Evaluation of a whole-exome sequencing pipeline and benchmarking of causal germline variant prioritizers

Most causal variants of Mendelian diseases are exonic. Whole-exome sequencing (WES) has become the diagnostic gold standard, but causative variant prioritization constitutes a bottleneck. Here we assessed an in-house sample-to-sequence pipeline and benchmarked free prioritization tools for germline causal variants from WES data. WES of 61 unselected patients with a known genetic disease cause was obtained. Variant prioritizations were performed by diverse tools and recorded to obtain a diagnostic yield when the causal variant was present in the first, fifth, and 10th top rankings. A fraction of causal variants was not captured by WES (8.2%) or did not pass the quality control criteria (13.1%). Most of the applications inspected were unavailable or had technical limitations, leaving nine tools for complete evaluation. Exomiser performed best in the top first rankings, while LIRICAL led in the top fifth rankings. Based on the more conservative top 10th rankings, Xrare had the highest diagnostic yield, followed by a three-way tie among Exomiser, LIRICAL, and PhenIX, then followed by AMELIE, TAPES, Phen-Gen,  AIVar, and VarNote-PAT. Xrare, Exomiser, LIRICAL, and PhenIX are the most efficient options for variant prioritization in real patient WES data.

A genome-wide association study of survival in patients with sepsis

BACKGROUND

Sepsis is a severe systemic inflammatory response to infections that is accompanied by organ dysfunction and has a high mortality rate in adult intensive care units. Most genetic studies have identified gene variants associated with development and outcomes of sepsis focusing on biological candidates. We conducted the first genome-wide association study (GWAS) of 28-day survival in adult patients with sepsis.

METHODS

This study was conducted in two stages. The first stage was performed on 687 European sepsis patients from the GEN-SEP network and 7.5 million imputed variants. Association testing was conducted with Cox regression models, adjusting by sex, age, and the main principal components of genetic variation. A second stage focusing on the prioritized genetic variants was performed on 2,063 ICU sepsis patients (1362 European Americans and 701 African-Americans) from the MESSI study. A meta-analysis of results from the two stages was conducted and significance was established at p < 5.0 × 10-8. Whole-blood transcriptomic, functional annotations, and sensitivity analyses were evaluated on the identified genes and variants.

FINDINGS

We identified three independent low-frequency variants associated with reduced 28-day sepsis survival, including a missense variant in SAMD9 (hazard ratio [95% confidence interval] = 1.64 [1.37-6.78], p = 4.92 × 10-8). SAMD9 encodes a possible mediator of the inflammatory response to tissue injury.

INTERPRETATION

We performed the first GWAS of 28-day sepsis survival and identified novel variants associated with reduced survival. Larger sample size studies are needed to better assess the genetic effects in sepsis survival and to validate the findings.

A catalog of the genetic causes of hereditary angioedema in the Canary Islands (Spain)

Hereditary angioedema (HAE) is a rare disease where known causes involve C1 inhibitor dysfunction or dysregulation of the kinin cascade. The updated HAE management guidelines recommend performing genetic tests to reach a precise diagnosis. Unfortunately, genetic tests are still uncommon in the diagnosis routine. Here, we characterized for the first time the genetic causes of HAE in affected families from the Canary Islands (Spain). Whole-exome sequencing data was obtained from 41 affected patients and unaffected relatives from 29 unrelated families identified in the archipelago. The Hereditary Angioedema Database Annotation (HADA) tool was used for pathogenicity classification and causal variant prioritization among the genes known to cause HAE. Manual reclassification of prioritized variants was used in those families lacking known causal variants. We detected a total of eight different variants causing HAE in this patient series, affecting essentially SERPING1 and F12 genes, one of them being a novel SERPING1 variant (c.686-12A&gt;G) with a predicted splicing effect which was reclassified as likely pathogenic in one family. Altogether, the diagnostic yield by assessing previously reported causal genes and considering variant reclassifications according to the American College of Medical Genetics guidelines reached 66.7% (95% Confidence Interval [CI]: 30.1-91.0) in families with more than one affected member and 10.0% (95% CI: 1.8-33.1) among cases without family information for the disease. Despite the genetic causes of many patients remain to be identified, our results reinforce the need of genetic tests as first-tier diagnostic tool in this disease, as recommended by the international WAO/EAACI guidelines for the management of HAE.

AB0913 EFFICACY AND SAFETY OF SWITCHING FROM FILGOTINIB TO TOFACITINIB IN PATIENTS WITH PSORIATIC ARTHRITIS AFTER 6 MONTHS OF FOLLOW-UP

Background

Phase 2 studies have shown that Filgotinib (FIL), a JAK-inhibitor (JAKi), significantly improves signs and symptoms of psoriatic arthritis (PsA) in patients with active disease. PENGUIN 1 and 2 were two phase III trials of FIL in PsA that were stopped. We considered Tofacitinib (TOFA) the best alternative drug for these patients because TOFA is the only JAKi approved so far in Spain for PsA. However, data in clinical practice about switching from FIL to TOFA have not been reported.

Objectives

To assess the efficacy and safety of switching FIL to TOFA in patients with PsA.

Methods

Prospective Single-University-hospital study of PsA patients diagnosed according to CASPAR criteria, and previously treated with FIL 100 mg and 200 mg/day in two clinical trials (PENGUIN 1 and 2). Based on a shared decision between the patient and the physician, once the trial was finished, patients receiving FIL were switched to TOFA (5 mg/12h) with a 7 days wash-up period. PsA activity, analytical and ultrasound outcomes were assessed at baseline and after 1, 3 and 6 months of treatment with TOFA.

A power doppler ultrasound score (PDUS) was obtained using a scoring system which assessed bilateral midline wrists, metacarpophalangeal joints 1-5, proximal and distal interphalangeal joints 2–5 in hands and feet, bilateral knees, ankles and metatarsophalangeal joints 2-5 (apart from any other painful joint). Each image was scored semi-quantitatively on a scale of 0-3.

We used MASEI index for the enthesis US evaluation (that includes entheses at 6 sites: proximal plantar fascia, distal Achilles tendon, distal and proximal patellar tendon insertion, distal quadriceps tendon and distal brachial triceps tendon). We also evaluated in these enthesis the presence/absence (0/1) of PD signal as it is the main activity signal.

Results

We included 11 patients (6 women/5 men) with a mean age of 52.5±6.5 years who had received FIL during a mean time of 16.0±9.3 weeks. JAKi was used in monotherapy or combined with sulfasalazine (n=2), methotrexate (n=1) and apremilast (n=1).

Disease activity, US scores and laboratory values during the follow-up are shown in Table 1. No significant changes were observed in any case.

Table 1.

Psoriatic Arthritis activity, ultrasound and analytical outcomes at baseline, month 1, 3 and 6.

BaselineMonth 1Month 3Month 6pMusculoskeletal activity scores, median [IQR]TJC – no.2 [0-3]3 [1.5-16]1 [0-12]2 [0-5]0.22SJC – no.0 [0-0]0 [0-5]0 [0-6]0 [0-2]0.09Ultrasound exam, median [IQR]PDUS score (0-90)2 [1-9]3 [1-6]2 [0-4]2 [2-9]0.99Enthesitis according to PDUS (n)1 [0-2]1 [0-2]0 [0-2]1 [0-1]0.85MASEI index16.5 ±10.519.6 ± 14.515.5 ± 4.817.5 ± 11.80.82Laboratory valuesHemoglobin (g/dl) - mean±SD13.96 ± 1.4013.54 ± 1.3813.79 ±1.6014.40 ± 1.750.64Leucocytes (x103/µL) - mean±SD7.10 ± 3.407.27 ± 2.967.14 ± 2.898.20 ± 2.870.89Lymphocytes (x103/µL) - mean±SD2.03 ± 1.011.94 ± 0.952.16 ± 0.861.96 ± 0.450.94Neutrophils (x103/µL) - mean±SD4.24 ± 2.924.54 ± 1.974.18 ± 1.845.30 ± 2.370.85Platelet count (x103/µL) - mean±SD266.44 ± 57.35250.67 ± 53.29264.90 ± 56.78287.20 ± 25.580.69CRP (mg/dl) - median [IQR]0.00 [0.00-1.70]0.00 [0.00-0.00]0.00 [0.00-0.00]0.00 [0.00-0.00]0.12ESR (mm/h) - median [IQR]15 [6-19]9 [5-15]12 [4-15]13 [5-45]0.12

CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; MASEI: Madrid Sonographic Enthesis Index; TJC: Tender joint count; PDUS: Power doppler ultrasound; SJC: Swollen joint count.

No adverse events were reported during the 6 month of follow-up except for 1 patient with lymphopenia (500/µL).

TOFA was discontinued after 1 month in 1 patient because of lypmphopenia and inefficacy and after 3 months in 4 patients for worsening of the joint pain. It was remarkable that in some of the patients who reported a worsening of painful joints we did not observed a higher inflammatory activity in the SJC or US exam, and this incongruity could be due to the role that JAK/STAT inhibition plays in pain signaling pathways.

Conclusion

Switching from FIL to TOFA appears to be an effective and safe therapeutic option.

Disclosure of Interests

None declared

AB0279 HERPES ZOSTER IN RHEUMATOID ARTHRITIS. PROSPECTIVE SINGLE UNIVERSITY CENTER STUDY

Background

Patients with Rheumatoid arthritis (RA) have an increased risk of infections due to the disease itself, and/or immunosuppressive therapy. The risk of herpes zoster (HZ) including disseminated HZ is also increased(1)

Objectives

In an unselected series of RA patientswe assessa)prevalence, b)general features and c) predictive factors of HZ.

Methods

Study of 393 RA patients included in the prospective vaccination program of the Preventive Medicine and Rheumatology department of a University hospital, from October 2011 to October 2016. The minimum follow-up was of 12 months; therefore, it was made until December 2020. HZ vaccination is not included in our vaccination program.

RA was diagnosed according to the ACR/EULAR 2010 criteria. HZ was diagnosed if presented: characteristic skin rash and blisters, paresthesia and local pain, in one (localized) or more dermatomes (generalized).

Information on patients and HZ characteristics was retrieved from the hospital and general physician records.

Results

We studied 393 patients (310 women), mean age 61.5±11.9 years. They were followed-up during a mean period of 82.6±15.2 months(range; 50 months-9 years).

HZ infection was observed in 31 of 393 patients (7.9%) (26 women); mean age 67.5±11.6ys. Prevalence of HZ in this period (122months) was 7.88% with an annual incidence rate of 0.73/100 patients/year. A comparison between patients with and without HZ was performed (Table 1).

Table 1.

Main features of different groups

VariablesRA patientsN= 393RA with HZN=31RA without HZN=362PHZ vs noHZVariables (continued)RA patientsN= 393RA with HZN=31RA without HZN=362PHZ vs noHZAge (years) (men±SD)59.4±12.964.7±11.859.1±12.90.02MTX365 (92.87)29 (93.54)336 (92.81)0.87Sex (women)(%)309(78.62)25 (80.6)284 (78.5)0.95LFN127 (32.31)12 (38.70)115 (31.76)0.42RA Evolution(months) (mean±SD)136.9±109.8155.3±117.0135.30±109.20.33SSZ94 (23.91)7 (22.58)87 (24.03)0.78Hypertension, n(%)165 (42.0)19 (61.3)146 (40.3)0.04Anti-TNFa, n (%)Diabetes Mellitus, n(%)55 (14.0)7 (22.6)48 (13.3)0.24ADA144 (36.6)15 (48.4)129 (35.6)0.22Dislypidemia, n(%)149 (37.9)15 (48.4)134 (37.0)0.29ETN139(35.4)16 (51.6)123 (33.9)0.05RAfeatures, n(%)IFX40 (10.1)5 (16.1)35 (9.7)0.25PositiveRF224 (57.0)17 (54.8)207 (57.2)0.95GLM33 (8.4)3 (9.7)30 (8.3)0.74PositiveACPA207 (52.7)13 (41.9)194 (53.6)0.29CZP13 (3.3)1 (3.2)12 (3.3)0.97Erosions145 (36.9)10 (32.3)135 (37.3)0.71Non anti-TNFa n (%)Subcutaneousnodules22 (5.6)1 (4.6)21 (5.8)0.85TCZ134 (34.1)16 (51.6)118 (32.6)0.05Pulmonary fibrosis20 (5.1)3 (9.7)17 (4.7)0.20RTX69 (17.5)9 (29.0)60 (16.7)0.13Associated Sjögren Syndrome20 (5.1)1 (3.2)19 (5.3)0.95ABA55 (13.9)6 (19.3)49 (13.5)0.41Vasculitis23 (5.9)2 (6.5)21 (5.8)0.7SARI2 (5.1)1 (3.2)1 (0.3)0.03RATreatment, n (%)JAK inhibitors n (%)Prednisone139 (35.4)19 (61.3)120 (33.1)0.04BARI32 (8.14)3 (9.67)29 (8.01)0.73Prednisona>5mg/d13 (3.30)5 (16.1)8 (2.20)0.001TOFA17 (4.32)3 (9.67)14 (3.87)0.14ConventionalDMARDsUPA4 (1.01)1 (3.22)3 (0.83)0.20

HZ locations were intercostal (n=6), dorsal (5), abdominal (3), lumbar (3), facial (3), cervical (1), gluteus (1), submmamary fold (1), intermmamary fold (1) and upper extremity (1). Main HZ complications were post-herpetic neuralgia (n=7), visual alteration in facial HZ (n=1) and disseminated HZ(n=1).

HZ treatment was anitiviral agents (n=23) (brivudine=7; acyclovir 6; famciclovir6; valaciclovir4), topic (n=2) and none (n=6).

