The endocannabinoid system is modulated in reward and homeostatic brain regions following diet-induced obesity in rats: a cluster analysis approach

Objectives

Increased availability of high-calorie palatable food in most countries has resulted in overconsumption of these foods, suggesting that excessive eating is driven by pleasure, rather than metabolic need. The behavior contributes to the rise in eating disorders, obesity, and associated pathologies like diabetes, cardiac disease, and cancers. The mesocorticolimbic dopamine and homeostatic circuits are interconnected and play a central role in palatable food intake. The endocannabinoid system is expressed in these circuits and represents a potent regulator of feeding, but the impact of an obesogenic diet on its expression is not fully known.

Methods

Food intake and body weight were recorded in male Wistar rats over a 6-week free-choice regimen of high fat and sugar; transcriptional regulations of the endocannabinoid system were examined post-mortem in brain reward regions (prefrontal cortex, nucleus accumbens, ventral tegmental area, and arcuate nucleus). K-means cluster analysis was used to classify animals based on individual sensitivity to obesity and palatable food intake. Endocannabinoid levels were quantified in the prefrontal cortex and nucleus accumbens. Gene expression in dopamine and homeostatic systems, including ghrelin and leptin receptors, and classical homeostatic peptides, were also investigated.

Results

The free-choice high-fat -and sugar diet induced hyperphagia and obesity in rats. Cluster analysis revealed that the propensity to develop obesity and excessive palatable food intake was differently associated with dopamine and endocannabinoid system gene expression in reward and homeostatic brain regions. CB2 receptor mRNA was increased in the nucleus accumbens of high sugar consumers, whereas CB1 receptor mRNA was decreased in obesity prone rats.

Conclusions

Transcriptional data are consistent with observations of altered dopamine function in rodents that have access to an obesogenic diet and point to cannabinoid receptors as GPCR targets involved in neuroplasticity mechanisms associated with maladaptive intake of palatable food.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-021-02613-0.

THU0215 WHOLE BLOOD TRANSCRIPTIONAL CHANGES FOLLOWING SELECTIVE INHIBITION OF JANUS KINASE 1 (JAK1) BY FILGOTINIB IN ADULTS WITH MODERATELY-TO-SEVERELY ACTIVE RHEUMATOID ARTHRITIS WITH PRIOR INADEQUATE RESPONSE TO METHOTREXATE (FINCH1)

Background:

Filgotinib (FIL), an oral selective JAK1 inhibitor, has shown efficacy and safety in multiple phase 3 studies in adults with moderately-to-severely active rheumatoid arthritis (RA). We have previously described the molecular response to FIL in large-scale RNA sequencing studies of gene expression in other RA populations1-3and herein conducted a similar study in RA patients (pts) with prior inadequate response to methotrexate (MTX; FINCH1).

Objectives:

Identify RA-associated gene transcripts and biological pathways that are altered in response to FIL treatment.

Methods:

RA pts who had an inadequate response to MTX were enrolled in FINCH1 (ClinicalTrials.govNCT02889796) and randomized to receive either a stable dose of MTX with placebo (PBO+MTX), adalimumab (ADA+MTX), or one of two doses of FIL (FIL 100mg+MTX, FIL 200mg+MTX) once daily (QD). Whole blood samples were collected from pts using PAXgene tubes at baseline, week 4, and week 12. RNA from these samples was extracted and sequenced on the Illumina HiSeq 2500 platform following globin RNA depletion. Correlations between baseline gene expression and disease measurements were performed using Spearman’s rank partial correlation with covariates. Differentially expressed genes (DEGs) were identified using voom-limma. Pathway analysis was performed on v6.1 of the Molecular Signature Database using single sample gene set enrichment analysis (GSEA) with the focus on immune signaling pathways from the Kyoto Encyclopedia of Genes and Genomes (KEGG). A false-discovery rate of 5% was applied for all analyses.

