Trapping Charge Mechanism in Hv1 Channels (CiHv1)

The majority of voltage-gated ion channels contain a defined voltage-sensing domain and a pore domain composed of highly conserved amino acid residues that confer electrical excitability via electromechanical coupling. In this sense, the voltage-gated proton channel (Hv1) is a unique protein in that voltage-sensing, proton permeation and pH-dependent modulation involve the same structural region. In fact, these processes synergistically work in concert, and it is difficult to separate them. To investigate the process of Hv1 voltage sensor trapping, we follow voltage-sensor movements directly by leveraging mutations that enable the measurement of Hv1 channel gating currents. We uncover that the process of voltage sensor displacement is due to two driving forces. The first reveals that mutations in the selectivity filter (D160) located in the S1 transmembrane interact with the voltage sensor. More hydrophobic amino acids increase the energy barrier for voltage sensor activation. On the other hand, the effect of positive charges near position 264 promotes the formation of salt bridges between the arginines of the voltage sensor domain, achieving a stable conformation over time. Our results suggest that the activation of the Hv1 voltage sensor is governed by electrostatic-hydrophobic interactions, and S4 arginines, N264 and selectivity filter (D160) are essential in the Ciona-Hv1 to understand the trapping of the voltage sensor.

Size Matters: Free-Energy Calculations of Amino Acid Adsorption over Pristine Graphene

There is still growing interest in graphene interactions with proteins, both for its possible biological applications and due to concerns over detrimental effects at the cellular level. As with any process involving proteins, an understanding of amino acid composition is desirable. In this work, we systematically studied the adsorption process of amino acids onto pristine graphene via rigorous free-energy calculations. We characterized the free energy, potential energy, and entropy of the adsorption of all proteinogenic amino acids. The energetic components were further separated into pair interaction contributions. A linear correlation was found between the free energy and the solvent accessible surface area change during adsorption (ΔSASAads) over pristine graphene and uncharged amino acids. Free energies over pristine graphene were compared with adsorption onto graphene oxide, finding an almost complete loss of the favorability of amino acid adsorption onto graphene. Finally, the correlation with ΔSASAads was used to successfully predict the free energy of adsorption of several penta-l-peptides in different structural states and sequences. Due to the relative ease of calculating the ΔSASAads compared to free-energy calculations, it could prove to be a cost-effective predictor of the free energy of adsorption for proteins onto nonpolar surfaces.

Control and evaluation of a humanoid robot with rolling contact joints on its lower body

In this paper, we introduce a new teen-sized humanoid platform dubbed DRACO 3, custom-built by Apptronik and altered for practical use by the Human Centered Robotics Laboratory at The University of Texas at Austin. The form factor of DRACO 3 is such that it can operate safely in human environments while reaching objects at human heights. To approximate the range of motion of humans, this robot features proximal actuation and mechanical artifacts to provide a high range of hip, knee, and ankle motions. In particular, rolling contact mechanisms on the lower body are incorporated using a proximal actuation principle to provide an extensive vertical pose workspace. To enable DRACO 3 to perform dexterous tasks while dealing with these complex transmissions, we introduce a novel whole-body controller (WBC) incorporating internal constraints to model the rolling motion behavior. In addition, details of our WBC for DRACO 3 are presented with an emphasis on practical points for hardware implementation. We perform a design analysis of DRACO 3, as well as empirical evaluations under the lens of the Centroidal Inertia Isotropy (CII) design metric. Lastly, we experimentally validate our design and controller by testing center of mass (CoM) balancing, one-leg balancing, and stepping-in-place behaviors.

Adjuvant Radiation Therapy Improves Local Control in the Treatment of Adnexal Carcinoma

PURPOSE/OBJECTIVE(S)

Adnexal carcinoma (AC) is a rare subset of cutaneous malignancies derived from skin adnexa. There are limited data on the role of adjuvant radiation therapy (RT). This study investigates outcomes associated with adjuvant RT at our high-volume referral center.

MATERIALS/METHODS

Using an institutional pathology database we identified 45 patients with locoregionally-confined AC treated between 2001-2020 with curative intent surgery and RT at initial diagnosis or at the time of locoregionally-confined recurrence. Clinicopathologic variables were described and time to relapse events were assessed by the Kaplan-Meier method.

