Uniparental disomy screen of Irish rare disorder cohort unmasks homozygous variants of clinical significance in the TMCO1 and PRKRA genes

A uniparental disomy (UPD) screen using whole genome sequencing (WGS) data from 164 trios with rare disorders in the Irish population was performed to identify large runs of homozygosity of uniparental origin that may harbour deleterious recessive variants. Three instances of whole chromosome uniparental isodisomy (UPiD) were identified: one case of maternal isodisomy of chromosome 1 and two cases of paternal isodisomy of chromosome 2. We identified deleterious homozygous variants on isodisomic chromosomes in two probands: a novel p (Glu59ValfsTer20) variant in TMCO1, and a p (Pro222Leu) variant in PRKRA, respectively. The overall prevalence of whole chromosome UPiD in our cohort was 1 in 55 births, compared to 1 in ∼7,500 births in the general population, suggesting a higher frequency of UPiD in rare disease cohorts. As a distinct mechanism underlying homozygosity compared to biallelic inheritance, the identification of UPiD has important implications for family planning and cascade testing. Our study demonstrates that UPD screening may improve diagnostic yields by prioritising UPiD chromosomes during WGS analysis.

Disentanglement network data to characterize leatherback sea turtle Dermochelys coriacea bycatch in fixed-gear fisheries

To characterize sea turtle bycatch in fixed-gear fisheries in Massachusetts, USA, we analyzed a 15 yr dataset of entanglement reports and detailed documentation from disentanglement operations. Almost all (272) of the 280 confirmed entanglements involved leatherback turtles Dermochelys coriacea. The majority of turtles were entangled in actively fished (96%), commercial (94%) pot/trap gear with unbroken/untriggered weak links, specifically the buoy lines marking lobster, whelk, and fish traps. Most reports came from recreational boaters (62%) and other sources (26%), rather than commercial fishers (12%). Leatherback entanglements occurred from May to November, with peak reporting in August, and included adult males, adult females, and subadults. All entanglements involved the turtle’s neck and/or front flippers, with varying degrees of visible injuries; 47 entangled leatherbacks were dead in gear, 224 were alive at first sighting, and 1 case was unknown. Post-release monitoring suggested turtles can survive for days to years after disentanglement, but data were limited. While the observed entanglements in our study are low relative to global bycatch, these numbers should be considered a minimum. Our findings are comparable to observed numbers of leatherbacks taken in Canadian fixed-gear fisheries, and represent just one of multiple, cumulative threats in the North Atlantic. Managers should focus on strategies to reduce the co-occurrence of sea turtles and fixed-fishing gear, including reductions in the number of buoy lines allowed (e.g. replace single sets with trawls), seasonal and area closures targeted to reduce sea turtle-gear interaction, and encourage the development of emerging technologies such as ‘ropeless’ fishing.

OP0308-PARE PREGNANCY AND ARTHRITIS - A PATIENT EDUCATION PROGRAMME IN IRELAND

Background:

The relationship between pregnancy and arthritis is a complex one. Because of the variability of arthritic conditions, it is important for patients to get advice from their doctor or a specialist nurse before trying for a baby. There can be implications for medication regimes, while the pregnancy itself can also affect the inflammatory arthritis. In the postpartum period, other considerations include breastfeeding and the frequent return of flares.

Through this education programme, Arthritis Ireland developed information resources primarily targeting women of child-bearing age. The multichannel campaign provided information about the wide range of issues of concern to women with inflammatory arthritis who are planning a family or are pregnant.

Objectives:

•To provide information and increase awareness around inflammatory arthritis and pregnancy;

•To support women living with inflammatory arthritis through their illness and life journey;

•To increase awareness of the work of Arthritis Ireland as a patient organisation.

Methods:

In developing and executing this education programme, Arthritis Ireland worked extensively with a team of healthcare professionals, who are regarded internationally as leaders in this field.

A multi-channel approach was taken to the development, production and dissemination of information, with public information events, literature and a suite of videos developed

Up to this point, there had not been any Irish-produced material on this subject. he topic was seen to be an important one and an issue of significant public health interest.

The series of information talks on pregnancy and inflammatory arthritis was delivered by consultant rheumatologists and were held in cities around Ireland. The information booklet covered topics such as planning for a baby, medication and pregnancy, the role of the father, fertility, genetics, during the pregnancy, after the pregnancy and breastfeeding.

