Clinical and genetic spectrum of a Chinese cohort with SCN4A gene mutations

Skeletal muscle sodium channelopathies due to SCN4A gene mutations have a broad clinical spectrum. However, each phenotype has been reported in few cases of Chinese origin. We present detailed phenotype and genotype data from a cohort of 40 cases with SCN4A gene mutations seen in neuromuscular diagnostic service in Huashan hospital, Fudan University. Cases were referred from 6 independent provinces from 2010 to 2018. A questionnaire covering demographics, precipitating factors, episodes of paralysis and myotonia was designed to collect the clinical information. Electrodiagnostic studies and muscle MRI were retrospectively analyzed. The clinical spectrum of patients included: 6 Hyperkalemic periodic paralysis (15%), 18 Hypokalemic periodic paralysis (45%), 7 sodium channel myotonia (17.5%), 4 paramyotonia congenita (10%) and 5 heterozygous asymptomatic mutation carriers (12.5%). Review of clinical information highlights a significant delay to diagnosis (median 15 years), reports of pain and myalgia in the majority of patients, male predominance, circadian rhythm and common precipitating factors. Electrodiagnostic studies revealed subclinical myotonic discharges and a positive long exercise test in asymptomatic carriers. Muscle MRI identified edema and fatty infiltration in gastrocnemius and soleus. A total of 13 reported and 2 novel SCN4A mutations were identified with most variants distributed in the transmembrane helix S4 to S6, with a hotspot mutation p.Arg675Gln accounting for 32.5% (13/40) of the cohort. Our study revealed a higher proportion of periodic paralysis in SCN4A-mutated patients compared with cohorts from England and the Netherlands. It also highlights the importance of electrodiagnostic studies in diagnosis and segregation studies.

Maintenance of Cell Wall Integrity under High Salinity

Cell wall biosynthesis is a complex biological process in plants. In the rapidly growing cells or in the plants that encounter a variety of environmental stresses, the compositions and the structure of cell wall can be dynamically changed. To constantly monitor cell wall status, plants have evolved cell wall integrity (CWI) maintenance system, which allows rapid cell growth and improved adaptation of plants to adverse environmental conditions without the perturbation of cell wall organization. Salt stress is one of the abiotic stresses that can severely disrupt CWI, and studies have shown that the ability of plants to sense and maintain CWI is important for salt tolerance. In this review, we highlight the roles of CWI in salt tolerance and the mechanisms underlying the maintenance of CWI under salt stress. The unsolved questions regarding the association between the CWI and salt tolerance are discussed.

Effects of replacing soybean meal with pumpkin seed cake and dried distillers grains with solubles on milk performance and antioxidant functions in dairy cows

Pumpkin seed cake (PSC), a byproduct of pumpkin seed oil processing, is used in ruminant feed as a beneficial protein source. Experiments were conducted to evaluate PSC as a substitute for soybean meal in the diets of lactating cows based on performance, rumen fermentation, antioxidant function and nitrogen partitioning. Six multiparous lactating cows were used in a replicated 3 × 3 Latin square experiment with 27-day periods. The cows were randomly divided into three treatment groups: group (1) was fed a diet containing no PSC (0PSC), and groups (2) and (3) were fed diets in which soybean meal was replaced with PSC and dried distillers grains with solubles (DDGS) at levels of 50% (50PSC) and 100% (100PSC), respectively. The diets were isonitrogenous and contained identical roughage but different proportions of PSC and DDGS. Replacement of soybean meal with PSC and DDGS did not influence rumen degradation, milk performance, rumen fermentation, DM intake or apparent total tract digestibility, and nitrogen partitioning between milk, feces and urine did not differ in the animals fed the three diets. However, compared with a diet containing no PSC, the total antioxidant capacity (P < 0.05) and antioxidant enzymes (total superoxide dismutase, glutathione peroxidase and catalase) activities (P < 0.05) were increased in the animals that received the 50PSC and 100PSC diets. In contrast, addition of PSC significantly reduced concentrations of aspartate transaminase (P < 0.05), alkaline phosphatase (P < 0.05) and malondialdehyde (P < 0.05) in the plasma. These results demonstrate that PSC can be completely substituted for soybean meal in the diet of dairy cows without any negative impact on milk performance, rumen fermentation or apparent digestibility and that this dietary change improves antioxidant functions and blood parameters in dairy cows, indicating that PSC has the potential for use as a feed source for dairy cows.