RESULTS

Median age was 64 yrs (IQR 57-71). Primary tumors were in the head and neck (H&N, n = 36, 80%), trunk/extremities (n = 8, 18%) or unknown (n = 1). The most common histologic subtypes were: sebaceous-14 (31%), microcystic adnexal carcinoma-9 (20%), eccrine-6 (13%), and trichilemmal-5 (11%). Twenty-two (50% of known primaries) had PNI. All patients had primary tumor excision. Six had clinically evident lymphadenopathy (13%), all of whom had lymph node dissection (LND). Five patients without evidence of nodal disease (13%) had sentinel lymph node biopsy (SLNB) with one having SLN+ disease. Thirty patients (67%) received adjuvant locoregional RT at initial diagnosis with the following targets: 21 (30%) primary only, 4 (13%) nodal only, and 5 (17%) both. Of those receiving nodal RT, 7 (78%) had LN+ LND with 2 of those receiving concurrent platinum-based chemoradiation. Sixteen were treated at recurrence with the following targets: 4 (25%) primary only (1 having had prior adjuvant nodal RT), 4 (25%) nodal only, and 8 (50%) both. Across the full cohort, median RT dose was 60 Gy in 30 fractions. Median follow-up from initial surgical resection was 60 months (IQR 30-160). 5-year LC, NC, DFS and DSS were 71%, 86%, 66%, and 91% respectively. The only evaluated factor associated with better outcome was adjuvant primary site RT (5-yr LC 83% vs. 56%, p = 0.01 and 5-yr DFS 83% vs. 46%, p = 0.0003). All 15 patients with local recurrence (LR) had salvage surgery with median subsequent follow-up of 75 months (IQR 2-94). Overall, 5 patients receiving adjuvant primary site RT at any time (initial or salvage) developed subsequent local recurrence (13%). Of the 8 patients who developed nodal recurrence (NR) during follow-up, 1 received adjuvant nodal RT at initial diagnosis. Six of 7 who did not receive prior RT then received adjuvant nodal RT after LND and only 1 developed subsequent NR.

CONCLUSION

AC is a rare skin cancer with a primarily locoregional recurrence pattern. In our experience, adjuvant RT was associated with improved LC which, depending on the tumor location, may help prevent morbid or cosmetically-impactful salvage surgery. Patients with AC would benefit from radiation oncology referral to discuss adjuvant treatment.

Metabolomic rearrangement controls the intrinsic microbial response to temperature changes

Temperature is one of the key determinants of microbial behavior and survival, whose impact is typically studied under heat- or cold-shock conditions that elicit specific regulation to combat lethal stress. At intermediate temperatures, cellular growth rate varies according to the Arrhenius law of thermodynamics without stress responses, a behavior whose origins have not yet been elucidated. Using single-cell microscopy during temperature perturbations, we show that bacteria exhibit a highly conserved, gradual response to temperature upshifts with a time scale of ~1.5 doublings at the higher temperature, regardless of initial/final temperature or nutrient source. We find that this behavior is coupled to a temperature memory, which we rule out as being neither transcriptional, translational, nor membrane dependent. Instead, we demonstrate that an autocatalytic enzyme network incorporating temperature-sensitive Michaelis-Menten kinetics recapitulates all temperature-shift dynamics through metabolome rearrangement, which encodes a temperature memory and successfully predicts alterations in the upshift response observed under simple-sugar, low-nutrient conditions, and in fungi. This model also provides a mechanistic framework for both Arrhenius-dependent growth and the classical Monod Equation through temperature-dependent metabolite flux.

The Homogeneous Azorean Machado-Joseph Disease Cohort: Characterization and Contributions to Advances in Research

Machado-Joseph disease (MJD)/spinocerebellar ataxia type 3 (SCA3) is the most common autosomal dominant ataxia worldwide. MJD is characterized by late-onset progressive cerebellar ataxia associated with variable clinical findings, including pyramidal signs and a dystonic-rigid extrapyramidal syndrome. In the Portuguese archipelago of the Azores, the worldwide population cluster for this disorder (prevalence of 39 in 100,000 inhabitants), a cohort of MJD mutation carriers belonging to extensively studied pedigrees has been followed since the late 1990s. Studies of the homogeneous Azorean MJD cohort have been contributing crucial information to the natural history of this disease as well as allowing the identification of novel molecular biomarkers. Moreover, as interventional studies for this globally rare and yet untreatable disease are emerging, this cohort should be even more important for the recruitment of trial participants. In this paper, we profile the Azorean cohort of MJD carriers, constituted at baseline by 20 pre-ataxic carriers and 52 patients, which currently integrates the European spinocerebellar ataxia type 3/Machado-Joseph disease Initiative (ESMI), a large European longitudinal MJD cohort. Moreover, we summarize the main studies based on this cohort and highlight the contributions made to advances in MJD research. Knowledge of the profile of the Azorean MJD cohort is not only important in the context of emergent interventional trials but is also pertinent for the implementation of adequate interventional measures, constituting relevant information for Lay Associations and providing data to guide healthcare decision makers.

Role of voltage-gated proton channel (Hv1) in cancer biology

The acid-base characteristics of tumor cells and the other elements that compose the tumor microenvironment have been topics of scientific interest in oncological research. There is much evidence confirming that pH conditions are maintained by changes in the patterns of expression of certain proton transporters. In the past decade, the voltage-gated proton channel (Hv1) has been added to this list and is increasingly being recognized as a target with onco-therapeutic potential. The Hv1 channel is key to proton extrusion for maintaining a balanced cytosolic pH. This protein-channel is expressed in a myriad of tissues and cell lineages whose functions vary from producing bioluminescence in dinoflagellates to alkalizing spermatozoa cytoplasm for reproduction, and regulating the respiratory burst for immune system response. It is no wonder that in acidic environments such as the tumor microenvironment, an exacerbated expression and function of this channel has been reported. Indeed, multiple studies have revealed a strong relationship between pH balance, cancer development, and the overexpression of the Hv1 channel, being proposed as a marker for malignancy in cancer. In this review, we present data that supports the idea that the Hv1 channel plays a significant role in cancer by maintaining pH conditions that favor the development of malignancy features in solid tumor models. With the antecedents presented in this bibliographic report, we want to strengthen the idea that the Hv1 proton channel is an excellent therapeutic strategy to counter the development of solid tumors.