Results:

Differential gene expression analyses comparing baseline samples with after-treatment samples revealed more rapid transcriptional kinetics for FIL-treated pts compared to ADA+MTX-treated pts. No significant DEGs were observed in PBO-treated pts. More significant DEGs were observed in the FIL 200mg+MTX arm compared to the FIL 100mg+MTX arm, consistent with the superior clinical efficacy of the FIL 200mg dosage. As with other FIL clinical trial RNA-seq studies and consistent with the selective MoA of FIL, JAK-STAT pathway-induced genes SOCS2 and CISH were significantly downregulated across both FIL treatment arms and timepoints, but not in the ADA+MTX arm. RA disease activity associated genes2-3FAM20A and METTL7B were significantly reduced at both 4 and 12 weeks only in the FIL 200mg+MTX arm. While no significant changes in KEGG immune signaling pathways were observed in the PBO+MTX arm, a dose-dependent effect on pathway modulation was observed in the FIL arms. The most prominently down-regulated KEGG pathways included JAK-STAT signaling and leukocyte transendothelial migration.

Conclusion:

More rapid and sustained changes of transcriptional activity were observed in the whole blood transcriptional profile of RA pts following FIL 200mg+MTX compared to ADA+MTX treatment. Dose-dependent changes were observed in FIL-treated pts, most notably in the KEGG JAK-STAT signaling pathway. These observations confirm an inhibition of JAK-STAT signaling by FIL and are consistent with the observed clinical efficacy of FIL in these pts.

References:

[1]Taylor PC, et al. (EULAR 2018).http://dx.doi.org/10.1136/annrheumdis-2018-eular.3759

[2]Taylor PC, et al. (ACR 2018).https://doi.org/10.1093/rheumatology/kez105.001

[3]Taylor PC, et al. (EULAR 2019).http://dx.doi.org/10.1136/annrheumdis-2019-eular.2509

Acknowledgments :

This study was funded by Gilead Sciences, Inc. Editorial support was provided by Fishawack Communications Inc and funded by Gilead Sciences, Inc.

Disclosure of Interests: :

Peter C. Taylor Grant/research support from: Celgene, Eli Lilly and Company, Galapagos, and Gilead, Consultant of: AbbVie, Biogen, Eli Lilly and Company, Fresenius, Galapagos, Gilead, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Roche, and UCB, Bryan Downie Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Emon Elboudwarej Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Sam Kim Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Angie Hertz Shareholder of: Gilead Sciences Inc, Employee of: Gilead Sciences Inc, Amer M. Mirza Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Jeffrey Siegel Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Rachael E. Hawtin Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Jinfeng Liu Shareholder of: Gilead Sciences Inc., Roche, Employee of: Gilead Sciences Inc.

FRI0285 FILGOTINIB TREATMENT RESULTS IN REDUCTION OF BIOMARKERS ASSOCIATED WITH DISEASE IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

Ankylosing spondylitis (AS) is a chronic, immune-mediated disease characterized by inflammation of the sacroiliac joints and spine, and a young age of onset of 20–40 years. In the recent TORTUGA study, filgotinib (FIL), an oral, selective Janus kinase 1 (JAK1) inhibitor, significantly reduced AS disease activity compared with placebo (PBO).1Selective JAK1 inhibition by FIL has the potential to simultaneously block multiple inflammatory pathways, thus we analyzed biomarker concentrations in serum samples from TORTUGA.

Objectives:

To evaluate the impact of selective JAK1 inhibition with FIL on circulating disease associated biomarkers in adult patients with active AS enrolled in the TORTUGA study.

