantation in the departments of cardiovascular medicine and cardiovascular surgery, Renmin Hospital of Wuhan University. All of them received portable sleep physiological monitoring. The characteristics of their SDB were analyzed before and after heart transplantation. Results: Of the 34 patients waiting for heart transplantation, 22 had central sleep apnea, 4 had obstructive sleep apnea and 8 had no SDB. The cycle length of Cheyne-Stokes respiration was negatively correlated with left ventricular ejection fraction. After heart transplantation, 15 patients received repeat sleep physiological monitoring and their results showed that the SDB was significantly improved, with the elimination of Cheyne-Stokes respiration. Conclusions: Patients waiting for heart transplantation had a high prevalence of SDB, with Cheyne-Stokes respiration with central sleep apnea as the main type. However, heart transplantation may eliminate the Cheyne-Stokes respiration in patients with chronic heart failure.

Nanophotonic structures with optical surface modes for tunable spin current generation

We propose a novel type of photonic-crystal (PC)-based nanostructures for efficient and tunable optically-induced spin current generation via the spin Seebeck and inverse spin Hall effects. It has been experimentally demonstrated that optical surface modes localized at the PC surface covered by ferromagnetic layer and materials with giant spin-orbit coupling (SOC) notably increase the efficiency of the optically-induced spin current generation, and provides its tunability by modifying the light wavelength or angle of incidence. Up to 100% of the incident light power can be transferred to heat within the SOC layer and, therefore, to the spin current. Importantly, the high efficiency becomes accessible even for ultra-thin SOC layers. Moreover, the surface patterning of the PC-based spintronic nanostructure allows for the local generation of spin currents at the pattern scales rather than the diameter of the laser beam.

A novel homozygous mutation (p.N958K) of SLC12A3 in Gitelman syndrome is associated with endoplasmic reticulum stress

PURPOSE

Gitelman syndrome (GS) is an autosomal recessive renal tubular disease that arises as a consequence of mutations in the SLC12A3 gene, which codes for an Na-Cl cotransporter (NCC) in distal renal tubules. This study was designed to explore the mutations associated with GS in an effort to more fully understand the molecular mechanisms governing GS.

METHODS

We analyzed SLC12A3 mutations in a pedigree including a 42-year-old male with GS as well as four related family members over three generations using Sanger and next generation sequencing approaches. We additionally explored the functional ramifications of identified mutations using both Xenopus oocytes and the HEK293T cell line.

RESULTS

We found that the subject with GS exhibited characteristic symptoms including sporadic thirst, fatigue, excess urination, and substantial hypokalemia and hypocalciuria, although magnesium levels were normal. Other analyzed subjects in this pedigree had normal laboratory findings and did not exhibit clear signs of GS. Sequencing analyses revealed that the GS subject exhibited a homozygous missense mutation (c.2874C > G, p.N958K) in exon 24 of SLC12A3. Both parents of this GS subject, as well as his older brother and daughter all exhibited heterozygous mutations at this same site. Functional analyses in Xenopus oocytes indicated that this mutated SLC12A3 gene encodes a protein which fails to mediate normal sodium transport, and when this mutant gene was expressed in HEK293T cells, we observed significant increases in endoplasmic reticulum (ER)-stress pathway activation.

CONCLUSION

The p.N958K mutation in exon 24 of SLC12A3 can trigger GS at least in part via enhancing ER stress responses.

Novel biomarkers of intervertebral disc cells and evidence of stem cells in the intervertebral disc

OBJECTIVE

Rat intervertebral disc (IVD) is one of the most commonly used and cost-effective alternative models for human IVD. Many IVD related clinical studies need to be pre-tested on rat IVDs. However, studies on the heterogeneous cell clusters of the rat IVD are inadequate, and a further understanding of the marker genes and cell phenotypes of healthy mature IVD cells is essential.

METHODS

In this study, we used the 10X Genomics technology to analyze the single-cell transcriptome of purified wild-type rat IVDs.

RESULTS

We identified potentially new gene markers of IVDs via single-cell sequencing. Based on the unsupervised cluster analysis of 13,578 single-cell transcripts, 3 known IVD cell types were identified. We provided a complete single-cell gene expression map of the IVD. Immunohistochemical and immunofluorescence images of rat disc sections confirmed the new marker genes of all cell types. One group of heterologous cell groups expressed multi-functional stem cell (MSC)-specific genes, indicating the stem cell potential of IVD cells.