Peripheral blood T-cell receptor repertoire as a predictor of clinical outcomes in gastrointestinal cancer patients treated with PD-1 inhibitor

BACKGROUND

Identifying valid biomarkers for patient selection impressively promotes the success of anti-PD-1 therapy. However, the unmet need for biomarkers in gastrointestinal (GI) cancers remains significant. We aimed to explore the predictive value of the circulating T-cell receptor (TCR) repertoire for clinical outcomes in GI cancers who received anti-PD-1 therapy.

METHODS

137 pre- and 79 post-treated peripheral blood samples were included. The TCR repertoire was evaluated by sequencing of complementarity-determining region 3 (CDR3) in the TRB gene. The Shannon index was used to measure the diversity of the TCR repertoire, and Morisita's overlap index was used to determine TCR repertoire similarities between pre- and post-treated samples.

RESULTS

Among all enrolled patients, 76 received anti-PD-1 monotherapy and 61 received anti-PD-1 combination therapy. In the anti-PD-1 monotherapy cohort, patients with higher baseline TCR diversity exhibited a significantly higher disease control rate (77.8% vs. 47.2%; hazard ratio [HR] 3.92; 95% confidence interval [CI] 1.14-13.48; P = 0.030) and a longer progression-free survival (PFS) (median: 6.47 months vs. 2.77 months; HR 2.10; 95% CI 1.16-3.79; P = 0.014) and overall survival (OS) (median: NA vs. 8.97 months; HR 3.53; 95% CI 1.49-8.38; P = 0.004) than those with lower diversity. Moreover, patients with a higher TCR repertoire similarity still showed a superior PFS (4.43 months vs. 1.84 months; HR 13.98; 95% CI 4.37-44.68; P < 0.001) and OS (13.40 months vs. 6.12 months; HR 2.93; 95% CI 1.22-7.03; P = 0.016) even in the cohort with lower baseline diversity. However, neither biomarker showed predictive value in the anti-PD-1 combination therapy cohort. Interestingly, the combination of TCR diversity and PD-L1 expression can facilitate patient stratification in a pooled cohort.

CONCLUSION

The circulating TCR repertoire can serve as a predictor of clinical outcomes in anti-PD-1 therapy in GI cancers.

Effect of substituting wet corn gluten feed and corn stover for alfalfa hay in total mixed ration silage on lactation performance in dairy cows

Wet corn gluten feed (WCGF) is a high moisture feed containing rapidly digestible, non-forage fiber and protein. The objective of this study was to investigate the effect of substituting WCGF and corn stover for alfalfa hay in total mixed ration (TMR) silage on lactation performance and nitrogen balance in dairy cows. Nine multiparous Holstein dairy cows (BW = 532 ± 28.9 kg and day in milk = 136 ± 5.6 d; mean ± SD) were used in a replicated 3 × 3 Latin square design with 21-d periods (14 d of diet adaption and 7 d of sample collection). Groups were balanced for parity, day in milk, and milk production and consumed one of three treatment diets during each period. The treatment diets were fed as TMR and contained similar concentrate mixtures and corn silage but different proportions of roughage and WCGF. The three treatments were: (1) 0% WCGF, 0% corn stover, and 22.1% alfalfa hay (0% WCGF); (2) 6.9% WCGF, 3.4% corn stover, and 11.8% alfalfa hay (7% WCGF); and (3) 13.3% WCGF, 4.9% corn stover, and 3.9% alfalfa hay (13.3% WCGF). Compared to the 0% WCGF diet, the cows fed the 7% and 13.3% WCGF diets had a higher milk yield and concentration of milk fat, protein, lactose, and total solids. Effective degradability of DM was higher in the cows fed the 7% and 13.3% WCGF diets than it was with the 0% WCGF diet. Cows fed the 13.3% WCGF had a higher CP effective degradability and a lower rumen undegraded protein than cows fed the 0% WCGF diet. The concentration of ruminal volatile fatty acids and ammonia-N was higher in cows fed the 7% and 13.3% WCGF diets than cows fed the 0% WCGF diet. The fecal N was lower in cows fed the 7% and 13.3% WCGF diets than it was in cows fed the 0% WCGF diet. Milk N secretion and milk N as a percent of N intake were higher in cows fed the 13.3% WCGF diet than cows fed the 0% and 7% WCGF diets. In conclusion, it appears that feeding a TMR silage containing WCGF and corn stover in combination, replacing a portion of alfalfa hay, may improve lactation performance and nitrogen utilization for lactating dairy cows.