Video was seen to be central to the success of the campaign. Working with the expert healthcare team, six information videos were developed around obstetrics, rheumatology, physiotherapy and occupational therapy. The videos were published and promoted across Arthritis Ireland’s social media channels and website.

The capstone video featured a young mother who was diagnosed with JIA when she was two. Her story was an incredibly powerful testimony of overcoming and dealing with adversity and complex health issues.

Results:

This educational campaign was developed to meet a significant need in the health information landscape. While there are no little resources produced focusing on pregnancy and parenting, there wasn’t anything in Ireland which specifically addressed the needs of women and men with inflammatory arthritis who are looking to have a family. The materials produced are a valuable part of Arthritis Ireland’s canon of patient education materials.

Conclusion:

It is anticipated that the materials developed will have a long lifespan and will support prospective parents for several years to come. Central to the success of the project was the involvement of the expert healthcare teams. Their commitment to the project spoke volumes of its importance and the considerable need for the clearly communicated information, which the project provided.

Ultimately, Arthritis Ireland has produced a suite of resources which will be referenced and used by patients, and will hopefully make a considerable impact on their quality of life.

Acknowledgments:

This patient education programme was supported by a grant from UCB.

Disclosure of Interests:

Brian Lynch Grant/research support from: Arthritis Ireland received a grant from MSD to develop this patient education programme. Brian Lynch has not benefited personally in any way.

PARE0003 MY RA STORY - PERSONAL ACCOUNTS OF LIVING WITH RHEUMATOID ARTHRITIS

Background:

Over 2,000 people are diagnosed with rheumatoid arthritis (RA) in Ireland each year; three in four are of working age. In total, RA affects some 45,000 people in the country; 70 per cent of whom are women.

For someone newly diagnosed with RA, coming to terms with the news can seem overwhelming.

Such a dramatic shift in life circumstances can impact one’s physical and mental well-being. While there is no shortage of information available about the condition, it can be overwhelming trying to filter this, assess what is trustworthy and reliable.

Objectives:

•To provide information and hope to people newly diagnosed with RA, and to give a voice to those living with the condition;

•To increase awareness and understanding of RA – encourage engagement with HCPs, contributing to early diagnosis and better outcomes;

•To increase awareness of work of Arthritis Ireland as a patient organisation.

Methods:

Arthritis Ireland approached best-selling author and RA patient, Sinead Moriarty, to front an RA awareness campaign, called My RA Story.

The purpose of the campaign was to increase awareness and understanding of rheumatoid arthritis, of what it is like to live with this chronic condition with its invisible pain and life-changing impact. In so doing, Arthritis Ireland wanted to give a platform to people to tell their own story, so that they could be heard. We then wanted to publish these experiences in book form.

In April 2019, we launched a video on social media featuring Sinead Moriarty speaking about her experience of living with RA. The video generated lots of engagement across social media and also helped garner national and regional media coverage in print and broadcast.

The call for RA stories received a fantastic response from the public and the reading panel had a tough job in selecting the contributions which would feature in the published volume. Once the successful contributions were chosen, Arthritis Ireland proceeded to design a book, which could be sold in the book trade and online.

Results:

In September 2019, Arthritis Ireland published My RA Story: Personal accounts of living with rheumatoid arthritis. Launched in the National Library of Ireland by Sinead Moriarty, the 46 contributions touched upon themes of pain, fatigue, emotional impact, disability, surgery, education, career, family, goal-setting, self-management, connecting with others, hope, etc.

The contributors came from people who were living with RA for over 40 years, as well as from those who were more recently diagnosed.

The book is a hugely valuable contribution to health literature. Arthritis Ireland now plans to make the book available for sale internationally, through Amazon and other retail channels, as well as promoting it more extensively in rheumatology clinics.

In October, one of the contributors was interviewed on national television about her RA story, as part of a feature on World Arthritis Day.

Conclusion:

This campaign gave people living with RA a platform to write about and share about their condition. Fronted by an RA champion with significant name recognition and an enormous audience in her own right, best-selling author, Sinéad Moriarty, the book, My RA Story. Crucially, the book is a valuable resource for people who are newly diagnosed with the disease and uncertain of what the future holds.