CONCLUSION

We provided the phenotype and marker genes of IVD cells at the single-cell level, reconfirmed existing data, and proposed new marker genes, including MSC marker genes. By identifying more accurate target cells and genes, our results pave the way for further study of the response of individual disc cells to disease states and provide the basis for future disc regeneration therapies.

Changes in ocular biomechanics after treatment for active Graves' orbitopathy

PURPOSE

To evaluate the changes in ocular biomechanical properties in active moderate-to-severe Graves' orbitopathy (GO) after intravenous glucocorticoids (IVGCs), and to clarify correlations between clinical findings and ocular biomechanical properties.

METHODS

A prospective study. A total of 20 consecutive GO patients and 20 age- and sex-matched healthy control subjects were included. GO was diagnosed on the basis of the recommendation by the European Group on Graves' Orbitopathy (EUGOGO), and disease activity was assessed by the clinical activity score (CAS). Patients were assigned to receive once weekly IVGCs (0.5 g, then 0.25 g, 6 weeks each). All participants received a full ophthalmic examination and biomechanical evaluation was performed with dynamic Scheimpflug analyzer (Corvis ST) at baseline and 12th weeks after therapy.

RESULTS

The biomechanically corrected intraocular pressure (bIOP) in GO patients was significantly higher than that in healthy subjects. In contrast, the whole eye movement (WEM) in GO patients was significantly lower than in healthy subjects after adjusting for bIOP. The CAS, NOSPECS score, and exophthalmos were significantly positively correlated with the bIOP and negatively correlated with the WEM after adjusting for bIOP, CCT and age. The WEM significantly increased, whereas bIOP significantly decreased after IVGCs (P < 0.001, P = 0.001 respectively). The overall response rate at the 12th week was 85% (17 of 20).

CONCLUSIONS

The changes of ocular biomechanical properties measured by Corvis ST were an objective indicator of inflammatory activity and severity of GO. Combining CAS and ocular biomechanical properties could better evaluate the therapeutic outcome of active moderate-to-severe GO.

[Long non-coding RNA UPK1A-AS1 promotes glycolysis in hepatocellular carcinoma cells via stabilization of HIF-1α]

OBJECTIVE

To investigate the effect of long non-coding RNA UPK1A-AS1 on glycolysis of hepatocellular carcinoma cells and its underlying molecular mechanisms.

OBJECTIVE

A hepatocellular carcinoma (HCC) cell line with lentivirus-mediated stable UPK1A-AS1 overexpression and the cells infected with a negative control lentiviral vector were cultured under normoxic (21% O₂) or hypoxic (1% O₂) conditions for 24 h. The effect of UPK1A-AS1 overexpression on glycolysis of the HCC cells was examined. The expressions of glycolysis-related genes HIF1A, GLUT1, HK1, HK2 and PGK1 were detected by qRTPCR, and the effect of UPK1A-AS1 overexpression on HRE activity was detected by dual luciferase report assay. The HCC cells were treated with cycloheximide to detect the effect of UPK1A-AS1 overexpression on the stability of HIF-1α protein. Immunoprecipitation assay was used to analyze the changes in ubiquitin modification of HIF-1α protein in response to UPK1A-AS1 overexpression. The effects of UPK1A-AS1 overexpression and RNA interference of HIF-1α expression on glucose consumption, lactate production and expressions of HRE activity and glycolysis-related genes (HK1, HK2 and PGK1) were examined in the HCC cells.

OBJECTIVE

Compared with the control group, overexpression of UPK1A-AS1 significantly promoted glucose consumption and lactate production in HCC cells under both normoxic and hypoxic conditions (P < 0.05). Overexpression of UPK1A-AS1 significantly increased the expression of glycolysis-related genes including HIF1A, GLUT1, HK1, HK2 and PGK1. Upregulation of UPK1A-AS1 obviously promoted the transcriptional activity of HRE (P < 0.05). Western blotting showed that UPK1A-AS1 overexpression obviously increased the stability of HIF-1α protein and significantly reduced ubiquitin modification of HIF-1α. Downregulation of HIF-1α obviously reversed the effect of UPK1A-AS1 overexpression in promoting glucose consumption, lactate production and HRE luciferase activity. Silencing HIF-1α also suppressed the upregulation of glycolysis-related gene expressions induced by UPK1A-AS1 overexpression (P < 0.05).