Predictive factors for HZ(Figure 1) were older age (>65 years), hypertension and treatment with high prednisone dose and antiTNF.

Figure 1.

Predictive factors for Herpes zoster

Conclusion

HZ is a relative frequent complication of RA. In our series, although are usually localized, post-herpetic neuralgia is relatively frequent. Probably to include HZ vaccine in our vaccination program of RA may be useful.

References

[1]Robert Harrington et al., J Inflamm Res, 2020 14;13:519-531

Disclosure of Interests

None declared

POS0405 INCREASED LEVELS OF CELLULAR ADHESION MOLECULES ARE LINKED TO THE PRESENCE OF INTERSTITIAL LUNG DISEASE IN PATIENTS WITH AUTOIMMUNE DISEASES

Background

Intercellular adhesion molecule-1 (ICAM-1) and E-Selectin are adhesion molecules considered as markers of underlying endothelial activity and damage. These molecules are known to play an important role in autoimmune disease (AD) [1]. Accordingly, they may contribute to the development of interstitial lung disease (ILD), one of the main causes of death in patients with AD [2]. In fact, they have been proposed as prognostic biomarkers in idiopathic pulmonary fibrosis (IPF) [3]. However, studies on the role of ICAM-1 and E-Selectin in AD-ILD+ are scarce.

Objectives

To study the role of ICAM-1 and E-Selectin in the pathogenesis of AD-ILD+.

Methods

Peripheral venous blood was collected from 57 patients with AD-ILD+ and three comparative groups: 45 AD-ILD- patients, 21 IPF patients and 21 healthy controls (HC). All the subjects were recruited from the Rheumatology and Pneumology departments of Hospital Universitario Marqués de Valdecilla, Santander, Spain. ICAM-1 and E-Selectin levels were measured in serum samples by enzyme-linked immunosorbent assay.

Results

Higher levels of ICAM-1 and E-Selectin were found in patients with AD-ILD+ compared to AD-ILD- patients (p<0.001 and p=0.001, respectively) and HC (p<0.001 in both cases). Likewise, IPF patients showed increased levels of ICAM-1 and E-Selectin in relation to AD-ILD- patients (p<0.001 and p=0.002, respectively) and HC (p<0.001 in both cases). However, no statistically significant difference in ICAM-1 and E-Selectin concentrations was observed between AD-ILD+ and IPF patients.

Conclusion

Our study suggests that increased levels of ICAM-1 and E-Selectin are associated with the presence of ILD in AD patients.

References

[1]Int J Mol Sci 2014;15(7):11324-49;

[2]Expert Rev Clin Immunol 2018;14(1):69-82;

[3]Eur Respir J 2019;54(3):1900295

Acknowledgements

VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL18/01); SR-M is supported by funds of the RETICS Program (RD16/0012/0009) from `Instituto de Salud Carlos III´ (ISCIII), co-funded by the European Regional Development Fund; RL-M is a recipient of a Miguel Servet type I programme fellowship from ISCIII, co-funded by the European Social Fund, `Investing in your future’ (grant CP16/00033).

Disclosure of Interests

Verónica Pulito-Cueto: None declared, Sara Remuzgo-Martínez: None declared, Fernanda Genre: None declared, Belén Atienza-Mateo: None declared, Virginia Portilla: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe Fernández: None declared, Leticia Lera-Gómez: None declared, Diana Prieto-Peña: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Alfonso Corrales: None declared, Oreste Gualillo: None declared, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD, GSK, Grant/research support from: Abbvie, MSD, Janssen, Roche.

AB0069 ASSOCIATION OF NUCLEAR FACTOR OF ACTIVATED T CELLS CYTOPLASMIC 1 (NFATc1) EXPRESSION WITH CARDIOVASCULAR RISK IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS

Background

Nuclear factor of activated T cells (NFAT) is a transcription factor family that plays a crucial role in physiological and immune processes, modulating intracellular and extracellular signaling pathways related with several diseases1,2. In this regard, it has been involved in the pathogenesis of rheumatoid arthritis (RA) and in the development of cardiovascular (CV) disease3-5. Given that CV disease is one of the main causes of morbidity and mortality in patients with RA6, functional studies focused on the implication of NFAT in CV disease in RA are of potential interest.

Objectives

To study the role of the gene expression of two members of the NFAT family, NFATc1 and NFATc2, in the risk of developing CV disease in patients with RA.

Methods

A total of 79 disease-modifying antirheumatic drug-naïve patients with early RA7 from Hospital Universitario Marqués de Valdecilla (Santander, Spain) were included in this study. The relative mRNA expression of NFATc1 and NFATc2 in peripheral blood was determined by qPCR. Carotid ultrasound data were used as surrogate markers of subclinical atherosclerosis. The association between NFATc1 and NFATc2 expression in RA patients and their clinical characteristics was evaluated. Results were adjusted by sex, age at the time of the study and traditional CV risk factors.

Results

A statistically significant increase of NFATc1 mRNA expression was found in women compared to men (fold change=+1.18, p=0.035). In addition, a higher NFATc1 mRNA expression was observed in patients with dyslipidemia compared to those with normal lipid profile (fold change=+1.18, p=0.006). With respect to this, we also disclosed a positive correlation between NFATc1 mRNA expression and low-density lipoprotein cholesterol levels (r=0.27, p=0.039). No significant associations were detected between NFATc2 mRNA expression and clinical characteristics of our RA patients. Carotid ultrasound findings were not related to NFATc1 and NFATc2 expression.

Conclusion

Our study suggests that a higher expression of NFATc1 in peripheral blood is associated with abnormalities in the lipid profile and, consequently, with an increased risk of CV disease in patients with early RA.

References

[1]Annu Rev Immunol.1997;15:707-747;

[2]Nat Rev Immunol.2005;5:472-484;

[3]Autoimmun Rev.2006;5:106-110;

[4]Immunol Rev. 2010;233:286-300;

[5]Front Cardiovasc Med. 2021;8:635172;

[6]Arthritis Rheumatol. 2019;71:351-360;

[7]Arthritis Rheum.2010;62:2569-2581.

Acknowledgements

Study supported by NVAL 19/18 awarded to SR-M (IDIVAL) and partially supported by PI18/00043 (ISCIII). Personal funds, SR-M: RD16/0012/0009 (ISCIII-ERDF); VP-C: PREVAL18/01 (IDIVAL); RL-M: Miguel Servet type I CP16/00033 (ISCIII-ESF).

Disclosure of Interests

Fernanda Genre: None declared, Verónica Pulito-Cueto: None declared, Alfonso Corrales: None declared, Virginia Portilla: None declared, Leticia Lera-Gómez: None declared, Belén Atienza-Mateo: None declared, Oreste Gualillo: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Iván Ferraz-Amaro: None declared, Santos Castañeda: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD and GSK, Grant/research support from: Abbvie, MSD, Janssen, and Roche, Sara Remuzgo-Martínez: None declared

POS0052 ANGIOGENIC T CELLS AS RELEVANT PLAYERS IN THE LUNG VASCULOPATHY OF RHEUMATOID ARTHRITIS, SYSTEMIC SCLEROSIS AND OTHER AUTOIMMUNE DISEASES

Background

Interstitial lung disease (ILD) is a common and life-threatening complication in patients with autoimmune diseases (AD), mainly in those with systemic sclerosis (SSc) and rheumatoid arthritis (RA). Growing evidence indicate that vascular abnormalities constitute the early phase in the pathogenesis of these inflammatory diseases [1]. We recently reported a decrease of angiogenic T cells (TAng), that promote endothelial repair and revascularization cooperating with endothelial progenitor cells (EPC) [2], in patients with AD-ILD+ [3]. Nevertheless, no studies have been conducted on the role of TAng in the presence of ILD in RA, SSc or other AD.

Objectives

To determine the contribution of TAng in the pathogenic processes of vasculopathy and lung fibrosis in RA-ILD+, SSc-ILD+ and other AD-ILD+, as well as their relationship with EPC in all the AD-ILD+ patients.

Methods

Peripheral venous blood was collected from 21 RA-ILD+ patients, 21 SSc-ILD+ patients and 15 patients with other AD-ILD+. Furthermore, we included 4 comparative groups: 25 RA-ILD- patients, 20 SSc-ILD- patients, 21 idiopathic pulmonary fibrosis (IPF) patients and 21 healthy controls (HC). TAng were considered as CD3+CD184+CD31+ cells by flow cytometry. Additionally, EPC data were previously published by Pulito-Cueto et al. [4-5].

Results

Regarding the role of TAng in vasculopathy, the frequencies of these cells were significantly lower in patients with RA-ILD+, SSc-ILD+ and other AD-ILD+, as well as with IPF in relation to HC (p=0.007, p=0.016, p=0.005 and p<0,001, respectively, Figure 1). No differences between RA-ILD- patients, SSc-ILD- patients and HC were found (Figure 1). With respect to TAng involvement in fibrosis, TAng frequencies were similar in patients with RA-ILD+, SSc-ILD+, other AD-ILD+ and those with IPF (Figure 1). Nevertheless, patients with RA-ILD+ and SSc-ILD+ showed significantly lower TAng frequencies than those with RA-ILD- and SSc-ILD-, respectively (p=0.006 and p=0.044, respectively, Figure 1). In this line, a higher frequency of TAng was found in SSc-ILD- and RA-ILD- patients in relation with those with IPF (p<0.001 and p=0.003, respectively, Figure 1). Moreover, TAng frequency did not show significant correlation with EPC frequency in the whole cohort of AD-ILD+ patients.

Figure 1.

Quantification of TAng population by flow cytometry in all individuals included in the study.

Conclusion

TAng play a relevant role in the lung vasculopathy of RA-ILD+, SSc-ILD+ and other AD-ILD+. Interestingly, circulating TAng may be considered as a useful biomarker of the presence of ILD in patients with RA and SSc.

References

[1]Expert Rev Clin Immunol 2018;14(1):69-82.

[2]Rheum Dis 2015;74(5):921–927.

[3]Ann Rheum Dis 2021;80(1):1047-1048.

[4]J Clin Med 2020;9(12):4098.

[5]Biomedicines 2021;9(7):847.

Acknowledgements

VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL18/01); SR-M is supported by funds of the RETICS Program (RD16/0012/0009) from `Instituto de Salud Carlos III´ (ISCIII), co-funded by the European Regional Development Fund; RL-M is a recipient of a Miguel Servet type I programme fellowship from ISCIII, co-funded by the European Social Fund, `Investing in your future’(grant CP16/00033).

Disclosure of Interests

Verónica Pulito-Cueto: None declared, Sara Remuzgo-Martínez: None declared, Fernanda Genre: None declared, Belén Atienza-Mateo: None declared, Virginia Portilla: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe Fernández: None declared, Leticia Lera-Gómez: None declared, Javier Rodriguez Carrio: None declared, Diana Prieto-Peña: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Alfonso Corrales: None declared, Oreste Gualillo: None declared, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD, GSK, Grant/research support from: Abbvie, MSD, Janssen, Roche

AB0280 SERIOUS INFECTIONS-RELATED HOSPITALIZATION IN RHEUMATOID ARTHRITIS. OBSERVATIONAL STUDY OF 392 PATIENTS FROM A SINGLE UNIVERSITY CENTER

Background

Patients with Rheumatoid Arthritis (RA) have an increased risk of infections. This may belinked to disease-related, the immunosuppressive therapy and the co-morbidities.

Objectives

in an unselected group of RA patients, our aim was to assess the a)incidence b)features of disease and c)predictive factors of serious infections-related hospitalization.

Methods

Observational study of all patients diagnosed with RA that were included in the vaccination program of our university hospital between October2011 and October 2016.The minimum follow-up was of 12 months; therefore, it was made until December 2020.

Patients with serious infections-related hospitalization were a) compared with those not requiring hospital admission and, b)identified predictive factors (multivariate analysis adjusted by age and sex).

Vaccination program in our hospital includes vaccination for Influenza, Streptococcus pneumoniae and Haemophilus influenzae.

Information on patients, infections and hospitalizations was retrieved from the hospital and general physician records.

Results

We studied 392RApatients (309women/83men); mean age 63.1±13.7 years.

After a mean follow-up of 71.8±20.6 months, in 88 of 392patients (22.4%) (60 women) 187serious infections-related hospitalizations were required. The median [IQR] number of hospitalizations were 1.5 [1-2]. The main serious infections were respiratory (44 patients; 78 hospitalizations), urinary (33 patients; 48 hospitalization), cutaneous (19 patients; 28 hospitalizations), abdominal (17 patients, 20 hospitalizations), septic arthritis (7 patients; 8 hospitalizations), maxillofacial(2 patients, 2 hospitalizations), bacterial endocarditis (2 patients, 2 hospitalizations) and genital (1 patient, 1 hospitalization).

Patients with serious infections-related hospitalization were older, with a longer RA, with more co-morbidities (hypertension, hypercholesterolemia diabetes mellitus, and Interstitial lung disease) and with more conventional and biological DMARDS (Table 1).

Table 1.

