[Modification of physical activity on genetic effects of type 2 diabetes mellitus: a twin pairs cohort study in China]

Objective: To explore the modification effect of physical activity on the genetic effects of type 2 diabetes mellitus (T2DM). Methods: The univariate moderation model was fitted to calculate the modifying effect of physical activity on the genetic effects of T2DM based on the data of 12 107 pairs of same gender twins aged 30 years and older enrolled by the Chinese National Twin Registry in 11 provinces/cities in China. Results: After adjusting for age and gender, the heritability of T2DM was 0.56 (0.31-0.84). Qualified physical activity could attenuate the genetic effects of T2DM. The heritability of T2DM in twin pairs with qualified physical activity was 0.46 (0.06-0.88), which was lower than that in twin pairs without qualified physical activity during the same model [0.68(0.36-0.94)]. Conclusion: T2DM is a moderate genetic disease, physical activity can modify the genetic effects of T2DM.

[A descriptive analysis on body mass index distribution in adult twin pairs in China]

Objective: To describe the differences in body mass index (BMI) distribution in adult twins registered in Chinese National Twin Registry (CNTR), and provide evidence for the risk factor analysis and prevention and control of overweight or obesity. Methods: A total of 32 725 twin pairs aged 18 years and above who completed the questionnaire survey during 2010-2018 and had complete registered information in CNTR and normal body weight and length were included in the analysis on the population and region specific distributions of BMI of twin pairs and the difference in BMI in twin pairs. Results: The twin pairs included in the analysis were aged (34.6±12.4) years, the twin pairs of same gender accounted for 79.7%. The average BMI was 22.5 kg/m². The overall prevalence of obesity and overweight was 4.9% and 23.7%, respectively. Participants who were men, 50-59 years old, married, had lower education level, and lived in northern China had higher overweight rate and obesity rate (P<0.001). The difference in overweight or obesity prevalence between monozygotic (MZ) twin pars and dizygotic (DZ) twin pairs was not significant, but firstborn twin pairs had slightly higher rates of overweight and obesity than later-born twin pairs (P<0.05). The analysis in same gender-twin pairs indicated that the difference in BMI was associated with age (trend test: P<0.001), and the difference was more obvious in DZ twin pair in MZ pair and this difference increased with age. The concordant rate of BMI was higher in MZ twin pairs than DZ twin pairs (P<0.05). Conclusion: The distribution of BMI of twin pairs varied with population and region and BMI varied with age due to its genetic nature.

Standardization in Quantitative Imaging: A Multicenter Comparison of Radiomic Features from Different Software Packages on Digital Reference Objects and Patient Data Sets

Radiomic features are being increasingly studied for clinical applications. We aimed to assess the agreement among radiomic features when computed by several groups by using different software packages under very tightly controlled conditions, which included standardized feature definitions and common image data sets. Ten sites (9 from the NCI's Quantitative Imaging Network] positron emission tomography–computed tomography working group plus one site from outside that group) participated in this project. Nine common quantitative imaging features were selected for comparison including features that describe morphology, intensity, shape, and texture. The common image data sets were: three 3D digital reference objects (DROs) and 10 patient image scans from the Lung Image Database Consortium data set using a specific lesion in each scan. Each object (DRO or lesion) was accompanied by an already-defined volume of interest, from which the features were calculated. Feature values for each object (DRO or lesion) were reported. The coefficient of variation (CV), expressed as a percentage, was calculated across software packages for each feature on each object. Thirteen sets of results were obtained for the DROs and patient data sets. Five of the 9 features showed excellent agreement with CV < 1%; 1 feature had moderate agreement (CV < 10%), and 3 features had larger variations (CV ≥ 10%) even after attempts at harmonization of feature calculations. This work highlights the value of feature definition standardization as well as the need to further clarify definitions for some features.

OP0005 DIETARY HYPERINSULINEMIC POTENTIAL AND RISK OF INCIDENT GOUT: 3 PROSPECTIVE COHORT STUDIES OF US MEN AND WOMEN

Background:

Gout and the metabolic (insulin resistance) syndrome frequently coexist. Intravenous insulin has been shown to raise serum urate (SU) levels in physiologic studies and a Mendelian Randomization study also showed a causal role of insulin on the risk of gout. However, it is unknown whether habitual hyperinsulinemic dietary intake confers gout risk.

Objectives:

Prospectively examine the relation between two distinct insulin-related dietary indices and risk of incident gout in three large cohorts of US women and men over 30 years.

Methods:

We studied 164,090 women from Nurses Health Study I (1986-2016) and II (1989-2017) and 40,598 men from Health Professionals Follow-up Study (1986-2016), who were free of gout at baseline. Dietary intake and covariates were assessed by validated questionnaires every 4 years. Insulinemic potential of diet was evaluated using 1) food-based empirical dietary index for hyperinsulinemia (EDIH) score that was pre-defined based on circulating C-peptide levels1 and reflects insulin resistance;2 and 2) dietary insulin index (DII), which reflects transient, postprandial insulin secretion.2 We assigned EDIH and DII scores for each participant, adjusted for total energy intake, and prospectively examined the association between scores and incident gout (using ACR survey criteria for gout3), adjusting for potential confounders.

Results:

We ascertained 2,874 incident gout cases over 5,124,490 person-years of follow-up. In pooled multivariable-adjusted analyses, those in the highest EDIH quintile had 1.76-times (95% CI: 1.56 to 1.99) higher gout risk, compared with the lowest (Table 1). This attenuated with further adjustment for BMI (a likely causal intermediate) but remained positive (RR 1.30, 1.15 to 1.48). DII scores were inversely associated with gout risk (RR 0.66, 0.58 to 0.74) (Table 1).

Table 1.

