Detailed phenotypic and functional characterization of CMV-associated adaptive NK cells in rhesus macaques

Previous research on adaptive NK cells in rhesus macaques suffered from the lack of specific antibodies to differentiate between inhibitory CD94/NKG2A and stimulatory CD94/NKG2C heterodimeric receptors. Recently we reported an expansion of NKG2C receptor-encoding genes in rhesus macaques, but their expression and functional role on primary NK cells remained unknown due to this deficit. Thus, we established monoclonal antibodies 4A8 and 7B1 which show identical specificities and bind to both NKG2C-1 and NKG2C-2 but neither react with NKG2C-3 nor NKG2A on transfected cells. Using a combination of 4A8 and Z199 antibodies in multicolor flow cytometry we detected broad expression (4-73%) of NKG2C-1 and/or NKG2C-2 (NKG2C-1/2) on primary NK cells in rhesus macaques from our breeding colony. Stratifying our data to CMV-positive and CMV-negative animals, we noticed a higher proportion (23-73%) of primary NK cells expressing NKG2C-1/2 in CMV+ as compared to CMV- macaques (4-5%). These NKG2C-1/2-positive NK cells in CMV+ macaques are characterized by lower expression of IL12RB2, ZBTB16, SH2D1B, but not FCER1G, as well as high expression of IFNG, indicating that antibody 4A8 detects CMV-associated adaptive NK cells. Single cell RNA seq data of 4A8-positive NK cells from a rhCMV-positive macaque demonstrated that a high proportion of these adaptive NK cells transcribe in addition to NKG2C-1 and NKG2C-2 also NKG2C-3, but interestingly NKG2A as well. Remarkably, in comparison to NKG2A, NKG2C-1 and in particular NKG2C-2 bind Mamu-E with higher avidity. Primary NK cells exposed to Mamu-E-expressing target cells displayed strong degranulation as well as IFN-gamma expression of 4A8+ adaptive NK cells from rhCMV+ animals. Thus, despite co-expression of inhibitory and stimulatory CD94/NKG2 receptors the higher number of different stimulatory NKG2C receptors and their higher binding avidity to Mamu-E outreach inhibitory signaling via NKG2A. These data demonstrate the evolutionary conservation of the CMV-driven development of NKG2C-positive adaptive NK cells with particular molecular signatures in primates and with changes in gene copy numbers and ligand-binding strength of NKG2C isotypes. Thus, rhesus macaques represent a suitable and valuable nonhuman primate animal model to study the CMV-NKG2C liaison in vivo.

O-125 Application of artificial intelligence using big data to devise and train a machine learning model on over 63,000 human embryos to automate time-lapse embryo annotation

Study question

Can a machine learning (ML) model, developed using modern neural network architecture produce comparable annotation data; utilisable for algorithmic outcome prediction, to manual time-lapse annotations?

Summary answer

The model automatically annotated unseen embryos with comparable results to manual methods, generating morphokinetic data to enable comparably predictive outputs from an embryo selection algorithm.

What is known already

The application of artificial intelligence across healthcare industries, including fertility, is increasing. Several ML models are available that seek to generate or analyse embryo images and morphokinetic data, and to determine embryo viability potential. Along with photographic images, the use of time-lapse in IVF laboratories has amassed numeric data, resulting predominantly from annotated manual assessment of images over time. Embryo annotation practice is variable in quality, can be subjective and is time-consuming; commonly taking several minutes per embryo. The development of rapid, accurate automatic annotation would represent a significant time-saving as well as an increase in reproducibility and accuracy.

Study design, size, duration

Multicentre quality assured annotation data from 63,383 time-lapse monitored embryos (EmbryoScope®), comprising over 400 million individual images, were used to train a ML model to automatically generate morphokinetic annotations. Data was derived from 8 UK clinics within a cohesive group between 2012-2021. Accuracy was assessed using 900 unseen embryos (with live birth outcome) by comparing the output of an established in-house, prospectively validated embryo selection model when the input was either ML-automated, or manual annotations.

Participants/materials, setting, methods

Multi-focal plane images were processed on the Azure cloud (Microsoft) and resampled to 300x300 pixels. A Laplacian-based focal stacking algorithm merged frames into a single image. The model consisted of an EfficientNetB4 Convolutional Neural Network classifier to extract features and classify the stage of embryo images. A Temporal Convolutional Network  interpreted a time-series of image features; producing annotations from pronuclear fading through to blastocyst. Soft localisation loss function used QA data to integrate annotation subjectivities.

Main results and the role of chance

The ML model rapidly and automatically generated annotations. Efficacy and comparability of the ML model to automate reliable, utilisable annotations was demonstrated by comparison with manual annotation data and the ML model’s ability to auto-generate annotations which could be used to predict live birth by providing annotation data to an established, validated in house embryo selection model. Live birth-predictive capability was measured, and benchmarked against manual annotation, using the area under the receiver operating characteristic curve (AUC).

When tested on time-lapse images, collected from pronuclear fading to full blastulation, representing 900 previously unseen, transferred blastocysts where live birth outcomes were blinded, the in-house developed auto-annotation ML model resulted in an AUC of 0.686 compared with 0.661 for manual annotations, for live birth prediction.

Auto annotation using the developed model took only milliseconds to complete per embryo. The developed auto-annotation model, built and tested on large data, is considered suitable for productionisation with the aim of being validated and integrated into an application to support IVF laboratory practice.

Limitations, reasons for caution

Whilst this model was trained to recognise key morphokinetic events, there are other morphokinetic variables that may be useful in the prediction of live birth and further improve embryo selection, or deselection, ability. Akin to manual interpretation, some embryos may fail to be annotated or need second opinion.

Wider implications of the findings

There is increasing evidence supporting the application of ML to utilise big data from time-lapse imaging and fertility care generally. Whilst promising benefits to IVF clinics and patients, responsible use of data is required alongside large high-quality datasets, and rigorous validation, to ensure safe and robust applications.

Trial registration number

N/A

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 < 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 < 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 <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: <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: <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.