Team IHMC at the 2020 Cybathlon: a user-centered approach towards personal mobility exoskeletons

Background

The past few decades have seen rapid advancements in exoskeleton technology, with a considerable shift towards applications involving users with gait pathologies. Commercial devices from ReWalk, Ekso Bionics, and Indego, mainly designed for rehabilitation purposes, have inspired the development of many research platforms aimed at extending capabilities for use as safe and effective personal mobility devices. The 2016 Cybathlon featured an impressive demonstration of exoskeletons designed to enable mobility for individuals with spinal cord injury, however, not a single team completed every task and only two completed the stairs. Major improvements were showcased at the 2020 Cybathlon, with seven of the nine teams completing a similar set of tasks. Team IHMC built upon its silver-medal success from 2016 with an upgraded device, Quix.

Methods

Quix features several notable improvements including an additional powered degree of freedom for hip ab/adduction to laterally shift the device and reduce user effort while walking, custom-tailored cuffs and soft goods based on 3D body scans to optimize user comfort, and a streamlined testing pipeline for online tuning of gait parameters.

Results

Team IHMC finished in fourth place behind the teams from EPFL and Angel Robotics. Although we suffered from a considerably slower flat-ground walking speed, our pilot reported marked improvements in overall effort, comfort, and ease-of-use compared to our previous device.

Conclusions

Clear progress in exoskeleton development has been exhibited since the inaugural Cybathlon, with tasks involving rough terrain, stairs, and ramps now posing little threat to most of the competitors. As a result, the layout of the powered exoskeleton course will likely undergo significant modifications to further push the devices towards suitability for personal everyday use. The current tasks do not address the issue of donning and doffing, nor do they simulate a scenario similar to maneuvering a kitchen to prepare a meal, for example. An additional limitation that may be more difficult to test in a competition setting is the required upper-body effort to manipulate the device in an effective manner.

AB0594 ULTRASOUND INTIMA MEDIA THICKNESS CUT-OFF VALUES FOR CRANIAL AND EXTRACRANIAL ARTERIES IN PATIENTS WITH GIANT CELL ARTERITIS

Background

Ultrasound (US) is a valid imaging tool to detect signs of giant cell arteritis (GCA). Although the halo sign has always been considered the most useful finding for GCA diagnosis, modern high frequency transducers are able to precisely measure the intima-media thickness (IMT) of cranial and extracranial arteries. However, data on optimal cut-off values for IMT to differentiate patients and controls in clinical practice are limited.

Objectives

To determine the optimal cut-off value for IMT of cranial and extracranial arteries in patients with suspected GCA.

Methods

This is a retrospective observational study of patients referred to our US fast-track clinic with suspected GCA. All patients underwent bilateral US examination of the cranial and extracranial (carotid, subclavian and axillary) arteries within 24 hours per protocol. The exam was performed using an EsaoteMyLab8 with a 12-18 MHz frequency transducer for cranial arteries and an 8-14 frequency transducer for extracranial arteries. The IMT was measured in gray scale mode and the presence of a non-compressible halo sign was checked in all arteries. The gold standard for GCA diagnosis was clinical confirmation by the referring rheumatologist after 6 months follow-up. Mean IMT values of each artery were compared between patients with and without GCA by independent samples T-test. Receiver operating characteristics analysis was performed and the Youden index was used to determine the optimal cut-off value for IMT of each artery.

Results

Of the 157 patients with suspected GCA (67.5% female, mean age 73.7 years) referred to the fast-track clinic, 47 (29.9%) had GCA clinical confirmation after 6 months. 41 (87.2%) patients with GCA had positive US findings (61.7% had cranial involvement, 44.7% extracranial involvement and 19.1% a mixed pattern of cranial and extracranial arteries). The following IMT cut-off values showed the highest diagnostic accuracy: 0.44mm for the common superficial temporal artery; 0.34 mm for the frontal branch; 0.36 mm for the parietal branch; 1.1 mm for the carotid artery: 1 mm for the subclavian and axillary arteries. The area under the ROC curve of the IMT for a clinical diagnosis of GCA was 0.984 (95% CI 0.959 - 1) for common superficial temporal artery, 0.989 (95% CI 0.976 -1) for frontal branch, 0.991 (95% CI 0.980 - 1) for parietal branch, 0.977 (95% CI 0.961 – 0.993) for carotid, 0.99 (95% CI 0.979 - 1) for subclavian and 0.996 (95% CI 0.991 -1) for axillary arteries (Table 1).

Table 1.