Risk Ratio (95% CI) of Gout According to Quintiles of Insulin-Related Dietary Index

EDIH (measure of insulin resistance)Q1:lowest circulating insulin levelsQ2Q3Q4Q5:highest circulating insulin levelsP for trendN cases430482598631733Person-years1,025,1291,025,2851,025,5741,025,3011,023,651Age-adjusted RR1.00 (Ref)1.13 (1.00-1.29)1.43 (1.26-1.61)1.53 (1.36-1.73)1.85 (1.64-2.09)<.0001MV-Adjusted*RR1.00 (Ref)1.11 (0.98-1.27)1.39 (1.22-1.57)1.47 (1.30-1.67)1.76 (1.56-1.99)<.0001MV-Adjusted**RR (+ BMI)1.00 (Ref)1.03 (0.90-1.17)1.21 (1.06-1.37)1.21 (1.07-1.37)1.30 (1.15-1.48)<.0001Dietary Insulin Index (measure of transient, post-prandial secretion and sensitivity)Q1:lowest insulin sensitivityQ2Q3Q4Q5:greatest insulin sensitivityP for trendN cases783611527498455Person-years1,024,7631,025,7301,025,0751,025,5381,023,834Age-adjusted RR1.00 (Ref)0.79 (0.71-0.88)0.69 (0.62-0.77)0.65 (0.58-0.73)0.59 (0.53-0.66)<.0001MV-Adjusted*RR1.00 (Ref)0.79 (0.71-0.88)0.69 (0.62-0.77)0.66 (0.59-0.74)0.60 (0.53-0.67)<.0001MV-Adjusted**RR (+ BMI)1.00 (Ref)0.78 (0.70-0.87)0.69 (0.62-0.77)0.67 (0.60-0.75)0.66 (0.58-0.74)<.0001

*Multivariable (MV) models adjusted for age (month), White race, smoking, menopause (women only), hormone use (women only), physical activity, history of hypertension, and diuretic use **MV + BMI models further adjusted for BMI (a likely causal intermediate)

Conclusion:

EDIH scores, reflecting chronic hyperinsulinemia (i.e., greater insulin resistance with reduced clearance), were positively associated with the risk of incident gout, even beyond the pathway through adiposity. Conversely, higher DII scores, which reflect short-term, postprandial elevations in insulin levels (and also greater insulin clearance and sensitivity) conferred a lower risk. This corroborates human physiologic experiments and Mendelian Randomization studies showing insulin resistance can increase SU levels by decreasing renal excretion of urate, and supports lowering insulinemic potential of diet as a strategy to reduce gout risk.

References:

[1]Tabung et al. PMID 27821188

[2]Lee et al. PMID 32618519

[3]Wallace et al. PMID 856219

Disclosure of Interests:

Natalie McCormick: None declared, Chio Yokose: None declared, Leo Lu: None declared, Amit Joshi: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, Vaxart, Grant/research support from: Ironwood, Horizon

OP0202 DOES EXCESS WEIGHT AFFECT GOUT RISK DIFFERENTLY AMONG GENETICALLY PREDISPOSED INDIVIDUALS? – SEX-SPECIFIC PROSPECTIVE COHORT FINDINGS OVER >26 YEARS

Background:

Global burden of gout has increased substantially, particularly among women.1,2 Addressing obesity, a major modifiable risk factor for gout, may alleviate this burden; however, there is also a significant genetic contribution to gout risk according to the genome-wide association studies (GWAS).3,4 Genetic predisposition may modify the excess weight effect on gout risk.

Objectives:

To investigate the potential role of genetic predisposition on the association between excess weight (i.e., BMI ≥ 25 kg/m2) and gout risk in two US prospective longitudinal cohorts over >26 years, stratified by sex.

Methods:

We examined the association between excess weight and risk of incident gout meeting the ACR survey criteria,5 according to genetic risk, in 18,512 women from the Nurses’ Health Study (NHS) over 32 years, and 10,917 men from Health Professionals Follow-Up Study (HPFS) over 26 years. We derived a genetic risk score (GRS) using 114 serum urate single nucleotide polymorphisms from the latest GWAS.3 We also calculated the population attributable risk (PAR) for excess weight according to GRS stratum.

Results:

We ascertained 530 incident gout cases in NHS and 983 in HPFS. While the relative risks (RRs) due to excess weight (overweight or obesity) appeared larger among women above the mean than below the mean, the RRs among men appeared similar according to genetic predisposition (Table 1). The RRs among women for excess weight compared to normal were 1.66 (95% CI, 1.17 to 2.37) and 2.55 (1.95 to 3.34) below and above the mean GRS, respectively (P for multiplicative interaction = 0.06), whereas corresponding RRs among men were 1.68 (95% CI, 1.31 to 2.16) and 1.76 (1.47 to 2.10) (P for multiplicative interaction = 0.8). The risk differences (RD) among women for excess weight were 0.69 and 2.38 with GRS below and above the mean, respectively, resulting in the relative excess risk due to interaction (RERI) of 1.69 (95% CI, 1.03 to 2.35, P for additive interaction = 5.4x10-7); for men, the corresponding RDs were 0.70 and 1.46, with RERI = 0.76 (0.26, 1.25; P for additive interaction = 2.6x10-3). Excess weight accounted for a larger proportion of incident gout cases among women with GRS above the mean (PAR, 48.5% [95% CI, 38.8 to 55.9]) compared to those with GRS below the mean (PAR, 29.0% [95% CI, 10.5 to 42.1]), whereas the PARs among men were similar (31.6% vs 29.7%, respectively).

Table 1.

Relative Risk of Gout by Body Mass Index, Stratified by Mean Genetic Score

HPFS (men)Below MeanAbove MeanBMIOverall<2525-30>30Overall<2525-30>30No. Cases3338817273650172349129Person-Years10405543314492531148898634419944609610544Age-Adjusted RR-1.0 (ref)1.71 (1.32, 2.22)3.00 (2.18, 4.12)-1.0 (ref)1.80 (1.50, 2.16)2.87 (2.27, 3.62)MV Adjusted* RR-1.0 (ref)1.53 (1.18, 1.99)2.31 (1.66, 2.21)-1.0 (ref)1.63 (1.35, 1.96)2.38 (1.87, 3.03)NHS (women)Below MeanAbove MeanBMIOverall<2525-30>30Overall<2525-30>30No. Cases17347408635772120165Person-Years24439212384976414441292392591202297612342907Age-Adjusted RR-1.0 (ref)1.23 (0.81, 1.88)4.46 (3.10, 6.41)-1.0 (ref)2.41 (1.79, 3.23)5.68 (4.82, 7.52)MV Adjusted* RR-1.0 (ref)1.00 (0.65, 1.53)2.84 (1.92, 4.20)-1.0 (ref)1.97 (1.46, 2.65)3.61 (2.68, 4.87)

*Adjusted for age (continuous), menopause, use of hormone therapy (never, past or current), history of hypertension, and systolic and diastolic blood pressure, alcohol, total energy intake and intake of meat, seafood and dairy foods (all continuous).

