Diabetes Management in Detention Facilities: A Statement of the American Diabetes Association

This statement provides guidance for diabetes care in detention facilities. It focuses on areas where the processes for delivery of care to people with diabetes in detention facilities may differ from those in the community, and key points are made at the end of each section. Areas of emphasis, which inform multiple aspects discussed in this statement, include 1) timely identification or diagnosis of diabetes treatment needs and continuity of care (at reception/intake, during transfers, and upon discharge), 2) nutrition and physical activity, 3) timely access to diabetes management tools (insulin, blood glucose monitoring, tracking data, current diabetes management technologies, etc.), and 4) treatment of the whole person with diabetes (self-management education, mental health support, monitoring and addressing long-term complications, specialty care, etc.).

Care of Young Children With Diabetes in the Childcare and Community Setting: A Statement of the American Diabetes Association

Diabetes management in children extends from the home to other settings where children spend a significant portion of their waking hours. For young children (generally, aged <5 years) with diabetes, this includes childcare centers. Given their age and developmental stage, young children require a carefully thought-out, proactive diabetes care plan for the childcare setting, developed jointly by the health care provider and parents/guardians, and implemented by childcare staff. In the U.S., federal laws and some state laws protect the rights of children with diabetes in childcare and other settings to ensure they receive appropriate assistance with the diabetes management and care. This American Diabetes Association (ADA) Statement addresses the legal rights of children in the childcare setting, outlines the current best practices for diabetes care, and provides resources and responsibilities for parents/guardians, childcare providers, and health care providers. The ADA intends for these tools and information to support the health and well-being of young children with diabetes and offer helpful guidance to those caring for them.

Longterm course of neuropsychological symptoms and ME/CFS after SARS-CoV-2-infection: a prospective registry study

A significant proportion of patients after SARS-CoV-2 infection suffer from long-lasting symptoms. Although many different symptoms are described, the majority of patients complains about neuropsychological symptoms. Additionally, a subgroup of patients fulfills diagnostic criteria for ME/CFS. We analyzed a registry of all patients presenting in the out-patients clinic at a German university center. For patients with more than one visit, changes in reported symptoms from first to second visit were analyzed. A total of 1022 patients were included in the study, 411 of them had more than one visit. 95.5% of the patients reported a polysymptomatic disease. At the first visit 31.3% of the patients fulfilled ME/CFS criteria after a median time of 255 days post infection and and at the second visit after a median of 402 days, 19.4% still suffered from ME/CFS. Self-reported fatigue (83.7-72.7%) and concentration impairment (66.2-57.9%) decreased from first to second visit contrasting non-significant changes in the structured screening. A significant proportion of SARS-CoV-2 survivors presenting with ongoing symptoms present with ME/CFS. Although the proportion of subjective reported symptoms and their severity reduce over time, a significant proportion of patients suffer from long-lasting symptoms necessitating new therapeutic concepts.

Hypomorphic RAG deficiency: impact of disease burden on survival and thymic recovery argues for early diagnosis and HSCT

Patients with hypomorphic mutations in the RAG1 or RAG2 gene present with either Omenn syndrome or atypical combined immunodeficiency with a wide phenotypic range. Hematopoietic stem cell transplantation (HSCT) is potentially curative, but data are scarce. We report on a worldwide cohort of 60 patients with hypomorphic RAG variants who underwent HSCT, 78% of whom experienced infections (29% active at HSCT), 72% had autoimmunity, and 18% had granulomas pretransplant. These complications are frequently associated with organ damage. Eight individuals (13%) were diagnosed by newborn screening or family history. HSCT was performed at a median of 3.4 years (range 0.3-42.9 years) from matched unrelated donors, matched sibling or matched family donors, or mismatched donors in 48%, 22%, and 30% of the patients, respectively. Grafts were T-cell depleted in 15 cases (25%). Overall survival at 1 and 4 years was 77.5% and 67.5% (median follow-up of 39 months). Infection was the main cause of death. In univariable analysis, active infection, organ damage pre-HSCT, T-cell depletion of the graft, and transplant from a mismatched family donor were predictive of worse outcome, whereas organ damage and T-cell depletion remained significant in multivariable analysis (hazard ratio [HR] = 6.01, HR = 8.46, respectively). All patients diagnosed by newborn screening or family history survived. Cumulative incidences of acute and chronic graft-versus-host disease were 35% and 22%, respectively. Cumulative incidences of new-onset autoimmunity was 15%. Immune reconstitution, particularly recovery of naïve CD4+ T cells, was faster and more robust in patients transplanted before 3.5 years of age, and without organ damage. These findings support the indication for early transplantation.

Feed efficiency of lactating Holstein cows is repeatable within diet but less reproducible when changing dietary starch and forage concentrations

Improving feed efficiency has become an important target for dairy farmers to produce more milk with fewer feed resources. With decreasing availability of arable land to produce feeds that are edible for human consumption, it will be important to increase the proportion of feeds in the diets for dairy cattle that are less edible for human consumption. The current research analyzed the ability of lactating dairy cows to maintain their feed efficiency when switching between a high starch diet (HS diet: 27% starch, 29% NDF, 47.1% forages on a DM basis) and a low starch diet (LS diet: 13% starch, 37% NDF, 66.4% forages on a DM basis). Sixty-two lactating Holstein cows (137 ± 23 days in milk (DIM) at the start of experiment), of which 29 were primiparous cows, were utilized in a crossover design with two 70-d experimental periods, including a 14-d adaption period for each. Feed efficiency was estimated as the individual deviation from the population average intercept in a mixed model predicting DM intake (DMI) with net energy in milk, maintenance and BW gain and loss. Repeatability was estimated within each diet by comparing feed efficiency estimated over the first 28-day period and the second 28-day period within each diet, using Pearson's and intraclass correlations, and the estimation of error of repeatability. Similarly, reproducibility was estimated by comparing the second 28-day period of one diet with the first 28-day period of the other diet. Feed efficiency was less reproducible across diets than repeatable within the same diet. This was shown by lower intraclass correlations (0.399) across diets compared to that in the HS diet (0.587) and LS diet (0.806), as well as a lower Pearson's correlation coefficient (0.418) across diets compared to that in the HS diet (0.630) and LS diet (0.809). In addition, the estimation of error of repeatability was higher (0.830 kg DM/d) across diets compared to that in the HS diet (0.761 kg DM/d) and LS diet (0.504 kg DM/d). This means that the feed efficiency of dairy cows is more likely to change after a diet change than over subsequent lactation stages. Other determinants, such as digestive processes, need to be further investigated to determine its effects on estimating feed efficiency.