OBJECTIVE

The long noncoding RNA UPK1A-AS1 upregulates the expression of glycolysis-related genes by stabilizing the expression of HIF-1α, thereby promoting glycolysis level in HCC cells.

NFAT2-HDAC1 signaling contributes to the malignant phenotype of glioblastoma

BACKGROUND

Deregulation of the nuclear factor of activated T cell (NFAT) pathway has been reported in several human cancers. Particularly, NFAT2 is involved in the malignant transformation of tumor cells and is identified as an oncogene. However, the role of NFAT2 in glioblastoma (GBM) is largely unknown.

METHODS

The expression and prognostic value of NFAT2 were examined in the databases of the Repository of Molecular Brain Neoplasia Data and The Cancer Genome Atlas (TCGA) and clinical samples. The functional effects of silencing or overexpression of NFAT2 were evaluated in glioma stem cell (GSC) viability, invasion, and self-renewal in vitro and in tumorigenicity in vivo. The downstream target of NFAT2 was investigated.

RESULTS

High NFAT2 expression was significantly associated with mesenchymal (MES) subtype and recurrent GBM and predicted poor survival. NFAT2 silencing inhibited the invasion and clonogenicity of MES GSC-enriched spheres in vitro and in vivo. NFAT2 overexpression promoted tumor growth and MES differentiation of GSCs. A TCGA database search showed that histone deacetylase 1 (HDAC1) expression was significantly correlated with that of NFAT2. NFAT2 regulates the transcriptional activity of HDAC1. Rescue of HDAC1 in NFAT2-knockdown GSCs partially restored tumor growth and MES phenotype. Loss of NFAT2 and HDAC1 expression resulted in hyperacetylation of nuclear factor-kappaB (NF-κB), which inhibits NF-κB-dependent transcriptional activity.

CONCLUSION

Our findings suggest that the NFAT2-HDAC1 pathway might play an important role in the maintenance of the malignant phenotype and promote MES transition in GSCs, which provide potential molecular targets for the treatment of GBMs.

[Clinicopathological characteristics and outcomes of 122 patients with colorectal cancer metastasize to the ovary]

Objective: To explore the clinicopathological characteristics and prognosis of patients with ovarian metastases from colorectal cancer. Methods: A total of 122 female patients with ovarian metastases from colorectal cancer underwent treatment in Cancer Hospital, Chinese Academy of Medical Sciences between 2010 and 2015 were recruited. The clinicopathological features, treatment details and survival data of these patients were retrospectively analyzed. Kaplan-Maier method was used for survival analysis, log rank test and Cox proportional hazards model were used for prognostic factor analysis. Results: The median overall survival (OS) was 19.7 months. The 1-year, 3-years and 5-years OS rates were 72.1%, 24.7% and 9.9%, respectively. A total of 99 (81.1%) patients underwent oophorectomy. The median OS of patients who underwent oophorectomy was 21.9 months, significantly longer than 10.3 months of patients without oophorectomy (P<0.01). Ovary as the only site of metastasis, primary tumor resection, and oophorectomy were associated with improved survival (all P<0.01). Primary tumor resection and oophorectomy were independent prognostic factors for OS (both P<0.01). Conclusion: Patients with ovarian metastases from colorectal cancer might acquire a survival benefit from surgical resection of the primary tumor and ovaries.