Comparative study of different groups

Patientswithserious infections-related hospitalization N=88Patients without serious infections-related hospitalization N=304pDemographic features and comorbiditiesAge (years),mean±SD69.7±11.259.2±12.60.005Women, n (%)60 (68.2)249 (81.9)0.33Active smokers, n (%)41 (46.6)114 (7.5)0.32Hypertension, n (%)56 (63.6)109 (35.8)0.004Hypercholesterolemia, n(%)47 (53.4)101 (33.2)0.02Diebetes Mellitus, n(%)25 (28.4)30 (9.9)0.0002RA featuresDuration of RA (months) mean±SD165.8±130.1128.6±102.60.005Positive RF, n (%)52(59.1)171(56.2)0.80Positive ACPA, n (%)48 (54.5)158 (52.6)0.81Erosive disease, n (%)32 (36.4)113 (51.9)0.89Associated Sjögren Syndrome, n (%)4 (4.5)16 (5.3)0.79Interstitial lung disease n (%)11 (12.5)9 (2.9)0.0008Subcutaneousnodules n (%)6 (6.8)16 (5.3)0.57Prednisone (or equivalent) dose mg/day, mean±SD5.3±4.53.3±3.80.001Number of convencional DMARDs, mean±SD1.9±1.41.5±1.30.05Number of biologic DMARDs, mean±SD0.1±0.20.1±0.40.03Number of JAK inhibitors, mean±SD69.7±11.259.2±12.60.1

The predictive factors for hospitalization were hypertension and Diabetes Mellitus, RA related interstitial lung disease and treatment with biologic DMARDs. (Figure 1)

Figure 1.

Predictive factors for serious infections-related hospitalization

Conclusion

Despite to be included in a vaccination program up to 22% of patients required hospitalization due to serious infection. The main predictive factors were co-morbidities, interstitial lung disease and treatment with biologic DMARDs. Serious infections in RA remain to be an unmet need.

Disclosure of Interests

None declared

AB0679 INTRAVENOUS INMUNOGLOBULIN IN INFLAMMATORY MYOPATHIES: EXPERIENCE OF A SINGLE REFERRAL CENTER

Background

Treatment of inflammatory idiopathic myopathies (IIM) is not well-stablished. Although the mechanism of action of intravenous immunoglobulins (IVIG) is not completely understood, they may be useful in rheumatic diseases, including IIM.

Objectives

To assess the efficacy and safety of IVIG in IIM.

Methods

Observational Single University study of IIM requiring therapy with at least one cycle of IVIG from January 2000 to December 2021. IIM, was diagnosed according to EULAR/ACR classification criteria (1).

Efficacy outcomes were a) clinical features (muscular strength and cutaneous involvement), b) analytical parameters (Creatine Kinase) and, c) glucocorticoid-sparing effect. All of them were measured at 2-4 weeks, 3 months, 6 months, 1 year and 2 years after IVIG onset.

Muscular Strength was measured in three muscle areas (upper limbs, lower limbs and neck flexor muscles) by using Medical Research Council Grading System.

We classified clinical outcomes (muscular strength and dermatological) improvement in 3 categories: Complete improvement, Partial improvement and No improvement.

IVIG schedule was a total of 2 g/kg administered in 1-5 days.

Results

We included 28 patients (22 females, mean age; 47.07±26.71 years) with IIM. The main clinical features are summarized in Table 1. Muscular weakness was present in 18 patients and cutaneous manifestations in 18 patients at baseline.

Table 1.

General features of 28 patients with inflammatory idiopathic myopathies with IVIG treatment

GENERAL FEATURESGENERAL FEATURES (continuation)Gender female / male, n (%)22(78.6) / 6 (21.4)Clinical manifestations at IVIG onset; n (%)Age (mean±SD)47.07±26.71Upper limbs involvement17 (60.71)Underlying IIM; n (%)Lower limbs involvement17 (60.71)Dermatomyositis12 (46.42)Neck flexors muscular involvement14 (50.00)Amyopathic Dermatomyositis1 (3.57)Cutaneous involvement18 (64.28)Juvenile Dermatomyositis6 (21.42)Dysphagia8 (28.57)Polymiositis2 (7.14)Constitutional symptoms9 (3.14)Inmune-mediated necrotizing miopathy5 (17.85)Malignancy2 (7.14)Systemic sclerosis/myositis overlap syndrome1 (3.57)Respiratory disease3 (10.71)Toxic myopathy1 (3.57)Articular involvement4 (14.28)IIM duration, months (mean±SD)28.74±38.75Cutaneous vasculitis2 (7.14)Previous immunosupressants before IVIG; n (%)Methotrexate9 (32.14)Concomitant Therapy with IVIG; n (%)Azathioprine4 (14.28)Oral Corticosteroids at IVIG onset18 (64.28)Cyclophosphamide1 (3.57)Methotrexate10 (35.71)Mycophenolate mofetil2 (7.14)Azathioprine4 (14.28)Hydroxychloroquine5 (17.85)Mycophenolate mofetil1 (3.57)Rituximab1 (3.57)Hydroxychloroquine5 (17.85)Plasmapheresis1 (3.57)

An early and maintained improvement was observed in all outcomes: clinical (muscular strength (a) and cutaneous manifestations (b)), Creatine Kinase (c) and glucocorticoid-sparing effect (d) (Figure 1).

Figure 1.

Efficacy Outcome.

Figure 1. *p< 0.05 (Wilcoxon test).

After two years of follow-up, we observed the following adverse effects: headache (n=6), pruritus (n=3), allergic reaction (n=2) and arterial hypertension (n=1). No heart failure, renal insufficiency or thrombotic events were found.

Conclusion

IVIG seems effective and safety in IIM treatment.

References

[1]Lundberg, et al. Ann Rheum Dis 2017:76; 1955-1964.

Disclosure of Interests

None declared

POS0537 MORTALITY IN RHEUMATOID ARTHRITIS: CHANGING CAUSES AND PREDICTIVE FACTORS. STUDY OF A COHORT FOLLOWED PROSPECTIVELY

Background

Patients with Rheumatoid Arthritis (RA) present an increased risk of mortality. In the last decades, mortality rates tended to decrease but cardiovascular (CV) events remained as the leading cause of death in most series (1).

Objectives

To assess mortality rates and leading causes of death, as well as predictors of mortality related to disease activity in a prospectively followed-up cohort of RA patients.

Methods

We conducted a prospective longitudinal study that included 673 RA patients from a single tertiary center. Univariate and multivariate Cox proportional hazards regression were used to identify predictors of mortality.

Results

We studied 673 patients with RA (75% women), mean age 61±13 years. The main general characteristics, CV risk factors, RA disease activity data and current treatment are summarized in the Table 1.

Table 1.

Baseline characteristics of 673 RA patients

Age, years, (mean±sd)61 ± 13Female/Male, n (%)505 (75) /168 (25)Past or Current smoker, n (%)338 (50)Obesity, n (%)226 (34)Hypertension, n (%)310 (46)Diabetes Mellitus, n (%)85 (13)Dyslipidemia, n (%)310 (46)BMI, kg/m2 (mean±sd)28 ± 6Abdominal circumference, cm (mean±sd)97 ± 15Total/HDL/LDL cholesterol, mg/dl (mean±sd)204±38/62±18/120 ± 31Disease duration, years (median, [IQR])13 [10-20]CRP, mg/l (median, [IQR])3.0 [0.8-7.0]ESR, mm/ 1º hour (median, [IQR])12 [5-21]Rheumatoid factor/ ACPA, n (%)376 (56) / 314 (48)DAS28-ESR/ DAS28-PCR (mean±sd)3.18 ± 1.41/3.00 ± 1.23NSAIDs / Prednisone, n (%)265 (39) /341 (51)Prednisone dose, mg/day (median, [IQR])5 (2.5-5)c-DMARDS: Metotrexate/ Leflunomide/ Hydroxychloroquine/ Salazopyrin, n (%)406 (60) /52 (8) / 178 (26) / 10 (1)b-DMARDS: TNFi/ Tocilizumab/ Rituximab/ Abatacept, n (%)88 (13) / 43 (6) / 13 (2) / 8 (1)JAK inhibitors, n (%)12 (2)

After a follow-up of 4,367 person-years (mean 6.4±1.4), 67 deaths were recorded. Considering all causes of mortality, the cumulative incidence was 14% (95% CI 11-18) with a mortality incidence rate of 0.015 (95% CI 0.012-0.020) patient/year. The main causes of mortality in decreasing order of frequency were infections (N=23) (34%), incidence rate-IR: 0.005 [95% CI 0.003-0.008]), cancer (N=18) (27%), IR: 0.004 [95% CI 0.002-0.007]), CV events (N= 12) (18%), IR: 0.003 [95% CI 0.001-0.005]), respiratory diseases (N=2) (3%), IR: 0.0005 [95% CI 0.00007-0.002] and other causes (N=12) (18%), IR: 0.003 [95% CI 0.001-0.005I].

The statistically significant predictive factors of mortality in the univariate analysis were male gender (HR 1.97[95%CI 1.20-3.21, p=0.007), abdominal circumference (HR 1.03 [95% CI 1.01-1.05], p=0,0006), diabetes (HR 2.85 [95%CI 1.68-4.86], p<0.001) and hypertension (HR 2.92 [95%CI 1.73-4.94], p<0.001). Also, baseline data of variables associated with disease activity such as increased CRP, ESR, DAS28-CRP, DAS28-ESR were predictors of mortality (Figure 1). Disease related parameters were adjusted by CV risk factors in a multivariate analysis. Following this procedure, the predictive factors that reached statistical significance; (Hazard Ratio [95%CI]), were an increased in DAS28-VSG (1.40 [1.07-1.83], p=0.016), DAS- 28-PCR (1.40 [1.07-1.83], p=0.016), CRP (1.02 [1.01-1.05] p=0.002), and ESR (1.03 [1.01- 1.05], p=<0.001) (Figure 1).

Figure 1.

Forest Plot of mortality (Univariate and multivariate analysis).

Results expressed in logarithmic scale. Multivariate analysis: Disease activity related parameters adjusted by age, gender, disease duration, smoker, diabetes, hypertension and abdominal circumference. CDAI, ESR and CPR expressed value/10. (*) p<0.05.

Conclusion

In a cohort of patients with RA followed prospectively in a tertiary hospital, infections and malignancies are the main cause of mortality rather than CV events. Disease activity parameters are associated with an increased risk of mortality in these patients with RA.

References

[1]Avina-Zubieta JA et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 2008,59:1690–97.

Disclosure of Interests

None declared.

POS0623 SUBCLINICAL ATHEROSCLEROSIS IS NOT RELATED WITH ACID URIC IN RHEUMATOID ARTHRITIS. STUDY OF 1005 PATIENTS OF A SINGLE UNIVERSITY HOSPITAL

Background

Rheumatoid Arthritis (RA) and Gout are associated with an increase of cardiovascular (CV) disease (1,2). Carotid plaques and increased carotid intima-media thickness (cIMT) are surrogate markers of CV mortality (3). The association of serum uric acid (SUA) levels as an independent factor of subclinical Atherosclerosis and mortality in RA remains not fully clarified (4,5).

Objectives

In a wide cohort of patients with RA our aims were to assess the relationship of SUA with a) CV risk factors and b) presence of atherosclerosis.

Methods

Cross-sectional study including 1005 patients with RA from a Single University Center. The presence of Atherosclerosis (c-IMT and carotid plaque) was explored by Carotid Ultrasonography. The relationship between SUA and markers of subclinical atherosclerosis was studied through linear regression and logistic multivariate analysis.

Results

We studied 1005 RA patients (741 women, 74%), mean age 61±13. The main general features, CV risks factors, RA activity data and current therapy are summarized in Table 1.

Table 1.

Main features of 1005 RA patients

GENERAL FEATURESRESULTSGENERAL FEATURES (CONTINUATION)RESULTS (CONTINUATION) Age, years, mean±SD60±13RA features Female/ Male, n (%)741 (74) / 264 (26)RA duration, years; mean±SD17±12CRP, mg/L, median, [IQR]3.0 [0.9-7.5]CV risk factorsESR, mm/ 1st hour; median, [IQR]14 [6-24] Past or Current smoker, n (%)539 (54)Rheumatoid factor, n (%)528 (53) Obesity/ Dyslipidemia, n (%)307 (31)/ 560 (56)ACPA, n (%)492 (50) Hypertension, n (%)453 (45)DAS28-ESR; mean±SD3.3 ± 1.5 Diabetes Mellitus, n (%)127 (13)DAS28-CRP; mean±SD3.1 ± 1.3 BMI, kg/m2, mean±SD28±5/93±15Uric acid Abdominal circumference cm;  mean±SDUric acid level (mg/dl); mean±SD4.8 ± 1.4 Previous CV Events, n (%)125 (12) Chronic Kidney Disease,  n (%)58 (6)Carotid Ultrasonography Gout / using drugs for  hyperuricemia; n (%)20 (2)cIMT microns; mean±SD708 ± 157 Total cholesterol, mg/dl;  mean±SD201±39Carotid plaque¸ n (%)617 (62) HDL cholesterol, mg/dl;  mean±SD61±17 LDL cholesterol, mg/dl;  mean±SD119 ± 32

Abbreviations: ACPA: Anti–citrullinated protein antibody; BMI: Body mass index; CV: Cardiovascular; cIMT: carotid intima-media thickness; cm: centimeter; CRP: C Reactive protein; DAS28-ESR: Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate; DAS28-PCR: Disease Activity Score-28 for Rheumatoid Arthritis with C reactive protein; dl: deciliter; ESR: Erythrocyte Sedimentation Rate; HDL: high-density lipoprotein; IQR: Interquartile range; Kg: kilogram; LDL: Low-density lipoprotein; mg: milligram; m2: square meter; n: number; RA: Rheumatoid Arthritis; SD: Standard Deviation.

SUA as a dependent variable was significantly correlated with age, male gender and most of CV risk factors (body mass index, abdominal circumference and obesity) (single-variable analysis). Similarly, a significative beta coef. [95%CI] positive relationship with SUA was observed with hypertension (0.7 [0.5-0.8], p<0.001), diabetes (0.5 [0.2-0.7], p<0.001), dyslipidemia (0.2 [0.04-0.4], p=0.016), renal chronic insufficiency (1.5 [95CI 1.1-0.8], p<0.001) and previous CV events (0.8 [0.4-1.2], p<0.001).