2D crystal structure and anisotropic magnetism of GdAu6.75-xAl0.5+x (x ≈ 0.54)

Exploration of the gold-rich part of the ternary Gd–Au–Al system afforded the intermetallic compound GdAu_6.75−xAl_0.5+x (x ≈ 0.54) which was structurally characterized by single crystal X-ray diffraction (Pnma, a = 18.7847(4) Å, b = 23.8208(5) Å, c = 5.3010(1) Å). GdAu_6.75−xAl_0.5+x crystallizes in a previously unknown structure type featuring layers of Gd₂(Au, Al)₂₉ and Gd₂(Au, Al)₂₈ clusters which are arranged as in a close-packing parallel to the ac plane. The Gd substructure corresponds to slightly corrugated 3⁶ nets (d_Gd–Gd = 5.30–5.41 Å) which are stacked on top of each other along the b direction with alternating short (5.4, 5.6 Å, within layers) and long distances (6.4 Å, between layers). The title compound has been discussed with respect to a quasicrystal approximant (1/1 AC) GdAu_5.3Al in the same system. The magnetic properties of GdAu_6.75−xAl_0.5+x were found to be reminiscent to those of some ternary ACs, with sharp peaks in the temperature dependent magnetization, and metamagnetic-like transitions. The material becomes antiferromagnetic below 25 K; magnetometry results suggest that the antiferromagnetic state is composed of ferromagnetic ac planes, coupled antiferromagnetically along the b direction.

Combining datasets in a dynamic residual feed intake model and comparison with linear model results in lactating Holstein cattle

A new method to estimate residual feed intake (RFI) was recently developed based on a multi-trait random regression model. This approach deals with the dynamic nature of the lactation, which is in contrast with classical linear approaches. However, an issue remains: pooling data across sites and years, which implies dealing with different (and sometimes unknown) diet energy contents. This will be needed for genomic evaluation. In this study, we tested whether merging two individual datasets into a larger one can lead to valuable results in comparison to analysing them on their own with the multi-trait random regression model. Three datasets were defined: the first one with 1 063 lactations, the second one with 205 lactations from a second farm and the third one combining the data of the two first datasets (1 268 lactations). The model was applied to the three datasets to estimate individual RFI as well as variance components and correlations between the four traits included in the model (fat and protein corrected milk production, BW, feed intake and body condition score), and a fixed month-year-farm effect was used to define the contemporary group. The variance components and correlations between animal effects of the four traits were very similar irrespective of the dataset used with correlations higher than 0.94 between the different datasets. The RFI estimates for animals from their single farm only were also very similar (r > 0.95) to the ones computed from the merged dataset (Dataset 3). This highlights that the contemporary group correction in the model adequately accounts for differences between the two feeding environments. The dynamic model can thus be used to produce RFI estimates from merged datasets, at least when animals are raised in similar systems. In addition, the 205 lactations from the second farm were also used to estimate the RFI with a linear approach. The RFI estimated by the two approaches were similar when the considered period was rather short (r = 0.85 for RFI for the first 84 days of lactation) but this correlation weakened as the period length grew (r = 0.77 for RFI for the first 168 days of lactation). This weakening in correlations between the two approaches when increasing the used time-period reflects that only the dynamic model permits the regression coefficients to evolve in line with the physiological changes through the lactation. The results of this study enlarge the possibilities of use for the dynamic RFI model.

Guillain-Barré Syndrome Following an Extended-Spectrum Beta-Lactamase Escherichia coli Urinary Tract Infection: A Case Report

Guillain-Barré syndrome (GBS) is a rare autoimmune disorder that typically develops after a respiratory or gastrointestinal infection. While Campylobacter jejuni is associated with approximately 30% of cases, organisms such as Haemophilus influenzae, Mycoplasma pneumonia, Epstein-Barr virus, cytomegalovirus, Zika virus, influenza virus, and hepatitis A, B, C, and E have demonstrated clinical associations to GBS. In rare instances, Escherichia coli infections have been documented as the underlying cause for GBS. Our patient, a 69-year-old female, was admitted with a two-week history of progressively worsening bilateral lower extremity weakness following diagnosis of an extended-spectrum beta-lactamase E. coli urinary tract infection. She was diagnosed with GBS based on acute flaccid paralysis, areflexia, and a nerve conduction velocity study showing an absent motor response in her lower extremities bilaterally. The patient subsequently underwent intravenous immunoglobulin (IVIG) treatment for five days which resulted in significant improvement in her bilateral lower extremity weakness, a response consistent with the diagnosis of GBS.

Sex related differences in vascular interventions and outcome of patients with critical limb threatening ischemia in a real-world cohort

Background

The prevalence of critical limb threatening ischemia (CLTI) is increasing worldwide and the focus is the reduction of outcome events like death or amputation of the lower limb (LL). Sex related differences in medical supply and outcome are a current matter of debate.

Purpose

In the present study, we included patients with CLTI in an unselected “real-world” cohort and studied sex related differences in their risk profile and vascular interventions, as well as their impact on long-term outcome.

Methods

We analyzed 119,953 unselected patients of the public health insurance in Germany (AOK), which were hospitalized between 2010 and 2017 for a main diagnosis of CLTI (Rutherford stage (RF) 4–6). In our data files, a baseline period of 2 years previous index hospitalization and a follow-up period until 2018 was included.