[Clinical analysis of re-operative management for residual partial anomalous pulmonary venous connection after previous cardiac surgery]

Objectives: To analyze the reasons of residual partial anomalous pulmonary venous connection (PAPVC) after previous cardiac surgery, and summarize the strategies and experience for diagnosis and treatment of secondary correction operation. Methods: The clinical data of 18 patients who were admitted to Fuwai Hospital of Chinese Academy of Medical Sciences and Fuwai Yunnan Cardiovascular Hospital from June 2009 to May 2019 were retrospectively analyzed. All the patients underwent secondary cardiac surgery to treat PAPVC. The preoperative and intraoperative characteristics and postoperative complications of the patients were summarized and analyzed. Results: Totally, there were 7 male and 11 female cases, aged 1-49 years (median age: 4.5 years). In the first cardiac surgery, 3 patients were diagnosed with PAPVC, which existed after surgery. One patient was diagnosed with total anomalous pulmonary venous connection (TAPVC), but left PAPVC after surgery. The remaining 14 patients were all missed preoperative and intraoperative diagnosis. After the initial surgery, most patients had no significant symptoms (11/18), but PAPVC was found in 11 cases due to postoperative cardiac murmur or transthoracic echocardiography (TTE). In the secondary surgery, there were 4 cases of type A, 10 cases of type B, 2 cases of type C, no type D, and 2 cases of mixed type, respectively, according to Bordy classification. The diagnostic accuracy of TTE and CT angiography (CTA) was 50.0% and 92.9%, respectively. There was no death after the second surgery, but pulmonary vein occlusion, pericardial effusion, anastomotic stenosis and other complications occurred in 4 patients. Conclusions: The main causes of missed diagnosis of PAPVC are the undefined cardiac structural deformities before operation and the lack of careful exploration during the operation. TTE is simple and feasible to diagnose PAPVC, and it can improve the diagnostic accuracy when combined with CTA.

Severe Periodontal Disease Increases Acute Myocardial Infarction and Stroke: A 10-Year Retrospective Follow-up Study

This study aimed to evaluate the causal association of periodontal disease with acute myocardial infarction (AMI) and stroke, after controlling for various confounders among the Korean population. A retrospective cohort study using the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) was performed during 2002 to 2015 (baseline: 2002 to 2005; follow-up: 2006 to 2015) in the Republic of Korea. A total of 298,128 participants with no history of AMI or stroke were followed up for 10 y. AMI and stroke were defined by a diagnosis using the International Classification of Diseases, 10th Revision (ICD-10) guideline. Periodontal condition was classified into 3 groups (healthy, moderate periodontal disease, severe periodontal disease [SPD]) using the combination of ICD codes, treatment codes in the NHIS, and recommendation of periodontal treatment by the dentists in HEALS. Various confounders, such as sociodemographic, behavioral, systemic, and oral health factors, including hypercholesterolemia, were considered. Multivariable Cox regression analysis was applied to estimate adjusted incidence rate ratio (adjusted hazard ratio [aHR]) based on person-year of periodontal condition for AMI, stroke, and nonfatal major adverse cardiovascular events (MACEs) encompassing AMI or stroke controlling for various confounders. Stratified analyses according to age group, sex, and toothbrushing frequency were also performed. After controlling for various confounders, participants with SPD compared with non-SPD participants had a higher incidence by 11% for AMI (aHR, 1.11; 95% confidence interval [CI], 1.02-1.20), by 3.5% for stroke (aHR, 1.035; 95% CI, 1.01-1.07), and by 4.1% for MACEs (aHR, 1.04; 95% CI, 1.01-1.07). The association of SPD with AMI and MACE was highly modified in females and adults aged 40 to 59 y. In the total Korean population, SPD increased total AMI events by 4.3%, total stroke events by 1.4%, and the total MACEs by 1.6%. Our data confirmed that SPD was causally associated with the new events of AMI and stroke.

Functionalized M2TiC2Tx MXenes (M = Cr and Mo; T = F, O, and OH) as high performance electrode materials for sodium ion batteries