Methods:

TORTUGA (Clinicaltrials.gov identifierNCT03117270) was a 12-week, randomized, double-blind, placebo-controlled, phase 2 study. Patients were randomized 1:1 to FIL 200 mg (n=58) or PBO (n=58) once-daily. Serum samples (FIL n=56, PBO n=53) were collected at baseline (BL) and weeks 1, 4 and 12, and analyzed using the Meso Scale Discovery immunoassay platform (Meso Scale Diagnostics, Rockville, MD, USA) to evaluate 135 biomarkers. Biomarker concentration changes from BL were analyzed on paired patient data and reported for weeks 1, 4 and 12, and clustering analysis was performed. Correlation between the 135 biomarkers and selected clinical scores at BL was assessed by Spearman rank correlation analysis.

Results:

FIL treatment produced significant reductions in serum concentrations of multiple biomarkers associated with AS disease activity. Five clusters of biomarker response were identified based on the kinetics and magnitude of percent changes from BL. These clusters also represented discrete biological functions: cluster 1 (rapid, strong >50% decrease in all three time points) included systemic inflammation biomarkers eg, CRP, SAA; cluster 2 (>20% decrease in at least one time point) included immune cell biomarkers eg, MIP3B, IL12p40; cluster 3 (<20% decrease in all three time points) included cellular adhesion biomarkers eg, ICAM-1, VCAM-1; cluster 4 (delayed decrease) included matrix remodelling biomarkers eg, MMP1, TIMP1; and cluster 5 included biomarkers that exhibited a gradual increase in serum concentration with FIL treatment.

Spearman rank correlation analyses showed that at BL, the systemic inflammation biomarkers CRP and SAA, as well as a number of biomarkers including ICAM-1 and MMP3, were positively correlated with BL AS disease activity score (ASDAS); conversely, only a few biomarkers showed a negative correlation with BL ASDAS, the cytokine receptor FLT3 and the chemotactic cytokine fractalkine (FRACTAL).

Conclusion:

In patients with active AS, FIL treatment significantly decreased levels of circulating biomarkers associated with active AS disease, including proinflammatory cytokines and chemokines, cell adhesion molecules, and markers of matrix remodelling. Clustering analysis revealed early and late biomarker changes associated with disease. These data are consistent with reduced AS disease activity in TORTUGA and suggest that FIL treatment leads to a rapid and sustained reduction of inflammation in AS.

References:

[1]van der Heijde Det al. Lancet2018;392:2378–87

Acknowledgments:

This study was funded by Gilead Sciences, Inc. Editorial support was provided by Fishawack Communications Inc and funded by Gilead Sciences, Inc.

Disclosure of Interests:

Walter P. Maksymowych Grant/research support from: AbbVie, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Employee of: Chief Medical Officer of CARE Arthritis Limited, Speakers bureau: AbbVie, Janssen, Novartis, Pfizer, and UCB, Yuan Tian Employee of: Gilead Sciences Inc., Oh Kyu Yoon Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., William Barchuk Shareholder of: Gilead Sciences Inc and Eli Lilly, Employee of: Current employee of Gilead Sciences Inc and a former employee of AbbVie, Eli Lilly, and Johnson & Johnson, René Galien Shareholder of: Galapagos, Employee of: Galapagos, Robin Besuyen Shareholder of: Galapagos, Employee of: Galapagos, Yihua Liu Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Amer M. Mirza Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Vlad Malkov Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Angie Hertz Shareholder of: Gilead Sciences Inc, Employee of: Gilead Sciences Inc

SAT0155 WHOLE BLOOD TRANSCRIPTIONAL CHANGES FOLLOWING SELECTIVE INHIBITION OF JANUS KINASE 1 (JAK1) BY FILGOTINIB IN MTX-NAÏVE ADULTS WITH MODERATELY-TO-SEVERELY ACTIVE RHEUMATOID ARTHRITIS (RA) (FINCH3)

Background:

Filgotinib (FIL), an oral selective JAK1 inhibitor, has shown efficacy and safety in multiple phase 3 studies in adults with moderately-to-severely active rheumatoid arthritis (RA). We have previously described the molecular response to FIL in large-scale RNA sequencing studies of gene expression in other RA populations1-3and conducted a similar study in methotrexate (MTX)-naïve RA patients (pts) (FINCH3).