Quality of life and patient-perceived symptoms in patients with psoriasis undergoing proactive or reactive management with the fixed-dose combination Cal/BD foam: A post-hoc analysis of PSO-LONG

Background

Psoriasis has important physical and psychosocial effects that extend beyond the skin. Understanding the impact of treatment on health‐related quality of life (HRQoL) and patient‐perceived symptom severity in psoriasis is key to clinical decision‐making.

Objectives

This post hoc analysis of the PSO‐LONG trial data assessed the impact of long‐term proactive or reactive management with fixed‐dose combination calcipotriene 50 µg/g and betamethasone dipropionate 0.5 mg/g (Cal/BD) foam on patient‐reported outcomes (PROs) in patients with psoriasis vulgaris.

Methods

Five hundred and twenty‐one patients from the Phase 3, randomized, double‐blind PSO‐LONG trial were included. An initial 4‐week, open‐label phase of fixed‐dose combination Cal/BD foam once daily (QD) was followed by a 52‐week maintenance phase, at the start of which patients were randomized to a proactive management arm (Cal/BD foam twice weekly) or reactive management arm (vehicle foam twice weekly). Patient‐perceived symptom severity and HRQoL were assessed using the Psoriasis Symptom Inventory (PSI), the Dermatology Life Quality Index (DLQI) and the EuroQol‐5D for psoriasis (EQ‐5D‐5L‐PSO).

Results

Statistically and clinically significant improvements were observed across all PRO measures. The mean difference (standard deviation) from baseline to Week 4 was −8.97 (6.18) for PSI, −6.02 (5.46) for DLQI and 0.11 (0.15) for EQ‐5D‐5L‐PSO scores. During maintenance, patients receiving reactive management had significantly higher DLQI (15% [p = 0.007]) and PSI (15% [p = 0.0128]) and a numerically lower EQ‐5D‐5L‐PSO mean area under the curve score than patients receiving proactive management (1% [p = 0.0842]).

Conclusions

Cal/BD foam significantly improved DLQI, EQ‐5D‐5L‐PSO and PSI scores during the open‐label and maintenance phases. Patients assigned to proactive management had significantly better DLQI and PSI scores and numerically better EQ‐5D‐5L‐PSO versus reactive management. Additionally, baseline flare was associated with worse PROs than the start of a relapse, and patients starting a relapse also had worse PROs than patients in remission.

P–164 Mulitcentre derived time lapse algorithms developed using 6228 transferred embryos with known birth outcome incorporating novel morphological and morphokinetic markers

Study question

Can incorporation of novel markers of morphology with known temporal events successfully rank embryos to enable prediction of propensity for live birth?

Summary answer

Incorporation of variables for trophectoderm and morula grading demonstrably enhanced the model to rank embryos in order of potential for live birth.

What is known already

Models built using morphokinetic markers of development are widely used to rank embryos within a cohort. Such models include defined temporal parameters which are closely related to morphological grade. However, morphological grading by an embryologist is subjective and is not strongly correlated to outcome. Combining with defined kinetic events has been suggested to improve prediction of outcome.

Study design, size, duration

Data from 6228 known live birth outcome embryos from 8 UK clinics between 2011 – 2018 were investigated using an exploratory approach to identify novel markers of development.

Participants/materials, setting, methods

Five significant variables were defined, a derivative of time to start of blastulation; a derivative of trophectoderm grade; a kinetic variable utilising t3, t4, t5 and t8; an interval variable of tB-tSB and a variable based on novel morula classification. To maximise the output, a proxy value was derived for missing datapoints. The model was built using logistical regression and validated using fivefold cross validation with the data split as 80% training and 20% test.

Main results and the role of chance

An algorithm was developed including the five significant variables identified with an AUC of 0.685 demonstrating reliable prediction of live birth. Without morphological variables, the AUC was 0.674 demonstrating the improvement in the prediction value by including the derivative of the trophectoderm and morula grade. This resulted in ten classes of algorithm scores, 1–10, giving a live birth rate from 2% to 46%, irrespective of patient variables, for chance of live birth.

Limitations, reasons for caution

Successful application of the algorithm is reliant on stringent quality assurance for maintenance of accurate annotation and grading, and may not be transferable between laboratories with different SOPs.

Wider implications of the findings: The addition of a trophectoderm and morula grade in combination with morphokinetic parameters, increases the predictive value of the algorithm in relation to live birth outcome. Using proxy values allows maximization of data for model generation, and allows the model to be applied when missing values are present.

Trial registration number

Not applicable

SinEx DB 2.0 update 2020: database for eukaryotic single-exon coding sequences

Single-exon coding sequences (CDSs), also known as ‘single-exon genes’ (SEGs), are defined as nuclear, protein-coding genes that lack introns in their CDSs. They have been studied not only to determine their origin and evolution but also because their expression has been linked to several types of human cancers and neurological/developmental disorders, and many exhibit tissue-specific transcription. We developed SinEx DB that houses DNA and protein sequence information of SEGs from 10 mammalian genomes including human. SinEx DB includes their functional predictions (KOG (euKaryotic Orthologous Groups)) and the relative distribution of these functions within species. Here, we report SinEx 2.0, a major update of SinEx DB that includes information of the occurrence, distribution and functional prediction of SEGs from 60 completely sequenced eukaryotic genomes, representing animals, fungi, protists and plants. The information is stored in a relational database built with MySQL Server 5.7, and the complete dataset of SEG sequences and their GO (Gene Ontology) functional assignations are available for downloading. SinEx DB 2.0 was built with a novel pipeline that helps disambiguate single-exon isoforms from SEGs. SinEx DB 2.0 is the largest available database for SEGs and provides a rich source of information for advancing our understanding of the evolution, function of SEGs and their associations with disorders including cancers and neurological and developmental diseases.

