Neurological research in Italy from 2020 to 2023

BACKGROUND

To assess the state of neurological scientific research in Italy in the time interval 2020-2023.

METHODS

Elsevier's modular integrated platform "SciVal" was used to analyze bibliometric research products starting from scientific production data uploaded onto Scopus. We considered the research area "Neurology" in the 01/01/2020-14/06/2023 time interval, and the following variables were extracted: number of published studies, number of citations, Field-Weighted Citation Impact, and percentage of international collaborations. The contribution of Italian scientists to the neurological research was compared to that of the other nations.

RESULTS

Research identified 90,633 scientific papers in the neurological area worldwide, with a total of 472,750 citations. The products assigned to Italian groups were 6670 (53,587 citations, Field-Weighted Citation Impact 1.68, 41% international collaborations).

CONCLUSIONS

According to the present study, Italian neurological research 2020 to 2023 ranks fifth globally and third in Europe.

Involvement of an IgE/Mast cell/B cell amplification loop in abdominal aortic aneurysm progression

AIMS

IgE type immunoglobulins and their specific effector cells, mast cells (MCs), are associated with abdominal aortic aneurysm (AAA) progression. In parallel, immunoglobulin-producing B cells, organised in tertiary lymphoid organs (TLOs) within the aortic wall, have also been linked to aneurysmal progression. We aimed at investigating the potential role and mechanism linking local MCs, TLO B cells, and IgE production in aneurysmal progression.

METHODS AND RESULTS

Through histological assays conducted on human surgical samples from AAA patients, we uncovered that activated MCs were enriched at sites of unhealed haematomas, due to subclinical aortic wall fissuring, in close proximity to adventitial IgE+ TLO B cells. Remarkably, in vitro the IgEs deriving from these samples enhanced MC production of IL-4, a cytokine which favors IgE class-switching and production by B cells. Finally, the role of MCs in aneurysmal progression was further analysed in vivo in ApoE-/- mice subjected to angiotensin II infusion aneurysm model, through MC-specific depletion after the establishment of dissecting aneurysms. MC-specific depletion improved intramural haematoma healing and reduced aneurysmal progression.

CONCLUSIONS

Our data suggest that MC located close to aortic wall fissures are activated by adventitial TLO B cell-produced IgEs and participate to their own activation by providing support for further IgE synthesis through IL-4 production. By preventing prompt repair of aortic subclinical fissures, such a runaway MC activation loop could precipitate aneurysmal progression, suggesting that MC-targeting treatments may represent an interesting adjunctive therapy for reducing AAA progression.

Development of a clot-adhesive coating to improve the performance of thrombectomy devices

BACKGROUND

The first-pass complete recanalization by mechanical thrombectomy (MT) for the treatment of stroke remains limited due to the poor integration of the clot within current devices. Aspiration can help retrieval of the main clot but fails to prevent secondary embolism in the distal arterial territory. The dense meshes of extracellular DNA, recently described in stroke-related clots, might serve as an anchoring platform for MT devices. We aimed to evaluate the potential of a DNA-reacting surface to aid the retention of both the main clot and small fragments within the thrombectomy device to improve the potential of MT procedures.

METHODS

Device-suitable alloy samples were coated with 15 different compounds and put in contact with extracellular DNA or with human peripheral whole blood, to compare their binding to DNA versus blood elements in vitro. Clinical-grade MT devices were coated with two selected compounds and evaluated in functional bench tests to study clot retrieval efficacy and quantify distal emboli using an M1 occlusion model.

RESULTS

Binding properties of samples coated with all compounds were increased for DNA (≈3-fold) and decreased (≈5-fold) for blood elements, as compared with the bare alloy samples in vitro. Functional testing showed that surface modification with DNA-binding compounds improved clot retrieval and significantly reduced distal emboli during experimental MT of large vessel occlusion in a three-dimensional model.

CONCLUSION

Our results suggest that clot retrieval devices coated with DNA-binding compounds can considerably improve the outcome of the MT procedures in stroke patients.

CD31 signaling promotes the detachment at the uropod of extravasating neutrophils allowing their migration to sites of inflammation

Effective neutrophil migration to sites of inflammation is crucial for host immunity. A coordinated cascade of steps allows intravascular leukocytes to counteract the shear stress, transmigrate through the endothelial layer, and move toward the extravascular, static environment. Those events are tightly orchestrated by integrins, but, while the molecular mechanisms leading to their activation have been characterized, the regulatory pathways promoting their detachment remain elusive. In light of this, it has long been known that platelet-endothelial cell adhesion molecule (Pecam1, also known as CD31) deficiency blocks leukocyte transmigration at the level of the outer vessel wall, yet the associated cellular defects are controversial. In this study, we combined an unbiased proteomic study with in vitro and in vivo single-cell tracking in mice to study the dynamics and role of CD31 during neutrophil migration. We found that CD31 localizes to the uropod of migrating neutrophils along with closed β2-integrin and is required for essential neutrophil actin/integrin polarization. Accordingly, the uropod of Pecam1-/- neutrophils is unable to detach from the extracellular matrix, while antagonizing integrin binding to extracellular matrix components rescues this in vivo migratory defect. Conversely, we showed that sustaining CD31 co-signaling actively favors uropod detachment and effective migration of extravasated neutrophils to sites of inflammation in vivo. Altogether, our results suggest that CD31 acts as a molecular rheostat controlling integrin-mediated adhesion at the uropod of egressed neutrophils, thereby triggering their detachment from the outer vessel wall to reach the inflammatory sites.

Thrombopoietin-Dependent Myelo-Megakaryopoiesis Fuels Thromboinflammation and Worsens Antibody-Mediated Chronic Renal Microvascular Injury

SIGNIFICANCE STATEMENT

Kidney-derived thrombopoietin (TPO) increases myeloid cell and platelet production during antibody-mediated chronic kidney disease (AMCKD) in a mouse model, exacerbating chronic thromobinflammation in microvessels. The effect is mirrored in patients with extracapillary glomerulonephritis associated with thromboinflammation, TGF β -dependent glomerulosclerosis, and increased bioavailability of TPO. Neutralization of TPO in mice normalized hematopoiesis, reduced chronic thromboinflammation, and ameliorated renal disease. The findings suggest that TPO is a relevant biomarker and a promising therapeutic target for patients with CKD and other chronic thromboinflammatory diseases.Neutralization of TPO in mice normalized hematopoiesis, reduced chronic thromboinflammation, and ameliorated renal disease. The findings suggest that TPO is a relevant biomarker and a promising therapeutic target for patients with CKD and other chronic thromboinflammatory diseases.

BACKGROUND

Chronic thromboinflammation provokes microvascular alterations and rarefaction, promoting organ dysfunction in individuals with various life-threatening diseases. Hematopoietic growth factors (HGFs) released by the affected organ may sustain emergency hematopoiesis and fuel the thromboinflammatory process.

METHODS

Using a murine model of antibody-mediated chronic kidney disease (AMCKD) and pharmacological interventions, we comprehensively monitored the response to injury in the circulating blood, urine, bone marrow, and kidney.

RESULTS

Experimental AMCKD was associated with chronic thromboinflammation and the production of HGFs, especially thrombopoietin (TPO), by the injured kidney, which stimulated and skewed hematopoiesis toward myelo-megakaryopoiesis. AMCKD was characterized by vascular and kidney dysfunction, TGF β -dependent glomerulosclerosis, and microvascular rarefaction. In humans, extracapillary glomerulonephritis is associated with thromboinflammation, TGF β -dependent glomerulosclerosis, and increased bioavailability of TPO. Analysis of albumin, HGF, and inflammatory cytokine levels in sera from patients with extracapillary glomerulonephritis allowed us to identify treatment responders. Strikingly, TPO neutralization in the experimental AMCKD model normalized hematopoiesis, reduced chronic thromboinflammation, and ameliorated renal disease.