Subclinical Atherosclerosis, as dependent variable, was significantly correlated with SUA (single-variable analysis). In addition, SUA showed a positive significative beta coef. [95%CI] relationship with cIMT (18 [12-25], p<0.001) and the presence of carotid plaques (1.29 [17-1.42], p<0.001). However, statistical significance was not observed in the multivariable analysis adjusted by Classic CV Risk Factors.

Conclusion

In RA, SUA is related with most of CV risk factors. However, SUA is not associated with Subclinical Atherosclerosis.

References

[1]Aviña-Zubieta JA, et al. Arthritis Rheum. 2008,15;59:1690-7.

[2]Klein R, et al. Arch Intern Med 1973, 132:401–410.

[3]de Groot E, et al. Circulation, 2004,109:33–38.

[4]Lauren Shahin, et al Cureus 2021. 5; 13.:e14855.

[5]Chiou A, et al. Arthritis Care Res (Hoboken). 2020, 72:950-958.

Disclosure of Interests

None declared

POS0327 IRISIN: A NEW MARKER OF SUBCLINICAL ATHEROSCLEROSIS, CARDIOVASCULAR RISK AND DISEASE ACTIVITY IN AXIAL SPONDYLOARTHRITIS?

Background

Axial spondyloarthritis (axSpA) is an inflammatory disease with detrimental effects on the health status of the individuals affected by this condition [1]. axSpA patients also exhibit high cardiovascular (CV) risk, mainly due to accelerated atherosclerosis [2]. Interestingly, the adipomyokine irisin was described to play a beneficial role in several physiological and pathophysiological processes such as inflammation, angiogenesis, oxidative stress, as well as lipid and bone metabolism [3]. However, studies on the role of irisin in CV risk in the setting of axSpA or in the pathogenesis of axSpA are limited [4].

Objectives

In this study we evaluated the role of irisin as a genetic and serological biomarker of subclinical atherosclerosis and CV risk in a large cohort of patients with axSpA. We also assessed its role as a marker of axSpA susceptibility and severity.

Methods

725 patients who fulfilled the Assessment of SpondyloArthritis international Society classification criteria for axSpA were included in this study [5]. In these patients, the presence of subclinical atherosclerosis (plaques and/or abnormal carotid intima-media thickness values) was assessed by carotid ultrasound. Four irisin polymorphisms (rs16835198 G/T, rs3480 A/G, rs726344 G/A and rs1570569 G/T) were genotyped by TaqMan probes in all the patients and in 656 age, sex and ethnically-matched healthy controls. Additionally, serum irisin levels were determined by ELISA in all the patients. All analyses were performed using STATA v.11.1 statistical software, adjusting for potential confounding factors. The strength of associations is indicated as odds ratios (OR) [95% confidence intervals].

Results

Low levels of serum irisin were linked to the presence of plaques (p=0.002) and with atherogenic index values indicative of an adverse lipid profile (p=0.01). Serum irisin levels also negatively correlated with visual analogue scale (VAS) patient, VAS physician and Bath Ankylosing Spondylitis Metrology Index (BASMI) values (p<0.05). Moreover, the presence of sacroiliitis was related to lower serum irisin levels (p<0.001). Furthermore, the minor alleles of rs3480 (G) and rs1570569 (T) were associated with higher values of Ankylosing Spondylitis Disease Activity Score (ASDAS) in axSpA patients (p≤0.01 in both cases). In this line, the frequency of the minor allele of rs1570569 (T) was higher in patients with ASDAS values >2.1 (indicative of high disease activity) (OR: 1.46 [1.08-1.97], p=0.01), while the minor allele of rs16835198 (T) was less frequent in this group of patients (OR: 0.73 [0.57-0.92], p=0.01).

Conclusion

Low serum irisin levels could be indicators of the presence of subclinical atherosclerosis, high CV risk and more severe disease in axSpA patients. In addition, irisin may also constitute a genetic biomarker of disease activity in axSpA.

References

[1]Packham J. Rheumatology (Oxford). 2018;57(6):vi29-vi34.

[2]Szabo SM, et al. Arthritis Rheum. 2011;63(11):3294–304.

[3]Korta P, et al. Medicina (Kaunas). 2019;55(8):485.

[4]Nam B, et al. Ann Rheum Dis. 2020;79:1358.

[5]Sieper J, et al. Ann Rheum Dis. 2009;68(2):ii1–44.

Acknowledgements

This work was partially supported by grants from Instituto de Investigación Sanitaria IDIVAL (NVAL17/10), from the `Asociación Cántabra de Reumatología’ awarded to FG. FG and JR-G are beneficiaries of a grant funded by `Instituto de Salud Carlos III´ (ISCIII) (PI20/00059). SR-M is supported by funds of the RETICS Program (RD16/0012/0009) from ISCIII, co-funded by the European Regional Development Fund. VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL18/01). RL-M is a recipient of a Miguel Servet type I programme fellowship from ISCIII, co-funded by the European Social Fund, `Investing in your future´ (grant CP16/00033).

Disclosure of Interests

Sara Remuzgo-Martínez: None declared, Javier Rueda-Gotor: None declared, Verónica Pulito-Cueto: None declared, Raquel López-Mejías: None declared, Alfonso Corrales: None declared, Leticia Lera-Gómez: None declared, Raquel Pérez-Fernández: None declared, Virginia Portilla: None declared, Iñigo Gonzalez-Mazon: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Rosa Expósito: None declared, Cristina Mata: None declared, Javier Llorca: None declared, Vanessa Hernández-Hernández: None declared, Carlos Rodríguez-Lozano: None declared, Nuria Barbarroja Puerto: None declared, Rafaela Ortega Castro: None declared, Esther F. Vicente-Rabaneda: None declared, Cristina Fernández-Carballido: None declared, Maria Paz Martínez-Vidal: None declared, David Castro-Corredor: None declared, Joaquín Anino-Fernández: None declared, Diana Peiteado: None declared, Chamaida Plasencia: None declared, E Galindez: None declared, María L. García Vivar: None declared, Nuria Vegas-Revenga: None declared, Irati Urionaguena: None declared, Oreste Gualillo: None declared, Juan Carlos Quevedo-Abeledo: None declared, Santos Castañeda: None declared, Iván Ferraz-Amaro: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene, MSD, GSK, Grant/research support from: Abbvie, MSD, Janssen, Roche, Fernanda Genre: None declared

Does exposure to greenness improve children's neuropsychological development and mental health? A Navigation Guide systematic review of observational evidence for associations

BACKGROUND

Contact with nature may have a key role in child brain development. Recent observational studies have reported improvements in children's neuropsychological development and mental health associated with greenness exposure. In a rapidly urbanizing word, researchers, policymakers, healthcare workers and urban planners need to work together to elaborate evidence-based policies and interventions to increase the availability of quality green space with the potential to enhance childhood development.

OBJECTIVE

To review the observational evidence assessing the effect of exposure to greenness on children's neuropsychological development and mental health.

METHODS

The protocol for the review was preregistered at PROSPERO (CRD42020213838). The Navigation Guide systematic review methodology was followed. Search strategies were formulated and adapted to each database. Searches were performed in PubMed, Scopus, Web of Science and EBSCO's GreenFILE on October 5, 2021. Additional articles were further identified by hand-searching reference lists of included papers.

RESULTS

A systematic search of 4 databases identified 621 studies, of which 34 were included in the review. The studies included investigated diverse domains within neuropsychological development and mental health, such as attention, working memory, intelligence, cognitive development, academic performance, well-being, attention-deficit/hyperactivity disorder symptoms, and behavior. Most of the studies were rated as having high or probably high risk of bias in the assessment.

DISCUSSION

Although nearly all studies showed a positive association between greenness exposure and the outcomes studied, the heterogeneity in the methods used to assess exposure and the diversity of domains within each main outcome has made it difficult to draw clear conclusions. Future studies should adopt a longitudinal design to confirm the causality of the associations and include measures to determine which characteristics of greenness have the greatest influence on each domain. Researchers should also try to explore pathways linking exposure to greenness with the neuropsychological development and mental health, by implementing mechanistic studies.

Admixture Mapping of Sepsis in European Individuals With African Ancestries

Sepsis is a severe systemic inflammatory response to infections that is accompanied by organ dysfunction. Although the ancestral genetic background is a relevant factor for sepsis susceptibility, there is a lack of studies using the genetic singularities of a recently admixed population to identify loci involved in sepsis susceptibility. Here we aimed to discover new sepsis loci by completing the first admixture mapping study of sepsis in Canary Islanders, leveraging their distinctive genetic makeup as a mixture of Europeans and African ancestries. We used a case-control approach and inferred local ancestry blocks from genome-wide data from 113,414 polymorphisms genotyped in 343 patients with sepsis and 410 unrelated controls, all ascertained for grandparental origin in the Canary Islands (Spain). Deviations in local ancestries between cases and controls were tested using logistic regressions, followed by fine-mapping analyses based on imputed genotypes, in silico functional assessments, and gene expression analysis centered on the region of interest. The admixture mapping analysis detected that local European ancestry in a locus spanning 1.2 megabases of chromosome 8p23.1 was associated with sepsis (lowest p = 1.37 × 10⁻⁴; Odds Ratio [OR] = 0.51; 95%CI = 0.40–0.66). Fine-mapping studies prioritized the variant rs13249564 within intron 1 of MFHAS1 gene associated with sepsis (p = 9.94 × 10⁻⁴; OR = 0.65; 95%CI = 0.50–0.84). Functional and gene expression analyses focused on 8p23.1 allowed us to identify alternative genes with possible biological plausibility such as defensins, which are well-known effector molecules of innate immunity. By completing the first admixture mapping study of sepsis, our results revealed a new genetic locus (8p23.1) harboring a number of genes with plausible implications in sepsis susceptibility.

Targeted analysis of genomic regions enriched in African ancestry reveals novel classical HLA alleles associated with asthma in Southwestern Europeans

Despite asthma has a considerable genetic component, an important proportion of genetic risks remain unknown, especially for non-European populations. Canary Islanders have the largest African genetic ancestry observed among Southwestern Europeans and the highest asthma prevalence in Spain. Here we examined broad chromosomal regions previously associated with an excess of African genetic ancestry in Canary Islanders, with the aim of identifying novel risk variants associated with asthma susceptibility. In a two-stage cases-control study, we revealed a variant within HLA-DQB1 significantly associated with asthma risk (rs1049213, meta-analysis p = 1.30 × 10^–7, OR [95% CI] = 1.74 [1.41–2.13]) previously associated with asthma and broad allergic phenotype. Subsequent fine-mapping analyses of classical HLA alleles revealed a novel allele significantly associated with asthma protection (HLA-DQA1*01:02, meta-analysis p = 3.98 × 10^–4, OR [95% CI] = 0.64 [0.50–0.82]) that had been linked to infectious and autoimmune diseases, and peanut allergy. HLA haplotype analyses revealed a novel haplotype DQA1*01:02-DQB1*06:04 conferring asthma protection (meta-analysis p = 4.71 × 10^–4, OR [95% CI] = 0.47 [0.29– 0.73]).

Whole-Blood Mitochondrial DNA Copies Are Associated With the Prognosis of Acute Respiratory Distress Syndrome After Sepsis

Acute respiratory distress syndrome (ARDS) is an inflammatory process of the lungs that develops primarily in response to pulmonary or systemic sepsis, resulting in a disproportionate death toll in intensive care units (ICUs). Given its role as a critical activator of the inflammatory and innate immune responses, previous studies have reported that an increase of circulating cell-free mitochondrial DNA (mtDNA) is a biomarker for fatal outcome in the ICU. Here we analyzed the association of whole-blood mtDNA (wb-mtDNA) copies with 28-day survival from sepsis and sepsis-associated ARDS. We analyzed mtDNA data from 687 peripheral whole-blood samples within 24 h of sepsis diagnosis from unrelated Spanish patients with sepsis (264 with ARDS) included in the GEN-SEP study. The wb-mtDNA copies were obtained from the array intensities of selected probes, with 100% identity with mtDNA and with the largest number of mismatches with the nuclear sequences, and normalized across the individual-probe intensities. We used Cox regression models for testing the association with 28-day survival. We observed that wb-mtDNA copies were significantly associated with 28-day survival in ARDS patients (hazard ratio = 3.65, 95% confidence interval = 1.39–9.59, p = 0.009) but not in non-ARDS patients. Our findings support that wb-mtDNA copies at sepsis diagnosis could be considered an early prognostic biomarker in sepsis-associated ARDS patients. Future studies will be needed to evaluate the mechanistic links of this observation with the pathogenesis of ARDS.

POS1467-HPR SEVERE RESPIRATORY INFECTIONS IN RHEUMATOID ARTHRITIS PATIENTS WITH BIOLOGIC THERAPY. COMPARATIVE STUDY BETWEEN VACCINATED AND NON VACCINATED PATIENTS

Background:

Rheumatoid arthritis (RA) patients are at increased risk of severe infections due to the disease itself, and the immunosuppressive treatment. Vaccination programs are designed to decrease the risk of infections.

Objectives:

In patients with RA treated with biologic therapy (BT) our aim was to assess a) the incidence of severe respiratory infections and b) to compare the risk between vaccinated and non vaccinated patients.

Methods:

Observational study of 431 patients diagnosed with RA that iniciated BT. One group of patients participated in a vaccination program from October 2011 to October 2016 (Group 1). The other group was not included in the vaccination program (Group 2). The follow-up was made until June 2017 with a minimum follow-up period of 8 months and a maximum of 5.5 years.