Database URL:http://v2.sinex.cl/

A phase I study of panobinostat and ruxolitinib in patients with primary myelofibrosis (PMF) and post--polycythemia vera/essential thrombocythemia myelofibrosis (post--PV/ET MF)

Ruxolitinib, a selective JAK1/JAK2 inhibitor, is the current first line therapy for myelofibrosis (MF), which reduces symptomatology and splenomegaly, but does not clearly modify disease course. Panobinostat, a histone deacetylase inhibitor, was shown to be safe and tolerable in phase I and II trials and demonstrated clinical activity in approximately a third of treated patients. Combination therapy of ruxolitinib and panobinostat showed synergistic activity in a preclinical MF model, which prompted clinical evaluation of this combination in both ruxolitinib naïve and treated MF patients. Herein, we report the results of an investigator-initiated, dose escalation, phase I trial of ruxolitinib and panobinostat in 15 patients with primary MF and post-polycythemia vera/essential thrombocythemia MF. This combination treatment proved to be safe and tolerable without dose limiting thrombocytopenia and a maximum tolerated dose of both agents in combination was not determined. The majority of patients maintained stable disease with this combination treatment and 40 % attained a clinical improvement (spleen n = 5, anemia n = 1) by modified IWG-MRT at the end of 6 cycles. This is one of the first attempts of rationally designed, JAK inhibitor-based, combination therapy studies and exemplifies the feasibility of such an approach in patients with advanced MF.

Successful knock-in of Hypertrophic Cardiomyopathy-mutation R723G into the MYH7 gene mimics HCM pathology in pigs

Familial Hypertrophic Cardiomyopathy (HCM) is the most common inherited cardiac disease. About 30% of the patients are heterozygous for mutations in the MYH7 gene encoding the ß-myosin heavy chain (MyHC). Hallmarks of HCM are cardiomyocyte disarray and hypertrophy of the left ventricle, the symptoms range from slight arrhythmias to sudden cardiac death or heart failure. To gain insight into the underlying mechanisms of the diseases' etiology we aimed to generate genome edited pigs with an HCM-mutation. We used TALEN-mediated genome editing and successfully introduced the HCM-point mutation R723G into the MYH7 gene of porcine fibroblasts and subsequently cloned pigs that were heterozygous for the HCM-mutation R723G. No off-target effects were determined in the R723G-pigs. Surprisingly, the animals died within 24 h post partem, probably due to heart failure as indicated by a shift in the a/ß-MyHC ratio in the left ventricle. Most interestingly, the neonatal pigs displayed features of HCM, including mild myocyte disarray, malformed nuclei, and MYH7-overexpression. The finding of HCM-specific pathology in neonatal R723G-piglets suggests a very early onset of the disease and highlights the importance of novel large animal models for studying causative mechanisms and long-term progression of human cardiac diseases.

122 A New Maturation Medium Improves Porcine Embryo Production In Vitro

Recently (Spate et al. 2017 Reprod. Fertil. Dev. 29, 150), a new medium [TCM-199 supplemented with hCG 10 IU, pregnant mare serum gonadotropin (PMSG) 10 IU mL−1, fibroblast growth factor (FGF) 40 ng mL−1, leukemia inhibitory factor (LIF) 2000 U mL−1, IGF-1 20 ng mL−1, epidermal growth factor (EGF) 10 ng mL−1], termed FLI medium, was demonstrated to improve porcine oocyte maturation in vitro. The effects on embryo development and quality have not yet been investigated. The purpose of the present study was to compare the FLI medium in porcine in vitro embryo production (IVP) with our standard maturation medium (DMEM supplemented with 10 IU mL−1 PMSG and hCG, 50 ng mL−1 EGF, 100 ng mL−1 IGF1, and 5 ng mL−1 FGF). Briefly, gilt oocytes were collected via aspiration of follicles from abattoir ovaries and matured for 44 h in either FLI or standard DMEM medium at 39°C, 5% CO2 in humidified air. In vitro fertilization was performed with freshly ejaculated sperm (250,000 mL−1) of a multi-transgenic boar (GGTA1-KO/hCD46/hCD55/hCD59/hHO-1/hA20) by co-incubation with the matured oocytes in PGMTac4 medium for 4 h. Zygotes were washed twice and then cultured for 6 days in PZM3 medium. Development to the blastocyst stage was recorded at Day 6 of culture. Blastocysts were fixed and Hoechst33342 stained for counting the nuclei. Each of the experiments was repeated 3 times. In a second step, Day 5 blastocysts derived from the FLI medium were transferred to synchronized pubertal gilts to test the in vivo developmental competence of the IVF embryos. Maturation of oocytes in FLI medium resulted in a significantly higher blastocyst rate (49.3 vs. 13.5; P ≤ 0.001, Chi-squared test) and nuclei number (41.3 ± 12.2 vs. 35.3 ± 10.8; P ≤ 0.001, one-way ANOVA) compared with the standard medium, whereas the cleavage rate was not affected. Transfer of Day 5 blastocysts (average 35 embryos/recipient) derived from the FLI system using 8 recipients resulted in 7 pregnancies (87.5%) as determined by ultrasound scanning on Day 25 of gestation. At the time of writing, one recipient had delivered 5 healthy piglets after a gestation length of 114 days. Results indicate that the FLI medium significantly improves blastocyst rates and the cell number of the resulting blastocysts (Table 1) and yields pig IVF embryos with a high developmental capacity in vivo. By producing high-quality porcine embryos, this FLI-based IVF system provides an efficient method to modify the porcine genome by cytoplasmic microinjection of CRISPR/Cas molecules into IVF-derived zygotes. Table 1.Results of maturation of oocytes in FLI medium compared with DMEM

Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study

BACKGROUND

We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America.

METHODS

We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs).

RESULTS

We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions.

CONCLUSIONS

Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.