Acknowledgments:

This project was supported by an educational grant from MSD.

Disclosure of Interests:

Brian Lynch Grant/research support from: Arthritis Ireland received a grant from MSD to develop this patient education programme. Brian Lynch has not benefited personally in any way.

Novel COL4A2 variant in a large pedigree: Consequences and dilemmas

Pathogenic COL4A2 variants cause abnormalities in collagen production and can have serious implications for a range of organ systems, most notably the brain. Herein, we describe a large family of first-degree relatives affected by a novel heterozygous variant in COL4A2 (c.3490G.A). A wide disease spectrum is described, from asymptomatic to symptomatic, including 2 children with porencephaly and co-existing juvenile idiopathic polyarthritis. During a subsequent pregnancy, antenatal testing identified a positive fetus. In view of the literature, we review management and genetic counselling dilemmas.

MELAS (Mitochondrial Encephalomyopathy, Lactic Acidosis, Stroke) - a Diagnosis Not to be Missed

MELAS is a rare mitochondrial disorder. We report two cases in Irish males where the characteristics were evident, but the diagnosis not made for a considerable period of time. In one of the cases the symptoms were presumed secondary to prematurity. In the other the symptoms were presumed secondary to epilepsy and he had three respiratory arrests secondary to benzodiazepine administration. This report wishes to highlight MELAS as a differential diagnosis in paediatric patients who present with stroke.

Climatic Conditions and the Reporting of Sun-Protective Behavior Survey Data: A Brief Report

Two hundred thirty-one spectators at a Cricket match in Brisbane, Australia, were interviewed and observed to determine their sun protective behaviors, and these behaviors were compared to the temperature and amount of cloud cover at the time of the study. People tended to protect themselves from the sun when there was less cloud cover and temperatures were higher.

Rapid identification and antimicrobial susceptibility testing of positive blood cultures using MALDI-TOF MS and a modification of the standardised disc diffusion test: a pilot study

AIMS

In an era when clinical microbiology laboratories are under increasing financial pressure, there is a need for inexpensive, yet effective, rapid microbiology tests. The aim of this study was to evaluate a novel modification of standard methodology for the identification and antimicrobial susceptibility testing (AST) of pathogens in positive blood cultures, reducing the turnaround time of laboratory results by 24 h.

METHODS

277 positive blood cultures had a Gram stain performed and were subcultured and incubated at 37°C in a CO2 atmosphere for 4-6 h. Identification of the visible growth was performed using matrix-assisted laser desorption time of flight mass spectrometry (MALDI-TOF MS). Taking a modified approach to the Clinical and Laboratory Standards Institute-standardised AST methodology, an inoculum density of 0.5 McFarland was prepared from the early growth for disc diffusion testing. The standard AST method was also performed on the 18-24 h culture.

RESULTS

96% (n=73/76) of gram-negative organisms were correctly identified by MALDI-TOF MS. Comparative analysis of the rapid and standard AST results showed an overall interpretive category error rate of 7.7% (6.7% minor errors, 0.6% major errors and 0.4% very major errors). 100% of Staphylococcus aureus (n=41) and enterococcus isolates (n=9) were correctly identified after 4-6 h incubation. The overall AST categorical agreement was also 100% for these isolates.

CONCLUSIONS

An incubation of 4-6 h directly from positive blood cultures allowed for both a rapid species identification and an antimicrobial susceptibility result approximately 24 h earlier than is possible using standard methodology.

Reporting of Acute Flaccid Paralysis in Children under 15 years of age: Improving Surveillance, January 2009 - December 2014

Acute Flaccid Paralysis (AFP) surveillance, including case investigation and specimen collection is a gold standard method for poliomyelitis surveillance. The expected annual non-polio AFP rate <15 years of age in Ireland is = 1/100 000 population. This study reviewed all cases of AFP reported to the Irish Paediatric Surveillance Unit and the Health Protection Surveillance Centre between January 2009 and December 2014 and compared reporting rates with the expected incidence rate annually. We assessed quality of surveillance data in terms of completeness of investigation for each case reported. Forty-three AFP cases in children <15 years were notified; 35 of which were confirmed. Guillain-Barre Syndrome (GBS) accounted for 48.6% (n=17) of AFP notifications. In 2014, the expected annual AFP target rate was reached. This study identified possible under-reporting of AFP paediatric cases in Ireland between 2009-2013. Completeness of investigations has improved over time, but requires further work.