Information on severe respiratory infections, defined as those that required hospitalization or at least one dose of intravenous antibiotic treatment at the emergency room, was retrieved from the hospital medical records.

Results:

We studied 431 patients (335 women/96 men); mean age 63.4±13.7 years. In the vaccination program (group 1) were included 299 (69.37%) patients and in the group 2 132 patients (30.63%). The main features of both groups are summarized in Table 1.

During the follow-up, we registered 299 hospital admissions due to severe respiratory infections in both groups (incidence density 9.9 (95% CI: 6.9-13.6).

In group 1, vaccinated patients, this incidence density was reduced to 7.1 (95% CI: 4.1-11.6). Figure 1.

The vaccination program reduced the general incidence of severe respiratory infection in 44%.

Conclusion:

RA patients with BT included in the vaccination program present a lower incidence of severe respiratory infections compared with non vaccinated patients.

Table 1.

Main general features at BT onset

Group 1Vaccination programN=299Group 2Non vaccination programN=132pAge (years) mean±SD61.32±13.0467.97±14.170.32Women, n (%)231 (77.3%)105 (79.5%)0.59Duration of RA (months) mean±SD73.24±10.4112.62±60.2Positive RF/ Positive ACPA, n (%)177(59.2)/172 (57.52%)93(70.5%)98 (74.24%)0.02/0,01Erosive disease, n (%)116 (38.8%)70 (53%)0.06Vasculitis, n (%)15 (5%)2 (1.5%)0.08Interstitial lung disease n (%)12 (4%)7 (5.3%)0.54Subcutaneous nodules n (%)16 (5.4%)6 (4.5%)0.72Corticosteroids299 (100%)132 (100%)1Number of conventional DMARDs, mean±SD1.66±0.892.03±1.050.3Figure 1.

Disclosure of Interests:

None declared

POS1407 COMPARISON OF CAROTID SUBCLINICAL ATHEROSCLEROSIS AND STRUCTURAL DAMAGE IN AXIAL SPONDYLITIS WITH AND WITHOUT CONCOMITANT INFLAMMATORY BOWEL DISEASE. A MULTICENTER STUDY WITH 886 PATIENTS. . A MULTICENTER STUDY WITH 886 PATIENTS

Background:

The prevalence of inflammatory bowel disease (IBD) in ankylosing spondylitis (AS) has been reported to range between 6%-15%. As occurs with axial spondyloarthrtitis (axSpA), patients with IBD have an increased risk of cardiovascular (CV) events because of a process of accelerated atherosclerosis1. However, it is unknown whether the presence of IBD confers an increased cardiovascular CV risk in patients with axSpA.

Objectives:

To compare the atherosclerotic burden, CV events, CV risk factors and disease related factors including structural damage in axSpA patients with and without IBD.

Methods:

Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA, comparing axSpA patients with and without concomitant IBD. Background information on CV and disease-related factors was reviewed. Data on CV risk and disease status at the time of the study were also obtained, including the structural damage assessed by the presence of syndesmophytes, the severity of the sacroiliitis (defined as grade 3 or 4 according to New York criteria), and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria.

Results:

A set of 886 axSpA patients were included. 829 (93.6%) of them had no concomitant IBD, which was present in 57 (6.4%) patients. Age, sex and AS/nr-axSpA ratio were comparable in both groups (Table 1. next page). Patients with IBD were characterised by a lower prevalence of HLA B27 (46% vs 72%, p=0.01) and a higher presence of concomitant psoriasis (21% vs 10%, p=0.01)

Regarding peripheral disease (history of synovitis, enthesitis, dactylitis) and hip involvement, no differences were found between both groups. There were either no differences in the structural damage found in patients with and without IBD (Table 1. next page).

With respect to the management of the disease, prednisone (21% vs 13%, p = 0.03), DMARDs (54% vs 35%, p = 0.01) and anti-TNFα therapy (54% vs 31%, p = 0.00) were more commonly used in the group with IBD, while treatment with NSAIDs was more frequent in patients without IBD (81% vs 70%, p = 0.04).

Regarding CV risk features, smoking was more frequent in patients without IBD (34% vs 21%, p = 0.045) (Table 1. next page). No differences were observed neither in the lipid profile or blood pressure at the time of the study, nor in the prevalence of CV events (5% vs 4%, p=0.99) (Table 1) and the subclinical atherogenic burden assessed both by the presence of carotid plaques (31% vs 37%, p=0.45) and the cIMT (645 ± 147 mm vs 636 ± 112 mm, p = 0.64) (Table 1. next page).

Conclusion:

The presence of IBD does not confer additional CV risk to axSpA. In our series, patients with axSpA and IBD showed a lower frequency of HLA B27 and a higher prevalence of psoriasis.

Table 1.axSpA without IBD (n=829)axSpA with IBD (n=57)pMen/Women, n272/55715/420.33Mean age (years) ±SD at the time of study49 ± 1349 ± 100.99AS/nr-AxSpa656/17345/120.97History of CV risk factors Current smoker285 (34)12 (21)0.045 Obesitty Dyslipemia280 (34)16 (28)0.42 Hypertension223 (27)16 (28)0.79 Diabetes Mellitus60 (7)4 (7)0.99 Chronic Kidney Disease20 (2)2 (4)0.65History of cardiovascular events, n (%)40 (5)2 (4)0.99Structural damage at the time of studyPresence of syndesmophytes, n (%)307 (37%)23 (49%)0.66mSASSS5 (1-15)6 (3-23)0.64Severe sacroiliitis (grade 3,4), n (%)436 (53)34 (60)0.42CV data at the time of studyCarotid plaques261 (31)21 (37)0.45IMT (mm)645 ± 147636 ± 1120.64IMT >= 0.9 mm46 (6)0 (0)0.066

Abbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IBD = Inflammatory bowel disease. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis.

Disclosure of Interests:

None declared

POS0977 CARDIOVASCULAR AND DISEASE RELATED FEATURES IN AXIAL SPONDYLITIS WITH AND WITHOUT CONCOMITANT PSORIASIS. A MULTICENTER STUDY WITH 882 PATIENTS

Background:

Patients with axial spondyloarthritis (axSpA) may present with concomitant psoriasis (Ps) in approximately 10% of cases. As with axSpA, Ps is also associated with an accelerated atherosclerosis process1. However, it is unknown whether the presence of Ps confers an increased cardiovascular (CV) risk in patients with axSpA.

Objectives:

To compare factors related to the disease, CV risk factors, atherosclerotic burden, and CV events in patients with axSpA with and without Ps.

Methods:

Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA. We compared axSpA patients with and without concomitant psoriasis, focusing mainly on CV risk characteristics. Background information on CV risk factors, CV events, and disease-related factors was reviewed, and data on maximum body index, blood pressure, lipid profile, and disease status at the time of the study were also obtained. Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria.

Results:

A set of 882 axSpA patients were included. 786 (89.1%) of them had no concomitant Ps, which was present in 96 (10.9%) patients. Although the mean age was similar, male sex was more prevalent in axSpA patients with Ps (79.1% Vs 66.5%, p=0.01) (Table 1).

Furthermore, it was found that axSpA with Ps had a more frequent history of synovitis (50% vs 33%, p = 0.001), dactylitis (13% vs 6%, p = 0.011) and concomitant inflammatory bowel disease (13% vs 6%, p = 0.01). AxSpA patients with Ps had a non-significant trend towards a higher prevalence of asymmetric sacroiliitis (23 vs 16%, p = 0.064) and had a lower frequency of positive HLA-B27 status (56% vs 72%, p = 0.003). Regarding the management of the disease, prednisone (23% vs 12%, p = 0.02), methotrexate (30% vs 15%, p = 0.000) and anti-TNFα therapy (50% vs 34%, p = 0.002) were more commonly used in the group with Ps.

Regarding CV risk characteristics, no differences were observed either in the prevalence of traditional CV risk factors (Table 1), nor in the total serum level, HDL and LDL, blood pressure and body mass index at that time of the study. However, axSpA patients with Ps showed a higher prevalence of CV events (9% vs 4%, p = 0.05), including ischemic heart disease (6% vs 3%, p = 0.042) and ischemic stroke (4% vs 1%, p = 0.016) (Table 1). The subclinical atherogenic burden was also more severe in the group with Ps, with a higher prevalence of carotid plaques (39% vs 31%, p = 0.098), and higher values of cIMT (0.664 ± 0.170 mm vs 0.642 ± 0.142 mm, p = 0.16), although the differences did not reach statistical significance.

Table 1.

Main sociodemographic and cardiovascular differences among axSpA patients with and without psoriasis.

axSpA without psoriasis (n=786)axSpA with psoriasis (n=96)pMen/Women, n523/26876/200.010Mean age (years) ±SD at the time of study49 ± 1349 ± 130.81AS/nr-AxSpa625/16677/190.79History of CV risk factors Current smokers267 (34)30 (31)0.60 Obesitty174 (22)26 (27)0.29 Dyslipidemia262 (33)35 (36)0.48 Hypertension211 (27)28 (29)0.57 Diabetes Mellitus56 (7)8 (8)0.65 Chronic Kidney Disease19 (2)3 (3)0.72History of cardiovascular events, n (%)33 (4)9 (9)0.023 Ischemic heart disease20 (3)6 (6)0.042 Congestive heart failure2 (0)1 (1)0.29 Ischemic stroke6 (1)4 (4)0.016 Peripheral artery disease6 (1)0 (0)0.99CV data at the time of studyCarotid plaques244 (31)38 (39)0.098IMT mm0.642 ± 0.1420.664 ± 0.1700.16IMT >= 900 mm40 (5)6 (6)0.66

Abbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis.

Conclusion:

The presence of Ps may confer additional CV risk to axSpA patients and is associated with particular disease related factors.

References:

[1]Fang N, Jiang M, Fan Y. Association Between Psoriasis and Subclinical Atherosclerosis: A Meta-Analysis. Medicine (Baltimore). 2016;95(20):e3576.

Disclosure of Interests:

None declared.

AB0070 ROLE OF VASPIN IN ATHEROSCLEROTIC DISEASE AND CARDIOVASCULAR RISK IN AXIAL SPONDYLOARTHRITIS

Background:

Vaspin is a novel anti-inflammatory adipokine associated with cardiovascular (CV) disease and inflammation in chronic inflammatory conditions different from axial spondyloarthritis (axSpA).1 Given the high incidence of CV disease (mainly due to accelerated atherosclerosis) exhibited by axSpA patients,2 we wondered if vaspin could also be a key molecule in this process. However, data on the role of vaspin regarding atherosclerotic disease in the context of axSpA is scarce.3

Objectives:

To evaluate the implication of vaspin, at the genetic and serological level, in subclinical atherosclerosis and CV risk in axSpA.

Methods:

510 patients who fulfilled the ASAS criteria for axSpA4 were included in this study. Carotid ultrasound (US) was performed to evaluate the presence of subclinical atherosclerosis. Three vaspin gene variants (rs2236242 T/A, rs7159023 G/A and rs35262691 T/C) were genotyped by TaqMan probes. Serum vaspin levels were assessed by Enzyme-Linked ImmunoSorbent Assay. Analysis was performed using a statistical software.

Results:

Serum vaspin levels were significantly higher in female patients than in males and also in obese patients when compared to those with normal weight (p<0.05). At the genetic level, we disclosed that the minor allele of rs2236242 (A) was associated with lower serum vaspin levels in axSpA, while the rs7159023 minor allele (A) was linked to higher serum levels (p<0.05). When the three polymorphisms assessed were combined conforming haplotypes, we disclosed that the TGC haplotype related to high serum levels of vaspin (p=0.01). However, no statistically significant association was observed between vaspin and markers of subclinical atherosclerosis, both at the genetic and serological level.

Conclusion:

Our results revealed that vaspin is linked to CV risk factors that may influence on the atherosclerotic process in axSpA. Additionally, we disclosed that serum vaspin concentration is genetically modulated in a large cohort of patients with axSpA.

References:

[1]Adv Exp Med Biol. 2019;1111:159-88.

[2]Front Med (Lausanne). 2018;5:62.

[3]Braz J Med Biol Res. 2016;49(7):e5231.

[4]Ann Rheum Dis. 2009;68(2):ii1-44.

Acknowledgements:

Personal funds: RL-M: Miguel Servet type I CP16/00033 (ISCIII-ESF); SR-M: RD16/0012/0009 (ISCIII-ERDF); VP-C: PREVAL18/01 (IDIVAL); LL-G: INNVAL20/06 (IDIVAL).

Disclosure of Interests:

Javier Rueda-Gotor: None declared, Raquel López-Mejías: None declared, Sara Remuzgo-Martínez: None declared, Verónica Pulito Cueto: None declared, Alfonso Corrales: None declared, Leticia Lera-Gómez: None declared, Virginia Portilla: None declared, Iñigo González-Mazón: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Rosa Expósito: None declared, Cristina Mata: None declared, Javier Llorca: None declared, Vanessa Hernández-Hernández: None declared, Carlos Rodríguez-Lozano: None declared, Nuria Barbarroja Puerto: None declared, Rafaela Ortega Castro: None declared, Noelia García Castañeda: None declared, Cristina Fernández-Carballido: None declared, Maria Paz Martínez-Vidal: None declared, David Castro-Corredor: None declared, Joaquín Anino-Fernández: None declared, Diana Peiteado: None declared, Chamaida Plasencia: None declared, E Galindez: None declared, María L. García Vivar: None declared, Oreste Gualillo: None declared, Juan Carlos Quevedo-Abeledo: None declared, Santos Castañeda: None declared, Iván Ferraz-Amaro: None declared, Miguel A González-Gay Speakers bureau: Pfizer, Abbvie, MSD, Grant/research support from: Pfizer, Abbvie, MSD, Fernanda Genre: None declared

POS1390 COMPARISON OF CAROTID SUBCLINICAL ATHEROSCLEROSIS AND STRUCTURAL DAMAGE IN AXIAL SPONDYLITIS WITH AND WITHOUT CONCOMITANT ANTERIOR UVEITIS. A MULTICENTER STUDY WITH 886 PATIENTS

Background:

Anterior uveitis (AU) is one of the most frequent extra articular manifestations of axial spondyloarthritis (axSpA), present in around 25% of patients. As with axSpA, AU has also been associated with the development of accelerated atherosclerosis1. If the presence of AU confers an increased cardiovascular (CV) risk or specific disease-related features to patients with axSpA remains unclear.