CONCLUSION

TPO-skewed hematopoiesis exacerbates chronic thromboinflammation in microvessels and worsens AMCKD. TPO is both a relevant biomarker and a promising therapeutic target in humans with CKD and other chronic thromboinflammatory diseases.

"Fare male farsi male" project - Are cyberbullying and cyber victimisation associated with physical activity levels? a cross sectional study in a sample of Italian adolescents

Background

The aim of this project is to study the prevalence of cyberbullies (CB) and cybervictims (CV) and cyberbully-victims(CBV) in Italian adolescent students and a possible correlation with physical activity (PA) levels and as potential protective factor.

Methods

The Italian version of the European Cyberbullying Intervention Project Questionnaire (ECIPQ) was used for categorized cyberbullies (CB) and cybervictims (CV). Six items of the IPAQ-A Italian version were considered to measure the PA levels.

Results

2112 questionnaires were collected, with response rate of 80.5%. The sample reported 9% was CV only, 5% was CB only, and 6% was cyberbully-victims (CBV). The factors that are significant associated to the CV students were: female gender (OR=1.7; 95%CI:1.18-2.35); stay at middle school (OR=1.56; 95%CI:1.01-2.44); spent more than 2 hours on IT devices (OR=1.63; 95%CI:1.08-2.47). The variables significant associated to the CB students were: gender male (OR=0.51 95%CI:0.320.80); spent more than 2 hours on IT devices (OR=2.37; 95%CI:1.32-4.26); tobacco use (OR=2.55; 95%CI:1.63-3.98); an inverse proportion with the number of days spent in vigorous physical activities (OR=0.82; 95%CI:0.68-0.98). The CBV students were significant associated with a male gender (OR=0.58; 95%CI:0.38-0.89) and tobacco consumption (OR=2.22; 95%CI:1.46-3.37).

Conclusions

The physical activity at vigorous level seem to be related to less involvement in cyberaggression, so it is recommended that those responsible for training adolescents' favour this aspect. Research on effective prevention is insufficient and evaluation of policy tools for cyberbullying intervention is a nascent research field an any prevention or intervention program could consider this factor.

Gender differences in microRNA expression in levodopa-naive PD patients

Gender is an important factor influencing epidemiological and clinical features of Parkinson's disease (PD). We aimed to evaluate gender differences in the expression of a panel of miRNAs (miR-34a-5p, miR-146a, miR-155, miR-29a, miR-106a) possibly involved in the pathophysiology or progression of disease. Serum samples were obtained from 104 PD patients (58 men and 46 women) never treated with levodopa. We measured levels of miRNAs using quantitative PCR. Correlations between miRNA expression and clinical data were assessed using the Spearman's correlation test. We used STRING to evaluate co-expression relationship among target genes. MiR-34a-5p was significantly upregulated in PD male patients compared to PD female patients (fc: 1.62; p < 0.0001). No correlation was found with age, BMI, and disease severity, assessed by UPDRS III scale, in male and female patients. MiR-146a-5p was significantly upregulated in female as compared to male patients (fc: 3.44; p < 0.0001) and a significant correlation was also observed between disease duration and mir-146a-5p. No differences were found in the expression of miR-29a, miR-106a-5p and miR-155 between genders. Predicted target genes for miR-34a-5p and miR-146-5p and protein interactions in biological processes were reported. Our study supports the hypothesis that there are gender-specific differences in serum miRNAs expression in PD patients. Follow-up of this cohort is needed to understand if these differences may affect disease progression and response to treatment.

The third age: physical activity and culture over 65

The present research focuses on the delicate and complex process of senilization of the population, being one of the most important anthropological and social problems of our time. These considerations lead us to examine not so much the aging process itself, but the relationship between the third age and society, focusing on the factors that promote or inhibit well-being and the relative perceptions that emerged in the sample. In this sense, an online questionnaire was administered, by email and by telephone message, over a period of approximately 10 months starting from March 2021 until December 2021. The questionnaire included multiple choice questions that produced clear data and simple analysis, arriving at an accurate analysis (qualitative and quantitative), on the topics of interest: the role of nutrition and sport in the over 65s, not only by the subjects in question, but also the considerations and perceptions of subjects belonging to different age groups with reference to the topics of interest relating to the third age. The sample results, allow us to identify the appropriate interven-tion strategies and policies useful for eradicating the stereotype that accompanied the concept of old age until a few years ago, making it synonymous with illness, loneliness, fragility and uselessness. Finally, today, we have freed ourselves from the role of "sedentary elderly" and motor activity in the third age is increasingly widespread and relevant as can be seen from the data analysis. This research is the result of a program that has been in place for several years now to combat the hypokinesis diseases, through physical movement and particularly by examples of appropriate lifestyles. This initiative was conceived and implemented by C.I.S.C.O.D. (Comitato Italiano Sport Contro Droga) and CO.NA.P.E.F.S. (Collegio Nazionale Professori Educazione Fisica e Laureati in Scienze Motorie), two C.O.N.I. well-deserving associations, and carried out as part of a larger "Survey on nutrition and culture over 65" project, proclaimed by Sport & Salute S.p.A.

Inverted direct allorecognition triggers early donor-specific antibody responses after transplantation

The generation of antibodies against donor-specific major histocompatibility complex (MHC) antigens, a type of donor-specific antibodies (DSAs), after transplantation requires that recipient's allospecific B cells receive help from T cells. The current dogma holds that this help is exclusively provided by the recipient's CD4+ T cells that recognize complexes of recipient's MHC II molecules and peptides derived from donor-specific MHC alloantigens, a process called indirect allorecognition. Here, we demonstrated that, after allogeneic heart transplantation, CD3ε knockout recipient mice lacking T cells generate a rapid, transient wave of switched alloantibodies, predominantly directed against MHC I molecules. This is due to the presence of donor CD4+ T cells within the graft that recognize intact recipient's MHC II molecules expressed by B cell receptor-activated allospecific B cells. Indirect evidence suggests that this inverted direct pathway is also operant in patients after transplantation. Resident memory donor CD4+ T cells were observed in perfusion liquids of human renal and lung grafts and acquired B cell helper functions upon in vitro stimulation. Furthermore, T follicular helper cells, specialized in helping B cells, were abundant in mucosa-associated lymphoid tissue of lung and intestinal grafts. In the latter, more graft-derived passenger T cells correlated with the detection of donor T cells in recipient's circulation; this, in turn, was associated with an early transient anti-MHC I DSA response and worse transplantation outcomes. We conclude that this inverted direct allorecognition is a possible explanation for the early transient anti-MHC DSA responses frequently observed after lung or intestinal transplantations.

P-722 Ending the anonymity of egg donors in shared donation programs could reduce the number of participants

Study question

Loss of egg donor anonymity could affect shared donation programs in Brazil?

Summary answer

Yes. Approximately 20% of the women who participated in this study would drop out of the program, especially those with higher incomes.

What is known already

The Brazilian Federal Council of Medicine seems to be increasingly flexible with regard to maintaining mandatory secrecy on the identity of donors. The resolution regarding assisted reproduction techniques, approved in 2021, concerns the possibility of donation between family members, up to fourth degree relatives. The possibility to know and have access to this identity or even the search for half-brothers can be a reality in many countries for children born through access to reproductive technology but the opinion or behaviour of this population about the presence or absence of anonymity is limited to a few studies.

Study design, size, duration

Women (n = 800) who applied for enrolment in the shared egg donation program at a private IVF clinic were invited to participate in an electronic survey developed using the online Survio® tool. The invitation to participate was sent by email from June to November 2021. 279 women (34.8%, 20-35 years) responded to the survey.