The FIKK kinase of Toxoplasma gondii is not essential for the parasite's lytic cycle

FIKK kinases are a novel family of kinases unique to the Apicomplexa. While most apicomplexans encode a single FIKK kinase, Plasmodium falciparum expresses 21 and piroplasms do not encode a FIKK kinase. FIKK kinases share a conserved C-terminal catalytic domain, but the N-terminal region is highly variable and contains no known functional domains. To date, FIKK kinases have been primarily studied in P. falciparum and Plasmodium berghei. Those that have been studied are exported from the parasite and associate with diverse locations in the infected erythrocyte cytosol or membrane. Deletion of individual P. falciparum FIKK kinases indicates that they may play a role in modification of the infected erythrocyte. The current study characterises the single FIKK gene in Toxoplasma gondii to evaluate the importance of the FIKK kinase in an apicomplexan that has a single FIKK kinase. The TgFIKK gene encoded a protein of approximately 280kDa. Endogenous tagging of the FIKK protein with Yellow Fluorescent Protein showed that the FIKK protein exclusively localised to the posterior end of tachyzoites. A Yellow Fluorescent Protein-tagged FIKK and a Ty-tagged FIKK both co-localised with T. gondii membrane occupation and recognition nexus protein to the basal complex and were localised apical to inner membrane complex protein-5 and Centrin2. Deletion of TgFIKK, surprisingly, had no detectable effect on the parasite's lytic cycle in vitro in human fibroblast cells or in acute virulence in vivo. Thus, our results clearly show that while the FIKK kinase is expressed in tachyzoites, it is not essential for the lytic cycle of T. gondii.

117 DEVELOPMENT OF A NONINVASIVE, FECAL PROTEIN PREGNANCY TEST FOR POLAR BEARS

Differentiating between pregnancy and nonpregnancy noninvasively is difficult in species that experience pseudopregnancy, including polar bears (Ursus maritimus). These bears usually breed in the spring, undergo delayed implantation until late summer or early fall, and give birth in late fall. In other species, the placental protein transthyretin (TTR) has been shown to be essential for early fetal growth, responsible for transporting thyroid hormone from the mother to the fetus during early pregnancy. Preliminary data obtained via 2D-DIGE indicated that fecal TTR is elevated during polar bear pregnancy, but further research is needed to validate its use as an accurate biomarker of pregnancy. The aim of this study was to develop a bench-side assay to characterize TTR in longitudinal fecal samples from pregnant and nonpregnant polar bears. Specific objectives were to 1) develop an effective method for total fecal protein extraction; 2) identify antibodies that cross-react with polar bear fecal TTR; 3) validate an EIA for measuring fecal TTR; and, for proof of concept, 4) compare fecal TTR concentrations among pregnant, pseudopregnant, and nonpregnant polar bears. Fecal samples (n = 205) were collected from females that produced cubs (pregnant; n = 2), did not breed but exhibited a prolonged increase in progesterone (P4; pseudopregnant; n = 2), or did not breed and did not exhibit an increase in P4 (nonpregnant; n = 2). Total protein of each sample was extracted using a modified ammonium sulfate method. Protein concentrations were quantified using the Bradford assay. Western blot was used to determine commercial antibody compatibility with polar bear fecal TTR. A sandwich EIA was optimized using a standard curve ranging from 12.5 to 400 pg of human TTR/well. A parallelism was performed using two-fold serial dilutions of pooled fecal protein. Fecal TTR concentrations were measured in duplicate and are reported as femtograms of TTR per micrograms of total protein. Mean TTR concentrations in samples collected from July–December were compared among groups. Values are reported as mean ± standard error of the mean. Total fecal protein yield was 459.38 ± 284.38 µg g–1 of feces. Successful binding of 2 polyclonal antibodies to the 15-kDa subunit of the TTR protein was verified via western blot and indicated that fecal proteins can retain antibody-binding capacity. The parallelism exhibited strong correlation with the standard curve (R2 = 0.989). Data suggest that fecal TTR is higher during late summer or early fall in pregnant bears (588.40 ± 116.52) when compared to the pseudopregnant state (111.23 ± 15.98) and the nonpregnant state (250.83 ± 34.34). This is the first EIA developed to measure fecal TTR in any species. Although preliminary, these data suggest that the fecal TTR EIA may be useful in diagnosing pregnancy in polar bears.