Conclusion:

These large scale longitudinal prospective cohorts suggest maintaining healthy weight is an important gout prevention strategy, regardless of underlying genetic risk. In genetically predisposed individuals, addressing excess weight may prevent a large proportion of gout cases, especially among women.

References:

[1]Safiri et al., PMID 32755051

[2]Xia et al., PMID 31624843

[3]Tin et al., PMID 31578528

[4]Tai et al., PMID: 32017447

[5]Wallace et al., PMID: 856219

Acknowledgements:

The authors thank the participants of the NHS and HPFS.

CY is supported by the Rheumatology Research Foundation Scientist Development Award and NIH T32 AR007258. HC is supported by NIH P50AR060772 and R01AR065944.

Disclosure of Interests:

None declared

OP0235 PRO-INFLAMMATORY DIET AND RISK OF INCIDENT GOUT: 3 PROSPECTIVE COHORT STUDIES OF US MEN AND WOMEN

Background:

Emerging evidence suggests inflammation may drive progression from hyperuricemia to clinical gout, but the role of extrinsic, modifiable sources of chronic inflammation, such as diet, on gout risk is unknown. Notably, greater dietary inflammatory potential has been independently associated with increased risk of incident cardiovascular disease (CVD)1 and type 2 diabetes (T2D).2

Objectives:

Prospectively examine the relation between dietary inflammatory potential and risk of gout in three large cohorts of US women and men over 30 years.

Methods:

Ascertaining the ACR survey criteria for gout for several decades,3 we studied gout risk among 164,090 women from Nurses Health Study I (1986-2016) and II (1989-2017) and 40,598 men from Health Professionals Follow-up Study (1986-2016), free of gout at baseline. Dietary intake and covariates were assessed by validated questionnaires every 4 years. Inflammatory potential of diet was evaluated using a food-based empirical dietary index of inflammatory potential score (EDIP) pre-defined based on circulating levels of IL-6, C-reactive protein, adiponectin, and TNFαR2.4

We assigned an EDIP score for each participant, adjusted for total energy take, and prospectively examined the association between quintiles of EDIP score and incident gout, adjusting for potential confounders. We also stratified by alcohol intake, as alcohol has anti-inflammatory properties,4 but is associated with a higher gout risk, particularly beer.5

Results:

We documented 2,874 incident gout cases over 5,124,940 person-years of follow-up. In pooled multivariable-adjusted analyses, those in the highest EDIP quintile had 59% higher gout risk (multivariable RR 1.59; 95% CI 1.41–1.79), compared with the lowest (Table 1). This remained positive with further adjustment for BMI, a likely causal intermediate (RR 1.27, 1.12 to 1.42), and was stronger among non-drinkers (RR 2.37, 1.58 to 2.56) than drinkers (RR 1.57, 1.38 to 1.78) (Table 1).

Table 1.

Risk Ratio (95% CI) of Gout According to Quintiles of Inflammatory Diet Score, Overall and by Alcohol Use

Q1:lowestQ2Q3Q4Q5:highestP for trendOverallN cases473493530623755Person-years1,024,5711,025,6181,025,2841,024,7791,024,688Age-adjusted RR1.00 (Ref)1.05 (0.92, 1.19)1.13 (0.99, 1.27)1.33 (1.18, 1.50)1.64 (1.46, 1.84)<0.001MV-Adjusted* RR1.00 (Ref)1.04 (0.92, 1.18)1.12 (0.98, 1.26)1.31 (1.16, 1.48)1.59 (1.41, 1.79)<0.001MV-Adjusted** RR (+ BMI)1.00 (Ref)1.00 (0.88, 1.13)1.03 (0.91, 1.17)1.16 (1.02, 1.31)1.27 (1.12, 1.42)<0.001No Alcohol UseN cases265884143251Person-years118,301189,938249,389313,511396,080MV-Adjusted* RR1.00 (Ref)1.31 (0.82, 2.08)1.37 (0.88, 2.13)1.80 (1.18, 2.74)2.37 (1.58, 2.56)<0.001MV-Adjusted**RR (+ BMI)1.00 (Ref)1.28 (0.80, 2.03)1.32 (0.85, 2.05)1.61 (1.06, 2.45)1.85 (1.23, 2.79)<0.001Alcohol UseN cases447435446480504Person-years906,271835,680775,895711,267628,609MV-Adjusted* RR1.00 (Ref)1.04 (0.91, 1.19)1.13 (0.99, 1.29)1.31 (1.15, 1.50)1.57 (1.38, 1.78)<0.001MV-Adjusted** RR (+ BMI)1.00 (Ref)1.00 (0.88, 1.14)1.05 (0.92, 1.20)1.17 (1.03, 1.33)1.28 (1.12, 1.46)<0.001

*Multivariable (MV) models adjusted for age (month), White race, smoking, menopause (women only), hormone use (women only), physical activity, history of hypertension, and diuretic use. **MV + BMI models additionally adjusted for BMI (a likely causal intermediate)

Conclusion:

Habitual pro-inflammatory dietary pattern was independently associated with higher risk of incident gout in these prospective cohorts, even beyond the pathway through adiposity. Our findings support a role for chronic inflammation in development of gout, similar to CVD1 and T2D.2 Adhering to a diet with lower inflammatory potential may modulate systemic inflammation, potentially reducing gout risk and these life-threatening comorbidities.