Optimal IMT cut-off values for cranial and extracranial arteries

ArterySidePatients without GCAPatients with GCACut-off (mm)AUC (CI 95%)Sensitivity (%)Specificity (%)Common superficialtemporal artery mm, mean (SD)Right0.33 (0.06)0.68 (0.28)0.430.997 (0.988 -1)10097.1Left0.35 (0.11)0.57 (0.21)0.450.966 (0.905 -1)10092.3Both0.34 (0.08)0.63 (0.25)0.440.984 (0.959 -1)94.795.1Frontal branch mm, mean (SD)Right0.26 (0.05)0.4 (0.18)0.340.994 (0.983 -1)10097.1Left0.27 (0.05)0.4 (0.18)0.340.985 (0.962 -1)10096.1Both0.26 (0.05)0.4 (0.18)0.340.989 (0.976 -1)10096.6Parietal branch mm, mean (SD)Right0.27 (0.05)0.43 (0.18)0.360.994 (0.981 -1)10098.9Left0.27 (0.05)0.41 (0.16)0.360.987 (0.967 -1)10097.6Both0.27 (0.05)0.42 (0.17)0.360.991 (0.980 -1)10098.3Carotid mm, mean (SD)Right0.8 (0.17)0.88 (0.29)10.974 (0.949 – 0.999)10092.6Left0.82 (0.15)1 (0.42)1.20.982 (0.961 - 1)90.996.2Both0.81 (0.16)0.96 (0.36)1.10.977 (0.961 – 0.993)9094Subclavian mm, mean (SD)Right0.74 (0.18)0.99 (0.44)10.987 (0.97 - 1)10093.4Left0.67 (0.17)0.9 (0.35)1.10.991 (0.975 - 1)10098.3Both0.7 (0.18)0.94 (0.4)10.99 (0.979 - 1)10096Axillary mm, mean (SD)Right0.69 (0.16)0.99 (0.5)10.992 (0.982 - 1)10096Left0.67 (0.17)0.99(0.49)10.998 (0.995 -1)10098.3Both0.68 (0.17)0.99 (0.49)10.996 (0.991 -1)10097.1

Conclusion

Different IMT cut-off values for each artery are necessary to establish a correct US diagnosis of GCA. These proposed IMT cut-off values may help to improve the diagnostic accuracy of US in clinical practice.

Disclosure of Interests

None declared

Objectively Measured Physical Activity and Sedentary Time of Suburban Toddlers Aged 12-36 Months

Low levels of physical activity may predispose children to the development of obesity and related chronic diseases in later life. The aims of this study were as follows: (1) quantitatively describe the levels of habitual physical activity in a contemporary sample of suburban children aged 12 to 36 months; (2) assess for gender differences in physical activity and sedentary behavior; (3) examine the specific effects of ethnicity, gender and overweight status on the objectively measured physical activity; and (4) quantify the tracking of physical activity in a subset of children over 1 year. During year one, 142 participants wore the GT3X Actigraph for 3 days. At a 1-year follow-up, a subset of 25 participants wore the Actigraph for 7 consecutive days. GLM and t-tests as appropriate were carried out to assess the influence of gender on the physical activity level. Spearman rank correlations, percentage agreement and kappa statistics assessed the tracking of physical activity. The results showed no significant gender differences in any anthropometric measurements, sedentary behavior or MVPA (p > 0.05). There were also no significant gender, ethnicity or overweight interaction for sedentary behavior, time spent in light PA and time spent in MVPA (p > 0.05). For tracking, there was a moderate strength of agreement for MVPA. Considering the disproportionate effects of obesity in minority groups, culturally appropriate interventions targeting the reduction in sedentary behavior are urgently required.

Continuous Infusion Low-Dose Unfractionated Heparin for the Management of Hypercoagulability Associated With COVID-19

INTRODUCTION

The Coronavirus Disease 2019 (COVID-19) is associated with severe hypercoagulability. There is currently limited evidence supporting the routine use of therapeutic anticoagulation in the setting of COVID-19.

OBJECTIVES

The primary objective was to compare the incidence of thromboembolic events in adult patients with COVID-19 treated with an unfractionated heparin (UFH) infusion versus prophylactic dose anticoagulation. Secondary objectives included exploration of the efficacy and safety of an UFH infusion through the evaluation of organ function and incidence of minor and major bleeding.

METHODS

Retrospective observational cohort study with propensity score matching of COVID-19 patients who received an UFH infusion targeting an aPTT between 40 and 60 seconds.

RESULTS

Fifty-six patients were included in this study. There was no difference in the composite of thromboembolic events comprised of venous thromboembolism, arterial thrombosis, and catheter-related thrombosis between the UFH and control group (17.9% vs. 3.6%, P = 0.19). There was a significant increase in median D-dimer concentrations from day 1 to day 7 in the control group (475 ng/mL [291-999] vs. 10820 ng/mL [606-21033], P = 0.04). Patients treated with UFH had a higher incidence of minor bleeding (35.7% vs. 0%, P < 0.005) and required more units of packed red blood cell transfusion (0.8 units ± 1.6 vs. 0 units, P = 0.01).

CONCLUSION

Continuous infusion of UFH for patients with COVID-19 infection did not decrease the overall incidence of thromboembolic complications. UFH was associated with stabilization of D-dimer concentrations and increased rates of minor bleeding and transfusions.