First-principles calculations were performed to study the electrochemical performance of M2TiC2 (M = Cr or Mo) and M2TiC2Tx (T = O, F or OH) used as anode materials for sodium ion batteries (SIBs). The O functionalized MXenes (Cr2TiC2O2 and Mo2TiC2O2) are found to be more stable than F and OH terminated systems. The diffusion performance of sodium in MXene materials is mainly affected by the functional groups. The lowest diffusion barrier of functionalized MXenes is about one order larger in magnitude than that of bare MXenes. Although the introduction of O-groups hinders the diffusion of sodium, it can greatly improve the theoretical storage capacities. Meanwhile, the diffusion paths and diffusion energy barriers of Na are affected by Na concentration effects, while the interactions between terminations have little effect. Furthermore, multiple layers of sodium atoms are found to be adsorbed between the layers of M2TiC2O2, thus significantly increasing the theoretical capacities. The theoretical sodium storage capacities of M2TiC2O2 monolayers reach 515.70 mA h g-1 (M = Cr) and 362.46 mA h g-1 (M = Mo) and the OCVs can approach 0.034 V (M = Cr) and 0.042 V (M = Mo). Therefore, Cr2TiC2O2 and Mo2TiC2O2 are expected to be promising anode materials for SIBs due to their excellent properties, such as good electronic conductivity, low sodium diffusion barrier, and high theoretical sodium storage capacity.

[Etiological survey and traceability analysis of five cases of typhoid fever during the same period in Yantai city]

Objective: To analyze the etiological characteristics and molecular epidemiological correlation of five cases of typhoid fever during the same period in yantai city. Methods: Six S. Typhis strains were isolated from 5 typhoid patients and epidemiological samples in Yantai city in 2018. The onset time of the cases were from May 26, 2018 to July 24, 2018, distributed in Shuidao Town of Muping District, Dengzhou Street of Penglai District, Donglai Street of Longkou District, Wenhua Street of Muping District and Fulaishan Street of zhifu District. S. Typhis strains were analyzed by conventional bacterial isolation method and XbaⅠ/BlnⅠ double-enzyme digestion pulse-field gel electrophoresis (PFGE). Meanwhile, ViaB virulence gene detection and 27 common antibiotics sensitivity tests were conducted to study the etiology of S. Typhis. Results: Six strains of S. Typhi were isolated from 5 patients and the domestic egg of one patient, which were divided into 4 PFGE patterns by PFGE-XbaⅠ and PFGE-BlnⅠ and among which 3 strains had the same PFGE patterns.One multi-drug resistant strain (foreign patient), one single-drug resistant strain (patient with a history of provincial retention), and one completely sensitive strain were detected. The three strains of the same PFGE pattern exhibit the same drug-sensitive phenotype which were intermediate against aminoglycosides and quinolones and susceptibility against the other antibiotics.All of the strains carried the ViaB virulence factor except the strain from the foreign patient. Conclusion: Local S. Typhi is susceptibility or intermediate against antibiotics commonly used in clinic.Sporadic cases of typhoid fever and typhoid imported infections still need attention.

Genome-wide surveillance of transcription errors in response to genotoxic stress

Mutagenic compounds are a potent source of human disease. By inducing genetic instability, they can accelerate the evolution of human cancers or lead to the development of genetically inherited diseases. Here, we show that in addition to genetic mutations, mutagens are also a powerful source of transcription errors. These errors arise in dividing and nondividing cells alike, affect every class of transcripts inside cells, and, in certain cases, greatly exceed the number of mutations that arise in the genome. In addition, we reveal the kinetics of transcription errors in response to mutagen exposure and find that DNA repair is required to mitigate transcriptional mutagenesis after exposure. Together, these observations have far-reaching consequences for our understanding of mutagenesis in human aging and disease, and suggest that the impact of DNA damage on human physiology has been greatly underestimated.

Inter- and intra-fractional stability of rectal gas in pelvic cancer patients during MRIgRT

PURPOSE

Due to the electron return effect (ERE) during magnetic resonance imaging guided radiotherapy (MRIgRT), rectal gas during pelvic treatments can result in hot spots of over-dosage in the rectal wall. Determining the clinical impact of this effect on rectal toxicity requires estimation of the amount and mobility (and stability) of rectal gas during treatment. We therefore investigated the amount of rectal gas and local inter- and intra-fractional changes of rectal gas in pelvic cancer patients.