Complement activation contributes to ventilator-induced lung injury in rats

The complement system contributes to ventilator induced lung injury (VILI). We hypothesized that pretreatment with the C1 esterase inhibitor (C1INH) Berinert® constrains complement activation consecutively inducing improvements in arterial oxygenation and histological pulmonary damage. At baseline, male Sprague-Dawley rats underwent mechanical ventilation in a conventional mode (PIP 13 cm H₂O, PEEP 3 cm H₂O). In the Control group, the ventilator setting was maintained (Control, n = 15). The other animals randomly received intravenous pretreatment with either 100 units/kg of the C1-INH Berinert® (VILI-C1INH group, n = 15) or 1 ml saline solution (VILI-C group, n = 15). VILI was induced by invasive ventilation (PIP 35 cm H₂O, PEEP 0 cm H₂O). After two hours of mechanical ventilation, the complement component C3a remained low in the Control group (258 ± 82 ng/ml) but increased in both VILI groups (VILI-C: 1017 ± 283 ng/ml; VILIC1INH: 817 ± 293 ng/ml; P < 0.05 for both VILI groups versus Control). VILI caused a profound deterioration of arterial oxygen tension (VILI-C: 193 ± 167 mmHg; VILI/C1-INH: 154 ± 115 mmHg), whereas arterial oxygen tension remained unaltered in the Control group (569 ± 26 mmHg; P < 0.05 versus both VILI groups). Histological investigation revealed prominent overdistension and interstitial edema in both VILI groups compared to the Control group. C3a plasma level in the VILI group were inversely correlated with arterial oxygen tension (R = -0.734; P < 0.001). We conclude that in our animal model of VILI the complement system was activated in parallel with the impairment in arterial oxygenation and that pretreatment with 100 units/kg Berinert® did neither prevent systemic complement activation nor lung injury.

Diversification of both KIR and NKG2 natural killer cell receptor genes in macaques - implications for highly complex MHC-dependent regulation of natural killer cells

The killer immunoglobulin-like receptors (KIR) as well as their MHC class I ligands display enormous genetic diversity and polymorphism in macaque species. Signals resulting from interaction between KIR or CD94/NKG2 receptors and their cognate MHC class I proteins essentially regulate the activity of natural killer (NK) cells. Macaque and human KIR share many features, such as clonal expression patterns, gene copy number variations, specificity for particular MHC class I allotypes, or epistasis between KIR and MHC class I genes that influence susceptibility and resistance to immunodeficiency virus infection. In this review article we also annotated publicly available rhesus macaque BAC clone sequences and provide the first description of the CD94-NKG2 genomic region. Besides the presence of genes that are orthologous to human NKG2A and NKG2F, this region contains three NKG2C paralogues. Hence, the genome of rhesus macaques contains moderately expanded and diversified NKG2 genes in addition to highly diversified KIR genes. The presence of two diversified NK cell receptor families in one species has not been described before and is expected to require a complex MHC-dependent regulation of NK cells.

Defining "intermittent UVR exposure"

BACKGROUND

Cutaneous malignant melanoma (CMM) has been associated with "intermittent UVR exposure", which in previous studies has mainly been assessed by retrospective questionnaire data. Further, there is no uniform definition of the term "intermittent UVR exposure".

OBJECTIVES

We aimed to define and quantify "intermittent UVR exposure" by an objective measure.

METHODS

A broad study population of adults and children had data collected during a summer period. Data were personal UVR dosimetry measurements, from which the number of "intermittent days" was derived, sun behaviour diaries and retrospective questionnaires. Two definitions of intermittent UVR exposure were tested: (1) days when UVR dose exceeded 3 times individual average daily UVR dose, and (2) days when UVR dose exceeded individual constitutive skin type. Measures of nevi and lentigines were used as surrogates for CMM.

RESULTS

Using the first definition based solely on UVR dosimetry data we found 1241 "intermittent days" out of a total of 17 277 days (7.2%) among 148 participants. The numbers for nevi and lentigo density were significantly predicted by the number of intermittent days (R(2) = 0.15 and R(2) = 0.40, p < 0.001). The corresponding numbers for prediction of nevi and lentigo density by retrospective questionnaire data was lower (R(2) = 0.11, R(2) = 0.26, p < 0.001).

CONCLUSIONS

We introduce a well-defined objective measure of intermittent UVR exposure. This measure may provide a better prediction of solar skin damage and CMM than retrospective questionnaire data.

Beneficial Immune Effects of Myeloid-Related Proteins in Kidney Transplant Rejection

Acute rejection is a risk factor for inferior long-term kidney transplant survival. Although T cell immunity is considered the main effector in clinical acute rejection, the role of myeloid cells is less clear. Expression of S100 calcium-binding protein A8 (S100A8) and S100A9 was evaluated in 303 biopsies before and after transplantation from 190 patients. In two independent cohorts of patients with acute rejection (n = 98 and n = 11; mostly cellular rejections), high expression of S100 calcium-binding protein A8 (S100A8) and A9 (S100A9) was related to improved graft outcome. Mechanisms of action of the S100 molecules were investigated. In the graft and peripheral blood cells, S100A8 and S100A9 expression correlated with myeloid-derived suppressor markers. In line with this finding, recombinant S100A8 and S100A9 proteins inhibited maturation and the allogeneic T cell stimulatory capacity of dendritic cells. S100A9 enhanced the production of reactive oxygen species by macrophages, which suppressed T cell activity at low concentrations in the form of hydrogen peroxide. Intragraft S100A8 and S100A9 expression linked to reduced expression of T cell immunity and tissue injury markers and higher expression of immune regulatory molecules. This study sheds new light on the importance of myeloid cell subsets in directing the outcome of T cell-mediated acute rejection.

Pulse photodynamic therapy reduces inflammation without compromising efficacy in the treatment of multiple mild actinic keratoses of the face and scalp: a randomized clinical trial

BACKGROUND

The main side-effects of photodynamic therapy (PDT) for actinic keratoses (AKs) are post-treatment erythema and oedema, and pain during illumination. Severe erythema after PDT enhances the down time associated with the treatment.

OBJECTIVES

To evaluate in a randomized intraindividual study whether pulse-PDT and corticosteroid pulse-PDT would reduce treatment-induced erythema compared with conventional PDT.

METHODS

Twenty-two patients with multiple mild AKs on the face and scalp were treated with methyl aminolaevulinate (MAL)-PDT in three similar areas. Two areas were incubated with MAL for 30 min (pulse-PDT) and one area was incubated with MAL for 3 h (conventional PDT). All areas were illuminated with red light after 3 h. In one of the pulse-PDT areas a superpotent corticosteroid was applied before and just after PDT (S-pulse-PDT).