Results

In our cohort, more than half were male CLTI patients (57% male vs. 43% female), while female CLTI patients were at higher age (median: 73.8 years male vs. 81.4 years female). Male patients had higher ratios of diabetes, dyslipidemia, smoking, cerebrovascular disease and chronic coronary syndrome, whereas female CLTI patients show a higher prevalence of hypertension, atrial fibrillation, chronic heart failure and chronic kidney disease (all p&lt;0.001). During index hospitalisation more than one quarter of all CLTI patients suffered from rest pain (RF 4), and approximately one third for minor (RF 5) and one third for major (RF 6) tissue lost. Female patients were more often diagnosed with RF 5 (32% male vs. 36% female), while the proportion of male patients was slightly higher at RF 4 (29% male vs. 27% female) and RF 6 (39% male vs. 37% female, all p&lt;0.001).

During index hospitalization, almost 70% underwent any diagnostic angiography and in 63% of all patients a revascularization procedure was performed. Both were carried out more often in male patients (both p&lt;0.001).The Kaplan Meier curve showed an increased mortality rate in female patients during follow up (figure 1), while no differences were observed for the combined endpoint amputation of the LL or death. Interestingly after adjustment for age and patients risk'constellation, female gender was associated with increased overall-survival (female HR 0.95; 95%-CI 0.94–0.96, p&lt;0.001) and amputation-free survival which is a combined endpoint of amputation of the LL or death (female HR 0.84; 95%-CI 0.83–0.85, p&lt;0.001).

Conclusion

Female patients with CLTI were older and showed lower rates of diagnostic angiography and revascularization procedures of the LL during index hopsitalization. Nevertheless, male sex was an independent risk factor for all-cause mortality and the combined endpoint amputation of the LL or death during long-term follow-up. These results indicate that further analyses are needed to determine the various individual needs of male and female CLTI patients.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The project upon which this publication is based was funded by The Federal Joint Committee, Innovation Committee (G-BA, Innovationsfonds, number 01VSF18051).

Stereoscopic particle image velocimetry in inhomogeneous refractive index fields of combustion flows

Particle image velocimetry (PIV) measurements in reactive flows are disturbed by inhomogeneous refractive index fields, which cause measurement deviations in particle positions due to light refraction. The resulting measurement errors are known for standard PIV, but the measurement errors for stereoscopic PIV are still unknown. Therefore, for comparison, the velocity errors for standard and stereoscopic PIV are analyzed in premixed propane flames with different Reynolds numbers. For this purpose, ray-tracing simulations based on the time-averaged inhomogeneous refractive index fields of the studied non-swirled flame flows measured by the background-oriented Schlieren technique are performed to quantify the resulting position errors of the particles. In addition, the performance of the volumetric self-calibration relevant to tomographic PIV is analyzed with respect to the remaining position errors of the particles within the flames. The position errors cause significant standard PIV errors of 2% for the velocity component radial to the burner symmetry axis. Stereoscopic PIV measurements result in measurement errors of up to 3% radial to the burner axis and 13% for the velocity component perpendicular to the measurement plane. Due to the lower refractive index gradients in the axial direction, no significant velocity errors are observed for the axial velocity component. For the investigated flame configurations, the position errors and velocity errors increase with the Reynolds numbers. However, this dependence needs to be verified for other flame configurations such as swirled flame flows.

Fretting-corrosion of CoCr-alloys against TiAl6V4: The importance of molybdenum in oxidative biological environments

Periprosthetic fluids often contain reactive oxygen species, including H₂O₂, that are generated during inflammatory processes. Here, we investigated the fretting-corrosion behavior of CoCrX-alloys (X = Mo, Fe) in a complex protein-containing lubricant, with and without the addition of H₂O₂. Given the known protective role of molybdenum as an alloying element in metal degradation, we considered its effects by designing a two-way factorial experiment. The aim of the study was to investigate tribocorrosive mechanisms in modular joints of knee and hip prostheses. A previously described test-rig was used to run fretting corrosion tests of CoCrX-alloys with (X=Mo) and without (X=Fe) molybdenum against TiAl6V4 in bovine calf serum (BCS) with and without a physiological relevant H₂O₂ level (3 mM) in gross slip mode (4 Hz, ±50 μm, p_max=0.18 GPa, 37 °C, 50,000 cycles). Two CoCr-pins were pressed against a cylindrical TiAl6V4-rod, forming a line contact. Normal and frictional forces, the displacement, and the open circuit potential (OCP) were measured and recorded continuously. The dissipated frictional work was independent of alloy composition. The addition of H₂O₂ lowered the dissipated frictional work and increased wear, and this was significant in the absence of Mo. The mean OCP value was lower with Mo-containing than with Mo-free alloy in both pure BCS (p = .042), and BCS ± H₂O₂ (p < .0005). The wear scar was deeper for the Mo-free alloy, and this was significant (p = .013) in the presence of H₂O₂. These findings suggest a marked weakening of the passive film in the presence of H₂O₂, which is mitigated by the availability of Mo.

OP0034 STP938, A NOVEL, POTENT AND SELECTIVE INHIBITOR OF CTP SYNTHASE 1 (CTPS1) DEMONSTRATES EFFICACY IN RODENT MODELS OF INFLAMMATION AND ARTHRITIS

Background:

The final rate-limiting step in pyrimidine synthesis is the conversion of UTP to CTP which is catalyzed by cytidine triphosphate synthase 1 (CTPS1) or CTPS2. A hypomorphic mutation in the CTPS1 gene has highlighted the essential and non-redundant role of CTPS1 in T and B lymphocyte proliferation1. These patients exhibit no effects on non-hematopoietic tissues. Thus, selective inhibition of CTPS1 represents a novel targeted approach to dampen pathological T- and B-cell lympho-proliferation. STP938 is an orally bioavailable, small molecular weight, selective inhibitor of CTPS1 developed by Step Pharma.

Objectives:

To demonstrate the in vitro effects of CTPS1 inhibition on T and B cell proliferation and the therapeutic potential of STP938 using in vivo models of disease.