Objectives:

To compare the atherosclerotic burden, CV events, CV risk factors and disease related factors including structural damage in axSpA patients with and without AU.

Methods:

Cross-sectional analysis of the AtheSpAin cohort, a Spanish multicenter cohort designed for the study of atherosclerosis in axSpA, comparing axSpA patients with and without concomitant uveitis. Background information on CV and disease-related factors was reviewed. Data on CV risk and disease status at the time of the study were also obtained, including the structural damage assessed by the presence of syndesmophytes, the severity of the sacroiliitis (defined as grade 3 or 4 according to New York criteria), and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Carotid ultrasound (US) was performed in all patients at the time of the study, including measurement of carotid intima-media wall thickness (cIMT) and plaque detection according to the Mannhein consensus criteria.

Results:

A set of 886 axSpA patients were included. 709 (80.0%) of them had no history of concomitant AU, which was present in the remaining 177 (20.0%). The group with AU was older (50 ± 11 vs 48 ± 13 years, p=0.05), had a higher proportion of patients with AS (90.1% vs 76.3%, p=0.00) (Table 1) and a longer disease duration 13(7-23) vs 7(2-16) years, p=0.00]. The prevalence of HLA-B27 was higher in AU patients (82% vs 67%).

Remarkably, structural damage showed interesting differences between both groups (Table 1). AU patients had a higher prevalence of severe sacroiliits (69% vs 49%, p=0.00), which remained significant after adjustment for age, disease duration and AS/nr-axSpA ratio. Furthermore, a non-significant trend towards a higher prevalence of syndesmophytes (44% vs 36%, p=0.06) and hip involvement (20% vs 15%, p=0.09) was observed in the group of AU.

Regarding CV risk features, no differences were observed in the prevalence of CV risk factors and events (Table 1). Patients with AU showed a higher cIMT in the crude analysis (665 ± 156 mm vs 640 ± 142 mm, p = 0.047), but no significant differences were observed after adjustment by age and sex (p=0.6). Prevalence of carotid plaques was comparable in both groups (32% Vs 32%, p=0.84).

Table 1.axSpA without uveitis (n=709)axSpA with uveitis (n=177)pP (adjusted model)Men/Women, n477/232122/550.68Mean age (years) ±SD at the time of study48 ± 1350 ± 110.049AS/nr-AxSpa541/168160/170.000History of CV risk factors, n (%) Current smoker247 (35)50 (28)0.096 Obesitty Dyslipemia233 (33)63 (36)0.48 Hypertension188 (27)50 (28)0.63 Diabetes Mellitus50 (7)14 (8)0.69 Chronic Kidney Disease18 (3)4 (2)0.99History of cardiovascular events, n (%)29 (4)12 (7)0.13Structural damage at the time of studyPresence of syndesmophytes, n (%)253 (36)77 (44)0.063mSASSS5 (1-15)6 (0-16)0.31Severe sacroiliitis (grade 3,4), n (%)348 (49)122 (69)0.0000.000*Carotid US data at the time of studyCarotid plaques, n (%)225 (32)57 (32)0.84IMT (mm)640 ± 142665 ± 1560.0470.6**IMT >= 0.900 mm36 (5)10 (6)0.72

*: adjusted by age, disease duration and AS/nr-axSpA ratio

**: adjusted by age and sex

Abbreviations: AS = ankylosing spondylitis. AxSpA= axial spondylitis. CV = cardiovascular. IMT = intima-media wall thickness. Nr-axSpA = no-radiographic axial spondylitis.

Conclusion:

The presence of AU does not confer additional CV risk to axSpA patients, although it is associated with a more severe structural damage in our series.

References:

[1]Conkar S, Güven Yilmaz S, Koska İÖ, Berdeli A, Mir S. Evaluation of development of subclinical atherosclerosis in children with uveitis. Clin Rheumatol. 2018 May;37(5):1305-1308.

Disclosure of Interests:

None declared

POS0533 EFFECT OF CAROTID ULTRASOUND ON THE ACHIEVEMENT OF LDL-CHOLESTEROL TARGETS IN THE ROUTINE CLINICAL CARE OF PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) is substantially elevated compared to the general population. In RA, as in the general population, CVD control includes the detection and treatment of CV risk factors based, among others, on blood pressure, smoking, diabetes, and lipid profiles. Little is known about the real impact of the use of carotid ultrasound in the prevention of CVD in patients with RA.

Objectives:

To determine whether the use of carotid ultrasound in the routine clinical care of patients with RA can improve the achievement of LDL-cholesterol targets over time.

Methods:

We conducted a retrospective, real-world study of 327 RA patients in which a carotid ultrasound was performed as part of routine clinical care. Participants were followed from 2012 to 2018. LDL-c levels were measured before and after the carotid ultrasound intervention. The achievement of the LDL-c goals recommended by the international guidelines was compared before and after the carotid ultrasound. Predictive factors of achievement of LDL-cholesterol targets were studied.

Results:

When considering the 2010 EULAR RA SCORE risk categories, serum LDL-c levels in the moderate CV risk category was significantly lower when follow-up finished (126 ± 33 to 109 ± 29 mg/dl, p=0.000) (Table 1). This was not the case for other CV risk categories. Similarly, LDL-c goal attainment in the moderate CV risk category was significant higher at the end of the study compared to baseline. Based on the 2016 European Society of Cardiology LDL-c targets, the achievement of a LDL-cholesterol inferior to 115 mg/dl for the moderate CV risk category significantly increased from 35 to 64% (p=0.000) after follow-up. However, significant changes were not observed in this regard for the low, high, and very-high CV risk categories.

Table 1.

LDL cholesterol serum levels and LDL goals differences between baseline and final follow-up

LDL, mg/dlLDL (mg/dl) ESC 2016 goalsn%BaselineFinal follow-upGoalBaselineFinal follow-upp2010 EULAR RA SCORELow12037116 ± 37119 ± 320.081< 13068%66%0.99Moderate19560126 ± 33109 ± 290.000< 11535%64%0.000High72121 ± 26104 ± 220.14< 10014%33%0.99Very High50131 ± 41115 ± 460.080< 700%20%0.99

ESC: European Society of Cardiology; EULAR: European League Against Rheumatism. SCORE: Systematic COronary Risk Evaluation; RA: Rheumatoid Arthritis; LDL: low-density lipoprotein. Significant ‘p’ value are depicted in bold.

When patients with RA, regardless the SCORE risk they had, were divided between those that attained LDL-cholesterol target or not, those that achieved their LDL goal, were more frequently female and had less diabetes mellitus. Moreover, the probability of achieving LDL-cholesterol goal was higher in those with an inferior total cholesterol, LDL-c and atherogenic index at baseline. Interestingly, no differences were observed in both populations regarding the baseline use of statins, aspirin or hypertension treatment at baseline. Concerning disease related data when study started, no differences about disease duration and activity or treatments were observed between dose that reached LDL-cholesterol goal and those that did not.

Those that achieved LDL-c objectives had a higher decrease in smoking quit and a superior control of hypertension. Besides, in those that attained objectives a superior increase in statins prescription was observed (36% vs. 13%, p=0.000), as well in hypertension and aspirin treatment. However, no differences were noticed in the changes in disease-related data that occur during the time the study was carried out.

Conclusion:

This real-world study demonstrates that incorporating carotid ultrasound into routine clinical practice in RA patients is effective in achieving LDL-cholesterol targets for the prevention of cardiovascular disease. This effect is not only mediated by the increase in the prescription of statins, but also by the better control of other cardiovascular risk factors that occurred after carotid ultrasound evaluation.

Disclosure of Interests:

None declared

AB0094 INCREASE OF ENDOTHELIAL PROGENITOR CELLS IN SYSTEMIC SCLEROSIS-ASSOCIATED INTERSTITIAL LUNG DISEASE

Background:

Endothelial progenitor cells (EPC), involved in vasculogenesis and endothelial tissue repair, have been described as relevant players in vascular and connective tissue diseases [1-2]. In this regard, a previous study of our group disclosed that the degree of EPC frequency may help to identify the presence of interstitial lung disease (ILD) in rheumatoid arthritis patients [3]. Given that ILD is the main cause of mortality in patients with systemic sclerosis (SSc) [1, 4-6], the understanding of the role of EPC in the mechanism of SSc-ILD+ vasculopathy is crucial.

Objectives:

To assess the potential role of EPC on vascular dysfunction associated with the presence of ILD in patients with SSc.

Methods:

Peripheral venous blood was collected from a total of 39 patients with SSc, 20 with ILD (SSc-ILD+) and 19 without ILD (SSc-ILD-). All subjects were recruited from the Rheumatology and Pneumology departments of Hospital Universitario Marqués de Valdecilla, Santander, Spain. Quantification of EPC was analyzed by flow cytometry. EPC were considered as CD34+, CD45Low, CD309+ and CD133+.

Results:

Statistically significant differences in EPC frequency between patients with SSc-ILD+ and patients with SSc-ILD- were disclosed. Specifically, an increase of EPC frequency was observed in SSc-ILD+ patients when compared to patients with SSc-ILD- (mean ± standard deviation: 0.033 ± 0.012 versus 0.021 ± 0.017, respectively, p=0.012).

Conclusion:

Our results suggest a potential role of EPC on vascular damage associated with the manifestation of ILD in patients with SSc.

References:

[1]Eur J Rheumatol 2020;7(Suppl 3):S139-S146.

[2]Arthritis Rheum 2009;60(11):3168-79.

[3]J Clin Med 2020;9(12):4098.

[4]Ann Rheum Dis 2007;66(7):940-4.

[5]Rheumatology (Oxford) 2010;49(12):2375-80.

[6]Eur Respir Rev 2015;24(135):102-14.

Acknowledgements:

Personal funds, VP-C: PREVAL18/01 (IDIVAL); SR-M: RD16/0012/0009 (ISCIII-ERDF); LL-G: INNVAL20/06 (IDIVAL); RP-F: START PROJECT (FOREUM); RL-M: Miguel Servet type I CP16/00033 (ISCIII-ESF).

Disclosure of Interests:

Verónica Pulito-Cueto: None declared, Sara Remuzgo Martinez: None declared, Fernanda Genre: None declared, Belén Atienza-Mateo: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe-Fernández: None declared, Leticia Lera-Gómez: None declared, Raquel Pérez-Fernández: None declared, Diana Prieto-Peña: None declared, Virginia Portilla: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Alfonso Corrales: None declared, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Pfizer, Abbvie, MSD, Grant/research support from: Pfizer, Abbvie, MSD

AB0026 DECREASE OF ANGIOGENIC T CELLS IN CONNECTIVE TISSUE DISEASE-ASSOCIATED INTERSTITIAL LUNG DISEASE

Background:

Interstitial lung disease (ILD) is one of the most significant complications of connective tissue diseases (CTD), leading to an increase of the morbidity and mortality in patients with CTD [1]. A specific T cell subset termed angiogenic T cells (TAng), that promote endothelial repair and revascularization, have been involved in the pathogenesis of CTD [2-4]. However, to the best of our knowledge, no information regarding the role of TAng in CTD-ILD+ is available.

Objectives:

To study, for the first time, the potential role of TAng related to vascular damage in CTD-ILD+.

Methods:

Peripheral venous blood was collected from 40 patients with CTD-ILD+ and three comparative groups: 44 CTD-ILD- patients, 21 idiopathic pulmonary fibrosis (IPF) patients and 20 healthy controls (HC). All subjects were recruited from the Rheumatology and Pneumology departments of Hospital Universitario Marqués de Valdecilla, Santander, Spain. Quantification of TAng was performed by flow cytometry. TAng were considered as triple-positive for CD3, CD31 and CXCR4.

Results:

Patients with CTD-ILD+ exhibited a significantly lower TAng frequency than CTD-ILD- patients (p<0.001). Similar results were obtained when patients with CTD-ILD+ were compared with HC (p=0.004) although no difference was observed between CTD-ILD+ and IPF. In addition, a significant increase of TAng frequency was shown in patients with CTD-ILD- in relation to IPF patients (p<0.001), while no difference was observed between CTD-ILD- and HC.

Conclusion:

Our results reveal a decrease of TAng frequency related to vascular damage in CTD-ILD+. Furthermore, we disclose that the presence of ILD is associated with lower TAng frequency.

References:

[1]Expert Rev Clin Immunol 2018;14(1):69-82.

[2]Circulation 2007;116(15):1671-82.

[3]Ann Rheum Dis 2015 74(5):921-7.

[4]PLoS One 2017;12(8):e0183102.

Acknowledgements:

Personal funds, VP-C: PREVAL18/01 (IDIVAL); SR-M: RD16/0012/0009 (ISCIII-ERDF); LL-G: INNVAL20/06 (IDIVAL); RP-F: START PROJECT (FOREUM); RL-M: Miguel Servet type I CP16/00033 (ISCIII-ESF).