RESULTS

Pulse-PDT significantly reduced PDT-induced erythema (P = 0·020), and erythema was even further reduced by S-pulse-PDT (P < 0·001). The complete lesion response rate 3 months after PDT did not differ significantly between the three treated areas.

CONCLUSIONS

Pulse-PDT and S-pulse-PDT reduced erythema 24 h after treatment of multiple mild AKs on the face and scalp. The use of a short MAL application time and topical corticosteroid did not affect the efficacy of PDT and may be an easy way to make PDT treatment of large visible areas more acceptable.

15 HISTONE ACETYLATION PROFILE OF PORCINE EMBRYOS PRODUCED BY 2 CLONING METHODS WITH OR WITHOUT IN VITRO CULTURE

Conventional “Dolly”-based cloned (CNT) embryos maintain zona pellucida and can be transferred early in development. Handmade cloned (HMC) embryos are zona free and are cultured to later stages for transfer. We have shown differences between HMC and CNT embryos (Rep. Fert. Dev. 26, 123), and both in vitro culture and cloning method (NT) are associated with alterations in histone acetylation. More studies are needed to clarify whether CNT and HMC embryos differ in epigenetic profiles due to NT method or culture condition. Here we investigated histone acetylation profile of NT embryos produced by CNT or HMC with or without 5 to 6 days in vitro culture, emphasising quality and gene expression in resulting embryos. Both NT methods were performed on Day 0 (D0) with same oocyte batch, donor cells, and culture medium (CNT in group, HMC in well of well). On D0, 5, and 6 after CNT (Clon. Stem Cells 10, 355) or HMC (Zygote 20, 61), all developed embryos of all morphological qualities were collected for immunostaining of H3K18ac, and on D0 and 6 for mRNA expression of the genes KAT2A/2B, EP300, HDAC1/2, DNMT1o/s, and GAPDH. Embryo quality was evaluated normal (clear inner cell mass, high cell number, no fragments) or bad (no clear inner cell mass, low cell number, fragments). Cell numbers per blastocyst were counted on D5 and 6. Differences in cell number and H3K18ac level between different groups and days were analysed by ANOVA; gene expression data were analysed by GLM (SAS version 9.3, SAS Institute Inc., Cary, NC, USA). Embryo development rates of both NT methods were reported previously (Rep. Fert. Dev. 26, 123). On D5 and 6, all HMC embryos were evaluated as normal, but the CNT group contained both normal and bad embryos. Regarding cell numbers (Table 1), on D5 there was no difference between normal CNT and HMC embryos, but numbers were lower in CNT bad embryos. On D6 the blastocyst cell number was lower in both normal and bad CNT embryos compared with HMC. Regarding H3K18ac levels (Table 1), no differences were found on D5 between normal CNT and HMC embryos, but on D6 both CNT normal and bad embryos had higher H3K18ac level compared with HMC. On D0, no difference was found in mRNA expression of all 8 genes. On D6, KAT2A expression was slight increased (1.8-fold) in CNT compared with HMC embryos (P < 0.05). In conclusion, no differences were found between CNT and HMC embryos after completed NT procedure (D0) or after 5 days in vitro culture. However, differences in quality (cell number and H3K18ac) and gene expression between the 2 NT methods were observed when blastocyst expansion was initiated (D6). Thus, the 2 NT methods seem to produce embryos of similar quality, which is maintained over 5 days in vitro culture, but thereafter gene expression and histone acetylation are more active in CNT embryos. Table 1.Cell number and H3K18ac level1

223 GENERATION OF INTERSPECIES CHIMERAS BETWEEN PRIMATE INDUCED PLURIPOTENT STEM CELLS AND PORCINE PARTHENOGENETIC EMBRYOS

The availability of human induced pluripotent stem cell (hiPSC) paves the way to generate regenerative tissue or organs from patient’s own stem cells. The production of chimeric piglets carrying organs that are entirely derived from human stem cells, or at least have a high contribution of human cells or tissues, could be used as a new tissue or an organ replacement in the future treatment of the patients. Here, we produced porcine-nonhuman primate chimeric embryos to assess the feasibility of the potential use of human iPSC for production of human stem cell-derived organs in pigs. Because in vitro culture conditions for cynomolgus monkey iPSC and porcine blastocysts are different, we first identified an effective in vitro culture system for porcine blastocysts and monkey iPSC. We compared blastocyst rates (Days 7 and 8) and number of cells of porcine parthenogenetic blastocysts (Day 8) cultured in 8 different monkey iPSC media and in porcine zygote medium 3 (PZM-3). The best developmental rates of porcine blastocysts were achieved in Knockout DMEM+20% serum replacement monkey medium (iPS 20% medium; N = 65, n = 3). The number of blastocysts on Day 8 cultured in iPS 20% medium was significantly higher (91%; P < 0.05) than in the commonly used porcine PZM-3 medium (65%). We found significantly fewer (P < 0.05) degenerate porcine embryos on Day 8 after culture in iPS 20% medium (9%) compared to PZM-3 (35%). The number of nuclei per blastocyst in iPS 20% medium (88 nuclei; N = 30, n = 3) was significantly higher (P < 0.0001) than in the PZM-3 medium (57 nuclei; N = 54, n = 3). Therefore, we decided to use iPS 20% medium for culture of porcine blastocysts injected with monkey iPSC. Thereafter, we injected clusters of 10 to 15 monkey iPSC transgenic with AAVS1-CAG-Venus into porcine parthenogenetic embryos from Days 4 and 6. Interspecies chimeras were cultured in iPS 20% medium for 24 (for Day 6 embryos) or 48 h (for Day 4 embryos) and observed by confocal microscopy to determine the proportion of Venus-expressing monkey iPSC in porcine embryos. Approximately 37% of blastocysts contained Venus-positive cells after injection of Day 6 embryos (N = 133, n = 4). In contrast, injection into porcine embryos from Day 4 resulted in 73% of Venus-positive blastocysts (N = 69, n = 3). Finally, we investigated proliferation and survival of monkey iPSC in interspecies chimeras after blastocyst plating onto murine fibroblasts. Chimeric blastocyst outgrowth resulted in Venus-expressing monkey iPSC proliferating over 1 week in culture. Outgrowths of all chimeric blastocysts established distinct but separate monkey and porcine stem cell colonies. Here, we optimized the culture conditions for an in vitro interspecies chimera assay in which monkey iPSC are able to survive in porcine embryos. Integration of monkey iPSC to host inner cell mass is relevant for the further contribution to the embryo development. Therefore, to verify this, analysis of cell-cell connection between monkey iPSC and porcine blastocysts and experiments using vivo-derived embryos are currently underway.