Development and Validation of a Novel Microbiome-Based Biomarker of Post-antibiotic Dysbiosis and Subsequent Restoration

Background: The human gut microbiota are important to health and wellness, and disrupted microbiota homeostasis, or “dysbiosis,” can cause or contribute to many gastrointestinal disease states. Dysbiosis can be caused by many factors, most notably antibiotic treatment. To correct dysbiosis and restore healthier microbiota, several investigational microbiota-based live biotherapeutic products (LBPs) are in formal clinical development. To better guide and refine LBP development and to better understand and manage the risks of antibiotic administration, biomarkers that distinguish post-antibiotic dysbiosis from healthy microbiota are needed. Here we report the development of a prototype Microbiome Health Index for post-Antibiotic dysbiosis (MHI-A).

Methods: MHI-A was developed and validated using longitudinal gut microbiome data from participants in clinical trials of RBX2660 and RBX7455 – investigational LBPs in development for reducing recurrent Clostridioides difficile infections (rCDI). The MHI-A algorithm relates the relative abundances of microbiome taxonomic classes that changed the most after RBX2660 or RBX7455 treatment, that strongly correlated with clinical response, and that reflect biological mechanisms believed important to rCDI. The diagnostic utility of MHI-A was reinforced using publicly available microbiome data from healthy or antibiotic-treated populations.

Results: MHI-A has high accuracy to distinguish post-antibiotic dysbiosis from healthy microbiota. MHI-A values were consistent across multiple healthy populations and were significantly shifted by antibiotic treatments known to alter microbiota compositions, shifted less by microbiota-sparing antibiotics. Clinical response to RBX2660 and RBX7455 correlated with a shift of MHI-A from dysbiotic to healthy values.

Conclusion: MHI-A is a promising biomarker of post-antibiotic dysbiosis and subsequent restoration. MHI-A may be useful for rank-ordering the microbiota-disrupting effects of antibiotics and as a pharmacodynamic measure of microbiota restoration.

Direct inhibition of CaV2.3 by Gem is dynamin dependent and does not require a direct alfa/beta interaction

The Rad, Rem, Rem2, and Gem/Kir (RGK) sub-family of small GTP-binding proteins are crucial in regulating high voltage-activated (HVA) calcium channels. RGK proteins inhibit calcium current by either promoting endocytosis or reducing channel activity. They all can associate directly with Ca²⁺ channel β subunit (Ca_Vβ), and the binding between Ca_Vα1/Ca_Vβ appears essential for the endocytic promotion of Ca_V1.X, Ca_V2.1, and Ca_V2.2 channels. In this study, we investigated the inhibition of Ca_V2.3 channels by RGK proteins in the absence of Ca_Vβ. To this end, Xenopus laevis oocytes expressing Ca_V2.3 channels devoid of auxiliary subunit were injected with purified Gem and Rem and found that only Gem had an effect. Ca currents and charge movements were reduced by injection of Gem, pointing to a reduction in the number of channels in the plasma membrane. Since this reduction was ablated by co-expression of the dominant-negative mutant of dynamin K44A, enhanced endocytosis appears to mediate this reduction in the number of channels. Thus, Gem inhibition of Ca_V2.3 channels would be the only example of a Ca_Vβ independent promotion of dynamin-dependent endocytosis.

1064. Treatment Success in Reducing Recurrent Clostridioides difficile Infection with Investigational Live Biotherapeutic RBX2660 Is Associated with Microbiota Restoration: Consistent Evidence from a Phase 3 Clinical Trial

Background

Several investigational microbiota-based live biotherapeutics are in clinical development for reducing recurrence of Clostridioides difficile infection (rCDI), including RBX2660 a liquid suspension of a broad consortium of microbiota, which includes Bacteridetes and Firmicutes. RBX2660 has been evaluated in >600 participants in 6 clinical trials. Here we report that RBX2660 induced significant shifts to the intestinal microbiota of treatment-responsive participants in PUNCH CD3—a Phase 3 randomized, double-blinded, placebo-controlled trial.

Methods

PUNCH CD3 participants received a single dose of RBX2660 or placebo between 24 to 72 hours after completing rCDI antibiotic treatment. Clinical response was the absence of CDI recurrence at eight weeks after treatment. Participants voluntarily submitted stool samples prior to blinded study treatment (baseline), 1, 4 and 8 weeks, 3 and 6 months after receiving study treatment. Samples were extracted and sequenced using shallow shotgun methods. Operational taxonomic unit (OTU) data were used to calculate relative taxonomic abundance, alpha diversity, and the Microbiome Health Index (MHI)—a biomarker of antibiotic-induced dysbiosis and restoration.

Results

Clinically, RBX2660 demonstrated superior efficacy versus placebo (70.4% versus 58.1%). From before to after treatment, RBX2660-treated clinical responders’ microbiome diversity shifted significantly (Mann-Whitney), and so did microbiome composition (Generalized Wald Test). Post-treatment changes were characterized by increased Bacteroidia and Clostridia and decreased Gammaproteobacteria and Bacilli, changes and were durable to at least 6 months. Repeated measures analysis confirmed that shifts were greater among RBX2660 responders compared to placebo responders (DMRepeat). The majority of responders’ MHI values shifted from a range common to antibiotic dysbiosis to a range common in healthy populations.