METHODS

To estimate the volume of gas present at treatment planning, the rectal gas contents in the planning computed tomography (CT) scans of 124 bladder, 70 cervical and 2180 prostate cancer patients were calculated. To estimate inter- and intra-fractional variations in rectal gas, 174 and 131 T2-w MRIs for six cervical and eleven bladder cancer patients were used. These scans were acquired during four scan-sessions (~20-25 min each) at various time-points. Additionally, 258 T2-w MRIs of the first five prostate cancer patients treated using MRIgRT at our center, acquired during each fraction, were analyzed. Rectums were delineated on all scans. The area of gas within the rectum delineations was identified on each MRI slice using thresholding techniques. The area of gas on each slice of the rectum was used to calculate the inter- and intra-fractional group mean, systematic and random variations along the length of the rectum. The cumulative dose perturbation as a result of the gas was estimated. Two approaches were explored: accounting or not accounting for the gas at the start of the scan-session.

RESULTS

Intra-fractional variations in rectal gas are small compared to the absolute volume of rectal gas detected for all patient groups. That is, rectal gas is likely to remain stable for periods of 20-25 min. Larger volumes of gas and larger variations in gas volume were observed in bladder cancer patients compared with cervical and prostate cancer patients. For all patients, local cumulative dose perturbations per beam over an entire treatment in the order of 60 % were estimated when gas had not been accounted for in the daily adaption. The calculated dose perturbation over the whole treatment was dramatically reduced in all patients when accounting for the gas in the daily set-up image.

CONCLUSION

Rectal gas in pelvic cancer patients is likely to remain stable over the course of an MRIgRT fraction, and also likely to reappear in the same location in multiple fractions, and can therefore result in clinically relevant over-dosage in the rectal wall. The over-dosage is reduced when accounting for gas in the daily adaption.

Impacts of Glycemic Control on Intracranial Plaque in Patients with Type 2 Diabetes Mellitus: A Vessel Wall MRI Study

BACKGROUND AND PURPOSE

The relationship between glycemic control in patients with type 2 diabetes mellitus and intracranial atherosclerotic plaque features has remained understudied. This study aimed to investigate the association of type 2 diabetes mellitus and glycemic control with the characteristics of intracranial plaques using vessel wall MR imaging.

MATERIALS AND METHODS

In total, 311 patients (217 [69.8%] men; mean age, 63.24 ± 11.44 years) with intracranial atherosclerotic plaques detected on vessel wall MR imaging were enrolled and divided into 3 groups according to type 2 diabetes mellitus and glycemic control statuses: the non-type 2 diabetes mellitus group, the type 2 diabetes mellitus with good glycemic control group, and the type 2 diabetes mellitus with poor glycemic control group. The imaging features of intracranial plaque were analyzed and compared among the groups. The clinical risk factors for atherosclerosis were also analyzed using logistic regression analysis.

RESULTS

The plaque length and thickness were significantly higher in the type 2 diabetes mellitus with poor glycemic control group than in the non-type 2 diabetes mellitus group. The prevalence of strongly enhanced plaques was significantly higher in the type 2 diabetes mellitus with poor glycemic control group than in the non-type 2 diabetes mellitus and type 2 diabetes mellitus with good glycemic control groups (92.9%, 63.4%, and 72.7%, respectively; P < .001). Multivariate logistic regression analysis showed a significant association of poor glycemic control with the plaque length (OR = 1.966; 95% CI, 1.170-3.303; P = .011), plaque thickness (OR = 1.981; 95% CI, 1.174-3.340; P = .010), and strongly enhanced plaque (OR = 5.448; 95% CI, 2.385-12.444; P < .001).

CONCLUSIONS

Poor glycemic control, compared with the history of diabetes, might have a greater impact on the burden and vulnerability of intracranial atherosclerotic plaques.

Positioning Bacillus subtilis as terpenoid cell factory

Increasing demands for bioactive compounds have motivated researchers to employ micro‐organisms to produce complex natural products. Currently, Bacillus subtilis has been attracting lots of attention to be developed into terpenoids cell factories due to its generally recognized safe status and high isoprene precursor biosynthesis capacity by endogenous methylerythritol phosphate (MEP) pathway. In this review, we describe the up‐to‐date knowledge of each enzyme in MEP pathway and the subsequent steps of isomerization and condensation of C5 isoprene precursors. In addition, several representative terpene synthases expressed in B. subtilis and the engineering steps to improve corresponding terpenoids production are systematically discussed. Furthermore, the current available genetic tools are mentioned as along with promising strategies to improve terpenoids in B. subtilis, hoping to inspire future directions in metabolic engineering of B. subtilis for further terpenoid cell factory development.