Paraneoplastic orthostatic hypotension associated with acute myeloid leukemia

Paraneoplastic neuropathies associated with leukemia are rare, and early diagnosis and treatment are crucial due to the potential for irreversible neurological deficits and delay in treatment of the leukemia. This is the first report to describe severe paraneoplastic orthostatic hypotension which resolved after treatment of the acute myeloid leukemia (AML). The patient is a 76 year-old woman who presented with progressive dizziness, anorexia, and fatigue. She had severe orthostatic hypotension (supine systolic blood pressure 186 mmHg and standing 79 mmHg). She was found to have AML, for which azacitidine was initiated, and orthostatic hypotension resolved after initiation of treatment. This case demonstrates a unique example of paraneoplastic sequelae remitting with treatment of the underlying hematologic neoplasm. Physicians should be aware of this unusual occurrence of autonomic neuropathy with AML as delay in treatment of the hematologic malignancy can lead to irreversible neurologic deficit and increased morbidity and mortality.

UVR exposure and vitamin D in a rural population. A study of outdoor working farmers, their spouses and children

BACKGROUND

Living and working in the countryside may result in excessive UVR exposure, with increased risk of skin cancer. Some sun exposure is, however, recommended, since vitamin D production is UVB-dependent.

OBJECTIVES

To examine UVR exposure and vitamin D levels in a rural population of outdoor working male farmers, their indoor working spouses and their children, expected to receive high UVR exposure.

METHODS

Prospective, cohort study. During the summer 2009 daily, personal UVR exposure and sun behaviour were recorded by dosimetry and diaries (17 403 days). Vitamin D was measured at the end of summer and the following winter.

RESULTS

Risk behaviour (= exposure of shoulders/upper body to the sun), beach days, sunscreen use and sunburns were infrequent. Farmers and boys had the highest daily UVR exposure (both 1.5 SED per day), likewise on work days. On non-work days the UVR exposure was even higher (up to 2.0 SED per day). Farmers, girls and boys had a higher chronic UVR exposure than the spouses, who had more intermittent high UVR exposure. Vitamin D levels did not differ between family members. At the end of summer 16% of the participants were vitamin D insufficient, the following winter, 61%. Some UVR exposure variables correlated positively, but weakly, with vitamin D levels.

CONCLUSIONS

UVR exposure was generally high among this study population, however, vitamin D levels still dropped below the recommended level during winter for most participants. Differences in UVR exposure between the groups did not result in differences in vitamin D levels.

siRNA mediated knockdown of tissue factor expression in pigs for xenotransplantation

Acute vascular rejection (AVR), in particular microvascular thrombosis, is an important barrier to successful pig-to-primate xenotransplantation. Here, we report the generation of pigs with decreased tissue factor (TF) levels induced by small interfering (si)RNA-mediated gene silencing. Porcine fibroblasts were transfected with TF-targeting small hairpin (sh)RNA and used for somatic cell nuclear transfer. Offspring were analyzed for siRNA, TF mRNA and TF protein level. Functionality of TF downregulation was investigated by a whole blood clotting test and a flow chamber assay. TF siRNA was expressed in all twelve liveborn piglets. TF mRNA expression was reduced by 94.1 ± 4.7% in TF knockdown (TFkd) fibroblasts compared to wild-type (WT). TF protein expression in PAEC stimulated with 50 ng/mL TNF-α was significantly lower in TFkd pigs (mean fluorescence intensity TFkd: 7136 ± 136 vs. WT: 13 038 ± 1672). TF downregulation significantly increased clotting time (TFkd: 73.3 ± 8.8 min, WT: 45.8 ± 7.7 min, p < 0.0001) and significantly decreased thrombus formation compared to WT (mean thrombus coverage per viewing field in %; WT: 23.5 ± 13.0, TFkd: 2.6 ± 3.7, p < 0.0001). Our data show that a functional knockdown of TF is compatible with normal development and survival of pigs. TF knockdown could be a valuable component in the generation of multi-transgenic pigs for xenotransplantation.

Evaluation of carcass composition of intact boars using linear measurements from performance testing, dissection, dual energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI)

The objective of this study was to investigate non-invasive imaging methods to update the used regression equation for stationary tested boars. A total of 94 boars were examined. 20 boars were dissected to provide the reference LMP. Performance data (PD) from right carcasses were available from all groups. The left carcasses were studied by MRI & DXA. Based on the reference LMP and the MRI & DXA data, regression equations for LMP were developed. The estimates for LMP based on MRI & DXA data were used to calculate new regression equations for entire male carcass halves based on linear PD. Further 33 PD sets served as independent sample, which was included in a Monte Carlo simulation for imputing the missing reference LMPs (n=74) and discussing the accuracy of the results. The LMP regression equation based on the combined MRI & DXA data is as accurate as the former regression equation, but needs only three instead of seven variables.

Alarmins MRP8 and MRP14 induce stress tolerance in phagocytes under sterile inflammatory conditions

Hyporesponsiveness by phagocytes is a well-known phenomenon in sepsis that is frequently induced by low-dose endotoxin stimulation of Toll-like receptor 4 (TLR4) but can also be found under sterile inflammatory conditions. We now demonstrate that the endogenous alarmins MRP8 and MRP14 induce phagocyte hyporesponsiveness via chromatin modifications in a TLR4-dependent manner that results in enhanced survival to septic shock in mice. During sterile inflammation, polytrauma and burn trauma patients initially present with high serum concentrations of myeloid-related proteins (MRPs). Human neonatal phagocytes are primed for hyporesponsiveness by increased peripartal MRP concentrations, which was confirmed in murine neonatal endotoxinemia in wild-type and MRP14(-/-) mice. Our data therefore indicate that alarmin-triggered phagocyte tolerance represents a regulatory mechanism for the susceptibility of neonates during systemic infections and sterile inflammation.

