POS0787 THE EFFECT OF ANTI-RIBOSOMAL-P AND ANTI-NR2 ANTIBODIES ON FUNCTIONAL BRAIN MRI NETWORKS IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITH DEPRESSION AND BEHAVIORAL COGNITIVE DISORDERS

Background

Cognitive dysfunction (CD) and mood disorders (MD) are among the most frequent neuropsychiatric (NP) events in Systemic Lupus Erythematosus (SLE), but their pathogenesis has not been clarified yet. Until now, an unquestionable correlation between the presence of specific autoantibodies, brain alterations and the presence of CDs and MDs in SLE is lacking.

Objectives

The primary aim of the study was to explore the effects of anti-NR2 (anti-DWEYS) and anti-ribosomal-P (anti-P) antibodies on CDs and MDs and their relation with functional brain connectivity in patients affected by SLE.

Methods

A cross-sectional study was conducted, between April 2019 and February 2020, including adult patients who fulfilled the ACR/EULAR 2019 SLE criteria.

Demographics, ongoing medications, SLEDAI and SLICC/Damage Index were recorded. Serum level quantification for anti-P (normal values <18 U/ml) and anti-NR2 (normal values <0.5 OD) antibodies were performed using an ELISA. A battery of neuropsychological testing was interpreted by a neuropsychologist, exploring cognitive domains, depression and quality of life. A resting-state functional connectivity (rs-fc) MRI analysis was performed within 2 weeks since the neuropsychological status assessments. Two region of interest to region of interest (ROI-to-ROI) analyses with the graph theory was performed.

Results

Thirty-three SLE patients (9% male) were enrolled, mean age 43.5 (+-14) years, and median disease duration of 10.4 years (IQR 2.9-25.4) (Table 1). Anti-P were positive (range 0-255 U/ml) in 6 patients (18.2%) and anti-DWEYS (range 0-1.8 OD) in 14 (42.4%). Nineteen out of 33 patients (57.6%) showed at least a cognitive test alteration, but no significant association with antibodies was found. Depression was found in 14 (42.4%) patients using the Center for Epidemiologic Studies Depression Scale (CES-D) as screening instrument. In multiple regression backward models, after correction for age, disease duration, SLEDAI and SDI, the CES-D showed an independent association with anti-P titre (β= 0.32 per U/ml; p=0.049) and prednisone daily dose (β=0.38 per mg/day; p=0.023). The rs-fc MRI analysis revealed a statistically significant association between the titre of anti-P and many altered properties of the brain ROIs (Figure 1), but no effects of PDN daily dose on specific cerebral networks.

Table 1.

Demographic and clinical characteristics of the patients in total, Legend: PDN: Prednisone; LLDAS: Lupus Low Disease Activity State; OD: Optical density

Demographic and clinical characteristics of the participants(N=33)Age, years mean (DS)43.5 (14.0)Gender (M, %)3 (9%)Disease duration, months median (IQR)124.4 (34.7-305)SLEDAI-2k mediane (IQR)4 (0-14)Dose PDN mg/daily median (IQR)6.4 (3.8-13.5)LLDAS N, %12 (36,4%)SLICC-DI mediane (IQR)0 (0-1)Ongoing treatment25 (75.8%)Hydroxychloroquine30 (90.9%)Immunosuppressive9 (27.3%)BiologicsEducation less than 8 years13 (39.4%)Anti-Rib-P N, %6 (18.2%)Anti-Rib-P (U/ml) mean (DS)10.9 (5.7-13.3)Anti-DWEYS N, %14 (42.4%)Anti-DWEYS (OD) mean (DS)0.4 (0.25-0.67)Anti-phospholipids N, %11 (33.3%)anti-dsDNA N, %18 (54.5%)anti-dsDNA Titre mediane (IQR)22.5 (2.9-74.5)Figure 1.

Results of rs-fc MR Analysis 1 (effects of Anti-rib-P titre) on cerebral networks. The regions with decreased and increased property are shown in blue and red nodes, respectively (p< 0.01). The node size represents the significance of the between-group differences in the nodal degree.

Conclusion

Anti-P antibodies are associated with depressive symptoms and changes of brain network properties in SLE patients, which add knowledge on their pathogenetic effect.

Disclosure of Interests

None declared

Presence of diabetes-specific autoimmunity in women with gestational diabetes mellitus (GDM) predicts impaired glucose regulation at follow-up

PURPOSE

Gestational diabetes mellitus (GDM) is the most frequent complication of pregnancy; around 10% of GDM cases may be determined by autoimmunity, and our aims were to establish the role of autoimmunity in a population of Sardinian women affected by GDM, to find predictive factors for autoimmune GDM, and to determine type 1 diabetes (T1D) auto-antibodies (Aabs) together with glucose tolerance after a mean 21.2 months of follow-up.

METHODS

We consecutively recruited 143 women affected by GDM and 60 without GDM; clinical data and pregnancy outcomes were obtained by outpatient visit or phone recall. T1D auto-antibodies GADA, IA2-A, IAA, ZnT8-A were measured in the whole population at baseline, and in the Aab-positive women at follow-up.

RESULTS

The overall prevalence of autoimmunity was 6.4% (13/203). No significant difference was found in the prevalence of auto-antibodies between GDM (5.6%) and control (8.3%) women, neither in antibody titres. Highest titres for GADA and ZnT8-A were observed in the control group; no phenotypic factors were predictive for autoimmune GDM. Diabetes-related autoantibodies were still present in all the GDM women at follow-up, and their presence was associated with a 2.65 (p < 0.0016) relative risk (RR) of glucose impairment.