Figure 1

Left panel. Mean relative abundance taxonomic class level at timepoints for participants in PUNCH CD3 before and after RBX2660 treatment, and for doses of RBX2660 administered in PUNCH CD3. The four taxonomic classes that change most from before to after treatment are shown with the mean and confidence intervals based on fitting OTU data to a Dirichlet multinomial distribution. Right panel, MHI biomarker for the same time points and investigational product groups, shown as median (red) and individual samples. A previously calculated threshold of MHI = 7.2 is shown (dotted line), above which MHI values predict healthy, below which MHI values predict antibiotic-induced dysbiosis.

Conclusion

Among PUNCH CD3 clinical responders, RBX2660 significantly restored microbiota from less to more healthy compositions, and this restoration was durable to at least 6 months. These clinically-correlated microbiome shifts are highly consistent with results from multiple prior trials of RBX2660.

Disclosures

Ken Blount, PhD, Rebiotix Inc., a Ferring Company (Employee) Dana M. Walsh, PhD, Rebiotix (Employee)

1039. Rapid Restoration of Bile Acid Compositions After Treatment with RBX2660 for Recurrent Clostridioides difficile Infection—Results from the PUNCH CD3 Phase 3 Trial

Background

Microbiota-based treatments are increasingly evaluated as a strategy to reduce recurrence of Clostridioides difficile infection (rCDI), and their proposed mechanisms include restoration of the microbiota and microbiota-mediated functions, including bile acid metabolism. RBX2660—a broad-consortium investigational live biotherapeutic—has been evaluated in &gt;600 participants in 6 clinical trials, with consistent reduction of rCDI recurrence. Here we report that fecal bile acid compositions were significantly restored in treatment-responsive participants in PUNCH CD3—a Phase 3 randomized, double-blinded, placebo-controlled trial of RBX2660.

Methods

PUNCH CD3 participants received a single dose of RBX2660 or placebo between 24 to 72 hours after completing rCDI antibiotic treatment. Clinical response was the absence of CDI recurrence at eight weeks after treatment. Participants voluntarily submitted stool samples prior to blinded study treatment (baseline), 1, 4 and 8 weeks, 3 and 6 months after receiving study treatment. A liquid chromatography tandem mass spectrometry method was developed to extract and quantify 33 bile acids from all participant fecal samples received up to the 8-week time point. Mean bile acid compositions were fit to a Dirichlet multinomial distribution and compared across time points and between RBX2660- and placebo-treated participants.

Results

Clinically, RBX2660 demonstrated superior efficacy versus placebo (70.4% versus 58.1%). RBX2660-treated clinical responders’ bile acid compositions shifted significantly from before to after treatment. Specifically, primary bile acids predominated before treatment, whereas secondary bile acids predominated after treatment (Figure 1A). These changes trended higher among RBX2660 responders compared to placebo responders. Importantly, median levels of lithocholic acid (LCA) and deoxycholic acid (DCA) showed large, significant increases after treatment (Figure 1B).

Conclusion

Among PUNCH CD3 clinical responders, RBX2660 significantly restored bile acids from less to more healthy compositions. These clinically correlated bile acid shifts are highly consistent with results from a prior trial of RBX2660.

Disclosures

Romeo Papazyan, PhD, Ferring Research Institute (Employee) Bryan Fuchs, PhD, Ferring Pharmaceuticals (Employee) Ken Blount, PhD, Rebiotix Inc., a Ferring Company (Employee)

129. Antimicrobial Resistance Genes Were Reduced Following Administration of Investigational Microbiota-Based Live Biotherapeutic RBX2660 to Individuals with Recurrent Clostridioides difficile Infection

Background

Intestinal colonization by antimicrobial resistant (AMR) pathogens is a known health and infection risk, and is common among individuals with recurrent Clostridioides difficile infections (rCDI). Accordingly, therapeutic approaches that decolonize the gut of AMR pathogens could be valuable to patients to reduce risk of associated illnesses. Herein, we assessed gut colonization with AMR bacteria before and after treatment with RBX2660—a microbiota-based investigational live biotherapeutic—in the PUNCH CD3 Phase 3 trial for reducing CDI recurrence.

Methods

rCDI participants enrolled in PUNCH CD3 received a blinded single dose of RBX2660 or placebo within 24 to 72 hours after completing antibiotic treatment for the most recent rCDI episode. Clinical response was the absence of CDI recurrence at eight weeks after treatment, and participants were asked to submit stool samples prior to RBX2660 or placebo treatment (baseline) and 1, 4 and 8 weeks, 3 and 6 months after study treatment. Samples were extracted and sequenced using a shallow shotgun method. The presence and number of AMR genes was determined for 175 participant samples and 116 RBX2660 samples using 90% K-mer sequence coverage based on the MEGARes database. AMR gene count data were collapsed into count columns to adjust for sparseness in the matrices and were analyzed using a Generalized Linear Mixed Model.