Alarmin S100A8/S100A9 as a biomarker for molecular imaging of local inflammatory activity

Inflammation has a key role in the pathogenesis of various human diseases. The early detection, localization and monitoring of inflammation are crucial for tailoring individual therapies. However, reliable biomarkers to detect local inflammatory activities and to predict disease outcome are still missing. Alarmins, which are locally released during cellular stress, are early amplifiers of inflammation. Here, using optical molecular imaging, we demonstrate that the alarmin S100A8/S100A9 serves as a sensitive local and systemic marker for the detection of even sub-clinical disease activity in inflammatory and immunological processes like irritative and allergic contact dermatitis. In a model of collagen-induced arthritis, we use S100A8/S100A9 imaging to predict the development of disease activity. Furthermore, S100A8/S100A9 can act as a very early and sensitive biomarker in experimental leishmaniasis for phagocyte activation linked to an effective Th1-response. In conclusion, the alarmin S100A8/S100A9 is a valuable and sensitive molecular target for novel imaging approaches to monitor clinically relevant inflammatory disorders on a molecular level.

18 DEVELOPMENTAL COMPETENCE OF CLONED PORCINE EMBRYOS PRODUCED WITH DIFFERENT CLONING PROCEDURES

Two nuclear transfer (NT) techniques are routinely used to produce cloned animals, traditional cloning (TC) and handmade cloning (HMC). The TC embryos keep their zona and can be transferred at early stages, whereas HMC embryos are zona-free and must be cultured to the morula/blastocyst stage before transfer. Some studies have shown that in vitro culture reduces embryo development and quality, but it is not known whether embryos produced by TC or HMC differ because of the NT method or the in vitro culture. Therefore, we investigated the developmental competence and histone acetylation (H3K18ac) of porcine NT embryos produced by TC and HMC with (Day 5 and 6) or without (Day 0) in vitro culture. Nuclear transfer experiments were performed on same day (Day 0), using same batch of porcine oocytes and donor cells and same in vitro culture conditions. Cloning procedures were previously described (TC : Cloning Stem Cells 10 : 355; HMC : Zygote 20 : 61). Parthenogenetically activated embryos (PA) were used as control of activation and culture conditions. Embryos from all groups were collected for immunostaining of H3K18ac on Days 0, 5, and 6. The normalized H3K18ac level was calculated as previously described (Epigenetics 6 : 177). Cell numbers per blastocyst in each group were counted on Days 5 and 6. The cleavage rate (Day 2) and blastocyst rates (Days 5 and 6) between groups were analysed by Chi-squared test, whereas cell number per blastocysts and H3K18ac level between groups and days were analysed by ANOVA (SAS version 9.2; SAS Institute Inc., Cary, NC, USA). Cleavage rate of HMC embryos was lower than that of TC embryos, but blastocyst rate and cell number per blastocyst were higher in the HMC group compared with TC (Table 1). Differences of H3K18ac level between HMC, TC, and PA groups were only observed on Day 6 but not on Day 0 or Day 5. Within HMC and TC groups, there was no difference in H3K18ac level between Day 0 and Day 5, but the level was lower on Day 6 compared with Day 5 in the HMC group, whereas the TC group displayed the opposite pattern. In conclusion, NT embryos produced by HMC show higher blastocyst rate and cell number per blastocyst compared with TC embryos. Both in vitro culture and the NT method result in differences of the normalized H3K18ac levels. Further study is needed to investigate putative differences between NT embryos produced by HMC and TC compared to in vivo embryos also after transfer to recipients. Table 1.Cleavage and blastocyst rate, cell numbers, and normalized H3K18ac level for handmade cloning (HMC), traditional cloning (TC), and parthenogenetically activated (PA) embryos1

Determinants of personal ultraviolet-radiation exposure doses on a sun holiday

BACKGROUND

A great number of journeys to sunny destinations are sold to the Danish population every year. We suspect that this travel considerably increases personal annual ultraviolet-radiation (UVR) exposure doses. This is important because such exposure is the main cause of skin cancer, and studies have shown a correlation between intermittent solar UVR exposure and malignant melanoma.

OBJECTIVES

To prospectively monitor the behaviour of a group of sun seekers during a winter sun holiday and to study the impact of behaviour on personal UVR exposure doses.

METHODS

In this observational study 25 Danish sun seekers were closely monitored by on-site investigators for 6 days during a winter sun holiday in the Canary Islands, thus avoiding the possible recall bias of retrospective studies with questionnaires. The volunteers recorded their location, clothing and sunscreen use in diaries, and their UVR doses were measured by personal UVR dosimeters worn on the wrist. This resulted in 3450 half-hour registrations during 150 participation days.

RESULTS

On average, each volunteer received a total UVR dose of 57 standard erythema doses over 6 days, which is 43% of the annual UVR dose of a Danish indoor worker. Their exposed body area, sunscreen use and percentage of body with sunscreen application were positively correlated with their personal UVR doses, and there was also a strong relationship between location and UVR doses received.

CONCLUSIONS

The behaviour of the volunteers had a major impact on their personal UVR doses. Our results emphasize the importance of changing the behaviour of sun seekers with protanning attitudes to reduce their personal annual UVR exposure doses, and possibly their risk of skin cancer.