Neurodevelopmental outcome at seven years in term, acidotic newborns

The objective was to follow up a cohort of acidotic full-term infants with or without hypoxic ischemic encephalopathy (HIE) and determine if at 7 years they displayed any neurodevelopmental delays. Children (n=44) were divided according to those with mild (n=25) or severe (n=19) acidosis and were then further subdivided into those with or without HIE. Participants were assessed using the Wechsler Intelligence Scale for Children (WISC-IVUK) and Achenbach Child Behaviour Checklist (CBCL). No differences in WISC-IVUK scores in children without HIE irrespective of the cord pH values were found. Children with HIE grade I scored significantly higher in perceptual reasoning than those with grade III (p<0.01). CBCL scores revealed no differences between groups. Findings suggest evidence of impairment at school-age that correlates with the degree of encephalopathy. Acidosis without the presence of clinical encephalopathy was associated with normal outcome.

Investigation of an association between onset of narcolepsy and vaccination with pandemic influenza vaccine, Ireland April 2009-December 2010

In 2011, the Irish Medicines Board received reports of onset of narcolepsy following vaccination against influenza A(H1N1)pdm09 with Pandemrix. A national steering committee was convened to examine the association between narcolepsy and pandemic vaccination. We conducted a retrospective population-based cohort study. Narcolepsy cases with onset from 1 April 2009 to 31 December 2010 were identified through active case finding. Narcolepsy history was gathered from medical records. Pandemic vaccination status was obtained from vaccination databases. Two independent experts classified cases using the Brighton case definition. Date of onset was defined as date of first healthcare contact for narcolepsy symptoms. Incidence of narcolepsy in vaccinated and non-vaccinated individuals was compared. Of 32 narcolepsy cases identified, 28 occurred in children/adolescents and for 24 first healthcare contact was between April 2009 and December 2010. Narcolepsy incidence was 5.7 (95% confidence interval (CI): 3.4–8.9) per 100,000 children/adolescents vaccinated with Pandemrix and 0.4 (95% CI: 0.1–1.0) per 100,000 unvaccinated children/adolescents (relative risk: 13.9; absolute attributable risk: 5.3 cases per 100,000 vaccinated children/adolescents). This study confirms the crude association between Pandemrix vaccination and narcolepsy as observed in Finland and Sweden. The vaccine is no longer in use in Ireland. Further studies are needed to explore the immunogenetic mechanism of narcolepsy.

Investigation of an association between onset of narcolepsy and vaccination with pandemic influenza vaccine, Ireland April 2009-December 2010

Binary file ES_Abstracts_Final_ECDC.txt matches

Fatty acid profile of <i>Longissimus dorsi</i> muscle of crossbred pigs fed with addition of conjugated linoleic acid or sunflower oil

Abstract. The aim of the paper was to investigate the impact of feeding pigs with different levels of conjugated linoleic acid or sunflower oil on fatty acid profile of Longissimus dorsi muscle. The subjects of research were 60 crossbred gilts divided into 6 groups, fed with different levels of conjugated linoleic acid (CLA) or sunflower oil (SFO) (0.5; 1.0 and 2.0 %, respectively). All fatteners were kept and fed under standardized conditions. Animals were slaughtered at 95 kg of body weight. Fatty acid profile was determined in samples of Longissimus dorsi muscle from each animal. Gas chromatography was used (in the research). The significance of differences between groups was verified by Duncan’s test. In the present study the addition of conjugated linoleic acid or sunflower oil did not impact the composition and amounts of saturated or unsaturated fatty acids in Longissimus dorsi muscle.