Disclosure of Interests:

Verónica Pulito-Cueto: None declared, Sara Remuzgo Martinez: None declared, Fernanda Genre: None declared, Belén Atienza-Mateo: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe-Fernández: None declared, Leticia Lera-Gómez: None declared, Raquel Pérez-Fernández: None declared, Pilar Alonso Lecue: None declared, Javier Rodriguez Carrio: None declared, Diana Prieto-Peña: None declared, Virginia Portilla: None declared, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Grant/research support from: Abbvie, MSD and Roche, Alfonso Corrales: None declared, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Speakers bureau: Pfizer, Abbvie, MSD, Grant/research support from: Pfizer, Abbvie, MSD

Genome-wide association study of asthma exacerbations despite inhaled corticosteroid use

RATIONALE

Substantial variability in response to asthma treatment with inhaled corticosteroids (ICS) has been described among individuals and populations, suggesting the contribution of genetic factors. Nonetheless, only a few genes have been identified to date. We aimed to identify genetic variants associated with asthma exacerbations despite ICS use in European children and young adults and to validate the findings in non-Europeans. Moreover, we explored whether a gene-set enrichment analysis could suggest potential novel asthma therapies.

METHODS

A genome-wide association study (GWAS) of asthma exacerbations was tested in 2681 children of European descent treated with ICS from eight studies. Suggestive association signals were followed up for replication in 538 European asthma patients. Further evaluation was performed in 1773 non-Europeans. Variants revealed by published GWAS were assessed for replication. Additionally, gene-set enrichment analysis focused on drugs was performed.

RESULTS

10 independent variants were associated with asthma exacerbations despite ICS treatment in the discovery phase (p≤5×10-6). Of those, one variant at the CACNA2D3-WNT5A locus was nominally replicated in Europeans (rs67026078; p=0.010), but this was not validated in non-European populations. Five other genes associated with ICS response in previous studies were replicated. Additionally, an enrichment of associations in genes regulated by trichostatin A treatment was found.

CONCLUSIONS

The intergenic region of CACNA2D3 and WNT5A was revealed as a novel locus for asthma exacerbations despite ICS treatment in European populations. Genes associated were related to trichostatin A, suggesting that this drug could regulate the molecular mechanisms involved in treatment response.

Evaluation of Whole-Exome Enrichment Solutions: Lessons from the High-End of the Short-Read Sequencing Scale

Whole-exome sequencing has become a popular technique in research and clinical settings, assisting in disease diagnosis and increasing the understanding of disease pathogenesis. In this study, we aimed to compare common enrichment capture solutions available in the market. Peripheral blood-purified DNA samples were enriched with SureSelect^QXT V6 (Agilent) and various Illumina solutions: TruSeq DNA Nano, TruSeq DNA Exome, Nextera DNA Exome, and Illumina DNA Prep with Enrichment, and sequenced on a HiSeq 4000. We found that their percentage of duplicate reads was as much as 2 times higher than previously reported values for the previous HiSeq series. SureSelect^QXT and Illumina DNA Prep with Enrichment showed the best average on-target coverage, which improved when off-target regions were included. At high coverage levels and in shared bases, these two solutions and TruSeq DNA Exome provided three of the best performances. With respect to the number of small variants detected, SureSelect^QXT presented the lowest number of detected variants in target regions. When off-target regions were considered, its ability equalized to other solutions. Our results show SureSelect^QXT and Illumina DNA Prep with Enrichment to be the best enrichment capture solutions.

Interactive Web-Based Resource for Annotation of Genetic Variants Causing Hereditary Angioedema (HADA): Database Development, Implementation, and Validation

BACKGROUND

Hereditary angioedema is a rare genetic condition caused by C1 esterase inhibitor deficiency, dysfunction, or kinin cascade dysregulation, leading to an increased bradykinin plasma concentration. Hereditary angioedema is a poorly recognized clinical entity and is very often misdiagnosed as a histaminergic angioedema. Despite its genetic nature, first-line genetic screening is not integrated in routine diagnosis. Consequently, a delay in the diagnosis, and inaccurate or incomplete diagnosis and treatment of hereditary angioedema are common.

OBJECTIVE

In agreement with recent recommendations from the International Consensus on the Use of Genetics in the Management of Hereditary Angioedema, to facilitate the clinical diagnosis and adapt it to the paradigm of precision medicine and next-generation sequencing-based genetic tests, we aimed to develop a genetic annotation tool, termed Hereditary Angioedema Database Annotation (HADA).

METHODS

HADA is built on top of a database of known variants affecting function, including precomputed pathogenic assessment of each variant and a ranked classification according to the current guidelines from the American College of Medical Genetics and Genomics.

RESULTS

HADA is provided as a freely accessible, user-friendly web-based interface with versatility for the entry of genetic information. The underlying database can also be incorporated into automated command-line stand-alone annotation tools.

CONCLUSIONS

HADA can achieve the rapid detection of variants affecting function for different hereditary angioedema types, and further integrates useful information to reduce the diagnosis odyssey and improve its delay.

Insulin resistance in non-diabetes patients with spondyloarthritis

Objectives: Insulin resistance (IR) constitutes a major underlying abnormality driving cardiovascular disease in the general population and has been linked to inflammatory diseases. In this study, we aimed to determine the prevalence of IR in patients with spondyloarthritis (SpA) and whether IR can be explained by disease-related features in such cases. Method: The study included 577 subjects: 306 patients diagnosed with SpA according to Assessment of SpondyloArthritis international Society criteria and 271 controls. Insulin and C-peptide serum levels, IR and β-cell function (%B) indices by homoeostatic model assessment (HOMA2), and lipid profiles were assessed in patients and controls. A multivariable regression analysis was performed to evaluate the differences in IR indices between patients and controls and to determine how IR is associated with disease-related characteristics in SpA patients. Results: HOMA2-%B and HOMA2-IR scores, both calculated with insulin or C-peptide, had significantly higher values in SpA patients compared to controls in multivariable analysis adjusted for age, gender, traditional IR-related factors, and glucocorticoid intake. Disease activity, functional status, and metrological SpA indices were positively related to IR, but only in univariable analysis. Disease duration and positivity for human leucocyte antigen-B27 were independently associated with a higher HOMA2-%B after multivariable analysis. Conclusion: Patients with SpA have an increased IR compared to controls. SpA disease-related data are independently associated with β-cell dysfunction.

SAT0014 ENDOTHELIAL PROGENITOR CELLS: ROLE IN ENDOTHELIAL DAMAGE OF INTERSTITIAL LUNG DISEASE ASSOCIATED TO RHEUMATOID ARTHRITIS

Background:

Interstitial lung disease (ILD) is one of the most significant comorbidities of rheumatoid arthritis (RA), increasing the mortality in these patients [1,2]. Although the pathogenesis of ILD associated to RA (RA-ILD+) remains poorly defined [1], it is known that vascular tissue plays a crucial role in lung physiology [3]. In this context, a population of cells termed endothelial progenitor cells (EPC) are involved in vasculogenesis and endothelial tissue repair [4]. Previous reports suggest the implication of EPC in different conditions such as RA and idiopathic pulmonary fibrosis (IPF), the most common and destructive ILD [5,6]. Nevertheless, little is known about their specific role in RA-ILD+.

Objectives:

The purpose of this study was to shed light on the potential role of EPC in endothelial damage in RA-ILD+.

Methods:

Peripheral venous blood was collected from a total of 68 individuals (18 with RA-ILD+, 17 with RA-ILD-, 19 with IPF and 14 healthy controls). All subjects were recruited from the Rheumatology and Pneumology departments of Hospital Universitario Marqués de Valdecilla, Santander, Spain. Quantification of EPC was analyzed by the expression of surface antigens by flow cytometry. The combination of antibodies against the stem cell marker CD34, the immature progenitor marker CD133, the endothelial marker VEGF receptor 2 (CD309) and the common leukocyte antigen CD45 was used. EPC were considered as CD34+, CD45Low, CD309+and CD133+. All statistical analyses were performed using Prism software 5 (GraphPad).

Results:

EPC frequency was significantly increased in patients with RA-ILD+, RA-ILD-and IPF compared to controls (p=0.001, p=0.002, p< 0.0001, respectively). Nevertheless, patients with RA, both RA-ILD+and RA-ILD-, showed a lower frequency of EPC than those with IPF (p= 0.048, p= 0.006, respectively).

Conclusion:

Our results provide evidence for a potential role of EPC as a reparative compensatory mechanism related to endothelial damage in RA-ILD+, RA-ILD-and IPF patients. Interestingly, EPC frequency may help to establish a differential diagnostic between patients with IPF and those who have an underlying autoimmune disease (RA-ILD+).

References:

[1] J Clin Med 2019; 8: 2038;

[2] Arthritis Rheumatol 2015; 67: 28-38;

[3] Nat Protoc 2015; 10: 1697-1708;

[4] Science 1997; 275: 964-966;

[5] Rheumatology (Oxford) 2012; 51: 1775-1784;

[6] Angiogenesis 2013; 16: 147-157.

Acknowledgments:

Personal funds, VP-C: PREVAL18/01 (IDIVAL); SR-M: RD16/0012/0009 (ISCIII-ERDF); LL-G: PI18/00042 (ISCIII-ERDF); RL-M: Miguel Servet type I CP16/00033 (ISCIII-ESF).

Disclosure of Interests:

Verónica Pulito-Cueto: None declared, Sara Remuzgo-Martínez: None declared, Fernanda Genre: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe Fernández: None declared, Sonia Fernández-Rozas: None declared, Leticia Lera-Gómez: None declared, Pilar Alonso Lecue: None declared, Javier Rodriguez Carrio: None declared, Belén Atienza-Mateo: None declared, Virginia Portilla: None declared, David Merino: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD, Alfonso Corrales Speakers bureau: Abbvie, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD

FRI0322 INSULIN RESISTANCE IN NON-DIABETES PATIENTS WITH SPONDYLOARTHRITIS

Background:

Insulin resistance (IR) is a state in which a given concentration of insulin is associated with a subnormal glucose response. IR constitutes a major underlying abnormality driving cardiovascular disease in the general population and has been linked to inflammatory diseases. In this sense, several reports have confirmed that inflammation worsens IR and impairs pancreatic β-cell function in inflammatory diseases such as rheumatoid arthritis and systemic lupus erythematosus.

Objectives:

In this study we aimed to determine the prevalence of IR in patients with spondyloarthritis (SpA) compared to controls, and whether IR can be explained by disease-related features in SpA patients.

Methods:

Study of 577 subjects, 306 patients diagnosed with SpA according to ASAS criteria and 271 controls. Insulin and C-peptide serum levels, IR and β-cell function (%B) indexes by homeostatic model assessment (HOMA2), and lipid profiles were assessed in patients and controls. A multivariate regression analysis was performed to evaluate the differences in IR indexes between patients and controls and to determine how IR is associated with disease-related characteristics.

Results:

SpA patients showed higher serum levels of insulin (8.7 [4.8-15.9] vs. 8.0 [5.7-11.2] uU/ml, p=0.001) and C peptide (1.4 [0.7-2.5] vs. 1.2 [0.7-1.7] ng/ml, p=0.000) than controls in the univariate analysis. Similarly, HOMA2-B% and IR were all significantly higher in SpA patients. These differences were still evident when the comparisons were made after the multivariate analysis had been adjusted for traditional IR-related factors (sex, age, BMI, hypertension, dyslipidemia, smoking and, cholesterol), glucocorticoids intake, insulin and C-peptide. Moreover, HOMA2-B% and HOMA2-IR scores, both calculated with insulin or C-peptide, yielded statistically higher significant values in SpA patients than controls.

Classic IR-related factors (age, BMI, waist circumference, hypertension, obesity, dyslipidemia, atherogenic index, and triglycerides), as well as CRP serum levels, were all related, to a greater or lesser degree, with IR and β-cell function. Regarding disease-related data, ASDAS-CRP, BASFI and BASMI scores were positively associated with IR; and BASMI and BASDAI scores were positively related to HOMA2-%B-C peptide. Moreover, the use of NSAID and prednisone were, respectively, positive and negatively related to β-cell function. However, only some of the associations of the univariate analysis were maintained after adjusting for confounders. In this sense, disease duration (beta coefficient 2 [95% CI 1-3], p=0.001) and positivity for HLA-B27 (beta coefficient 30 [95% CI 12-49], p=0.002) were associated with higher β-cell functionality after the multivariate analysis.

Conclusion:

Patients with SpA have an increased IR compared to controls. SpA disease-related data like disease duration and HLA-B27 are independently associated with β-cell dysfunction.

Disclosure of Interests:

Juan Carlos Quevedo-Abeledo Speakers bureau: Abbvie, Fernanda Genre: None declared, Javier Rueda-Gotor: None declared, Alfonso Corrales Speakers bureau: Abbvie, Vanessa Hernández-Hernández Speakers bureau: Pfizer, Abbvie, MSD, Natalia Fañanas-Rodríguez: None declared, Bernardo Lavín-Gómez: None declared, delgado frias esmeralda Speakers bureau: Pfizer, Abbvie, MSD, Antonia de Vera-González: None declared, Alejandra Delgado-González: None declared, Laura de Armas-Rillo: None declared, Maria Teresa García-Unzueta: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Iván Ferraz-Amaro Grant/research support from: Pfizer, Abbvie, Speakers bureau: Pfizer, Abbvie, MSD.