References:

[1]Li et al. J Amer Coll Cardiology (2020) PMID 33153576

[2]Lee et al. Diabetes Care (2020) PMID 32873589

[3]Wallace et al. PMID 856219

[4]Tabung et al. PMID 27358416

[5]Choi et al. PMID 15094272

Disclosure of Interests:

Natalie McCormick: None declared, Chio Yokose: None declared, Leo Lu: None declared, Amit Joshi: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, Vaxart, Grant/research support from: Ironwood, Horizon

OP0042 BLOCKING OF CD103+ TISSUE RESIDENT MEMORY T CELLS (TRM) AS A THERAPEUTIC STRATEGY IN SJOGREN’S SYNDROME

Background:

Tissue-resident memory T cells (TRM), are a recently identified T cells population featuring tissue localization and expression of markers of tissue homing, CD69 and CD103. Recently, the expansion of CD8+ TRMs and their involvement in the sialadenitis was described in a murine model of SS. However, CD4+ and CD8+ TRM’s functional relevance in pSS is still not fully understood, and the TRM therapeutic targeting unexplored.

Objectives:

The study aimed to address the role of CD4+ and CD8+ TRMs in the pathogenesis of pSS and to explore the therapeutic targeting of the tissue residency marker of TRM CD103.

Methods:

An animal model of experimental (ESS) obtained by immunization of female C57BL/6 mice (n=10) with salivary glands (SG) protein extract and Freund’s complete adjuvant used to investigate the dynamic of infiltration of SG by CD4+ and CD8+ TRMs, their frequency, and the impact of CD103 blockade. For the therapeutic intervention, at 10-weeks post-immunization, the salivary gland was cannulated via Wharton’s duct, and an anti-CD103 neutralizing antibody or vehicle-injected. The mice’s saliva flow rate was assessed, and SGs were analyzed by Flow-cytometry and immunohistochemistry (IHC).

The frequency and localization of TRMs was analyzed in minor SG of sicca syndrome (nSS) and pSS patients (n=39) by flow cytometry and IHC. The expression of genes involved in the tissue retention of TRMs was assessed in SG by RT-PCR.

Results:

Upon the ESS progression, a significant progressive increase in CD45+CD103+ cells frequency was observed from 5wk to 20wk post-immunization (p<0.001), where the CD8+ were the most abundant, followed by CD4+. Consistently, CD103+CD8+ T cells were detected within the lymphocytic infiltration of SG from ESS mice. Sorted purified SG CD10+CD3+CD8+ T cells showed higher Granzyme B, TNF-alpha expression compared to CD103-CD3+CD8+ at both mRNA and protein levels. Notably, ESS mice treated with anti-CD103 showed improvement in salivary function (p<0.05) and reduced lymphocytic infiltrations measured as focus score (FS) (p<0.01) and area-fraction (p<0.01). Consistently, anti-CD103 treatment consistently reduced CD103+ cells and IFN-gamma+, Granzyme B+, and TNFa+ CD8+ cells. We next performed phenotypic analysis of CD45+CD103+ immune cells in the SG of pSS patients observing an increase in both with CD8+CD103+CD69+ and CD4+CD103+CD69+ (p<0.05). Finally, IHC showed that the expansion of TRMs in pSS salivary glands was accompanied by a down-regulation of E-cadherin glandular expression and their migration outside the epithelium in the context of inflammatory infiltrates. SG of patients with pSS showed a significant up-regulation of BLIMP1, KFL-2, and S1PR1 and down-regulation of ITGB2. CXCL9 and CXCL10, and IL-15 involved in the tissue recruitment and long-term survival of TRMs were significantly modulated in pSS salivary glands.

Conclusion:

TRM are expanded and activated in the SG of pSS and ESS, participating in the organization of tissue inflammation. Although the mechanisms behind this expansion are still not fully understood, CD103 could be a valuable novel therapeutic target to prevent lymphocytic infiltrations and glandular destruction in Sjogren syndrome.

Disclosure of Interests:

None declared

Tongxin formula protects H9c2 cardiomyocytes from cobalt chloride-induced hypoxic injury via inhibition of apoptosis

In this study, the effect of the Tongxin formula (TXF) on the apoptosis of H9c2 cardiomyocytes induced by cobalt chloride (CoCl₂) was investigated, and the potential mechanism was explored. A hypoxic injury model of H9c2 cardiomyocytes was established using CoCl₂. The cell viability was measured using a Cell Counting Kit-8 assay. The lactate dehydrogenase (LDH) release and caspase-3 activity were measured using spectrophotometry. The apoptosis was measured via Annexin V-FITC/PI staining and flow cytometry. The changes in the mitochondrial membrane potential were examined using immunofluorescence microscopy following the loading of JC-1 probes. The expressions of apoptosis-related proteins and key proteins in the phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) pathway were examined via immunoblotting. The different TXF concentrations studied significantly improved the percentage of viability of cardiomyocytes with hypoxic injury, and the LDH release, apoptotic rate, caspase-3 activity, and levels of cleaved caspase-3 protein were reduced in the injured cells. Additionally, the TXF group had increased mitochondrial membrane potential, upregulated expression of Bcl-2 and p-Akt proteins, and significantly reduced expression of cleaved caspase-3 protein in the cells with hypoxic injury. Moreover, in the TXF group, the treatment significantly reduced the BAX protein expression, but the difference was not statistically significant compared with the CoCl2 group. In this study, TXF regulated the expression of apoptosis-related proteins, inhibited apoptosis, increased the mitochondrial membrane potential, and alleviated damage to the mitochondrial membrane, thereby protecting the cardiomyocytes from hypoxic injury. The underlying mechanism could be related to activation of the PI3K/Akt signaling pathway and upregulation of the Bcl-2 protein.

OP0203 GENE-DIET INTERACTION ON THE RISK OF INCIDENT GOUT AMONG WOMEN – PROSPECTIVE COHORT STUDY OVER 32 YEARS

Background:

Although gout is conventionally known as a male condition, the recent Global Burden of Disease (GBD) Study found disproportionate worsening among women.1 We have found Dietary Approaches to Stop Hypertension (DASH) diet is independently associated with a lower risk of incident gout, while Western diet is associated with increased risk.2 Whether these risks vary according to genetic risk remains unknown.

Objectives:

To investigate the influence of genetic predisposition on the relation between diets (one protective and another hazardous) and gout risk in a large prospective US cohort of women over 32 years.