Plasma metabolic differences in cows affected by inactive ovaries or normal ovarian function post partum

Anestrus is essential to an unsuccessful pregnancy in dairy cows. One of the many factors that influences anestrus is the inactive ovary. To characterize in detail the plasma metabolic pro- file, anestrus cows suffering from inactive ovaries were compared with those with natural estrus. The Holstein cows 60 to 90 day postpartum in an intensive dairy farm were assigned into inactive ovaries groups (IO, n=20) and natural estrus group (CON, n=22) according to estrus signs and rectal palpation of ovaries. Plasma samples from two groups of cows were collected from the tail vein to screen differential metabolites using gas chromatography/mass spectrometry (GC/MS) techniques and multivariate statistical analysis and pathways. The results showed that 106 compounds were screened by GC/MS and 14 compounds in the IO group were decreased by analyzing important variables in the projection values and p values of MSA.Through pathway analysis, 14 compounds, mainly associated with carbohydrate metabolism and amino acid meta- bolism, were identified to results in IO, which may seriously affect follicular growth. Metabolo- mics profiling, together with MSA and pathway analysis, showed that follicular growth and development in dairy cows is related to carbohydrate and amino acid metabolism by a single or multiple pathway(s).

Subclinical ketosis risk prediction in dairy cows based on prepartum metabolic indices

ABSTRACT Ketosis can seriously impair cow performance. This study detected changes in prepartum blood metabolic parameters for predicting postpartum ketosis occurrence in dairy cows. Body condition score (BCS) was assessed before and after delivery. Blood samples of 63 cows were collected from 10 days before calving to 10 days after calving to measure metabolic parameters including β-hydroxybutyric acid (BHBA), non-esterified fatty acid (NEFA), glucose (GLU), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), total protein (TP), albumin (ALB), globulin (GLO), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). There was a postpartum subclinical ketosis incidence of 42.25%. Compared with prepartum, plasma, levels of BHBA, AST, and NEFA significantly increased postpartum, and prepartum AST (R=0.57) and NEFA (R=0.45) showed a significant positive correlation with ketosis postpartum. Plasma GLU level significantly decreased postpartum and was significantly negatively correlated with ketosis (R=-0.21). Receiver operating characteristic curve analysis revealed prepartum BSC < 2.88, and prepartum plasma AST > 68.0 U/L, GLU < 3.97mmol/L, NEFA > 0.27mmol/L, and BHBA > 0.43mmol/L, indicating a high risk of subclinical ketosis postpartum. These levels can be used as risk indicators to predict the occurrence of subclinical ketosis in postpartum cows.

Effects of blood pathological changes before TAI on pregnancy of dairy cows with anestrus and estrus

ABSTRACT The objective of this study was to investigate the influence of plasma pathological changes before timed artificial insemination (TAI) on pregnancy of cows. The contents of estrogen (E2), progesterone (P4), glucose (Glu), selenium (Se), brain-derived neurotrophic factor (BDNF), and histamine (HIS) in plasma of 48 Holstein cows were measured before TAI. According to the estrus detection, the cows were divided into estrus (E) and anestrus (A) groups. After pregnancy testing at 28 d after TAI, two groups of E and A were divided into positive pregnancy of E group (EP+), negative pregnancy of E group (EP-), positive pregnancy of A group (AP+), and negative pregnancy of A group (AP-). The contents of E2, P4, Glu, Se, BDNF and hIS significantly differed among the four groups (P<0.01). The ROC analysis was used to determine the risk of negative pregnancy test (-) after TAI was increased when plasma E2 was less than 46.45 pmol/L in cows before TAI. The changes in E2, P4,hIS, Glu, and BDNF in the blood of natural estrus and natural anestrus cows affected the pregnancy after TAI. the level of E2 in plasma may be used to assess the risk of negative pregnancy after TAI.

On-Site Fluorination for Enhancing Utilization of Lithium in a Lithium-Sulfur Full Battery

The rechargeability of the lithium anode in lithium-sulfur (Li-S) batteries is an issue for this type of battery. In this work, we demonstrate a Li-S full battery comprising a protected anode scaffold and a Li₂S cathode. The stabilized performance is attained by an on-site fluorination strategy, using BiF₃ for the interfacial coating of the anode. Unlike previously reported LiF protective coating derived from the vapor/solution depositions, BiF₃ nanocrystals would be lithiated on-site to the anode surface and server as the protective layer. The chemically inertial Li₃Bi alloy can provide additional ion-conductive paths and stitch the LiF to form a seamless protective layer, thereby suppressing the dendrite propagation and parasitic reactions effectively. With the designed anode structures and compositions, the high-loading full battery (8.05 mg cm^-2) can achieve an exceptional utilization of both sulfur (898 mAh g_S^-1) and lithium (1533 mAh g_Li^-1) over 200 cycles, marking a step toward cyclable Li metal batteries at a high capacity.