AB0242 SURVIVAL ANALYSIS IN THE DEVELOPMENT OF SERIOUS INFECTIONS AND SERIOUS RESPIRATORY INFECTIONS IN AR PATIENTS INCLUDED IN A VACCINATION PROGRAM

Background:

Rheumatoid arthritis is an autoimmune disorder in which patients have an increased risk of developement of serious infections. This risk may be augmented due to RA itself and to immunosuppressive drugs, specially biologic therapy. Vaccination programs may change this condition.

Objectives:

Our aim in this study was to evaluate the incidence of serious infections in a vaccinate RA patients cohort.

Methods:

Prospective study of 401 patients diagnosed with RA who were invited to participate in the vaccination program of the Preventive Medicine department of our hospital from October 2011 to October 2016. The follow up was made until June 2017 with a minimun follow-up period of 8 months and maximun of 5.5 years. Serious infections were defined as those that required hospitalization or at least one dose of intravenous antibiotic treatement at emergency room. Information was retrieved from dthe hospital records.

Only 7 patients refused vaccination (2%). Information was not obtained in 4 of the remaining 394 patients. Therefore, these 4 patients were not incuded in the assessment.

Survival análisis was assessed by Kaplan-Meier method.

Results:

We finally studied 390 patients (307♀/83♂) mean age±SD 61,28 ± 12,9 years that participate in the vaccination program and followed-up. The main features at the time of vaccination were: median disease duration (4years), positive rheumatoid factor (56,7%), subcutaneous nodules (4.9%), erosive arthritis (36.9%), pulmonary fibrosis (3.8%), secondary Sjögren syndrome (5.1%), other extraartocular manifestations (14.6%) and rheumatoid vasculitis (5.6%) Most patients had received imunosuppressive drugs before the vaccination program. The most frequently used were systemic corticosteroids (n=228), methotrexate (n=362) and biologic agents (40.3%).

During the follow-up, 42 patients (10.7%) had required hospital admissions due to infections, 17 of them were severe respiratory infections (4.35%). The remaining 25 admissions were in the setting of urinary tract infections (n=12), intraabdominal infections (7), skin and soft tissues (12) and articular (1). Also 12 of these patients had a zoster herpes.

Afeter a median follow-up of 1061,89 ± 417 days, the incidence of serious infection, with a CI (95%), was 4.00 (2.95-5.41) for 100 patients yearly. Concerning to admissions due to serious respiratory infections, with a CI (95%), was 1.55 (0.9-2.47) for 100 patients yearly.Images 1 and 2.

Image 1.

Survival analysis on serious infections

Image 1.

Survival analysis on serious respiratory infections

Conclusion:

In this stydy we can concluded that our RA vaccinated patients present a dicrease of the incidence of serious infeccions, similar to other published cohorts. The incidence of serious respiratory infections shows a dicrease even lower to other published cohorts. The vaccination program seems to be effective to prevent hospital admissions due to infections.

Disclosure of Interests:

Lucia Domínguez: None declared, Paz Rodriguez Cundin: None declared, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Nuria Vegas-Revenga Grant/research support from: AbbVie, Roche, Pfizer, Lilly, Gebro Pharma, MSD, Novartis, Bristol-Myers, Janssen, and Celgene, Virginia Portilla: None declared, Francisco Manuel Antolin-Juarez: None declared, Maria Henar Rebollo Rodriguez: None declared, Alfonso Corrales Speakers bureau: Abbvie, Natalia Palmou-Fontana: None declared, D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

Admixture mapping of asthma in southwestern Europeans with North African ancestry influences

The prevalence of asthma symptoms in Canary Islanders, a southwestern European population from Spain, is almost three times higher than the country average. Because the genetic risks identified so far explain <5% of asthma heritability, here we aimed to discover new asthma loci by completing the first admixture mapping study in Canary Islanders leveraging their distinctive genetic makeup, where significant northwest African influences coexist in the European genetic diversity landscape. A 2-stage study was conducted in 1,491 unrelated individuals self-declaring having a Canary Islands origin for the 4 grandparents. Local ancestry estimates were obtained for the shared positions with reference data from putative ancestral populations from Europe, North Africa, and sub-Saharan Africa. Case-control deviations in local ancestry were tested for each ancestry separately using logistic regressions adjusted for principal components, followed by fine-mapping analyses based on imputed genotypes and analyses of the likely deleterious exonic variants. The admixture mapping analysis of asthma detected that local North African ancestry in a locus spanning 365 kb of chromosome 16q23.3 was associated with asthma risk at study-wide significance [lowest P = 1.12 × 10^-4; odds ratio (OR) = 2.05; 95% confidence interval (CI) = 1.41-3.00]. Fine-mapping studies identified a variant associated with asthma, and results were replicated in independent samples (rs3852738, OR = 1.34; 95% CI = 1.13-1.59, P = 7.58 × 10^-4). Whole exome sequencing data from a subset of individuals revealed an enrichment of likely deleterious variants among asthma cases in 16q23.3, particularly in the phospholipase Cγ2 (PLCG2) gene (P = 3.67 × 10^-4). By completing the first mapping study of asthma in admixed populations from Europe, our results revealed a new plausible asthma locus.

Sepsis-associated acute respiratory distress syndrome in individuals of European ancestry: a genome-wide association study

BACKGROUND

Acute respiratory distress syndrome (ARDS) is a lung inflammatory process caused mainly by sepsis. Most previous studies that identified genetic risks for ARDS focused on candidates with biological relevance. We aimed to identify novel genetic variants associated with ARDS susceptibility and to provide complementary functional evidence of their effect in gene regulation.

METHODS

We did a case-control genome-wide association study (GWAS) of 1935 European individuals, using patients with sepsis-associated ARDS as cases and patients with sepsis without ARDS as controls. The discovery stage included 672 patients admitted into a network of Spanish intensive care units between January, 2002, and January, 2017. The replication stage comprised 1345 individuals from two independent datasets from the MESSI cohort study (Sep 22, 2008-Nov 30, 2017; USA) and the VISEP (April 1, 2003-June 30, 2005) and MAXSEP (Oct 1, 2007-March 31, 2010) trials of the SepNet study (Germany). Results from discovery and replication stages were meta-analysed to identify association signals. We then used RNA sequencing data from lung biopsies, in-silico analyses, and luciferase reporter assays to assess the functionallity of associated variants.

FINDINGS

We identified a novel genome-wide significant association with sepsis-associated ARDS susceptibility (rs9508032, odds ratio [OR] 0·61, 95% CI 0·41-0·91, p=5·18 × 10^-8) located within the Fms-related tyrosine kinase 1 (FLT1) gene, which encodes vascular endothelial growth factor receptor 1 (VEGFR-1). The region containing the sentinel variant and its best proxies acted as a silencer for the FLT1 promoter, and alleles with protective effects in ARDS further reduced promoter activity (p=0·0047). A literature mining of all previously described ARDS genes validated the association of vascular endothelial growth factor A (VEGFA; OR 0·55, 95% CI 0·41-0·73; p=4·69 × 10^-5).

INTERPRETATION

A common variant within the FLT1 gene is associated with sepsis-associated ARDS. Our findings support a role for the vascular endothelial growth factor signalling pathway in ARDS pathogenesis and identify VEGFR-1 as a potential therapeutic target.

FUNDING

Instituto de Salud Carlos III, European Regional Development Funds, Instituto Tecnológico y de Energías Renovables.

Genomic Analyses of Human European Diversity at the Southwestern Edge: Isolation, African Influence and Disease Associations in the Canary Islands

Despite the genetic resemblance of Canary Islanders to other southern European populations, their geographical isolation and the historical admixture of aborigines (from North Africa) with sub-Saharan Africans and Europeans have shaped a distinctive genetic makeup that likely affects disease susceptibility and health disparities. Based on single nucleotide polymorphism array data and whole genome sequencing (30×), we inferred that the last African admixture took place ∼14 generations ago and estimated that up to 34% of the Canary Islander genome is of recent African descent. The length of regions in homozygosis and the ancestry-related mosaic organization of the Canary Islander genome support the view that isolation has been strongest on the two smallest islands. Furthermore, several genomic regions showed significant and large deviations in African or European ancestry and were significantly enriched in genes involved in prevalent diseases in this community, such as diabetes, asthma, and allergy. The most prominent of these regions were located near LCT and the HLA, two well-known targets of selection, at which 40‒50% of the Canarian genome is of recent African descent according to our estimates. Putative selective signals were also identified in these regions near the SLC6A11-SLC6A1, KCNMB2, and PCDH20-PCDH9 genes. Taken together, our findings provide solid evidence of a significant recent African admixture, population isolation, and adaptation in this part of Europe, with the favoring of African alleles in some chromosome regions. These findings may have medical implications for populations of recent African ancestry.

A vascular endothelial growth factor receptor gene variant is associated with susceptibility to acute respiratory distress syndrome

BACKGROUND

The acute respiratory distress syndrome (ARDS) is one of the main causes of mortality in adults admitted to intensive care units. Previous studies have demonstrated the existence of genetic variants involved in the susceptibility and outcomes of this syndrome. We aimed to identify novel genes implicated in sepsis-induced ARDS susceptibility.

METHODS

We first performed a prioritization of candidate genes by integrating our own genomic data from a transcriptomic study in an animal model of ARDS and from the only published genome-wide association study of ARDS study in humans. Then, we selected single nucleotide polymorphisms (SNPs) from prioritized genes to conduct a case-control discovery association study in patients with sepsis-induced ARDS (n = 225) and population-based controls (n = 899). Finally, we validated our findings in an independent sample of 661 sepsis-induced ARDS cases and 234 at-risk controls.

RESULTS

Three candidate genes were prioritized: dynein cytoplasmic-2 heavy chain-1, fms-related tyrosine kinase 1 (FLT1), and integrin alpha-1. Of those, a SNP from FLT1 gene (rs9513106) was associated with ARDS in the discovery study, with an odds ratio (OR) for the C allele of 0.76, 95% confidence interval (CI) 0.58-0.98 (p = 0.037). This result was replicated in an independent study (OR = 0.78, 95% CI = 0.62-0.98, p = 0.039), showing consistent direction of effects in a meta-analysis (OR = 0.77, 95% CI = 0.65-0.92, p = 0.003).

CONCLUSIONS

We identified FLT1 as a novel ARDS susceptibility gene and demonstrated that integration of genomic data can be a valid procedure to identify novel susceptibility genes. These results contribute to previous firm associations and functional evidences implicating FLT1 gene in other complex traits that are mechanistically linked, through the key role of endothelium, to the pathophysiology of ARDS.

Insulin resistance in hidradenitis suppurativa: a case-control study

BACKGROUND

The association between chronic inflammatory diseases, such as rheumatoid arthritis and psoriasis, and insulin resistance (IR) has been well established. Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disease that affects the apocrine gland-bearing areas of the body.

OBJECTIVE

We aimed to determine the prevalence of IR in patients with HS.

METHODS

This cross-sectional, case-control study enrolled 137 subjects, 76 patients with HS and 61 age- and gender-matched controls. Demographic data, clinical examination of HS patients, anthropometric measures, cardiovascular risk factors and laboratory studies were recorded. The homeostasis model assessment of IR (HOMA-IR) was calculated in all participants by measuring fasting plasma glucose and insulin levels.

RESULTS

The median (IQR) HOMA-IR value in HS patients was significantly higher [2.0 (1.0-3.6)] than in controls [1.5 (0.9-2.3)] (P = 0.01). The prevalence of IR was significantly higher in cases (43.4%) compared with controls (16.4%) (P = 0.001). In the linear regression multivariable analysis after adjusting for age, sex and body mass index (BMI), HS remained as a significant factor for a higher HOMA-IR [2.51 (0.18) vs 1.92(0.21); P = 0.04]. The HOMA-IR value and the prevalence of IR did not differ significantly among HS patients grouped by severity of the disease.

CONCLUSION

Our results show an increased frequency of IR in HS. Thus, we suggest HS patients to be evaluated for IR and managed accordingly.

A pathway-based association study reveals variants from Wnt signalling genes contributing to asthma susceptibility

BACKGROUND

Genetic susceptibility to asthma is currently linked to a handful of genes which have a limited ability to predict the overall disease risk, suggesting the existence of many other genes involved in disease development. Accumulated evidence from association studies in genes related by biological pathways could reveal novel asthma genes.

OBJECTIVE

To reveal novel asthma susceptibility genes by means of a pathway-based association study.

METHODS

Based on summary data from a previous a genomewide association study (GWAS) of asthma, we first identified significant biological pathways using a gene-set enrichment analysis. We then mapped all tested single nucleotide polymorphisms (SNPs) on the genes contributing to significant pathways and prioritized those with a disproportionate number of nominal significant associations for further studies. For those prioritized genes, association studies were performed for selected SNPs in independent case-control samples (n = 1765) using logistic regression models, and results were meta-analysed with those from the GWAS.

RESULTS

Two biological processes were significantly enriched: the cytokine-cytokine receptor interaction (P = 0.002) and the Wnt signalling (P = 0.012). From the 417 genes interacting in these two pathways, 10 showed an excess of nominal associations, including a known asthma susceptibility locus (encoding SMAD family member 3) and other novel candidate genes. From the latter, association studies of 14 selected SNPs evidenced replication in a locus near the frizzled class receptor 6 (FZD6) gene (P = 9.90 × 10^-4 ), which had a consistent direction of effects with the GWAS findings (meta-analysed odds ratio = 1.49; P = 5.87 × 10^-6 ) and was in high linkage disequilibrium with expression quantitative trait loci in lung tissues.

CONCLUSIONS AND CLINICAL RELEVANCE

This study revealed the importance of two biological pathways in asthma pathogenesis and identified a novel susceptibility locus near Wnt signalling genes.