Participants/materials, setting, methods

The information was obtained through questioning and gaining information about: socioeconomic profile of the donors, their motives, ambivalence in relation to the sharing of eggs and feelings about a possible end of anonymity. Thereafter, answers given to 10 specific questions were recorded. Furthermore, a correlation analysis was performed to assess the relationship between acceptance of the end of donor anonymity and various study parameters.

Main results and the role of chance

Approximately 61% of patients would want to become egg donors for two reasons: to reduce IVF costs and to help another woman. However, significantly younger women want to be part of the egg donation program just to reduce their treatment costs (P &lt; 0.05). Approximately 71% of women do not want any contact with the child born from their eggs; 69% of them would not like to meet the recipients and 75% would not like to meet the child, even if only the recipient had become pregnant. If donors lost a child, they would not even want to meet the child who was born with their donated eggs (76%).

Most participants also responded that they would be in the program even if the anonymity was not maintained (80%). However, women with higher income would drop out of the program if donor anonymity was not maintained (56.3%) compared to women with lower income (13.5%;P &lt; 0.001).

Limitations, reasons for caution

Confounding variables related to the male partner's opinion cannot be excluded. Studies with larger samples are needed to confirm these findings.

Wider implications of the findings

A possible end to the anonymity of egg donors in Brazil would pose numerous challenges to the current practice of gamete donation. These concerns give rise to a broad discussion in society about how best to safeguard and promote the interests of donor-conceived children and protect the rights of donors.

Trial registration number

Not applicable.

P-535 Preimplantation Genetic Testing for Aneuploidy (PGT-A) for patients aged ≤ 37 years: Today, evidence-based medicine does not support its use. A meta-analysis

Study question

Do patients aged ≤37 years truly benefit from using PGT-A as an add-on to increase ongoing pregnancy rate (OPR)/live birth rate (LBR) in their first IVF/ICSI cycle?

Summary answer

The use of PGT-A is not superior to classic morphological embryonic selection to increase OPR/LBR in patients aged ≤37 years in their first IVF/ICSI cycle.

What is known already

The embryonic aneuploidies increase exponentially with advancing-maternal-age, ranging from 30-50% up to 37 years to 80% in women ≥42 years. Consequently, the use of PGT-A seems to be a useful add-on for patients with advanced-maternal-age, but not necessarily for young women undergoing their first IVF/ICSI cycle. Recent studies investigated the benefit of PGT-A, concluding that it was accompanied with lower OPR/LBR, when compared to conventional-cycles in women aged ≤37 years. However, the use of this add-on in IVF/ICSI cycles is increasing alarmingly. Furthermore, adding PGT-A in reproductive treatments is related with increased costs and limitations inherent to the test itself.

Study design, size, duration

A systematic review based on electronics searches of databases (PubMed/MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane database. Keywords: PGT-A; Morphological embryonic selection; ongoing pregnancy; live birth) up to December 2021 was conducted to identify randomised controlled trials (RCTs) comparing clinical outcomes of IVF/ICSI cycles with PGT-A versus Morphological embryonic selection. The primary outcomes were ongoing pregnancy and live birth rates.

Participants/materials, setting, methods

Seven RCTs were included as targets for data extraction and meta-analysis. Three studies reported on OPR and five reported LBR of patients who underwent their first IVF/ICSI cycle. Data were combined for meta-analysis using StatsDirect statistical software. Dichotomous data were expressed as Relative Risk(RR) with a 95% confidence interval(CI). The amount of heterogeneity was evaluated using Cochran’sQ and I2. Study data were combined using a Random-effects model. P-values &lt;0.05 were considered to be statistically significant.

Main results and the role of chance

-Ongoing pregnancy rates (three trials): PGT-A group: 67.4% (485/720) versus morphological embryo selection group: 63.2% (460/728) with no statistically significant differences (RR = 1.11; 95% CI = 0.89–1.39; P=0.35)

-Live birth rate (five trials): PGT-A group: 58.9% (578/981) versus Morphological embryo selection group: 57.9% (585/1010) with no statistically significant differences (RR = 1.01; 95% CI = 0.81–1.26; P=0.91).

Table 1 shows the data.

Limitations, reasons for caution

The main limitation of this meta-analysis is the low number and heterogeneity of studies included. However, all of the included studies are randomised controlled trials, and the data were meta-analysed using Random-effects.

Wider implications of the findings

This meta-analysis brings to light a fundamental discussion currently, in which physicians and embryologists employ add-ons to improve clinical outcomes even without adequate scientific support.Medical practices are based on scientific evidence and Reproductive Medicine is not different. Therefore, at the moment, PGT-A should not be indicated for patients aged ≤37years.

Trial registration number

Not applicable

O-190 Endometrial compaction in artificial frozen-thawed embryo transfer cycles is associated with improvement in pregnancy outcomes: a meta-analysis

Study question

Does the decrease in endometrial thickness between the end of oestrogen phase and embryo transfer day (endometrial compaction) impact the pregnancy outcomes in frozen-thawed embryo transfer (FET) cycles?

Summary answer

The combined data indicated that cycles with endometrial compaction resulted in significantly higher ongoing pregnancy/live birth rate than cycles with no decrease in endometrial thickness.

What is known already

In FET cycles the monitoring of endometrial thickness was mostly concentrated at the end of the endometrium proliferation phase, while research on endometrial thickness in the luteal phase around the embryo transfer day was relatively rare. In addition, few studies have investigated the change in endometrial thickness after progesterone administration, and the conclusions are contradictory. Some studies included women who used hormone replacement therapy for endometrial preparation and showed that endometrial compaction (decreased thickness between the end of oestrogen phase and embryo transfer day) was associated with higher pregnancy rates. However, others reached different conclusions.

Study design, size, duration

A systematic review and meta-analyses was carried out to analyse the effect of endometrial compaction on FET cycle outcomes. The search strategy included online searching of databases (MEDLINE, EMBASE, The Science Citation Index, Google scholar, Cochrane Controlled Trials Register and OVID) up to December 2021. There was no language restriction and included grey literature. The following Medical Subject Headings and text words were used: frozen-thawed embryo transfer, hormonal preparation, endometrial thickness, endometrial compaction.

Participants/materials, setting, methods

Only cycles with artificial endometrial lining preparation (oestrogen-progesterone) and that compared outcomes of endometrial compaction cycles versus no endometrial compaction (no change/increased in endometrial thickness) cycles were considered. The primary outcomes were clinical pregnancy(CPR), miscarriage(MR) and ongoing pregnancy/livebirth (OPR/LBR) rates. The Breslow–Day-statistic, Q-statistic and I² (inconsistency) were used to determine the combinability of the trials. The random effects model was used for odds ratio(OR). The StatsDirect statistical software (Cheshire, UK) was used for data analysis.

Main results and the role of chance

Although endometrial compaction does not significantly affect CPR (OR:1.31[0.91-1.89],P=0.14) and MR (OR:1.18[0.87-1.59];P=0.27, it seems to be associated with a higher OPR/LBR (OR:1.54[1.12-2.13];P=0.007). Table 1 shows the data.

Limitations, reasons for caution

Some trials did not report clinical pregnancy or miscarriage rate. It could be associated with differences in the results. The retrospective nature and lack of standardisation of procedures across studies should be highlighted. Some analyses show high heterogeneity. Although statistically significant, the results in both arms are very close. 

Wider implications of the findings

The combined results support the change in endometrial thickness as an easy, low-cost, potential noninvasive marker of endometrial receptivity. However, additional trials are still needed.

Trial registration number

Not applicable

O-180 Body mass index (BMI) is not associated with ovarian response to gonadotropin during IVF/ICSI treatment: An evaluation of 4499 IVF/ICSI cycles

Study question

Is there an association between body mass index (BMI) and ovarian response in IVF/ICSI treatment?

Summary answer

BMI does not seem to be associated with the ovarian response to gonadotropin.