Objectives:

Identify gene transcripts and biological pathways associated with RA and those altered in response to FIL treatment.

Methods:

MTX-naïve RA pts who were enrolled in FINCH3 (ClinicalTrials.govNCT02886728) received a stable dose of MTX with placebo (PBO+MTX), FIL 200mg alone (FIL 200mg monotherapy), or one of two doses of FIL once daily (QD) together with MTX (FIL 100mg+MTX, FIL 200mg+MTX). Whole blood samples were collected from pts using PAXgene tubes at baseline, week 4, week 12, and week 24. RNA from these samples was extracted and sequenced on the Illumina HiSeq 2500 platform following globin RNA depletion. Correlations between baseline gene expression and disease measurements were performed using Spearman’s rank partial correlation to account for covariates. Differentially expressed genes (DEGs) were identified using voom-limma. Biological pathway analyses were performed on v6.1 of the Molecular Signature Database using single sample gene set enrichment analysis (GSEA) with the focus on immune signaling pathways from the Kyoto Encyclopedia of Genes and Genomes (KEGG). A false-discovery rate of 5% was applied for all analyses.

Results:

Differential gene expression analyses comparing baseline samples with after-treatment samples revealed rapid onset of transcriptional changes in FIL-treated pts, most notably for the two FIL 200mg arms. Fewer DEGs were observed at all timepoints in PBO+MTX treated patients with a peak number at week 24, an observation consistent with the clinical response kinetics of MTX.4Up to 3x as many significant DEGs were observed in the FIL 200mg+MTX arm compared to the FIL 100mg+MTX arm, a finding consistent with the superior clinical efficacy of the FIL 200mg dosage. As with other FIL clinical trial RNA-seq studies and consistent with the selective MoA of FIL, JAK-STAT pathway-induced genes SOCS2 and CISH were significantly downregulated across FIL treatment arms and timepoints, but not for PBO+MTX. RA disease activity-associated genes2-3FAM20A and METTL7B were significantly reduced at all timepoints in FIL-treated pts, but only at week 24 in PBO+MTX pts. While no significant changes in KEGG immune signaling pathways were observed in the PBO+MTX arm, a dose-dependent effect on pathway modulation was observed in the FIL arms, including reductions in JAK-STAT, toll-like receptor, chemokine, and RIG-I like receptor signaling.

Conclusion:

More rapid and sustained changes of transcriptional activity in the whole blood transcriptional profile of RA pts after FIL treatment were found compared to PBO+MTX. Dose-dependent changes were observed in FIL-treated pts, most notably in the KEGG JAK-STAT signaling pathway. These observations confirm an inhibition of JAK-STAT signaling by FIL and are consistent with the observed clinical efficacy of FIL in these pts.

References:

[1]Taylor PC, et al. (EULAR 2018).http://dx.doi.org/10.1136/annrheumdis-2018-eular.3759

[2]Taylor PC, et al. (ACR 2018).https://doi.org/10.1093/rheumatology/kez105.001

[3]Taylor PC, et al. (EULAR 2019).http://dx.doi.org/10.1136/annrheumdis-2019-eular.2509

[4]Taylor PC, et al. J Clin Med. 2019;8(4): pii: E515. doi: 10.3390/jcm8040515

Acknowledgments:

This study was funded by Gilead Sciences, Inc. Editorial support was provided by Fishawack Communications Inc and funded by Gilead Sciences, Inc.

Disclosure of Interests:

Peter C. Taylor Grant/research support from: Celgene, Eli Lilly and Company, Galapagos, and Gilead, Consultant of: AbbVie, Biogen, Eli Lilly and Company, Fresenius, Galapagos, Gilead, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Roche, and UCB, Bryan Downie Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Emon Elboudwarej Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Sam Kim Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Angie Hertz Shareholder of: Gilead Sciences Inc, Employee of: Gilead Sciences Inc, Amer M. Mirza Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Jeffrey Siegel Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Rachael E. Hawtin Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Jinfeng Liu Shareholder of: Gilead Sciences Inc., Roche, Employee of: Gilead Sciences Inc.