Methods:

We examined the role of genes on the association between two dietary patterns (DASH and Western) on the risk of incident gout in 18,512 women from the Nurses’ Health Study. Using validated food frequency questionnaires, for each participant we derived: 1) DASH score emphasizing fruits, vegetables, nuts, legumes, whole grains, low-fat dairy, and reduced intake of saturated fat and sugar-sweetened beverages (SSBs) and 2) Western diet score characterized by high intake of red and processed meats, SSBs, desserts, French fries, and refined grains. A genetic risk score (GRS) was derived using 114 serum urate single nucleotide polymorphisms from the latest GWAS consortium.3

Results:

There were 523 incident gout cases meeting ACR survey criteria4 (170 vs. 353 in GRS below and above the mean, respectively) (Table 1). Among women with GRS below and above the mean, the multivariable relative risks (RRs) of gout were 1.0, 1.56. 1.32, 0.89, and 0.61 (0.34 to 1.09) and 1.0, 1.0, 0.85, 0.51, and 0.68 (0.49 to 0.96), for quintiles (Q) 1 through 5 of DASH score, respectively (p for interaction = 0.69) (Table 1). For the Western diet, RRs for Q1 through 5 were 1, 1.34, 1.07, 1.33, and 1.63 (0.91 to 2.93) for those with GRS below the mean and 1.0, 1.17, 0.93, 1.27, and 1.77 (1.19 to 2.61) among those with GRS above the mean, respectively (p for multiplicative interaction = 0.64).

Table 1.

Relative Risk of Gout by Quintiles of DASH and Western Diet Score, Stratified by Mean GRS

DASHBelow MeanAbove MeanQ1Q2Q3Q4Q5Q1Q2Q3Q4Q5P InteractionNo. Cases27495121227589903465Person-Years39208472475722734953587643981545853554013473356521Age-Adjusted RR1.0 (ref)1.43 (0.89, 2.29)1.22 (0.76, 1.96)0.8 (0.45, 1.42)0.5 (0.28, 0.88)1.0 (ref)0.97 (0.72, 1.33)0.79 (0.58, 1.07)0.47 (0.31, 0.70)0.54 (0.39, 0.76)0.73MV-Adjusted* RR1.0 (ref)1.56 (0.97, 2.51)1.32 (0.82, 2.12)0.89 (0.50, 1.59)0.61 (0.34, 1.09)1.0 (ref)1.0 (0.73, 1.37)0.85 (0.63, 1.17)0.51 (0.33, 0.76)0.68 (0.49, 0.96)0.69WesternBelow MeanAbove MeanQ1Q2Q3Q4Q5Q1Q2Q3Q4Q5P InteractionNo. Cases21362839465270567699Person-Years47397493484783747589452834552947913473574644785Age-Adjusted RR1.0 (ref)1.49 (0.86, 2.56)1.26 (0.71, 2.23)1.71 (1.00, 2.93)2.22 (1.31, 3.74)1.0 (ref)1.21 (0.85, 1.74)0.98 (0.67, 1.43)1.35 (0.94, 1.93)1.88 (1.34, 2.65)0.72MV-Adjusted* RR1.0 (ref)1.34 (0.78, 2.32)1.07 (0.60, 1.90)1.33 (0.76, 2.34)1.63 (0.91, 2.93)1.0 (ref)1.17 (0.81, 1.68)0.93 (0.63, 1.38)1.27 (0.87, 1.84)1.77 (1.19, 2.61)0.64

*Adjusted for age (continuous), menopause, use of hormone therapy (never, past or current), history of hypertension, systolic and diastolic blood pressure (continuous), alcohol (continuous), total energy intake (continuous), and intake of meat, seafood, and dairy foods (continuous).

Conclusion:

In this prospective female cohort that ascertained gout with standardized criteria over 32 years, regardless of genetic predisposition, DASH diet was similarly associated with lower risk of incident gout while Western diet was associated with a higher risk. The anticipated absolute impact of diet among genetically predisposed females was larger with greater absolute risk difference. These data agree with the recent GBD Study’s recommendation for intensive dietary and anti-obesity measures for gout prevention, especially in females.1

References:

[1]Xia et al., PMID 31624843

[2]Keller et al., PMID: 28487277

[3]Tin et al., PMID 31578528

[4]Wallace et al., PMID: 856219

Acknowledgements:

The authors thank the participants of the NHS.

CY is supported by the Rheumatology Research Foundation Scientist Development Award and NIH T32 AR007258. HC is supported by NIH P50AR060772 and R01AR065944.

Disclosure of Interests:

None declared

Alcoholism and Osteoimmunology

BACKGROUND

Chronic consumption of alcohol has an adverse effect on the skeletal system, which may lead to osteoporosis, delayed fracture healing and osteonecrosis of the femoral head. Currently, the treatment is limited, therefore, there is an urgent need to determine the underline mechanism and develop a new treatment. It is well-known that normal bone remodeling relies on the balance between osteoclast-mediated bone resorption and - mediated bone formation. Various factors can destroy the balance, including the dysfunction of the immune system. In this review, we summarized the relevant research in the alcoholic osteopenia with a focus on the abnormal osteoimmunology signals. We provided a new theoretical basis for the prevention and treatment of the alcoholic bone.

METHODS

We searched PubMed for publications from 1 January 1980 to 1 February 2020 to identify relevant and recent literature, summarizing evaluation and the prospect of alcoholic osteopenia. Detailed search terms were 'alcohol', 'alcoholic osteoporosis', 'alcoholic osteopenia' 'immune', 'osteoimmunology', 'bone remodeling', 'osteoporosis treatment' and 'osteoporosis therapy'.

RESULTS

A total of 135 papers are included in the review. About 60 papers described the mechanisms of alcohol involved in bone remodeling. Some papers were focused on the pathogenesis of alcohol on bone through osteoimmune mechanisms.

CONCLUSION

There is a complex network of signals between alcohol and bone remodeling and intercellular communication of osteoimmune may be a potential mechanism for alcoholic bone. Studying the osteoimmune mechanism is critical for drug development specific to the alcoholic bone disorder.

Effect of hsa_circ_RNA0023397 regulation of miR-106b expression on proliferation and apoptosis of esophageal cancer cells

OBJECTIVE

To explore the potential function of a candidate circular ribonucleic acid (circRNA) [human serum albumin (hsa)_circ_RNA0023397] in esophageal cancer cells.