CONCLUSION

We observed a low prevalence (5.6%) of diabetes-related autoimmunity in our GDM cohort, consistent with the prevalence reported in previous studies. It was not possible to uncover features predictive of autoimmune GDM. However, given the significant risk of a persistent impaired glycemic regulation at follow-up, it is advisable to control for glucose tolerance in GDM women with diabetes-related autoimmunity.

High prevalence of diabetes-specific autoimmunity in first-degree relatives of Sardinian patients with type 1 diabetes

BACKGROUND

The incidence of type 1 diabetes mellitus (T1DM) in Sardinia is among the highest in the world (44.8 cases/100,000 person-years). Recommendations of the Immunology of Diabetes Society advise evaluating autoantibody positivity in first-degree relatives (FDRs) of patients with T1DM, for their higher risk to develop the disease. The aim of this study was to determine the prevalence of beta-cell autoimmunity in FDRs of T1DM patients in Sardinia.

METHODS

A total of 188 Sardinian families were recruited in collaboration between diabetes and pediatric units of university and district hospitals in Sardinia. The recruitment involved 188 patients with diagnosed T1DM and all their available FDRs (n = 447). Autoantibodies (Aabs) against GAD, IA2, insulin, and ZnT8 were measured in all subjects. Human leukocyte antigen (HLA) risk genotypes (HLA-DR and DQ loci) were analyzed in 43 Aabs-positive FDR.

RESULTS

The prevalence of Aabs (any type of autoantibody, single or multiple) in FDR was 11.9% (53/447). Of those with autoantibodies, 62.3% (33/53) were positive to only 1 autoantibody, 22.6% (12/53) had 2 autoantibodies, 7.55% (4/53) had 3 autoantibodies, and 7.55% (4/53) had all 4 autoantibodies. Typing of HLA-DR and DQ loci showed that 89% of FDR carried moderate- to high-risk genotypes, with only 5 FDR with low-risk genotypes.

CONCLUSIONS

The prevalence of T1DM autoantibodies in FDRs of T1DM patients was very high (11.9%) in the Sardinian population, higher than in other populations from the United States and Europe, and similar to that observed in Finland. Autoantibody positivity strongly associated with HLA risk. This study provides evidence of the high risk of T1DM in FDR of T1DM patients in Sardinia and warrants longitudinal follow-up to estimate the risk of progression to T1DM in high-risk populations.

Vertebral morphometry by dual-energy X-ray absorptiometry (DXA) for osteoporotic vertebral fractures assessment (VFA)

PURPOSE

This study was done to evaluate the diagnostic accuracy of dual-energy X-ray absorptiometry (DXA) compared with conventional radiography for identifying vertebral fractures.

MATERIALS AND METHODS

A total of 930 postmenopausal women underwent conventional radiography and DXA imaging of the spine. The images were evaluated by two expert skeletal radiologists using the semiquantitative (SQ) method for conventional radiography and the morphometric vertebral fracture assessment (VFA) for DXA.

RESULTS

The SQ method for radiography (SQ-Rx) analysed 99.1% of vertebrae, identifying 442 vertebral fractures; VFA analysed 97.5% vertebrae, detecting 420 vertebral fractures. Agreement between SQ-Rx and VFA reached 98.76%, and the κ-score was 0.96 [95% confidence interval (CI), 0.95-0.98]. Assessing the grading of vertebral fractures, agreement reached 97.5% and the κ-score was 0.841 (95% CI, 0.821-0.891). Considering SQ-Rx method as "gold standard", VFA had a sensitivity of 97.85 % and a specificity of 99.81%. The negative (NPV) and positive (PPV) predictive value for VFA were 99.83 % and 98.15%, respectively. Fractures were identified in 251 (27 %) and 242 (26 %) of patients on SQ-Rx and VFA, respectively. On a per-patient basis, the agreement between the two methods was 97% and the κ-score was 0.95 (95% CI, 0.920-0.968). The diagnostic parameters for VFA were 97.23% sensitivity, 98.86% specificity, 97.60% PPV and 98.84% NPV.

CONCLUSIONS

This study demonstrated that VFA with DXA may reach a high level of accuracy for diagnosing vertebral fractures, suggesting that VFA should be introduced in the screening of individuals with a risk of osteoporosis and in the follow-up of osteoporotic patients receiving treatment.

[Active surveillance of nosocomial infections in heart surgery patients: implementation of the American National Nosocomial Infections Surveillance (NNIS) System in a large hospital in Rome]

The authors present the implementation of the American NNIS System method for active surveillance in the heart surgery and its intensive care unit (ICU) of a large hospital in Rome (almost 1.000 beds). This surveillance was based on full time infection control professionals. Device-associated infection rates were calculated for adult ICU surveillance component. For surgical patient surveillance component we used the surgical site infection (SSI) risk index based on wound class, duration of operation and American Society of Anesthesiology score. The NNIS System method allowed us to understand the most relevant problems in heart surgery patients: in comparison with NNIS data, we found high rates of SSIs both in procedures on valves and in coronary artery bypass grafts. The central line-associated bloodstream infection rate was higher than the American median rate. Therefore, we decided to focus on surgical risk factors linked to SSIs and to revise recommendations for intravascular-device use. In conclusion, in our experience the NNIS System method proved to be a very useful and versatile tool for nosocomial infections active surveillance.

Synthesis of new derivatives of the 4,5-diphenyloxazole series

In continuation of earlier studies carried out in the field of 2-amino- and 2-aminoalkyl-4,5-diphenyloxazoles, some of which had shown anti-inflammatory, analgesic and platelet antiaggregating properties, a series of 2-alkylthio-4,5-diphenyloxazoles was prepared.