Methods:

The in vitro anti-proliferative activity of STP938 was investigated using cell lines and primary human PBMCs. STP938 was assessed in vivo using the DTH-KLH rat model and the mouse collagen-induced arthritis (CIA) model. For the KLH-DTH model, Lewis rats were immunized with KLH, a week later, challenged locally at the ear with KLH antigen, ear swelling was assessed after 24 hours. Blood samples were collected for detection of KLH-specific IgG levels at day 8. STP938 was given orally one-hour prior to immunization and then b.i.d. for 7 days. For the CIA model, DBA-1 mice were immunized with Collagen type II and complete Freund’s adjuvant and received a booster immunization three weeks later. STP938 was administered to mice developing signs of arthritis from Day 28 to 45 orally daily b.i.d.

Results:

STP938 inhibited in vitro proliferation of HEKwt but not HEK-CTPS1KO cells as well as Jurkat and human PBMCs. STP938 demonstrated a significant and dose-dependent inhibition of KLH-specific T and B cell responses in vivo. STP938 significantly reduced the disease severity in the CIA model in a dose-dependent manner as determined by clinical and histopathological readouts.

Conclusion:

Our preliminary in vitro and in vivo results indicate that inhibition of CTPS1 specifically blocks proliferation of cells derived from the lymphocyte lineage and reduces the T cell driven inflammatory response. These data highlight the therapeutical potential of STP938 in treating patients with autoimmune diseases such as rheumatoid arthritis.

References:

[1]Martin et al, JCI Insight. 2020, 12;5(5):133880

Disclosure of Interests:

Hélène ASNAGLI Employee of: Step Pharma, Andrew Novak: None declared, Louise Birch Shareholder of: Step Pharma, Rebecca Lane: None declared, Norbert Minet Employee of: employee as Ph D student under CIFRE grant, David Laughton: None declared, Pascal George Shareholder of: Step Pharma, Geoffroy de Ribains Shareholder of: as former employee of Step Pharma, Employee of: former employee of Step Pharma, Sylvain Latour: None declared, Alain Fischer: None declared, Tim Bourne Shareholder of: UCB, Step Pharma, Sitryx Therapeutics, Consultant of: a range of biotech companies, Employee of: former employee of Step Pharma and Sitryx Therapeutics, Andrew Parker Employee of: Step Pharma

Reinforcement learning with artificial microswimmers

Artificial microswimmers that can replicate the complex behavior of active matter are often designed to mimic the self-propulsion of microscopic living organisms. However, compared with their living counterparts, artificial microswimmers have a limited ability to adapt to environmental signals or to retain a physical memory to yield optimized emergent behavior. Different from macroscopic living systems and robots, both microscopic living organisms and artificial microswimmers are subject to Brownian motion, which randomizes their position and propulsion direction. Here, we combine real-world artificial active particles with machine learning algorithms to explore their adaptive behavior in a noisy environment with reinforcement learning. We use a real-time control of self-thermophoretic active particles to demonstrate the solution of a simple standard navigation problem under the inevitable influence of Brownian motion at these length scales. We show that, with external control, collective learning is possible. Concerning the learning under noise, we find that noise decreases the learning speed, modifies the optimal behavior, and also increases the strength of the decisions made. As a consequence of time delay in the feedback loop controlling the particles, an optimum velocity, reminiscent of optimal run-and-tumble times of bacteria, is found for the system, which is conjectured to be a universal property of systems exhibiting delayed response in a noisy environment.

[Experimental cadaveric study assesing protection and osteotomy guide system (BARU) in hallux valgus surgery using Reverdin-Isham technic]

INTRODUCTION

Hallux valgus is a high frequency disorder, affecting the first ray. Operative correction techniques have grown popularity lately. One of them is the Reverdin-Isham technique (first metatarsal medial incomplete osteotomy). Recently, a protection and osteotomy cutting guide has been developed: the BARU system.

OBJECTIVE

To test the usefulness of the BARU system as a protective factor for soft structures adjacent to the surgical site and guidance for osteotomy.

MATERIAL AND METHODS

Experimental cadaveric study. Six cadaveric feet (two fresh-frozen and four in formaldehyde solution), unapproached. Feet were numbered and intervened with RI technique, three of them with BARU system and three without it. Afterwards, dissection by two dissectors who did not know whether the BARU system had been used or not, establishing a single-blinded model. 13 structures were evaluated in each foot. Data was recovered into Microsoft Office Excel and processed with SPSS. 2 test (significative if p value < 0.05) and relative risk were calculated.

RESULTS

Approach using BARU system was satisfactory, with usual-size operation-ports. BARU system colocation was simple and radiological control showed adequate spatial location. The device contributed as reference for cutting direction and depth. 65 out of the 78 searched structures were found (83.3%). Six injuries were found among the assessed structures: plantar medial nerve (one injury), plantar medial artery (one injury), flexor brevis muscle (three injuries), abductor muscle (one injury). Five of these injuries occurred in non-utilizing BARU system feet.

CONCLUSION

Promising results in terms of protection of nearby structures, cutting guide, and ease of intervention. Avoids X-rays exposure. Not significant statistical calculations, the sample should be enlarged.

Single cell sequencing reveals endothelial plasticity with transient mesenchymal activation after myocardial infarction

 

After myocardial infarct (MI), followed by ischemia and scar formation, interstitial cells play key roles in the adaptation to injury. Endothelial cells (ECs), for instance, can clonally expand, migrate into the infarct area and facilitate crucial functions promoting revascularization, reestablishment of oxygen supply and secretion of paracrine factors. Moreover, ECs can transiently undergo changes towards a mesenchymal phenotype (Endothelial-to-mesenchymal transition; EndMT). Whether this process contributes to long-term cardiac fibrosis or helps to facilitate post-ischemic vessel growth remains controversial. Here, we aim to delineate kinetics and characteristics of phenotypic changes in ECs with single cell RNA-sequencing (scRNA-seq).