MATERIALS AND METHODS

Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was used to detect the expression level of hsa_circ_RNA0023397 in three esophageal cancer cell lines (KYSE-150, ECA109, and TE-1), which was compared with that in normal human esophageal epithelial cell line (HET-1A). The expression plasmid of hsa_circ_RNA0023397 was constructed, and the effect of overexpression of hsa_circ_RNA0023397 on cell proliferation was determined by cell counting kit-8 (CCK-8) and colony formation assay. The effect of overexpression of hsa_circ_RNA0023397 on cell apoptosis was detected by flow cytometry. Further bioinformatics analysis and Luciferase reporter gene analysis were carried out to explore the role of hsa_circ_RNA0023397 as a sponge of micro RNAs (miRNAs).

RESULTS

Compared with that in normal human esophageal epithelial cell line HET-1A, the expression of hsa_circ_RNA0023397 was down-regulated in three esophageal cancer cell lines in vitro. Overexpression of hsa_circ_RNA0023397 overtly inhibited KYSE-150 cell proliferation and promoted its apoptosis. Bioinformatics prediction and Luciferase reporter gene assay confirmed that hsa_circ_RNA0023397 could bind to miR-160b. MiR-106b participated in hsa_circ_RNA0023397-mediated inhibition of proliferation of esophageal cancer KYSE-150 cells.

CONCLUSIONS

Hsa_circ_RNA0023397 is down-regulated in esophageal cancer cells and can act as miR-106b to affect the biological function of esophageal cancer cells.

Initiation and progression of dental-stimulated temporomandibular joints osteoarthritis

Temporomandibular joint (TMJ), a site that is often impacted by osteoarthritis (OA), is biomechanically linked with dental occlusion. Tissue responses in TMJ condyle to biomechanical stimulation could be investigated by intervention of the dental occlusion in animals. Unilateral anterior crossbite, an experimental malocclusion, has been demonstrated to induce TMJ-OA lesions, showing primarily as enhanced cartilage calcification and subchondral cortical bone formation at the osteochondral interface, causing the osteochondral interface thickening and stiffening. The changed interface would worsen the local biomechanical environment. At the cartilage side, the matrix degenerates. In the case of insufficient restoration of the matrix, the cells in the deep zone flow into the ones undergoing autophagy, apoptosis, and terminal differentiation while the cells in the superficial zone are promoted to differentiate to supply the loss of the deep zone cells. At the meantime, the bone marrow stromal cells are stimulated to bone formation in the subchondral cortical region which is uncoupled with the sites of the osteoclast-mediated resorption process that is predominantly observed at the subchondral trabecular bone region. Overall, the thickening and stiffening osteochondral interface, due greatly to the enhanced endochondral ossification in deep zone cartilage, should be a central pathological process that links with cartilage decay and subchondral bone remodelling in OA joints. The residual chondrocytes locating in the cartilage superficial zone have the progenitor-like qualities that can proliferate, and also differentiate into the deep zone chondrocytes, thus should be critical in progression and rehabilitation of TMJ-OA.

Gemcitabine combined with cisplatin vs. taxane, cisplatin, and fluorouracil in the treatment of locally advanced nasopharyngeal carcinoma: a retrospective case-control study

OBJECTIVE

Reports of the efficacy of induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) on locoregionally advanced nasopharyngeal carcinoma (NPC) are scarce. This study aimed to compare the clinical outcomes of the GP (gemcitabine plus cisplatin) regimen and the TPF (taxane, cisplatin and 5-FU) regimen combined with CCRT in patients with NPC.

PATIENTS AND METHODS

This study retrospectively analyzed 827 patients with advanced NPC who received IC combined with CCRT in People's Hospital of Rizhao, China from January 2006 to June 2012. The propensity score method was used to reduce the effects of the observed confounding between the GP and TPF groups. Study end points were disease-free survival (DFS) and overall survival (OS). In total, 694 patients received GP or TPF as the IC treatment program. Propensity score matching identified 166 patients in each cohort.

RESULTS

The 5-year OS and DFS rates of the entire cohort were 83.5% and 80.9%, respectively. GP was associated with a significantly improved 5 year OS (87.4% vs. 79.2%, p< 0.001), and DFS (86.2% vs. 78.5%, p< 0.001) rates compared with the TPF group. In the PSM (propensity score-matching) cohort, the GP group showed a significantly better OS (HR, 1.842, 95% CI:1.627-2.588; p= 0.011), and DFS (HR, 1.904, 95% CI: 1.742-2.737; p= 0.004) compared with the TPF group in multivariable analyses. The prevalence of acute adverse events of neutropenia and leukopenia were higher in severe (grade 3-4) adverse blood events in the TPF group (p<0.05). Thrombocytopenia had more adverse reactions in the GP group (p<0.05). The main non-hemotoxicities were nausea and vomiting, while the TPF group was slightly higher (p=0.031).

CONCLUSIONS

The clinical efficacy of the GP regimen combined with CCRT for the treatment of locoregionally advanced NPC may be better than that of the TPF regimen.

[Research progress of cellular senescence in the pathogenesis of osteoarthritis]

Objective

To review the pathological effects of cellular senescence in the occurrence and development of osteoarthritis (OA) and potential therapeutic targets.

Methods

The role of chondrocyte senescence, synovial cell senescence, mesenchymal stem cells senescence in OA, and the biological mechanism and progress of chondrocyte senescence were summarized by consulting relevant domestic and abroad literature.

Results

The existing evidence has basically made clear that chondrocyte senescence, mesenchymal stem cells senescence, and cartilage repair abnormalities, and the occurrence and development of OA have a certain causal relationship, and the role of the senescence of synovial cells, especially synovial macrophages in OA is still unclear. Transcription factors and epigenetics are the main mechanisms that regulate the upstream pathways of cellular senescence. Signal communication between cells can promote the appearance of senescent phenotypes in healthy cells. Targeted elimination of senescent cells and promotion of mesenchymal stem cells rejuvenation can effectively delay the progress of OA.

Conclusion

Cellular senescence is an important biological phenomenon and potential therapeutic target in the occurrence and development of OA. In-depth study of its biological mechanism is helpful to the early prevention and treatment of OA.