CDK8 is associated with RAP2.6 and SnRK2.6 and positively modulates abscisic acid signaling and drought response in Arabidopsis

CDK8 is a key subunit of Mediator complex, a large multiprotein complex that is a fundamental part of the conserved eukaryotic transcriptional machinery. However, the biological functions of CDK8 in plant abiotic stress responses remain largely unexplored. Here, we demonstrated CDK8 as a critical regulator in the abscisic acid (ABA) signaling and drought response pathways in Arabidopsis. Compared to wild-type, cdk8 mutants showed reduced sensitivity to ABA, impaired stomatal apertures and hypersensitivity to drought stress. Transcriptomic and chromatin immunoprecipitation analysis revealed that CDK8 positively regulates the transcription of several ABA-responsive genes, probably through promoting the recruitment of RNA polymerase II to their promoters. We discovered that both CDK8 and SnRK2.6 interact physically with an ERF/AP2 transcription factor RAP2.6, which can directly bind to the promoters of RD29A and COLD-REGULATED 15A (COR15A) with GCC or DRE elements, thereby promoting their expression. Importantly, we also showed that CDK8 is essential for the ABA-induced expression of RAP2.6 and RAP2.6-mediated upregulation of ABA-responsive genes, indicating that CDK8 could link the SnRK2.6-mediated ABA signaling to RNA polymerase II to promote immediate transcriptional response to ABA and drought signals. Overall, our data provide new insights into the roles of CDK8 in modulating ABA signaling and drought responses.

[Identification of a novel mutation of SOX10 gene and analysis of the phenotype]

Objective: To explore the clinical features and pathogenic mechanisms of a special syndrome with congenital sensorineural hearing loss, albinism, heterochromia iridis, nystagmus and myelin dysplasia. Methods: Detailed medical history, systematic audiology tests, ophthalmic and neurological examinations were carried out to analyze the clinical features of the child, and further molecular genetic tests including chromosome karyotype analysis, and deafness gene screening were conducted. Results: A new de novo heterozygous mutation (c.336G>T/p.Met112Ile) was detected in the child, while both his parents were demonstrated to be wild-type and symptom free. The analysis of clinical features indicated the diagnosis of PCW syndrome. Conclusion: This study identified a new mutation of SOX10 gene, which enriched the mutation spectrum of this gene. And the analysis of clinical characteristics of this patient also expanded the phenotype of this gene. This study provided a reference for clinical diagnosis and genetic diagnosis of PCW syndrome.

Outcomes associated with modern treatment paradigms in connective tissue disease (CTD)-associated pulmonary arterial hypertension (PAH): a meta-analysis of randomized controlled trials (RCTs)

Background

CTD-PAH has historically represented a PAH subtype with poor prognosis. New therapies, as well as combination therapy approaches targeting multiple pathways have been approved for PAH based on RCTs. CTD-PAH patients comprise a subgroup of the RCT populations and efficacy analyses are based on subgroup analyses which can be less reliable than the overall analysis. We conducted a meta-analysis of RCTs of approved PAH therapies to evaluate outcomes of patients with CTD-PAH.

Purpose

To use meta-analysis to determine response to treatment in patients with CTD-PAH.

Methods

The PubMed and EMBASE databases were searched for English-only articles published between January 1, 2000 and November 25, 2019. Inclusion criteria were multicenter RCTs that enrolled adults with WHO group 1 pulmonary hypertension (PAH); enrollment in 2000 or later; long-term clinical morbidity and/or mortality event or 6-minute walk distance (6MWD) as an efficacy endpoint reported for ≥30 patients with CTD-PAH; and evaluation of a US Food and Drug Administration-approved PAH therapy. The primary outcomes were treatment effect as measured by the study time to first morbidity or morality event and change in 6MWD from baseline to between 3–6 months, per the data provided in each article. Results from individual studies were combined using a random-effects model for overall study population (PAH patients) and the subgroup of CTD-PAH patients.