What is known already

Obesity is becoming an increasingly widespread health problem. Elevated BMI in patients who undergo assisted reproduction technology has been associated with higher doses of gonadotropins, higher risks of ovarian hyperstimulation syndrome, increased cancellation rates, and lower oocyte recovery compared to women with normal BMI. In addition, overweight and obese women submitted to IVF may present reduced rates of clinical pregnancy and live births and an increased miscarriage rate. However, population differences should be considered.

Study design, size, duration

This prospective cohort study included 4499 women who underwent IVF/ICSI cycles. Only one cycle per couple was considered. Inclusion criteria included normal karyotype, presence of two ovaries as observed by ultrasound examination, and no history of ovarian surgery, endometriosis, hydrosalpinx, infection, or endocrine disorders. Patients were stratified into four groups by BMI: &lt;18.5 kg/m2 (underweight); 18.5-24.9 kg/m2 (normal weight); 25-29.9 kg/m2 (overweight); and ≥30 kg/m2 (obesity).

Participants/materials, setting, methods

The BMI values were associated with age, anti-Müllerian hormone (AMH) levels, antral follicle counts (AFC), total dose of FSH and LH, number of follicles and number of retrieved oocytes (total and metaphase II) of IVF/ICSI cycles. The statistical analyses for group comparisons were performed using t test, Mann–Whitney test and the Kruskal–Wallis test.

Main results and the role of chance

No statistically significant differences were observed between BMI groups regarding age, AMH levels, AFC, dose of gonadotropin used (FSH and LH), days of stimulation, number of follicles and number of retrieved eggs (total and metaphase II). Table 1 summarizes the results.

Limitations, reasons for caution

A possible limitation is the cross-sectional nature of the data. Differences in sample size between BMI groups may have influenced the results.

Wider implications of the findings

Against common sense in the literature, the results did not reveal a relationship between BMI and the ovarian response to gonadotropins. BMI as an additional tool in the individualization of ovarian stimulation protocols should be reviewed.

Trial registration number

Not applicable.

O-157 Female body mass index (BMI) influences pregnancy outcomes: An evaluation of 4349 IVF/ICSI cycles

Study question

Does female body mass index (BMI) impair pregnancy outcomes after IVF/ICSI cycles?

Summary answer

High BMI (overweight and obesity) and low BMI (underweight) are associated with decreased clinical pregnancy and live birth rates and an increased miscarriage rate.

What is known already

Obese women undergoing treatment for infertility may face problems, such as the need for higher doses of drugs to stimulate ovulation, oocyte morphological changes, reduction in fertilization and implantation rates, and embryo quality. Compared to women of normal BMI, obese women submitted to IVF may present reduced rates of clinical pregnancy and live births and an increased miscarriage rate. Regarding the effects of low BMI, unfavourable pregnancy outcomes and infertility problems have been described, but evidence is still scarce and conflicting.

Study design, size, duration

A prospective analysis was performed of 4349 couples who underwent IVF/ICSI treatment and fresh embryo transfer. Only one cycle per couple was considered. Exclusion criteria included abnormal karyotype, uterine defects, evidence of hydrosalpinx, infections, endocrine problems, coagulation defects or thrombophilia and autoimmune defects. Couples were stratified into four groups by female BMI: &lt;18.5kg/m2 (underweight); 18.5-24.9kg/m2 (normal weight); 25-29.9kg/m2 (overweight); and ≥30kg/m2 (obesity). Clinical pregnancy, miscarriage and live birth rates were the outcomes analysed.

Participants/materials, setting, methods

Variables such as age, duration/type of infertility, previous embryo transfers, aetiologies, endometrial thickness, type of ovarian stimulation, and number/quality/development stage of embryo transferred were included as potential confounding factors. For group comparisons, the t test or chi-square test was used. Multivariate logistic regression analyses were performed to evaluate the associations between BMI and the probabilities of clinical pregnancy (CP), miscarriage and live birth (LB). Normal-weight patients were considered as the reference group.

Main results and the role of chance

Regarding confounding factors, no significant differences between BMI groups were observed.

-BMI-group comparisons showed that CP, miscarriage and LB rates significantly worsened with the increase in BMI (overweight and obesity groups). Miscarriage and LB rates also worsened with the decrease in BMI (underweight group) (Table 1).

-Compared with the normal-weight group, the overweight and obesity groups had significantly reduced rates of CP (19%/29%, respectively) and LB (27%/40%, respectively) and an increased rate of miscarriage (1.7x and 2.3x, respectively). Underweight was associated with a 49%-reduced rate of LB and a 3.0x increase in the rate of miscarriage (Table 2).

Limitations, reasons for caution

Differences in sample size between BMI groups may have influenced the results. In clinical outcomes, only fresh transfers were considered (not cumulative data). Population characteristics should be considered when interpreting the results.

Wider implications of the findings

The study suggests that higher BMI (overweight and obesity) and lower BMI (underweight) in women have a detrimental effect on ART outcomes, especially regarding the evolution of pregnancies. Problems associated with abnormal BMI should be discussed when advising couples interested in fertility treatment.

Trial registration number

Not applicable.

P371 1 YEAR OUTCOME OF BICARBON AORTIC MECHANICAL VALVE IN LOW–INR REGIMEN: RESULTS FROM SURE–AVR REGISTRY

Background

The drawback of using mechanical valve is lifelong anticoagulation use, and close monitoring is required to prevent postoperative complications, including thromboembolism and anticoagulation–related bleeding. Moderate anticoagulation after mechanical heart valve replacement has been proposed to reduce these risks. The present study aimed to evaluate the safety and feasibility of reduced oral anticoagulation after Bicarbon aortic mechanical valve replacement.

Methods

SURE–AVR is a propsective, multinational registry of patients undergoing aortic valve replacement. Between July 2018 and October 2020, among subjects undergoing AVR with Bicarbon valve in the SURE–AVR registry, 108 were assigned at discharge to low–INr regimen (international normalized ratio 1.5–2.5). Mean INr at discharge was 1.8+/–0.5 and 2.2+/–0.4 at 1 year. in–hospital and post–discharge outcomes up to 1 years were collected. The mean age was 55.5 +/–10.6 years old (range 25–82). Concomitant procedures included coronary artery bypass grafting (14.6%), mitral valve procedure (3.7%) and myectomy (1.9%). The follow–up duration averaged 1 year (361.8 +/– 258 days).

Results

No bleeding events were reported in the late follow up. The low–INR regimen did not affect the thromboembolism rates, since no stroke or transient ischemic attack were reported post–operatively at each time point. No in–hospital or late deaths were reported among the 108 subjects analyzed. In the early period (&lt;30 days), three reinterventions occurred: two because of postoperative bleeding requiring thoracotomy and one due to pericardial effusion. In the late postoperative period two reinterventions with device explant occurred (one for non–structural valve dysfunction and one for endocarditis (1.2%).

Conclusion

The results of the SURE–AVr Registry demonstrated that the proposed Lower–INR Target is safe and feasible after Bicarbon aortic mechanical valve replacement. The low–intensity anticoagulation strategy is associated with a low risk of hemorrhagic events without any increase of thromboembolic complications.

Coronary stent CD31-mimetic coating favours endothelialization and reduces local inflammation and neointimal development in vivo

AIMS

The rapid endothelialization of bare metal stents (BMS) is counterbalanced by inflammation-induced neointimal growth. Drug-eluting stents (DES) prevent leukocyte activation but impair endothelialization, delaying effective device integration into arterial walls. Previously, we have shown that engaging the vascular CD31 co-receptor is crucial for endothelial and leukocyte homeostasis and arterial healing. Furthermore, we have shown that a soluble synthetic peptide (known as P8RI) acts like a CD31 agonist. The aim of this study was to evaluate the effect of CD31-mimetic metal stent coating on the in vitro adherence of endothelial cells (ECs) and blood elements and the in vivo strut coverage and neointimal growth.