Beneficial effects of endophytic Pantoea ananatis with ability to promote rice growth under saline stress

AIMS

Soil salinization severely inhibits plant growth, leading to a low crop yield. The aim of the current study was to isolate endophytic bacteria with the ability to promote rice growth under saline conditions.

METHODS AND RESULTS

We isolated eight salt-tolerant endophytic bacteria from rice roots. An isolated strain D1 was selected due to its ability to stimulate rice seed germination in the presence of NaCl, which was identified as Pantoea ananatis D1. It exhibited multiple plant growth-promoting traits including phosphate solubilization, production of indole-3-acetic acid, 1-aminocyclopropane-1-carboxylic acid (ACC) deaminase and siderophore. Inoculation of P. ananatis D1 obviously enhanced the rice root and shoot growth under normal and saline conditions. It also significantly increased the contents of chlorophyll, total soluble protein, and proline in salt-stressed rice seedlings. Moreover P. ananatis D1 could ameliorate the oxidative stress in rice induced by NaCl and Na₂ CO₃ treatment. The malondialdehyde content and various antioxidant enzyme activities were decreased by P. ananatis D1 inoculation in salt-affected rice. In addition, P. ananatis D1 showed a positive potential for limiting the Na⁺ accumulation and enhancing the K⁺ uptake, leading to an increase of 1·2-1·7 fold in K⁺ /Na⁺ ratio under saline environment.

CONCLUSIONS

Pantoea ananatis D1 has the ability to improve the salt tolerance of rice seedlings.

SIGNIFICANCE AND IMPACT OF THE STUDY

The application of plant growth-promoting bacteria (PGPB) is an eco-friendly strategy to improve plant tolerance towards abiotic stresses. We demonstrated that P. ananatis D1 could be used as an effective halotolerant PGPB to enhance rice growth in different salt-affected soils.

[Research study on nucleic acid testing of hemostatic stickers used and the surface of the recipients' hands after the inoculation of inactivated SARS-CoV-2 vaccine]

Among the staff of Beijing Chao-Yang Hospital, Capital Medical University, who received the inactivated SARS-CoV-2 vaccine on January 30 in 2021, 28 recipients were selected for this research. Samples for nucleic acid tests were collected from the surface of the recipients' both hands before and after vaccination. The hemostatic stickers used after the inoculation were also collected for nucleic acid tests. The nucleic acid tests of the samples collected from the surface of both hands of the 28 recipients before vaccination were all negative. After vaccination, the nucleic acid tests of the samples collected from the surface of both hands of recipients were positive in 3 cases, and suspicious in 8 cases, with a positive rate of 10.7%. A total of 25 hemostatic stickers used were collected, 24 of them had positive nucleic acid tests, and the rest one had suspicious nucleic acid test result, with a positive rate of 96%. The hemostatic stickers used after the inoculation have the risk of nucleic acid contamination.

Targeting EZH2 by microRNA-449a inhibits osteosarcoma cell proliferation, invasion and migration via regulation of PI3K/AKT signaling pathway and epithelial-mesenchymal transition

OBJECTIVE

Osteosarcoma (OS) is one common bone malignant tumor prevailing in young adults and children. It is increasingly recognized microRNA 449a (miR 449a) as an anti-tumor factor in various tumours. However, little is known about the biological significance of miR 449a in OS. The intent of our study was to seek the prognostic values of miR-449a in OS.

PATIENTS AND METHODS

Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to examine the level of miR-449a expression in 48 pairs of OS tissues and para-cancerous specimens, and the relationship between miR-449a level and clinical features of OS patient prognosis was analyzed. Moreover, we measured the miR-449a expression levels in OS cells. Transwell assay was further performed to investigate whether miR-449a influenced MG63 cell migration and invasion, which was important for malignant metastases.

RESULTS

Quantitative real-time polymerase chain reaction (qRT-PCR) analysis demonstrated a notable decrease of miR-449a expressions in OS. The declined miR-449a expression was relevant with the poor prognosis and malignant clinicopathologic characteristics of OS patients. Thereafter, the functional assay was performed to determine the role of miR-449a in OS progression. Results of MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assays and transwell assays indicated that miR-449a overexpression significantly repressed OS cell proliferation, invasion, and migration. Furthermore, luciferase reporter assay showed that enhancer of zeste homolog 2 (EZH2) was a downstream target of miR-449a in OS cells. Additionally, Western blot analysis demonstrated that miR-449a exerted anti-OS functions via the regulation of phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway and epithelial-mesenchymal transition. We also indicated that miR-449a restoration could inhibit in vivo tumor growth.

CONCLUSIONS

These results manifested that miR-449a may thus be used as a therapeutic target in OS treatments.

Multiscale measurements with adjustable x-ray spot size for in situ imaging and diffraction

A large field of view is normally desired for synchrotron x-ray imaging, while a small x-ray spot size is required for x-ray diffraction. A multiscale measurement system with an adjustable x-ray spot size is developed to accommodate different spot size requirements for in situ phase-contrast imaging and diffraction. The centers of a diffraction scintillator with a through-hole and an imaging scintillator are collinear with the x-ray beam. With the proof-of-principle experiments on a magnesium alloy under uniaxial tension, we demonstrate the feasibility of the multiscale measurement system for full azimuthal range diffraction measurements with improved resolution and large field of view strain field measurements via x-ray digital image correlation.

[Expert consensus on the treatment of oral and maxillofacial space infections]

Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts' expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig's angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.

Bleeding Risk of Direct Oral Anticoagulants in Patients With Heart Failure And Atrial Fibrillation

BACKGROUND

Patients with heart failure and atrial fibrillation are an important atrial fibrillation subgroup in which direct oral anticoagulants (DOACs) have not been adequately studied in real-world settings. Since DOACs rely on renal elimination and renal dysfunction is prevalent in patients with heart failure, their use may increase bleeding risk, negating some of their advantage over warfarin.

METHODS

We conducted a retrospective cohort study using linked Veterans Administration databases of patients with heart failure newly started on warfarin or DOACs for atrial fibrillation from October 2010 to August 2017 (23 635 warfarin, 25 823 DOAC). Outcomes included time to first bleeding, stroke, and death using Cox proportional hazards models with inverse probability of treatment weighting.