Results

Clinically, RBX2660 demonstrated superior efficacy versus placebo (70.4% and 58.1%, respectively), and the total AMR genes per participant decreased significantly from before to after treatment in RBX2660-treated responders (p< .05, Figure 1) and remained low to at least 6 months. Among genes that decreased in RBX2660 responders were clinically important extended-spectrum beta-lactamase (bla_TEM, bla_SHV, bla_CTX-M), vancomycin resistance (vanA, vanB), and fluoroquinolone resistance genes (gyrA, parC).

Total AMR genes per PUNCH CD3 participant among RBX2660-treated responders at the indicated time points and in the RBX2660 investigational product. The red lines indicate timepoint group medians.

Conclusion

In the PUNCH CD3 Phase 3 trial of RBX2660 for rCDI, AMR gene content decreased after RBX2660 treatment and remained low to at least 6 months, consistent with prior RBX2660 trials. This underscores the potential of microbiota-based biotherapeutics for decolonizing AMR bacteria from gut microbiota and thereby reducing AMR infection risks.

Disclosures

Heidi Hau, PhD, Rebiotix Inc. (Employee) Dana M. Walsh, PhD, Rebiotix (Employee) Ken Blount, PhD, Rebiotix Inc., a Ferring Company (Employee)

Frequency of allogenic blood transfusion in patients with gastrointestinal cancer: a cross-sectional study in Peru

Background

Gastrointestinal cancer demands a high frequency of transfusions, and the high availability of blood products. We aimed to determine the frequency of blood transfusions and the most used blood products according to the type of gastrointestinal cancer.

Methods

A cross-sectional study was conducted in a Peruvian Type I Hemotherapy and Blood Bank Service of a Private Oncological Clinic during 2016–2018. We included patients with gastrointestinal cancer using the International Code of Diseases. The donations were made in compliance with the requirements of the Programa Nacional de Hemoterapía y Banco de Sangre and in accordance with the Standardised Operational Procedure of the clinic.

Results

We analysed 3,022 patients, of which 163 (5.4%) had gastrointestinal cancer (67.1 ± 12 years). The 80 (49.1%) men did not show significant differences with the 83 (50.9%) women (p = 0.178). The most frequent neoplasia was the colon (41.7%) and pancreas (37.4%). Three hundred and four blood products were transfused (average 1.8 ± 2.5 units (range: 1–30 units/patient)), of which 81.3% (247 units) were red blood cells concentrated, 8.6% (26 units) were fresh-frozen-plasma (FFP) and 6.6% (20 units) were cryoprecipitate. The type of cancer that most blood products demanded was colon neoplasia (41.8%), followed by pancreatic cancer (26.3%) and liver cancer (10.9%). We determined that ~55% of patients were O Rh(D)+ and in five patients we were poly-transfused.

Conclusion

Our findings suggested that patients with gastrointestinal cancer require large numbers of transfusions of blood cell concentrate and FFP. Also, we showed that cancer of the colon, pancreas and liver demanded more than 75% of blood products.

Association between overcrowded households, multigenerational households, and COVID-19: a cohort study

OBJECTIVES

The role of overcrowded and multigenerational households as a risk factor for COVID-19 remains unmeasured. The objective of this study is to examine and quantify the association between overcrowded and multigenerational households and COVID-19 in New York City (NYC).

STUDY DESIGN

Cohort study.

METHODS

We conducted a Bayesian ecological time series analysis at the ZIP Code Tabulation Area (ZCTA) level in NYC to assess whether ZCTAs with higher proportions of overcrowded (defined as the proportion of the estimated number of housing units with more than one occupant per room) and multigenerational households (defined as the estimated percentage of residences occupied by a grandparent and a grandchild less than 18 years of age) were independently associated with higher suspected COVID-19 case rates (from NYC Department of Health Syndromic Surveillance data for March 1 to 30, 2020). Our main measure was an adjusted incidence rate ratio (IRR) of suspected COVID-19 cases per 10,000 population. Our final model controlled for ZCTA-level sociodemographic factors (median income, poverty status, White race, essential workers), the prevalence of clinical conditions related to COVID-19 severity (obesity, hypertension, coronary heart disease, diabetes, asthma, smoking status, and chronic obstructive pulmonary disease), and spatial clustering.

RESULTS

39,923 suspected COVID-19 cases were presented to emergency departments across 173 ZCTAs in NYC. Adjusted COVID-19 case rates increased by 67% (IRR 1.67, 95% CI = 1.12, 2.52) in ZCTAs in quartile four (versus one) for percent overcrowdedness and increased by 77% (IRR 1.77, 95% CI = 1.11, 2.79) in quartile four (versus one) for percent living in multigenerational housing. Interaction between both exposures was not significant (β_interaction = 0.99, 95% CI: 0.99-1.00).

CONCLUSIONS

Overcrowdedness and multigenerational housing are independent risk factors for suspected COVID-19. In the early phase of the surge in COVID cases, social distancing measures that increase house-bound populations may inadvertently but temporarily increase SARS-CoV-2 transmission risk and COVID-19 disease in these populations.

Current systematic reviews and meta-analyses of COVID-19

BACKGROUND

Coronavirus disease 2019 (COVID-19) has left a significant impact on the world's health, economic and political systems; as of November 20, 2020, more than 57 million people have been infected worldwide, with over 1.3 million deaths. While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life.