METHODS AND RESULTS

We produced Cobalt Chromium discs and stents coated with a CD31-mimetic peptide through two procedures, plasma amination or dip-coating, both yielding comparable results. We found that CD31-mimetic discs significantly reduced the extent of primary human coronary artery EC and blood platelet/leukocyte activation in vitro. In vivo, CD31-mimetic stent properties were compared with those of DES and BMS by coronarography and microscopy at 7 and 28 days post-implantation in pig coronary arteries (n = 9 stents/group/timepoint). Seven days post-implantation, only CD31-mimetic struts were fully endothelialized with no activated platelets/leukocytes. At day 28, neointima development over CD31-mimetic stents was significantly reduced compared to BMS, appearing as a normal arterial media with the absence of thrombosis contrary to DES.

CONCLUSION

CD31-mimetic coating favours vascular homeostasis and arterial wall healing, preventing in-stent stenosis and thrombosis. Hence, such coatings seem to improve the metal stent biocompatibility.

I-FABP is decreased in COVID-19 patients, independently of the prognosis

BACKGROUND

Severe acute respiratory syndrome caused by the novel coronavirus (SARS-CoV-2) is frequently associated with gastrointestinal manifestations. Herein we evaluated the interest in measuring the intestinal fatty acid-binding protein (I-FABP), a biomarker of intestinal injury, in COVID-19 patients.

METHODS

Serum I-FABP was analyzed in 28 consecutive patients hospitalized for a PCR-confirmed COVID-19, in 24 hospitalized patients with non-COVID-19 pulmonary diseases, and 79 patients admitted to the emergency room for abdominal pain.

RESULTS

I-FABP serum concentrations were significantly lower in patients with COVID-19, as compared to patients with non-COVID-19 pulmonary diseases [70.3 pg/mL (47-167.9) vs. 161.1 pg/mL (88.98-305.2), respectively, p = 0.008]. I-FABP concentrations in these two populations were significantly lower than in patients with abdominal pain without COVID-19 [344.8 pg/mL (268.9-579.6)]. I-FABP was neither associated with severity nor the duration of symptoms. I-FABP was correlated with polymorphonuclear cell counts.

CONCLUSIONS

In this pilot study, we observed a low I-FABP concentration in COVID-19 patients either with or without gastrointestinal symptoms, of which the pathophysiological mechanisms and clinical impact remain to be established. Further explorations on a larger cohort of patients will be needed to unravel the molecular mechanism of such observation, including the effects of malabsorption and/or abnormal lipid metabolism.

Biliary tract microbiota: a new kid on the block of liver diseases?

The microbiome plays a crucial role in maintaining the homeostasis of the organism. Recent evidence has provided novel insights for understanding the interaction between the microbiota and the host. However, the vast majority of such studies have analyzed the interactions taking place in the intestinal tract. The biliary tree has traditionally been considered sterile under normal conditions. However, the advent of metagenomic techniques has revealed an unexpectedly rich bacterial community in the biliary tract. Associations between specific microbiological patterns and inflammatory biliary diseases and cancer have been recently described. Hence, biliary dysbiosis may be a primary trigger in the pathogenesis of biliary diseases. In particular, recent studies have suggested that microorganisms could play a significant role in the development of gallstones, pathogenesis of autoimmune cholangiopathies and biliary carcinogenesis. Moreover, the intimate connection between the biliary tract, liver and pancreas, could reveal hidden influences on the development of diseases of these organs. Further studies are needed to deepen the comprehension of the influence of the biliary microbiota in human pathology. This knowledge could lead to the formulation of strategies for modulating the biliary microbiota in order to treat and prevent these pathological conditions.

A CD31-Derived Peptide Prevents the Development of Antibody-Mediated Lesions in a Rat Model of Aortic Allograft

BACKGROUND

Antibody-mediated rejection (AMR) is a major cause of graft loss. The development of donor-specific antibodies (DSAs) directed against the allogeneic HLA molecules expressed by the graft also leads to accelerated arteriosclerosis. CD31 is a protein expressed on endothelial and immune cells, ensuring homeostasis at this interface. When strong immune stimulation occurs, the regulatory function of CD31 is lost owing to cleavage of its extracellular portion. P8RI, a synthetic peptide that binds to the ectodomain of CD31, is able to restore the CD31 immunomodulatory function. In this study, we hypothesized that CD31 could represent an attractive molecular target in AMR and investigated whether P8RI could prevent the development of vascular antibody-mediated lesions.

MATERIALS AND METHODS

A rat model of orthotopic aortic allograft was used, and P8RI was administered for 28 days. Circulating DSAs were quantified to assess the alloimmune humoral response, and histologic and immunohistochemical analyses of aortic allografts were performed to estimate antibody-mediated lesions in the allograft.

RESULTS

Aorta-allografted rats receiving P8RI developed fewer DSAs than control animals (mean fluorescence intensity 344 vs 741). The density of nuclei in the media (3.4 x 10^-5 vs 2.2 x 10^-5 nuclei/px²) and media surface area (2.33 x 10⁶ vs 2.02 x 10⁶ px²) were higher in animals treated with P8RI than in control animals.

CONCLUSIONS

These data support a therapeutic potential for molecules able to restore the CD31 signaling to fight AMR. P8RI, an agonist synthetic peptide targeting CD31, might prevent DSA production and have a beneficial effect in limiting arterial antibody-mediated lesions. CD31 agonists may become therapeutic tools to prevent and treat solid organ transplant arteriosclerosis.

CD31 Mimetic Coating Enhances Flow Diverting Stent Integration into the Arterial Wall Promoting Aneurysm Healing

BACKGROUND AND PURPOSE

Beyond aneurysmal occlusion, metallic flow diverters (FDs) can induce an adverse endovascular reaction due to the foreignness of metal devices, hampering FD endothelialization across the aneurysm neck, and arterial healing of intracranial aneurysms. Here, we evaluated the potential benefits of an FD coating mimicking CD31, a coreceptor critically involved in endothelial function and endovascular homeostasis, on the endothelialization of FDs implanted in vivo.

METHODS

Nitinol FD (Silk Vista Baby) and flat disks were dip-coated with a CD31-mimetic peptide via an intermediate layer of polydopamine. Disks were used to assess the reaction of endothelial cells and blood elements in vitro. An aneurysm rabbit model was used to compare in vivo effects on the arterial wall of CD31-mimetic-coated (CD31-mimetic, n=6), polydopamine-coated (polydopamine, n=6), and uncoated FDs (bare, n=5) at 4 weeks post-FD implantation. In addition, long-term safety was assessed at 12 weeks.

RESULTS

In vitro, CD31-mimetic coated disks displayed reduced adhesion of blood elements while favoring endothelial cell attachment and confluence, compared to bare and polydopamine disks. Strikingly, in vivo, the neoarterial wall formed over the CD31-mimetic-FD struts at the aneurysm neck was characteristic of an arterial tunica media, with continuous differentiated endothelium covering a significantly thicker layer of collagen and smooth muscle cells as compared to the controls. The rates of angiographic complete occlusion and covered branch arterial patency were similar in all 3 groups.

CONCLUSIONS

CD31-mimetic coating favors the colonization of metallic endovascular devices with endothelial cells displaying a physiological phenotype while preventing the adhesion of platelets and leukocytes. These biological properties lead to a rapid and improved endothelialization of the neoarterial wall at the aneurysm neck. CD31-mimetic coating could therefore represent a valuable strategy for FD biocompatibility improvement and aneurysm healing.

Effects of BAFF Neutralization on Atherosclerosis Associated With Systemic Lupus Erythematosus

OBJECTIVE

Cardiovascular disease (CVD) is the leading cause of death in systemic lupus erythematosus (SLE). B cells play a key role in the pathogenesis of lupus, and anti-BAFF therapy has been approved for use in SLE. Since mature B cells also promote atherosclerosis, we undertook this study to evaluate, in a mouse model and in SLE patients, whether BAFF neutralization has an atheroprotective effect in SLE.