RESULTS

Total bleeding (hazard ratio, 0.62 [95% CI, 0.56-0.68]), major bleeding (hazard ratio, 0.49 [95% CI, 0.40-0.61]), and death (hazard ratio, 0.74 [95% CI, 0.71-0.78]) were lower with DOAC than warfarin, and with apixaban and dabigatran, but not rivaroxaban. Moderate/severe chronic kidney disease was common (48.7%); moderate chronic kidney disease was associated with increased bleeding with DOACs but not warfarin. However, death and bleeding remained lower with DOACs than warfarin across all renal function levels and clinical subgroups. A >20% transient/persistent decline in renal function occurred in 53% of DOAC-treated patients at some point during follow-up, would have required dose reduction in 10.5% of patients, and was associated with increased bleeding. Dose adjustments were made more often, and bleeding and death were lower in patients seen by pharmacists or anticoagulation clinics. There were significant between-site variations in DOAC dosing.

CONCLUSIONS

DOACs overall, apixaban, and dabigatran, but not rivaroxaban, were associated with less total bleeding and death than warfarin in patients with heart failure and atrial fibrillation at all levels of renal function. Renal function decline resulted in increased bleeding in patients with DOACs. DOAC dose adjustment was often indicated, associated with increased bleeding when not adjusted, emphasizing the need for closer monitoring in these patients.

Interleukin-17A Interweaves the Skeletal and Immune Systems

The complex crosstalk between the immune and the skeletal systems plays an indispensable role in the maintenance of skeletal homeostasis. Various cytokines are involved, including interleukin (IL)-17A. A variety of immune and inflammatory cells produces IL-17A, especially Th17 cells, a subtype of CD4⁺ T cells. IL-17A orchestrates diverse inflammatory and immune processes. IL-17A induces direct and indirect effects on osteoclasts. The dual role of IL-17A on osteoclasts partly depends on its concentrations and interactions with other factors. Interestingly, IL-17A exerts a dual role in osteoblasts in vitro. IL-17A is a bone-destroying cytokine in numerous immune-mediated bone diseases including postmenopausal osteoporosis (PMOP), rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA). This review will summarize and discuss the pathophysiological roles of IL-17A on the skeletal system and its potential strategies for application in immune-mediated bone diseases.

[Prevalence and related factors of dyslipidemia in patients with 21-hydroxylase deficiency]

Objective: To analyze the prevalence and the related factors of dyslipidemia in 21-hydroxylase deficiency (21-OHD) patients. Methods: A total of 205 patients with 21-OHD were recruited in Peking Union Medical College Hospital from January 2016 to January 2018. The basic information, glucocorticoid replacement therapy, and laboratory examination results of patients were obtained from medical records. The genotypes of CYP21A2 were identified by Sanger sequencing and multiplex ligation dependent probe amplification. The prevalence of dyslipidemia among 21-OHD patients, basic information and related hormone levels of 21-OHD patients with different status of blood lipid were described. Logistic regression model was used to analyze the related factors of dyslipidemia in 21-OHD patients. Results: The age of subjects was 17.0 (8.3, 25.0) years old, including 51 males (24.9%). According to CYP21A2 genotypes, there were 16 cases in Null group, 26 cases in Group A, 105 cases in group B, 27 cases in group C, and 31 cases in group D. The incidence of dyslipidemia was 29.3% (60/205), among which 37.3% (19/51) in male and 26.6% (41/154) in female patients, respectively. The M (Q₁, Q₃) of total cortisol level (nmol/L) and body mass index (kg/m²) of male 21-OHD patients with dyslipidemia were 0.17 (0.06, 0.35) and 25.76 (17.01, 30.45), respectively, which were higher than those with ortholiposis [0.04 (0.02, 0.21) and 18.83 (16.53, 23.88)] (all P<0.05). The M (Q₁, Q₃) of progesterone level (nmol/L), body mass index (kg/m²) and age (years) of female 21-OHD patients with dyslipidemia were 74.40 (50.97, 98.52), 23.09 (21.78, 27.78) and 23.00 (16.50, 28.00), respectively, which were higher than those with ortholiposis [52.81 (33.41, 68.85), 21.55 (18.63, 25.71) and 18.00 (9.50, 25.00)] (all P<0.05). The risk of dyslipidemia increased by 5.0% [OR (95%CI): 1.05 (1.01, 1.09)] for every 1 nmol/L increase of progesterone. Conclusion: The incidence of dyslipidemia is high in 21-OHD patients, and progesterone level is positively correlated with dyslipidemia.

Persistent negative symptoms in youth at clinical high risk for psychosis: A longitudinal study

BACKGROUND

Severity of negative symptoms has been associated with poor functioning, cognitive deficits, and defeatist beliefs in schizophrenia patients. However, one area that remains understudied is persistent negative symptoms (PNS). Negative symptoms, including PNS, have been observed in those at clinical high-risk (CHR) for psychosis. The aim of this study was to determine if PNS were associated with functioning, neurocognition, and defeatist beliefs in a CHR sample.

METHOD

CHR participants (n = 764) were recruited for the North American Prodrome Longitudinal Study. Negative symptoms were rated on the Scale of Psychosis-risk Symptoms. Generalized linear mixed models for repeated measures were used to examine changes over time between and within groups (PNS vs non-PNS).

RESULTS

The PNS group (n = 67) had significant deficits in functioning at baseline, 6, 12, 18, and 24-months compared to the non-PNS group (n = 673). Functioning improved over time in the non-PNS group, while functioning in the PNS group remained relatively stable and poor over a two-year period. A consistent trend emerged demonstrating higher defeatist beliefs in the PNS group; however, this result was lost when controlling for persistent depressive symptoms. There were no significant differences between the groups on neurocognition, social cognition, and transition to psychosis.

CONCLUSIONS

PNS exist in youth at CHR for psychosis, resulting in significant and persistent functional impairment, which remains when controlling for persistent depressive symptoms. PNS remain even in CHR youth who do not transition to psychosis. Thus, PNS may represent an unmet therapeutic need in CHR populations for which there are currently no effective treatments.