Development of quantitative analytical methods for the control of actinides in a pyrochemical partitioning process

Advanced nuclear fuel cycles are being developed in order to reduce the long-term radiotoxicity of highly radioactive waste. Pyrochemical partitioning techniques appear particularly attractive for advanced fuel cycles in which the minor actinides are recycled. The electrochemical processes of practical importance are the electrorefining process and the liquid–liquid extraction of transuranic (TRU) elements from fission products using either non-miscible molten metal or molten salt–metal phases. Analytical methods for the accurate assay of actinide elements in these matrices needed to be developed. A quantitative assay is required in order to establish a material balance for process development and – at a later stage – for accountancy and control purposes. To this end radiometric techniques such as energy-dispersive X-ray fluorescence analysis (XRF), neutron coincidence counting (NCC) and high-resolution gamma spectrometry (HRGS) were extensively employed for the quantitative determination of actinides (U, Np, Pu, Am, Cm) in process samples. Comparative analyses were performed using inductively coupled plasma mass spectrometry (ICP-MS). The respective samples were available in small quantities (≅100 mg) either in the form of eutectic salt or in metallic form with Cd, Zr or Bi as major metallic matrix constituents.

Safety studies of LP20 powder produced from heat-killed Lactobacillus plantarum L-137

The safety of LP20 and its prototype, a powder, with potential use in food, produced from a mixture of dextrin and heat-killed Lactobacillus plantarum L-137, was assessed in an acute study in mice, and in an in vitro bacterial reverse mutation assay, an in vitro chromosome aberration assay, and an in vivo mouse micronucleus assay. LP20 prototype was not acutely toxic when administered to male and female Slc:ICR mice by single gavage at 2000mg/kg bw. Dosing was not associated with mortality, clinical signs, changes in bodyweight, or macroscopic abnormalities. The LD(50) in mice was greater than 2000mg/kg bw. There was no evidence of genotoxicity of LP20 in the Ames assay (0-5000microg/plate) or in the in vitro chromosome aberration assay with Chinese hamster lung fibroblasts (0-5000microg/mL). Administration of two consecutive daily doses of 500, 1000, or 2000mg/kg bw by gavage to male Crlj:CD-1 mice was not associated with an increased incidence of micronuclei and did not alter the ratio of polychromatic to normochromatic erythrocytes. These studies show that LP20 powder is not acutely toxic and is without genotoxic activity both in vitro and in vivo.

Report of an Expert Panel on the reanalysis by of a 90-day study conducted by Monsanto in support of the safety of a genetically modified corn variety (MON 863)

MON 863, a genetically engineered corn variety that contains the gene for modified Bacillus thuringiensis Cry3Bb1 protein to protect against corn rootworm, was tested in a 90-day toxicity study as part of the process to gain regulatory approval. This study was reanalyzed by Séralini et al. who contended that the study showed possible hepatorenal effects of MON 863. An Expert Panel was convened to assess the original study results as analyzed by the Monsanto Company and the reanalysis conducted by Séralini et al. The Expert Panel concludes that the Séralini et al. reanalysis provided no evidence to indicate that MON 863 was associated with adverse effects in the 90-day rat study. In each case, statistical findings reported by both Monsanto and Séralini et al. were considered to be unrelated to treatment or of no biological or clinical importance because they failed to demonstrate a dose-response relationship, reproducibility over time, association with other relevant changes (e.g., histopathology), occurrence in both sexes, difference outside the normal range of variation, or biological plausibility with respect to cause-and-effect. The Séralini et al. reanalysis does not advance any new scientific data to indicate that MON 863 caused adverse effects in the 90-day rat study.

Long chain fatty acid oxidation defects in children: importance of detection and treatment options

BACKGROUND

Mitochondrial beta oxidation plays a major role in energy production. Long chain fatty acid oxidation defects include deficiency of the trifunctional protein (rare) or more commonly defects of the long chain 3-hydroxy acyl-CoA dehydrogenase enzyme (LCHAD). These long chain defects have variable presentations, they may present in the neonate or infant with sudden death, hepatopathy (Reyes disease), hypoketotic hypoglycaemia, rhabdomyolysis, myopathy, cardiomyopathy and with late complications such as peripheral neuropathy, pigmentary retinopathy, retinal degeneration and progressive visual loss. The correct diagnosis at presentation is not only life saving but also allows for the appropriate dietary and other intervention, which may have major effects on outcome.

AIM

Three case reports of patients with long chain fatty acid oxidation defects who have shown significant benefits from treatment are reported.

CONCLUSIONS

These paediatric presentations illustrate the clinical heterogeneity of long chain fatty acid oxidation defects and opportunities for effective management if correctly diagnosed.