We performed a time course (homeostasis or 0 day (d), 1d, 3d, 5d, 7d, 14d, 28d post-MI) in mice and isolated the non-cardiomyocyte fraction for scRNA-seq (n=35,312 cells). Pecam1/Cdh5 double positive ECs showed expression of apoptosis, hypoxia and inflammation markers at 3d. Bioinformatic cell cycle analysis predicted high association with proliferative capacities at 3d, indicative of EC turnover post-MI. Metabolism, recently linked to regulate EndMT, was altered. We found genes of the glycolysis and the TCA-cycle pathway upregulated at 1d to 3d, and a decrease of fatty acid signaling genes. At 3d, mesenchymal markers Fn1, Vim, S100a4, Serpine1 transiently increased compared to homeostasis (&gt;1.6-fold, p&lt;0.05) together with a reduction of EC genes such as Pecam1. Interestingly, mesenchymal transition was transient and returned to baseline levels at 28d after MI. Cell fate trajectory analysis confirmed these findings by identifying an EC state characterized by high proliferation and mesenchymal but low EC properties. At 3d to 7d the majority of the ECs were assigned to this state, based on their transcriptomic profile.

We additionally used Cdh5-CreERT2; R26-mT/mG mice followed by scRNA-seq to trace the fate of ECs. Bioinformatic analysis of GFP-positive ECs confirmed the gain in mesenchymal marker but revealed no full transition to the mesenchymal state at later timepoints. This suggests a transient mesenchymal activation of ECs rather than a complete lineage transition. We further induced EndMT with TGF-β2 in ECs in vitro and observed reversibility of the phenotype after withdrawal of the stimulus. After treatment, ECs upregulated various mesenchymal marker genes. Withdrawal of TGF-β2 at 3d or 7d, reverted expression to baseline levels. We further determined DNA methylation of EndMT gene loci to assess if TGF-β2 leads to a true fate change but did not observe changes after TGF-β2 stimulation and withdrawal. Taken together, our data suggests that ECs undergo a transient mesenchymal activation concomitant with a metabolic adaptation early after MI but do not acquire a long-term mesenchymal fate. This activation may facilitate EC migration and clonal expansion to regenerate the vascular network.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): German Center of Cardiovascular Research (DZHK), Deutsche Forschungsgemeinschaft (DFG) CRC1366 Project B4

m6A RNA methylation contributes to translational control in heart failure progression

Background/Introduction

Heart failure, characterized by reduced cardiac function and left ventricular dilatation, is a leading cause of hospital admission and mortality. Among increased apoptosis and fibrosis, the progression of heart failure is accompanied by changes in gene expression. There is increasing evidence, that also epigenetic processes such as DNA and histone modifications, long non-coding RNAs and transcription factors orchestrate aberrant gene expression in heart failure. Among these epigenetic processes, N6-methyladenosine (m6A) is the most prevalent modification found in all classes of RNA. Such m6A patterns in for example mRNA can have influence on various mechanisms such as splicing, transport, storage or decay of mRNAs. Due to its reversible and dynamic nature regulated via methyltransferases (mainly the METTL3/METTL14/WTAP-complex) and demethylases (mainly FTO and ALkBH5) it adds a new layer of epigenetic regulation.

Purpose

Changes in epigenetic processes are important mechanisms in heart failure progression. We aimed to elucidate the potential role of m6A methylation in heart failure development.

Methods

We analysed m6A methylation in different stages of heart failure progression in mouse and human tissue via methylated RNA immunoprecipitation (meRIP) followed by next generation sequencing (NGS). With polysome fractionation followed by NGS, we studied a potential link between polysomal occupancy and m6a RNA methylation.

Results

We found that approximately one quarter of all RNA transcripts in healthy mouse and human tissue carry m6A RNA methylation. During progression to heart failure we found that changes in m6A methylation exceed changes in gene expression in both, mouse and human. RNAs with altered m6A levels were mainly linked to metabolic and regulatory pathways, whereas changes in expression represented changes in structural plasticity. Furthermore, we found a link between m6A RNA methylation and altered RNA translation. Interestingly, transcripts with unchanged expression level but a differential change in their methylation level also showed differential polysomal occupancy. We could show a corresponding change in protein level, which points to a potential new mechanism of transcription-independent modulation of translation. The importance of m6A methylation was furthermore confirmed in a cardiomyocyte specific knock-out of the RNA demethylase FTO in mice where it lead to impaired cardiac function compared to control mice.

Conclusions

We could show that the m6A landscape is altered in heart hypertrophy and heart failure. Methylation changes exceed expression changes in disease progression and lead to changes in protein abundance, which uncovers a new transcription-independent mechanism of translation regulation. Therefore, our data suggest that targeting epitranscriptomic mechansims, such as m6A methylation, might be a an interesting approach for thereapeutic interventions.

Funding Acknowledgement

Type of funding source: Public grant(s) – EU funding. Main funding source(s): SFB 1002 Modulatory Units in Heart Failure

Effects of dietary gamma-cyclodextrin on voluntary activity and muscle strength in mice

Gamma-cyclodextrin (γCD) is a cyclic oligosaccharide consisting of eight α-(1,4)-linked glucopyranose subunits, which is often used in the food and pharmaceutical industries. However, little is known regarding the metabolic activity of "empty" γCD per se. Therefore, in the present study young C57BL/6 male mice received a control diet (CON) or an experimental diet that was supplemented with 12.88% γCD exchanged against corn starch. After 6 weeks of treatment, the voluntary wheel running activity was monitored and the muscle strength of mice was measured by employing Kondziela's inverted screen test and forelimb grip strength assay. The γCD-treated mice covered a significantly larger distance per night (CON 8.6 km, γCD 12.4 km) and were significantly longer active (CON 340 min, γCD 437 min). Moreover, γCD-treated mice significantly performed better at the inverted screen test indicated by an enhanced Kondziela score (CON 3.10, γCD 4.63). These data suggest that dietary γCD leads to an increased endurance. We also found a slightly anti-glycemic effect of γCD during oral glucose tolerance test. However, our mice from the γCD group exhibited no difference in terms of GLUT2 protein level in ileum tissue nor increased muscle glycogen storage. Furthermore, γCD exhibited no DPP-4 inhibitory activity in vitro. By analysing candidate muscle genes and proteins related to endurance and muscle performance we did not observe any differences in terms of Sirt1, Pgc1α, Cpt1b, Mef2c, Myh1 and Myh2 gene expression levels as well as total oxidative phosphorylation (OXPHOS), mtTFA and GLUT4 protein expression levels in skeletal muscle in response to γCD. We could not fully establish the exact underlying molecular mechanisms of the fitness improvement by dietary γCD which warrants further investigations.