Platelet membrane-coated nanoparticles target sclerotic aortic valves in ApoE−/− mice by multiple binding mechanisms under pathological shear stress

Background

Aortic valve disease is the most common valvular heart disease leading to valve replacement. The efficacy of pharmacological therapy for aortic valve disease is limited by the high mechanical stress at the aortic valves impairing the binding rate. We aimed to identify nanoparticle coating with entire platelet membranes to fully mimic their inherent multiple adhesion mechanisms and target the sclerotic aortic valve of apolipoprotein E-deficient (ApoE−/−) mice based on their multiple sites binding capacity under high shear stress.

Methods

Considering the potent interaction of platelet membrane glycoproteins with components present in sclerotic aortic valves, platelet membrane-coated nanoparticles (PNPs) were synthetized and the binding capacity under high shear stress was evaluated in vitro and in vivo.

Results

Compared with PNPs bound intensity in the static station, 161%, 59%, and 39% of attached PNPs remained adherent on VWF-, collagen-, and fibrin-coated surfaces under shear stress of 25dyn/cm2 respectively. PNPs demonstrated effectively adhering to von Willebrand factor, collagen and fibrin under shear stresses in vitro. In an aortic valve disease model established in ApoE−/− mice, PNPs group exhibited significant increase of accumulation in the aortic valves compared with PBS and control NP group. PNPs displayed high degrees of proximity or co-localization with vWF, collagen and fibrin, which exhibited good targeting to sclerotic aortic valves by mimicking platelet multiple adhesive mechanisms.

Conclusion

PNPs could provide a promising platform for the molecular diagnosis and targeting treatment of aortic valve disease.

Targeting combination

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): National Natural Science Foundation of China

Development of an immunocompetent mouse model susceptible to Cryptosporidium tyzzeri infection

AIMS

Immunocompromised mice are extensively used in the screening of vaccines and drugs for Cryptosporidium, but this study model does not reflect the real status of infection in immunocompetent animals. This study aimed to provide an optimized animal model for future studies of Cryptosporidium vaccine.

METHODS AND RESULTS

Three mouse strains (ICR, BALB/c and KM) with or without immunosuppression were compared after challenge with Cryptosporidium tyzzeri (C tyzzeri). The results indicated that ICR mice shed a greater number of faecal oocysts (20 346 ± 203 oocysts/g) compared with BALB/c (2077 ± 142 oocysts/g) and KM mice (3207 ± 431 oocysts/g) after experimental infection with C tyzzeri (P < .001). However, ICR mouse model is uniquely effective for C tyzzeri, not for other Cryptosporidium spp. such as C parvum. ICR mice were then used to determine the immunoreactions and immunoprotection of P23-DNA vaccine (pVAX1-P23) to C tyzzeri experimental infection. The results showed that a significant increase in anti-P23 antibody levels was induced by the pVAX1-P23 vaccine. Compared to pVAX1, TB and blank control mice, pVAX1-P23 immunized mice produced specific spleen cell proliferation as well as enhanced IL-5, IL-12p70 and IFN-γ production in sera. After challenge with 5 × 10⁶ C tyzzeri oocysts, the oocyst shedding of the pVAX1-P23 immunized group was reduced by 69.94% comparing to the infection control.

CONCLUSION

These results provide an optimized animal model for the study of prophylactic vaccines and this model might be applied to other candidates against Cryptosporidium, not only for pVAX1-P23.

[Prevalence and clinical characteristics of obstructive sleep apnea in patients with primary hyperaldosteronism]