Analysis of a territorial approach to the delivery of nursing home care services based on historical data

We analyze a territorial approach to deliver nursing homecare services to a territory public health. We present the case of the CSSS assigned to Côte-des-Neiges, Métro center and Parc Extension, specifically the case of the Côte-des-Neiges site (CLSC CDN), where a territorial approach is used since 1980. We first give an historical comparison of patient visits delivered in 1998-1999 and in 2002-2003. We follow with an in-depth analysis of the home services delivered in 2002-2003 to determine whether or not the territorial approach can well support the changing needs of the population. We conclude that the territorial approach to deliver homecare nursing services does not sufficiently support fluctuations in population needs for services. Not only is it difficult to predict these fluctuations, but it is difficult to accurately quantify the true needs for services since the availability of nursing services tends to determine the services actually delivered. In sectors of the territory where resources are more scarce (based on previous population needs analyses) or demand for services is greater, the result is work overload for the nursing staff. In addition, this results in service delivery inequities across the entire territory. Therefore, a more dynamic assignment of clients to the nurses based on each nurse's work load and case load rather than based on the geographic location of clients is worth the extra administrative time in case assignment to ensure a more equitable case load attribution between nurses as well as less inequities between clients in terms of service delivery considering their needs.

Cost-effectiveness of a systematic training programme in breast self-examination

Breast self-examination (BSE) appears to be an effective method for earlier detection of breast cancer. The provision of specialized training programmes in BSE may increase the awareness of breast cancer as well as improve the practice of BSE. This study assessed the cost-effectiveness of a BSE programme that a Danish health authority is considering implementing. A model was developed that related the cost of training (of a specified target group) to the anticipated effects of the training. These anticipated effects included increased knowledge of BSE, more routine use of BSE, fewer cases diagnosed with breast cancer where the tumour is larger than 20 mm and fewer cases where the cancer has spread to lymph nodes. The model was calibrated with data synthesized from the literature, own survey data and local expert guess. In the baseline scenario, the incremental cost per person with better knowledge of BSE was estimated to be 106 euro (2002 price level), the cost per person who begins to undertake BSE to be 180 euro, and the cost per person who correctly applies the technique to be 142 euro. The cost per avoided cancer with spreading to lymph nodes was estimated to be 15 410 euro and the cost of avoiding a cancer tumour larger than 20 mm to be 16 318 euro. Sensitivity analysis showed that these cost-effectiveness ratios varied with different assumptions for the effects of BSE training.

Agricultural pesticide use in California: pesticide prioritization, use densities, and population distributions for a childhood cancer study

Several studies have suggested an association between childhood cancer and pesticide exposure. California leads the nation in agricultural pesticide use. A mandatory reporting system for all agricultural pesticide use in the state provides information on the active ingredient, amount used, and location. We calculated pesticide use density to quantify agricultural pesticide use in California block groups for a childhood cancer study. Pesticides with similar toxicologic properties (probable carcinogens, possible carcinogens, genotoxic compounds, and developmental or reproductive toxicants) were grouped together for this analysis. To prioritize pesticides, we weighted pesticide use by the carcinogenic and exposure potential of each compound. The top-ranking individual pesticides were propargite, methyl bromide, and trifluralin. We used a geographic information system to calculate pesticide use density in pounds per square mile of total land area for all United States census-block groups in the state. Most block groups (77%) averaged less than 1 pound per square mile of use for 1991-1994 for pesticides classified as probable human carcinogens. However, at the high end of use density (> 90th percentile), there were 493 block groups with more than 569 pounds per square mile. Approximately 170,000 children under 15 years of age were living in these block groups in 1990. The distribution of agricultural pesticide use and number of potentially exposed children suggests that pesticide use density would be of value for a study of childhood cancer.