An enhanced prognostic score for overall survival of patients with cancer derived from a large real-world cohort

BACKGROUND

By understanding prognostic biomarkers, we gain insights into disease biology and may improve design, conduct, and data analysis of clinical trials and real-world data. In this context, we used the Flatiron Health Electronic Health Record-derived deidentified database that provides treatment outcome and biomarker data from >280 oncology centers in the USA, organized into 17 cohorts defined by cancer type.

PATIENTS AND METHODS

In 122 694 patients, we analyzed demographic, clinical, routine hematology, and blood chemistry parameters within a Cox proportional hazard framework to derive a multivariable prognostic risk model for overall survival (OS), the 'Real wOrld PROgnostic score (ROPRO)'. We validated ROPRO in two independent phase I and III clinical studies.

RESULTS

A total of 27 variables contributed independently and homogeneously across cancer indications to OS. In the largest cohort (advanced non-small-cell lung cancer), for example, patients with elevated ROPRO scores (upper 10%) had a 7.91-fold (95% confidence interval 7.45-8.39) increased death hazard compared with patients with low scores (lower 10%). Median survival was 23.9 months (23.3-24.5) in the lowest ROPRO quartile Q1, 14.8 months (14.4-15.2) in Q2, 9.4 months (9.1-9.7) in Q3, and 4.7 months (4.6-4.8) in Q4. The ROPRO model performance indicators [C-index = 0.747 (standard error 0.001), 3-month area under the curve (AUC) = 0.822 (0.819-0.825)] strongly outperformed those of the Royal Marsden Hospital Score [C-index = 0.54 (standard error 0.0005), 3-month AUC = 0.579 (0.577-0.581)]. We confirmed the high prognostic relevance of ROPRO in clinical Phase 1 and III trials.

CONCLUSIONS

The ROPRO provides improved prognostic power for OS. In oncology clinical development, it has great potential for applications in patient stratification, patient enrichment strategies, data interpretation, and early decision-making in clinical studies.

Electroconvulsive therapy: a review on indications, methods, risks and medication

This paper reviews and presents data of practical impact for those administering electroconvulsive therapy (ECT). In the first section, physical and physiological aspects of the stimulus as well as methods of stimulation are discussed. The second section deals with indications for ECT, efficacy and treatment modalities such as seizure duration, treatment frequency and total number of ECT applications. The last section is devoted to side effects, risks, comedication and comorbidity.

Precision feed restriction improves feed and milk efficiencies and reduces methane emissions of less efficient lactating Holstein cows without impairing their performance

A possible driver of feed inefficiency in dairy cows is overconsumption. The objective was therefore to test precision feed restriction as a lever to improve feed efficiency of the least efficient lactating dairy cows. An initial cohort of 68 Holstein lactating cows was monitored from calving to end of ad libitum feeding at 196 ± 16 d in milk, with the last 70 d being used to estimate feed efficiency. For a given expected dry matter (DM) intake (DMI) during ad libitum feeding, offered DMI during restriction was set to observed DMI of the 10% most efficient cows during ad libitum feeding for similar performance. Feed restriction lasted during 92 d, with only the last 70 d being used for data analyses. A single diet was fed during ad libitum and restriction periods, and was based on 64.9% of corn silage and 35.1% of concentrates on a DM basis. Individual DMI, body weight, milk production, milk composition, and body condition score were recorded, as well as methane emissions. Feed efficiency was defined as the repeatable part of the random effect of cow on the intercept in a mixed model predicting DMI with net energy in milk, maintenance and body weight gain and loss within parity, feeding level, and time. Milk energy efficiency was estimated in the same way, predicting net energy in milk instead of DMI. The 15 least efficient cows ate 2.6 kg of DM/d more than the 15 most efficient cows during ad libitum feeding with 2 g/kg of DMI lower methane yield, but similar daily methane emissions. Feed restriction decreased DMI by 2.6 kg of DMI/d for the least efficient cows, which was 1.8 kg of DMI/d more than the most efficient cows, and decreased daily methane emissions by 49.2 g/d for the least efficient cows, which was 22.4 g/d more than the most efficient cows. Feed restriction had no significant effect on milk, body weight, or body weight change. Feed restriction reduced the variability of both milk energy and feed efficiencies, as shown by a decrease of their standard deviation from 0.87 to 0.69 kg of DM/d for feed efficiency and from 1.14 to 0.65 UFL/d for milk energy efficiency. Despite narrow efficiency differences, the most efficient cows during ad libitum feeding remained more efficient during feed restriction (r = 0.46 for feed efficiency and 0.49 for milk energy efficiency). The 2 efficiency groups no longer differed in feed efficiency during precision feed restriction. Precision feed restriction seemed to bring the least efficient cows closer to the most efficient cows and to reduce their methane emissions without impairing their performance.

The bovine epimural microbiota displays compositional and structural heterogeneity across different ruminal locations

Dairy cattle are globally important agricultural animals. Central to their biology is the rumen, which houses an essential microbial community, or microbiome, important for providing nutrition from otherwise host-inaccessible dietary components. The rumen environment is noted for its substantial spatial heterogeneity, as illustrated by the stratification into ruminal solid and liquid phases. A third microbiota found directly attached to the ruminal epithelium (the epimural microbiota) also exists but is less well understood because of challenges in sampling the ruminal epithelium. As a result, our understanding of the epimural microbiota is based on analyses of cannulated animals sampled at a single location-the ventral sac-and does not account for other ruminal locations, which may have importance for overall rumen function. To address this knowledge gap, we hypothesize that the epimural microbiota at different ruminal locations differs due to known morphological, physiological, and functional differences across the geographic spread of the rumen epithelium. Here, we characterized bacterial epimural communities at different sites within 8 lactating Holstein dairy cows using 16S rRNA gene sequencing. Four different sites were sampled via rumen tissue biopsy: cranial sac (CS), ventral sac (VS), caudodorsal blind sac (CDBS), and caudoventral blind sac (CVBS). We found that locations differed in both epimural bacterial community structure and composition, with the CDBS community displaying the greatest diversity. Across all sampling sites, epimural bacterial communities were dominated by members of the phyla Bacteroidetes, Firmicutes, and Proteobacteria. Bacteria within Prevotellaceae, Butyrivibrio, Campylobacter, Mogibacterium, and Desulfobulbus all showed high relative sequence abundance and differential distributions according to sample location. There appears to be a core epimural microbiota present across all locations in all cows, although relative abundance was highly variable. The difference in relative abundance in epimural microbial communities, perhaps influenced by host physiology and the diversity within rumen contents, likely has important consequences for nutrition acquisition and general health. To the best of our knowledge, this work represents the first characterization of the ruminal epimural microbiota across different epithelial locations for any bovine ruminant.