Results

Ten RCTs (N=4329 PAH patients; n=1263 (29%) with CTD-PAH) met inclusion criteria and were included in the meta-analysis. At baseline, PAH patients had a mean age of 50 years, approximately 78% were female, and approximately 58% had functional class III or IV disease. These characteristics were balanced between treatment and control groups. Baseline 6MWD was 356 m for the overall population and 337 m for patients with CTD-PAH. Five RCTs (N=3172; n=941 with CTD-PAH [30%]) reported hazard ratios (HRs) for time to a morbidity or mortality event by drug treatment and PAH etiology: overall population HR=0.63 (95% confidence interval [CI], 0.56–0.72; P&lt;0.001); CTD-PAH population HR=0.64 (95% CI, 0.51–0.80; P&lt;0.001) (Figure). Nine RCTs reported mean change with drug treatment from baseline to 3 to 6 months in 6MWD for PAH and CTD patients: 33.9 m (95% CI, 21.9–45.9; P&lt;0.001) in the overall population; 20.2 m (95% CI, 10.8–29.7; P&lt;0.001) in CTD-PAH patients.

Conclusions

The improvement in 6MWD in patients with CTD-PAH is smaller than in those with other types of PAH, perhaps reflecting comorbidities and CTD-induced mobility constraints, independent of their cardiopulmonary capacity. Data from long term clinical morbidity/mortality endpoint studies in this large group of patients with CTD-PAH demonstrate that these patients derive significant benefit from currently available PAH therapies which, in many patients, comprised the addition of a drug targeting a second or third pathway involved in the pathophysiology of PAH.

Treatment effect on morbidity/mortality

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Actelion Pharmaceuticals US, Inc.

Characteristics and clinical course of the first 500 patients (pts) from SPHERE (SelexiPag: tHe usErs dRug rEgistry) receiving selexipag in real-world clinical practice

Background

SPHERE is a US, multicentre, prospective registry collecting real-world data from pts with pulmonary arterial hypertension (PAH) treated with selexipag, a selective oral IP prostacyclin receptor agonist.

Methods

SPHERE (planned N=800) included newly initiated (NI, receiving selexipag ≤60 days) and previously initiated (PI) pts. We describe disease characteristics, selexipag dose and clinical course of the first 500 pts and risk assessment based on REVEAL 2.0 risk calculator and COMPERA risk assessment strategy.

Results

Disease characteristics at initiation were: 75.0% female, median age 61.0 years, idiopathic etiology (49.2%) or associated with connective tissue disease (26.4%). Pts were mostly WHO functional class (FC) II (31.0%) or III (49.6%) (unknown for 9.2%). Median time from PAH diagnosis to selexipag initiation was 3.4 years. Of the first 500 pts enrolled, 138 (28%) were NI and 362 (72%) were PI; characteristics were consistent between NI and PI.

Risk classification at initiation differed depending on method used: with REVEAL 2.0, low/intermediate/high risk were 41.8%/29.6%/28.6% (38.4%/26.1%/35.5% for NI and 43.1%/30.9%/26.0% for PI, respectively) and with COMPERA were 22.0%/67.2%/9.6% (13.8%/73.2%/10.9% for NI and 25.1%/64.9%/9.1% for PI), respectively. Note, missing variables in real-world registry data may affect risk assessment.

In both cohorts, median individualised maintenance dose was 1200 μg twice daily (NI 1000 μg, PI 1200 μg); median time to individualised maintenance dose was 8.1 weeks. Median treatment duration was 21.7 months (17.7 months NI, 25.8 months PI). Overall, 32.4% of pts discontinued selexipag (46.4% NI, 27.1% PI), most commonly (22.8%) for adverse events (AEs) (34.8% NI, 18.2% PI). Of note, disease progression is classified as an AE. No selexipag-related deaths were reported.

At 18 months, WHO FC improved/remained stable in the majority of pts (205/235, 87%; improved, 24%; stable, 63%), but worsened in 12.8% of pts. At 18 months, the majority of pts had improved/stable risk by REVEAL 2.0 (265/334, 79% [improved, 22%; stable, 57%]) and by COMPERA (255/316, 81% [improved, 23%; stable, 58%]). This was consistent for NI and PI.

For both risk assessment tools higher risk was associated with increased risk of death. With REVEAL 2.0, risk of death was 2.9 and 9.3 times higher for intermediate and high risk, respectively vs low risk. Similarly with COMPERA, risk of death was 3.2 and 11.4 times higher in intermediate and high risk, respectively vs low risk.

Conclusions

Of the first 500 pts in SPHERE, the vast majority were prevalent PAH cases in FC II or III. Around one-quarter of pts had improved FC and/or risk; the majority of pts remained stable risk. Higher risk was associated with increased mortality risk. Over 50% of pts completed 18 months of selexipag. Discontinuations were most commonly for AEs and/or PAH progression.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Actelion Pharmaceuticals US, Inc.