METHODS

The effect of BAFF on atherosclerosis associated with lupus was investigated in the atherosclerosis/lupus-prone apolipoprotein E-knockout D227K mouse model and in a cohort of SLE patients. Mice were treated with a blocking anti-BAFF monoclonal antibody (mAb), while fed a standard chow diet. Carotid plaque and carotid intima-media thickness were assessed by ultrasound at baseline and during follow-up in SLE patients who were asymptomatic for CVD.

RESULTS

Anti-BAFF mAb in ApoE^-/- D227K mice induced B cell depletion, efficiently treated lupus, and improved atherosclerosis lesions (21% decrease; P = 0.007) in mice with low plasma cholesterol levels but worsened the lesions (17% increase; P = 0.06) in mice with high cholesterol levels. The atheroprotective effect of the BAFF-BAFF receptor signaling inhibition on B cells was counterbalanced by the proatherogenic effect of the BAFF-TACI signaling inhibition on macrophages. In SLE patients, blood BAFF levels were associated with subclinical atherosclerosis (r = 0.26, P = 0.03). Anti-BAFF mAb treatment had a differential effect on the intima-media thickness progression in SLE patients depending on body mass index.

CONCLUSION

Depending on the balance between lipid-induced and B cell-induced proatherogenic conditions, anti-BAFF could be detrimental or beneficial, respectively, to atherosclerosis development in SLE.

Vascular Remodeling and Immune Cell Infiltration in Splenic Artery Aneurysms

Rupture of splenic artery aneurysms (SAAs) is associated with a high mortality rate. The aim of this study was to identify the features of SAAs. Tissue sections from SAAs were compared to nonaneurysmal splenic arteries using various stains. The presence of intraluminal thrombus (ILT), vascular smooth muscle cells (VSMCs), cluster of differentiation (CD)-68+ phagocytes, myeloperoxidase+ neutrophils, CD3+, and CD20+ adaptive immune cells were studied using immunofluorescence microscopy. Analysis of SAAs revealed the presence of atherosclerotic lesions, calcifications, and ILT. Splenic artery aneurysms were characterized by a profound vascular remodeling with a dramatic loss of VSMCs, elastin degradation, adventitial fibrosis associated with enhanced apoptosis, and increased matrix metalloproteinase 9 expression. We observed an infiltration of immune cells comprising macrophages, neutrophils, T, and B cells. The T and B cells were found in the adventitial layer of SAAs, but their organization into tertiary lymphoid organs was halted. We failed to detect germinal centers even in the most organized T/B cell follicles and these lymphoid clusters lacked lymphoid stromal cells. This detailed histopathological characterization of the vascular remodeling during SAA showed that lymphoid neogenesis was incomplete, suggesting that critical mediators of their development must be missing.

Haemodynamic stress-induced breaches of the arterial intima trigger inflammation and drive atherogenesis

AIMS

Inflammatory mediators, including blood cells and their products, contribute critically to atherogenesis, but the igniting triggers of inflammation remain elusive. Atherosclerosis develops at sites of flow perturbation, where the enhanced haemodynamic stress could initiate the atherogenic inflammatory process due to the occurrence of mechanic injury. We investigated the role of haemodynamic stress-induced breaches, allowing the entry of blood cells in the arterial intima, in triggering inflammation-driven atherogenesis.

METHODS AND RESULTS

Human coronary samples isolated from explanted hearts, (n = 47) displayed signs of blood entry (detected by the presence of iron, ferritin, and glycophorin A) in the subintimal space (54%) as assessed by histology, immunofluorescence, high resolution episcopic microscopy, and scanning electron microscopy. Computational flow dynamic analysis showed that intimal haemorrhagic events occurred at sites of flow disturbance. Experimental carotid arteries from Apoe deficient mice showed discrete endothelial breaches and intimal haemorrhagic events specifically occurring at the site of flow perturbation, within 3 days after the exacerbation of the local haemodynamic stress. Endothelial tearing was associated with increased VCAM-1 expression and, within 7 days, substantial Ly6G+ leucocytes accumulated at the sites of erythrocyte-derived iron and lipids droplets accumulation, pathological intimal thickening and positive oil red O staining. The formation of fatty streaks at the sites of intimal breaches was prevented by the depletion of Ly6G+ leucocytes, suggesting that the local injury driven by haemodynamic stress-induced breaches triggers atherogenic inflammation.

CONCLUSION

Haemodynamic-driven breaches of the arterial intima drive atherogenic inflammation by triggering the recruitment of leucocyte at sites of disturbed arterial flow.

Prevalence of elevated pulmonary artery systolic pressure in Down Syndrome young patients with and without congenital heart disease

This study examined the prevalence and distribution of elevated systolic pulmonary arterial pressure, measured by echocardiography, in young patients with down syndrome associated or not with congenital heart disease and surgical correction during childhood. Pulmonary artery systolic pressure, computed by regurgitant tricuspid flow velocity evaluation, is the most frequently used parameter for the screening of pulmonary hypertension. Down syndrome and congenital heart disease often coexist and the probability to detect elevated systolic pulmonary arterial pressure in this setting is high. However, little is known about the evaluation of pulmonary arterial pressure during growth of patients with down syndrome with or without congenital heart disease. We enrolled 47 young patients (55% of male sex; mean age: 18.4 ± 6.0 years), 40 with congenital heart disease and 7 without a cardiac defect. Systolic pulmonary arterial pressure was assessed by echocardiography. No difference was found in the population dichotomized by presence or absence of CHD. Only male sex (p=0.000), highly sensitive troponin-T (P=0.027), tricuspid annular plane systolic excursion (TAPSE, p=0.045) and sPAP (p=0.004) were elevated in surgical group. The ASD was found as, the most common structural abnormality in our patients (50%), followed by VSD (27.5%) and complex CHD (such as complete atrioventricular canal defect, CAVC = 25% and Fallot disease = 15%). Furthermore, about 45% of patients had the combined defect. Only 37.5% of patients underwent to corrective surgery during the first months of life. We observed a significantly increase of sPAP values in patients with complex CHD, such as CAVC (p=0.019) and Fallot disease (p=0.001) but, in the following multivariate analysis performed in the patients with CHD, only Fallot disease remains as independent predictors of elevated values of sPAP (p=0.022). An elevated systolic pulmonary arterial pressure may represent the key screening tool in the diagnostic assessment of suspect pulmonary arterial hypertension in high risk population with down syndrome regardless the presence of congenital heart disease.

AB0140 BAFF NEUTRALIZATION HAS JANUS-FACED EFFECT ON ATHEROSCLEROSIS ASSOCIATED WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Cardiovascular diseases (CVD) are the leading cause of death in systemic lupus erythematosus (SLE). B cells play a key role in the pathogenesis of lupus and anti-BAFF therapy has been approved in SLE. Since mature B cells also promote atherosclerosis, BAFF neutralization is expected to have an atheroprotective effect in SLE.

Objectives:

The aim of our study was to test this hypothesis using a new mouse model with a mix susceptibility to lupus and atherosclerosis that received or not an anti-BAFF treatment, and in a cohort of SLE patients in whom we monitored carotid plaques, the B cell compartment and BAFF levels.

Methods:

The effect of BAFF on atherosclerosis associated with lupus was investigated in the atherosclerosis- and lupus-proneApoe°D227Kmouse model and in a cohort of SLE patients. Mice were treated with a blocking anti-BAFF monoclonal antibody (Ab), while fed with a standard chow diet. Carotid plaque and carotid intima media thickness were assessed by ultrasound at baseline and during follow-up in SLE patients asymptomatic for CVD.