Comparison of the Copan WASPLab incorporating the BioRad expert system against the SIRscan 2000 automatic for routine antimicrobial disc diffusion susceptibility testing

OBJECTIVES

This study investigated the agreement at the categorical level between the Copan WASPLab incorporating the BioRad expert system against the SIRscan 2000 automatic for antimicrobial disc diffusion susceptibility testing.

METHODS

The 338 clinical strains (67 Pseudomonas aeruginosa, 19 methicillin-resistant Staphylococcus aureus, 75 methicillin-sensitive S. aureus and 177 Enterobacterales isolates) analysed in this study were non-duplicate isolates obtained from consecutive clinical samples referred to the clinical bacteriology laboratory at Geneva University Hospitals between June and August 2019. For the WASPLab the inoculum suspension was prepared in strict accordance with the manufacturer's instruction (Copan WASP srl, Brescia, Italy) by adding 2 mL of the 0.5 McFarland primary suspension used for the SIRscan analysis into a sterile tube filled with 4 mL of sterile saline (1:3 dilution). The inoculum (2 × 30 μL loop/spreader) was spread over the entire surface of Mueller-Hinton agar plates according to the AST streaking pattern defined by Copan. The antibiotic discs were dispensed by the WASP and inoculated media were loaded on conveyors for transfer to the automatic incubators. The plates were incubated for 16 h, and several digital images were acquired. Inhibition zone diameters were automatically read by the WASPLab and were adjusted manually whenever necessary. For the SIRscan 2000 automatic, the antimicrobial disc diffusion susceptibility testing was performed according to the EUCAST guidelines. The gradient strip method was used to resolve discrepancies.

RESULTS

The overall categorical agreement between the compared methods reached 99.1% (797/804; 95% CI 98.2%-99.6%), 99.5% (1029/1034; 95% CI 98.9%-99.8%), and 98.8% (2798/2832; 95% CI 98.3%-99.1%) for P. aeruginosa, S. aureus and the Enterobacterales, respectively.

CONCLUSIONS

WASPLab incorporating the BioRad expert system provides a fully automated solution for antimicrobial disc diffusion susceptibility testing with equal or better accuracy than other available phenotypic methods.

P1621m6A RNA-methylation in the progression of heart failure

Introduction

N6-Methyladenosine (m6A) is the most abundant modification of RNA and was found to be a dynamic and reversible process. It is found in many classes of RNA, such as mRNA, noncodingRNA (ncRNA) and microRNA (miR). mRNA methylation can affect splicing, transport and storage or decay, ncRNA methylation might influence signal transduction directly as well as it might affect miR interference. Deregulation of such epigenetic processes and aberrant gene expressions are important mechanisms in heart failure. Here we studied the potential relevance of m6A RNA-methylation in cardiac hypertrophy and heart failure development.

Methods and results

m6A RNA-methylation was analysed via methylated RNA immunoprecipitation (meRIP) and subsequent next generation sequencing (NGS). Our data shows that approximately one quarter of the transcripts in the healthy mouse (24.09%) and human heart (14.6%) exhibit m6A RNA-methylation. A mild positive correlation of m6A RNA-methylation at the 5'UTR and coding region with transcript level was observed while m6A RNA-methylation at the 3'UTR showed a mild negative correlation.

We analysed heart failure in mice and humans and observed that changes in m6A RNA-methylation exceed changes in gene-expression (in human data 1219 differentially methylated and 198 diff. expressed, with 30 showing changes in both methylation and expression; in mouse data 1135 diff. methylated and 127 diff. expressed, with 47 showing changes in both methylation and expression). In mouse and human heart failure, transcripts with altered m6A RNA-methylation were mainly linked to metabolic and regulatory pathways while changes in transcript level mainly represented changes in structural plasticity. In the diseased state m6A RNA-methylation showed no correlation to transcript level. To gain further insight into m6A mediated effects on the translational level, polysome-sequencing was applied. These data provide evidence that in the diseased heart changes in m6A RNA-methylation affect RNA translation, represented by a positive correlation (r=0.37, p=2.2e-16) of log2fc changes in translation and m6A methylation.

Conclusions

Our study describes m6A RNA-methylation at the genome-wide level in the human heart. The mouse model provides evidence that changes in m6A RNA-methylation plays an important role in heart failure development by affecting regulatory pathways distinct from those genes with altered expression levels. Our data suggest that modulation of epitranscriptomic processes such as m6A-methylation might be an interesting target for therapeutic interventions.

Acknowledgement/Funding

CRC 1002

6091Chronic heart failure is associated with inflammatory deterioration of the bone marrow vascular niche

Introduction

Inflammation plays a crucial role in many aspects of cardiovascular disease. Particularly, acquired mutations of hematopoietic stem cells (HSC) leading to clonal expansion of inflammatory cells (CHIP) are increased with age and are associated with an enhanced risk of cardiovascular disease. The bone marrow (BM) vascular niche plays a crucial role in maintenance and regulation of HSC functions. Previous studies in mice showed the reduction of a specific Endomucin-high (H-type) endothelial cells (EC) subpopulation by aging. However, the impact of cardiovascular disease is unclear. Therefore, we aimed to investigate the effects of age and heart failure (HF) on the vascular BM cell composition in mice and humans.