325 PRODUCTION OF GAL KNOCKOUT/hA20 TRANSGENIC PIGS WITH IMPROVED XENOPROTECTIVE PROPERTIES

Pig-to-human xenotransplantation is promising for overcoming the shortage of suitable human donor organs, but is hampered by immunological barriers. The next immunological hurdle is the acute vascular rejection (AVR), which is associated with activation of the endothelium and the coagulation system. Recently, we demonstrated that transgenic expression of the zinc finger protein A20 protects porcine cells against apoptotic and inflammatory stimuli (Oropeza et al. 2009 Xenotransplantation 16, 522–534). Compared with other anti-apoptotic proteins, A20 also has immune-modulatory potential as shown in an CD95(Fas)Ligand assay. However, in that study, hA20 was only expressed in skeletal muscle, heart and porcine aortic endothelial cells of transgenic pigs. For use in xenotransplantation, it is critical to produce pigs with ubiquitous expression of hA20. Here, we constructed a new vector based on the Sleeping Beauty transposon plasmid pT2/HB containing the hA20 cDNA driven by the ubiquitously and strongly expressing CAGGS-promoter and co-transfected gal–/– porcine fibroblasts (Hauschild et al. 2011 Proc. Natl. Acad. Sci. USA 108, 15 010) together with the SB transposase 100X plasmid (pT2/HB and SB transposase both kindly provided by Dr. Zoltan Ivics). Cells were selected with 400 µg of G418/mL of medium for 14 days. Subsequently, cells were screened by PCR. Transfected cell clones were pooled and used as donor cells in somatic cell nuclear transfer. Reconstructed embryos were transferred to 2 synchronized sows. Both remained pregnant on Day 25 of gestation. One recipient is expected to deliver in September 2012. The second sow, which received 104 embryos, was sacrificed on Day 26 of pregnancy and 2 fetuses could be obtained (cloning efficiency 1.92%). The fetuses had integrated the transgene into their genome as shown by PCR. Real-time PCR results from fetal fibroblasts indicated similar hA20 mRNA expression levels in both fetuses, whereas wild type controls were negative. The hA20 expression level was 2.5 and 3.1 times lower than in the original pooled of transfected cells. Fetus #1, which showed a slightly higher hA20 mRNA expression, was used for recloning. In total, 3 more recipients received an average of 104 hA20 transgenic embryos each. Currently, the hA20 protein level in fetal fibroblasts is determined by fluorescence activated cell sorting analysis. Once pigs are born, the tissue distribution of hA20 will be analysed. In parallel, the function of the transgene will be studied in the CD95(Fas)Ligand assay. Hearts and kidneys of the hA20-transgenic pigs will be further tested in ex vivo perfusion assays and in a pig-to-baboon xenotransplantation. This approach is promising for advancing pig-to-human xenotransplantation to preclinical application.

54 EXPRESSION PATTERN OF DNMT1 AND DNMT3a GENES DURING INTERGENERIC SOMATIC CELL NUCLEAR TRANSFER EMBRYO DEVELOPMENT

One of the most-discussed reasons for developmental incompetence of embryos constructed by the cloning procedure is inadequate reprogramming of the transferred nucleus to a state equivalent to that of an early embryonic nucleus. Previous studies have shown species-dependent expression patterns of DNA methyltransferase (DNMT) genes in mammalian oocytes and preimplantation embryos, and also a correlation between incomplete DNA methylation and the lack of NT success in mammals. In the present study, the expression pattern of DNMT1 and DNTM3a genes at the 2-cell and 4-cell stages of bovine versus porcine intergeneric nuclear transfer (iSCNT) embryos was observed by reverse-transcriptase (RT) PCR. All pools were done in triplicate and contained 10 iSCNT embryos. The species-specific primers for DNMT1 and DNMT3a genes were designed for determination of de novo synthesis of epigenetic enzymes. As positive controls, porcine and bovine parthenogenetic embryos were used. Gene transcription for bovine DNMT1 (bDNMT1) and DNMT3a (bDNMT3a) was not observed in 2- and 4-cell stage embryos generated by bovine fibroblast transfer into the porcine ooplasm; however, using primers for pig DNMT1 (pDNMT1) and DNMT3a (pDNMT3a), positive results were obtained. In the 2- and 4-cell-stage embryos constructed using porcine fibroblast and bovine ooplasm, only the bovine-specific primers showed positive signals. Based on the different timing of major genome activation during embryonic development in bovine and porcine embryos, the strong influence of ooplasm on introduced fibroblast was expected. Despite the mRNA presence of DNMT1 and DNMT3a enzymes of oocyte origin, de novo transcription of somatic DNMT1 and DNMT3a genes was not detected and iSCNT embryos did not develop beyond the 4-cell stage. These results strongly suggest species-specific and maternally driven regulation of epigenetic reprogramming during early embryogenesis. This work was supported by VEGA 1/0077/11.

44 LIMITATIONS OF PORCINE OOPLASM TO REPROGRAM BOVINE SOMATIC CELLS

The oocyte cytoplasm (ooplasm) constitutes a unique mixture of factors that are critical for successful reprogramming of haploid maternal and paternal genomes at fertilization as well as the diploid somatic cell genome after somatic cell nuclear transfer (SCNT). The 1-cell-stage embryos (produced by transfer of bovine fibroblast into porcine enucleated ooplast; interspecies SCNT, iSCNT) were processed at different time points (2, 4, 8, and 12 h post-activation, hpa) for detailed nuclear and nucleolar analysis by transmission electron microscopy (TEM; 4 to 5 embryos per group), and immunofluorescence (4 and 12 hpa) for visualization of nucleolar proteins related to transcription (upstream binding factor, UBF) and processing (fibrillarin; 8 to 9 embryos per group). The parameters of interspecies embryos were compared with porcine parthenogenetic (PA) counterparts (4 to 5 embryos per group for TEM analysis; 8 to 9 embryos per group for immunofluorescence analysis). At all evaluated time points, embryos in both groups displayed pronucleus-like nuclei with abundant euchromatin and characteristic porcine nucleolus precursor body (NPB), indicating maternal origin of nucleolar components. Fibrillarin was in both groups localized into shell-like intranuclear entities surrounding NPB. On the contrary, UBF in PA embryos was at 12 hpa colocalized with fibrillarin, whereas in iSCNT embryos, UBF staining was absent at both time points. Despite the similar morphology and localization of processing factor fibrillarin, striking differences in localization of transcription factor UBF suggest limitation of porcine ooplasm to mediate initial phases of nucleolar remodelling. This work was supported by VEGA 1/0077/11.