Results:

Anti-BAFF Ab inApoe°D227Kmice i/ induced a B cell depletion, ii/ efficiently treated lupus, iii/improved atherosclerosis lesions in mice that had low plasma cholesterol levels but worsened the lesions in mice with high cholesterol levels. In that case, the atheroprotective effect of the BAFF-BAFFR signaling inhibition on B cells was counterbalanced by the proatherogenic effect of the BAFF-TACI signaling inhibition on macrophages. In SLE patients, BAFF blood levels were associated with subclinical atherosclerosis. Anti-BAFF Ab treatment had a differential effect on the intima media thickness progression in SLE patients depending on the body mass index

Conclusion:

Depending on the balance between metabolic- and B cell-induced proatherogenic conditions, anti-BAFF could be respectively detrimental or beneficial on atherosclerosis development in SLE

Acknowledgments:

Guillaume Even, Yasmine Lamri, Anh-Thu Gaston,

Disclosure of Interests:

Fanny Saidoune Grant/research support from: supported by a research partnerships between the academic and GlaxoSmithKline France.

Anti-BAFF mAb (IgG1, clone 10F4B) in mice was provided by Glaxosmithkline, Nicolas Charles: None declared, Julie Chezel: None declared, Brigitte Escoubet: None declared, Thomas Papo: None declared, Antonino Nicoletti: None declared, karim sacre: None declared

Relationship of Iron Deposition to Calcium Deposition in Human Aortic Valve Leaflets

BACKGROUND

Intraleaflet hematomas are associated with advanced stages of aortic valve calcification and suspected to be involved in disease progression. However, the mechanism by which the entry of blood cells into the valves affects the biology of aortic valvular interstitial cells (VICs) remains to be elucidated.

OBJECTIVES

This study sought to evaluate the putative link between intraleaflet hematoma and aortic valve calcification and to assess its pathophysiological implications.

METHODS

The spatial relationship between calcium deposits and intraleaflet hematomas was analyzed by whole-mount staining of calcified and noncalcified human aortic valves, obtained in the context of heart transplantation and from patients who underwent surgical valve replacement. Endothelial microfissuring was evaluated by en face immunofluorescence and scanning electron microscopic analyses of the fibrosa surface. Red blood cell (RBC) preparations were used in vitro to assess, by immunofluorescence microscopy and Alizarin red staining, the potential impact of intraleaflet hematomas on phenotypic changes in VICs.

RESULTS

Intraleaflet hematomas, revealed by iron deposits and RBCs into the fibrosa, secondary to endothelial microfissuring, were consistently found in noncalcified valves. The contact of primary VICs derived from these valves with RBCs resulted in a global inflammatory and osteoblastic phenotype, reflected by the up-regulation of interleukin-6, interleukin-1β, bone sialoprotein, osteoprotegerin, receptor activator of nuclear factor kappa B, bone morphogenic protein 2, and muscle segment homeobox 2, the production of osteocalcin, and the formation of calcium deposits.

CONCLUSIONS

The acquisition of an osteoblastic phenotype in VICs that come into contact with the senescent RBCs of intraleaflet hematomas may play a critical role in the initiation of calcium deposition into the fibrosa of human aortic valves.

Missing self triggers NK cell-mediated chronic vascular rejection of solid organ transplants

Current doctrine is that microvascular inflammation (MVI) triggered by a transplant -recipient antibody response against alloantigens (antibody-mediated rejection) is the main cause of graft failure. Here, we show that histological lesions are not mediated by antibodies in approximately half the participants in a cohort of 129 renal recipients with MVI on graft biopsy. Genetic analysis of these patients shows a higher prevalence of mismatches between donor HLA I and recipient inhibitory killer cell immunoglobulin-like receptors (KIRs). Human in vitro models and transplantation of β2-microglobulin-deficient hearts into wild-type mice demonstrates that the inability of graft endothelial cells to provide HLA I-mediated inhibitory signals to recipient circulating NK cells triggers their activation, which in turn promotes endothelial damage. Missing self-induced NK cell activation is mTORC1-dependent and the mTOR inhibitor rapamycin can prevent the development of this type of chronic vascular rejection.

‘Missing self’ is a mode of natural killer (NK) cell activation aimed to detect the lack of HLA-I molecules on infected or neoplastic cells. Here, the authors show that mismatch between donor HLA-I and cognate receptors on recipient NK cells mediates microvascular inflammation-associated graft rejection, a pathology that is preventable by mTOR inhibition.

Gut microbiota and aging

The hypothesis of an important role of gut microbiota in maintaining physiological state into the gastrointestinal (GI) system is supported by qualitative and quantitative alteration of the intestinal flora in a number of physiological and pathological condition as shown in several studies. The evidence of the inflammatory state alteration, highlighted in neurodegenerative diseases such as Parkinson's and Alzheimer's strongly recalls the microbiota disturbance, highly suggesting a link between the gastrointestinal system and cognitive functions. Given this perspective, looking at the mutual influence between microbiota products, inflammation mediators and immune system, the modulation of gut microbiota may help to facilitate a physiological and non-pathological aging process and, perhaps, to contrast the progression of degenerating mechanisms. Some studies have already characterized gut microbiota in elderly, with promising results. Future studies should be designed to better understand the correlation between the gut microbiota, the ageing process and degenerative diseases typical of the elderly.

P4618Lack of CD31 results in microvascular plugging and increased infarction size in an experimental model of myocardial ischemia-reperfusion injury

Background

The success of coronary recanalization therapy for the treatment of myocardial infarction can be hampered by microvascular plugging which prevents effective reperfusion of the ischemic tissue. Due to its constitutive expression in platelets, leukocytes, and endothelial cells and its peculiar tyrosine phosphatase cell detaching signaling properties, the trans-homophilic CD31 receptor may be important to modulate platelet and leukocyte aggregation in the microvasculature.

Objective

To investigate the impact of CD31 genetic deficiency on the infarct size, peri-infarction microvascular plugging and macrophage phenotype in a mouse model of heart ischemia/reperfusion.

Methods

Cardiac ischemia was induced in WT and CD31 KO mice (n=30, 15 females and 15 males in each group) by surgical ligation of the left anterior descending coronary artery (LAD) for 45 minutes followed by reperfusion for 72 hours. The area at risk (AAR) and necrotic zone (NZ) were assessed using ImageJ software on three consecutive 1 mm thick slices of the left ventricle (LV) by a combination of a blue dye and 2,3,5-triphenyltetrazolium chloride staining. Parallel sets of experiments served to evaluate by both fluorescence microscopy and cytometry the presence of microvascular plugs and leukocyte phenotype in the infarction area as compared to the peri-necrotic myocardium.

Results

The AAR was similar in WT and CD31 KO mice (41,7±3,5 vs 37±2,9% of LV, NS) whereas the size of myocardial infarction was significantly greater in CD31 KO as compared to WT mice (23,4±2 vs 17,8±1,7% of LV, p<0,05). Immunofluorescent microscopy showed a dramatic increase in microvascular platelets-rich plugs around the infarction in CD31 KO mice (Figure), confirmed by cytometry analysis (9749±573 vs 5976±376 platelet-leukocyte aggregates/mg of tissue, p<0.001). Furthermore, we found that the ratio between M1 and M2 type macrophages in the peri-infarction myocardium was significantly increased in CD31 KO mice (0,7±0.07) as compared to WT mice (0,4±0.06, p<0,01).

Conclusions

Our data suggest that CD31 is important for reducing the size of necrosis following coronary recanalization procedures by preventing the no-reflow phenomenon due to microvascular plugging and by promoting a reparative phenotype of peri-infarction macrophages.

Acknowledgement/Funding

Institut Servier - ANRT (CIFRE doctoral grant)

Hyperkinetic movement disorders in congenital disorders of glycosylation

BACKGROUND AND PURPOSE

Congenital disorders of glycosylation (CDG) represent an increasing number of rare inherited metabolic diseases associated with abnormal glycan metabolism and disease onset in infancy or early childhood. Most CDG are multisystemic diseases mainly affecting the central nervous system. The aim of the current study was to investigate hyperkinetic movement disorders in patients affected by CDG and to characterize phenomenology based on CDG subtypes.