Methods and results

Aging mice showed an age-dependent decrease of type H (Emcn-high) BM ECs (p=0.004), whereas the BM frequencies of type L (Emcn-low) ECs did not significantly differ (P=0.18). Importantly, we also observed a marked reduction of type H EC in chronic ischemic mice (P=0.016 vs. sham) indicating that chronic ischemic HF induces similar alterations of the vascular stem cell niche. Importantly, type H ECs were also significantly reduced in ischemic HF patients (n=16) compared with control subjects (n=8; P=0.0003). To gain insights into the mechanisms underlying the changes in the vascular niche, we performed single cells RNA sequencing of human BM ECs. These studies confirmed the decrease in Emcn-expressing ECs in ischemic HF patients, which was accompanied by significantly increased expression of inflammatory genes, including IL1b (P<0.0001 vs. control). Inflammatory EC phenotypes and IL1b expression in HF could be further confirmed at protein level using cytospin immunostainings. Finally, we comprehensively evaluated phenotype-associated differences in the bone marrow plasma proteomes of healthy individuals (n=19) and patients with chronic ischemic (n=22) and non-ischemic (n=19) HF, using proximity extension assays. Here, we identified 182 proteins significantly differentially regulated in CHF versus CTRL. Among the top upregulated proteins the BM environment of patients with CHF showed a striking enrichment of inflammatory and ECM remodeling components.

Conclusions

Our data show for the first time an impact of chronic heart failure on the bone marrow vascular niche in humans. These changes seem to be strongly associated with increased inflammatory response and bone matrix remodeling in CHF. Specifically, the induction of the inflammatory cytokine IL1b may contribute to the disturbed phenotype suggesting that inhibition of IL1b (e.g. by canakinumab) may be used as a novel strategy to prevent or reverse the deterioration of the vascular BM niche.

1180Cardiomyocyte-specific deletion of Brd4 induces hypertrophic cardiomyopathy and suggests a novel function for the chromatin reader as co-repressor in the healthy heart

Introduction

There is increasing evidence that epigenetic mechanisms such as histone modifications integrate stress stimuli into cellular responses during pathogenesis of heart failure (HF). The chromatin readers of the Bromo- and extraterminal domain (BET) family (BRD2, BRD3, BRD4) were reported to recognize acetylated histone tails and to promote transcription. Previously, BET inhibition by JQ1 was shown to displace BET readers from chromatin preventing pathologic remodelling after pressure overload (PO). This suggests a major role for BET proteins in HF development and demonstrates their therapeutic potential. However, JQ1 acts systemically and simultaneously inhibits all BET proteins making precise conclusions on functions of particular BET members in cardiac cells impossible. This work presents the first in vivo deletion of Brd4 in cardiomyocytes and its impact on the healthy and diseased murine heart.

Purpose

This study aims to analyse if deleting Brd4 in cardiomyocytes can protect the heart from pathologic remodelling after PO as observed with BET inhibition.

Methods

The αMHC-MerCreMer line and a conditional Brd4 allele were used to induce a knockout of Brd4 (Brd4 KO) in cardiomyocytes by tamoxifen application (i.p. 3x30 mg/kg/day) at postnatal week 5. Transverse aortic constriction (TAC) was used to induce PO in 8 weeks old mice. Global gene expression changes in Brd4 KO mice were analysed by mRNA sequencing.

Results

Adult Brd4 KO mice showed left ventricular (LV) wall thickening, increased LV mass, cardiomyocyte hypertrophy and mild interstitial fibrosis in comparison to control but lived for over 1 year and showed normal ejection fraction. Transcriptome analysis of Brd4 KO hearts revealed the induction of a pathologic gene program like the expression of fetal genes such as Myh7 or Acta1, Nppa, and Nppb and genes involved in extra cellular matrix organization. After TAC, Brd4 KO mice showed higher mortality with a median survival of 37 days in comparison to 132 days in the control group. However, Brd4 KO mice that survived the acute phase showed significantly higher ejection fraction than control 10 weeks after TAC. Despite the basal hypertrophy, Brd4 KO mice showed no further pathologic remodelling in response to PO and had significantly lower LV weights and diameters.

Conclusions

The development of concentric hypertrophy, expression of fetal genes, and fibrosis with preserved ejection fraction in Brd4 KO animals resemble typical characteristics of hypertrophic cardiomyopathy, and the increased mortality after TAC is likely due to diastolic dysfunction or arrythmias. However, surviving Brd4 KO mice show limited remodelling and partially preserved heart function suggesting cardio-protective potential as previously observed with BET inhibition. Together with relevant literature our findings suggest two distinct roles for Brd4, co-repression of hypertrophy genes in the healthy heart and their co-activation in response to stress.

Acknowledgement/Funding

German Research Foundation - Collaborative Research Center 1002

Cutaneous granulomas with primary immunodeficiency in children: a report of 17 new patients and a review of the literature

BACKGROUND

Paediatric cutaneous granuloma with primary immunodeficiency (PID) is a rare condition. The physiopathology is unclear, and treatment is challenging. We report on 17 paediatric cases and review the literature.

OBJECTIVES

To make dermatologists and dermatopathologists aware of the diagnostic value of skin granulomas in paediatric PID.

METHODS

We collected data on 17 patients with cutaneous granulomas and PID registered with us and also reviewed 33 cases from the literature.

RESULTS

Cutaneous granuloma was the presenting feature of the PID in 15 of the 50 collated cases. The lesions presented as red-brownish nodules and infiltrated ulcerative plaques, predominantly on the face and limbs. Scleroderma-like infiltration on a single limb was observed in 10% of the cases. The associated PID was ataxia-telangiectasia (52%), combined immunodeficiency (24%), cartilage-hair hypoplasia (6%) and other subtypes (18%). The granulomas were mostly sarcoidal, tuberculoid, palisaded or undefined subtypes. In some patients, several different histopathologic granulomatous patterns were found in the same biopsy. Some granulomas were associated with the presence of a vaccine strain of rubella virus.

CONCLUSION

Cutaneous granulomas associated with a PID have a variable clinical presentation. A PID can be suspected when crusty, brownish lesions are found on the face or limbs. The concomitant presence of several histological subtypes in a single patient is suggestive of a PID.