Objective: To explore the proportion of obstructive sleep apnea (OSA) in primary aldosteronism (PA) in Chinese population and compare the clinical characteristics between PA patients with OSA and those without. Methods: A total of 96 patients diagnosed with PA from September 2015 to November 2018 were recruited in this study. OSA was screened by cardio-respiratory polygraphy. According to the apnea hypopnea index (AHI), the patients were divided into PA with OSA group (AHI ≥5 times) and PA without OSA group (AHI<5 times). Results: Among all patients (96), 69 (71.9%) were with OSA, among them 22 patients (22.9%) were with mild OSA, 17 patients (17.7%) were with moderate OSA and 30 patients (31.3%) were with severe OSA. Compared with the patients without OSA, the patients with OSA were elder, and had higher levels of body mass index (BMI), waist circumference (WC), hip circumference (HC), creatinine (CR) and glycosylated haemoglobin (HbA1c) (P<0.05), but lower concentrations of plasma aldosterone (PAC), supine aldosterone renin concentration ratio(ARR) and the PAC after the diagnosis test (P<0.05). Spearman correlation analyses showed that BMI, WC, HC, CR and HbA1c were positively correlated with AHI (P<0.05), while high-density lipoproteincholesterol (HDL-C), supine-PAC and saline infusion test(SIT)-post PAC were negatively correlated with AHI (P<0.05). Conclusions: The proportion of OSA in PA patients is relatively high (71.9%). Metabolic abnormalities are more common in PA patients with OSA, indicating that screening for OSA should be carried out routinely in PA patients.

Metastasis of pulmonary adenocarcinoma to right occipital parafalcine meningioma: A case report and literature review

RATIONALE

Tumor-to-tumor metastasis is a rare clinical phenomenon. Although meningioma is the most common intracranial recipient of cancer metastasis, only a few cases have been reported. We present a case of metastasis of lung adenocarcinoma into intracranial meningioma and review the published literature.

PATIENT CONCERNS

A 70-year-old woman was admitted to our hospital for a 1-month history of headache and pain in her lower extremities.

DIAGNOSIS

Brain and lumbar vertebral magnetic resonance imaging showed an intracranial space-occupying lesion in the right occipital region and spinal canal stenosis. Pulmonary computed tomography showed an irregular mass in the right upper lobe of the lung. The postoperative histological examination demonstrated adenocarcinoma metastasis to meningioma.

INTERVENTION

The patient underwent right occipital craniotomy for tumor removal and lumbar spinal canal decompression.

OUTCOMES

There were no initial abnormal conditions after the operation. However, the patient died suddenly 7 days after surgery.

LESSONS

Tumor-to-meningioma metastasis is a rare but important phenomenon. According to previous reports, it is associated with rapid onset of symptoms and a poor prognosis. Histological examination is of great importance in diagnosis. The history and process of malignant carcinoma should be closely monitored.

[Pleural effusion as the first manifestation of pleural isolated myeloid sarcoma: a case report and literature review]

Objective: To analyze the clinic features of isolated myeloid sarcoma (IMS) involving the pleural cavity. Methods: A case of pleural isolated myeloid sarcoma (PIMS) with pleural effusion as the first manifestation was described. The related cases in literatures were reviewed with"myeloid sarcoma"and"pleural effusions"as the keywords to search China HowNet, Wanfang database and PubMed database. Results: A 59-year-old man complained of right chest pain for 2 months and worsening pain with distress and shortness of breath for 2 weeks. The chest CT scan showed pleural effusion on the right side. Flow cytometric analysis of pleural fluid showed that a population of blasts with CD₃₄ expressing was 37.6% of the total nucleated cells. The pleural biopsy through medical thoracoscopy indicated lymphoproliferative lesions by pathological examination. Immunohistochemistry was performed on pleural histological sections and cell blocks of pleural effusions, which showed CD₃₄ and CD₁₁₇ positive expression. The diagnosis of PIMS was finally made. Two literature papers with 2 complete cases were found and reviewed. The 3 cases were analyzed. There were 2 males and 1 female. The age was 59, 51, 56 years respectively. One case was a patient with 3 weeks of right upper quadrant and epigastric pain, nausea, and weight loss. Cytological examination of the pleural fluid showed numerous poorly differentiated malignant cells. Histology from an open laparotomy in duodenal biopsies, gallbladder, and mesenteric lymph nodes supported the diagnosis of IMS. The other case was a patient with 6 weeks of dyspnea and a large swelling in the upper vestibular region. Thoracentesis showed 82% myeloid blasts in the pleural fluid. A gingival biopsy showed a diffuse infiltration by cells with a blastic appearance and supported IMS. Conclusion: PIMS was a very rare cause of pleural effusions. The cytological and histopathological evidences were useful to diagnose IMS involving the pleural cavity.