METHODS

Subjects were identified from a cohort of patients with CDG who were referred to the University Hospital of Catania, Italy. Patients were evaluated by neurologists with expertise in movement disorders and videotaped using a standardized protocol.

RESULTS

A variety of hyperkinetic movement disorders was detected in eight unrelated CDG patients. Involuntary movements were generally observed early in childhood, maintaining a clinical stability over time. Distribution ranged from a generalized, especially in younger subjects, to a segmental/multifocal involvement. In patients with phosphomannomutase 2 CDG, the principal movement disorders included dystonia and choreo-athetosis. In patients affected by other CDG types, the movement disorders ranged from pure generalized chorea to mixed movement disorders including dystonia and complex stereotypies.

CONCLUSIONS

Hyperkinetic movement disorder is a key clinical feature in patients with CDG. CDG should be considered in the differential diagnosis of childhood-onset dyskinesia, especially when associated with ataxia, developmental delay, intellectual disability, autism or seizure disorder.

Core-Shell Polymer-Based Nanoparticles Deliver miR-155-5p to Endothelial Cells

Heart failure occurs in over 30% of the worldwide population and most commonly originates from cardiovascular diseases such as myocardial infarction. microRNAs (miRNAs) target and silence specific mRNAs, thereby regulating gene expression. Because the endogenous miR-155-5p has been ascribed to vasculoprotection, loading it onto positively charged, core-shell poly(isobutylcyanoacrylate) (PIBCA)-polysaccharide nanoparticles (NPs) was attempted. NPs showed a decrease (p < 0.0001) in surface electrical charge (ζ potential), with negligible changes in size or shape when loaded with the anionic miR-155-5p. Presence of miR-155-5p in loaded NPs was further quantified. Cytocompatibility up to 100 μg/mL of NPs for 2 days with human coronary artery endothelial cells (hCAECs) was documented. NPs were able to enter hCAECs and were localized in the endoplasmic reticulum (ER). Expression of miR-155-5p was increased within the cells by 75-fold after 4 hours of incubation (p < 0.05) and was still noticeable at day 2. Differences between loaded NP-cultured cells and free miRNA, at days 1 (p < 0.05) and 2 (p < 0.001) suggest the ability of prolonged load release in physiological conditions. Expression of miR-155-5p downstream target BACH1 was decreased in the cells by 4-fold after 1 day of incubation (p < 0.05). This study is a first proof of concept that miR-155-5p can be loaded onto NPs and remain intact and biologically active in endothelial cells (ECs). These nanosystems could potentially increase an endogenous cytoprotective response and decrease damage within infarcted hearts.

Adipocytes orchestrate the formation of tertiary lymphoid organs in the creeping fat of Crohn's disease affected mesentery

The formation of tertiary lymphoid organs (TLOs) is orchestrated by the stromal cells of tissues chronically submitted to inflammatory stimuli, in order to uphold specific adaptive immune responses. We have recently shown that the smooth muscle cells of the arterial wall orchestrate the formation of the TLOs associated with atherosclerosis in response to the local release of TNF-α. Observational studies have recently documented the presence of structures resembling TLOs the creeping fat that develops in the mesentery of patients with Crohn's disease (CD), an inflammatory condition combining a complex and as yet not elucidated infectious and autoimmune responses. We have performed a comprehensive analysis of the TLO structures in order to decipher the mechanism leading to their formation in the mesentery of CD patients, and assessed the effect of infectious and/or inflammatory inducers on the potential TLO-organizer functions of adipocytes. Quantitative analysis showed that both T and B memory cells, as well as plasma cells, are enriched in the CD-affected mesentery, as compared with tissue from control subjects. Immunohistochemistry revealed that these cells are concentrated within the creeping fat of CD patients, in the vicinity of transmural lesions; that T and B cells are compartmentalized in clearly distinct areas; that they are supplied by post-capillary high endothelial venules and drained by lymphatic vessels indicating that these nodules are fully mature TLOs. Organ culture showed that mesenteric tissue samples from CD patients contained greater amounts of adipocyte-derived chemokines and the use of the conditioned medium from these cultures in functional assays was able to actively recruit T and B lymphocytes. Finally, the production of chemokines involved in TLO formation by 3T3-L1 adipocytes was directly elicited by a combination of TNF-α and LPS in vitro. We therefore propose a mechanism in which mesenteric adipocyte, through their production of key chemokines in response to inflammatory/bacterial stimuli, may orchestrate the formation of functional TLOs developing in CD-affected mesentery.

Peptide binding to cleaved CD31 dampens ischemia/reperfusion-induced intestinal injury

BACKGROUND

CD31 is a key transmembrane neutrophil immunoregulatory receptor. Mesenteric ischemia/reperfusion-induced neutrophil activation leads to a massive cleavage and shedding of the most extracellular domains of CD31 into plasma, enhancing the deleterious effect of neutrophil activation. We have evaluated the preventive therapeutic potential of an engineered synthetic octapeptide (P8RI), which restores the inhibitory intracellular signaling of cleaved CD31, in an experimental model of acute mesenteric ischemia/reperfusion.

METHODS

In a randomized, controlled, and experimenter-blinded preclinical study, mesenteric ischemia/reperfusion (I/R) was induced in Wistar rats by superior mesenteric artery occlusion for 30 min followed by 4 h of reperfusion. Three groups of rats were compared: I/R + saline perfusion (I/R controls group, n = 7), I/R + preventive P8RI perfusion (P8RI group, n = 7), and sham-operated rats + saline perfusion (sham group, n = 7).

RESULTS

Compared with I/R controls, P8RI perfusion significantly decreased intestinal ischemia/reperfusion injury (Chiu's score, P = 0.01; epithelial area, P = 0.001) and bacterial translocation (plasma Escherichia coli DNA, P = 0.04) and could limit intestinal bleeding (P = 0.09). P8RI decreased neutrophil activation assessed by matrix metalloproteinase-9 release in plasma (P < 0.001) and in the intestinal wall, albeit without statistical significance (P = 0.06 and P = 0.058 for myeloperoxydase). Inhibition of CD31 cleavage from neutrophils could play a major role in the protective effects of P8RI (P < 0.0001).

CONCLUSIONS

Preventive administration of P8RI, a CD31-agonist peptide, could decrease I/R-induced intestinal injury by potentially limiting neutrophil activation.

Blink reflex recovery cycle to differentiate progressive supranuclear palsy from corticobasal syndrome

BACKGROUND AND PURPOSE

Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) may share similar clinical findings and tests to distinguish between the two disorders could be useful. We evaluated the blink reflex and R2 blink reflex recovery cycle (R2BRRC), determining diagnostic sensitivity, specificity and positive and negative predictive value of R2BRRC in differentiating patients with PSP from those with CBS.

METHODS

This was a prospective data collection study investigating blink reflex and R2BRRC at interstimulus intervals (ISIs) of 100, 150, 200, 300, 400, 500 and 750 ms in 12 patients with PSP, eight patients with CBS and 10 controls.

RESULTS

Patients with PSP have earlier recruitment of R2BRRC as compared with patients with CBS (ISI: 100 ms, P = 0.002; 150 ms, P < 0.001; 200 ms, P < 0.001; 300 ms, P = 0.02) and controls (ISI: 100 ms, P < 0.001; 150 ms, P < 0.001; 200 ms, P < 0.001; 300 ms, P = 0.004). The presence of an early recovery of the R2 differentiated PSP from CBS with a specificity and sensitivity of 87.5% and 91.7%, respectively.

CONCLUSIONS

The R2BRRC curve might be considered to be a useful tool in differentiating patients with PSP from those with CBS.