AIM

To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence, highlight gaps in knowledge, and elucidate further meta-analyses and umbrella reviews that are yet to be performed.

METHODS

We explored studies based on systematic reviews and meta-analyses with the key-terms, including severe acute respiratory syndrome (SARS), SARS virus, coronavirus disease, COVID-19, and SARS coronavirus-2. The included studies were extracted from Embase, Medline, and Cochrane databases. The publication timeframe of included studies ranged between January 01, 2020, to October 30, 2020. Studies that were published in languages other than English were not considered for this systematic review. The finalized full-text articles are freely accessible in the public domain.

RESULTS

Searching Embase, Medline, and Cochrane databases resulted in 1906, 669, and 19 results, respectively, that comprised 2594 studies. 515 duplicates were subsequently removed, leaving 2079 studies. The inclusion criteria were systematic reviews or meta-analyses. 860 results were excluded for being a review article, scope review, rapid review, panel review, or guideline that produced a total of 1219 studies. After screening articles were categorized, the included articles were put into main groups of clinical presentation, epidemiology, screening and diagnosis, severity assessment, special populations, and treatment. Subsequently, there was a second subclassification into the following groups: gastrointestinal, cardiovascular, neurological, stroke, thrombosis, anosmia and dysgeusia, ocular manifestations, nephrology, cutaneous manifestations, D-dimer, lymphocyte, anticoagulation, antivirals, convalescent plasma, immunosuppressants, corticosteroids, hydroxychloroquine, renin-angiotensin-aldosterone system, technology, diabetes mellitus, obesity, pregnancy, children, mental health_, smoking, cancer, and transplant.

CONCLUSION

Among the included articles, it is clear that further research is needed regarding treatment options and vaccines. With more studies, data will be less heterogeneous, and statistical analysis can be better applied to provide more robust clinical evidence. This study was not designed to give recommendations regarding the management of COVID-19.

AB0706 ASSOCIATED RISK FACTORS AND OUTCOMES IN HOSPITALISED COVID-19 PATIENTS WITH BIOLOGICS AND JAK-INHIBITORS: A REPORT FROM A CENTER SPECIALISED IN IMMUNE-MEDIATED DISEASES

Background:

There’s little data of patients with immune diseases (ID) treated with biologic and JAK-inhibitors and COVID19. Current consensus is to keep treatment, however more studies are needed to ascertain the risk in these patients.

Objectives:

To describe the associated risk factors and outcomes in hospitalized patients with ID treated with biologics and JAK-inhibitors of a tertiary center.

Methods:

Observational retrospective study of patients with COVID19 from March 1st 2020 to January 31st 2021. Out of all the patients receiving subcutaneous (SC) or intravenous (IV) biologics and oral (PO) JAK-inhibitors, we selected those requiring hospitalization due to pneumonia for analysis. We collected demographic data, comorbidities, seasonal flu vaccination, smoking history and the outcome (discharge/admission in an intensive care unit (ICU)/death). We used a composite index (Charlston’s index) for comorbidities.

Results:

Of 153 patients, 29 (18.9%) were hospitalized. 18 (62%) were women with a median age of 61 (IQ 52-69). 14 (48.2%) had rheumatoid arthritis, 5 (17%) had axial spondylarthritis and 4 (13.7%) had Chron’s disease. The main IV was Rituximab in 3 (50%), and abatacept, infliximab and vedolizumab had one each. Of the SC, tocilizumab and adalimumab had 5 (22.7%) each, etanecept and golimumab had 3 (13.6%) each and secukinumab, ustekinumab and abatacept had 2 (9%) each. The PO was tofacitinib. There were no outcome differences for each treatment.

24 (82.7%) patients had at least 1 comorbidity with significative difference between patients (Table 1). There were 6 (20.6%) deaths, 3 (50%) in the ICU, 2 (33%) did not meet the ICU criteria, and 1 (16%) before ICU admission. None them had the same ID.

Table 1.

Baseline data.

Variables, (%)Total29 (100)Deaths 6 (20.6)Discharged23 (79.3)PWomen (%)18 (62)4 (66.6)14 (61)0.79Age, Median (IQ range)61 (52-69)69.5 (62-78.5)59.9 (51-65.5)0.09Flu vaccine (%)15 (51.7)5 (83.3)10 (43.7)0.08ICU (%)8 (27.5)3 (50)5 (22)0.16TreatmentIV (%)6 (20.1)4 (66.7)2 (8.7)0.001SC (%)22 (75.8)2 (33.3)20 (87)<0.0001PO (%)1 (3.4)0 (0)1 (4.3)0.6ComorbiditiesCharlston, Mean (standard deviation)2.72 (+/-1.6)5.16 (+/- 1.8)2.08 (+/-1.5)<0.0001Hypertension/HTA (%)16 (55)5 (83.3)11 (48)0.11Dyslipidemia/DL (%)12 (41.3)4 (66.7)8 (34.8)0.15Obesity (%)10 (34.5)1 (16.7)9 (39.1)0.30Chronic obstructive pulmonary disease/COPD (%)3 (10.3)3(50)0 (0)<0.0001Heart disease (%)8 (27.5)4 (66.6)4 (17.4)0.01Chronic kidney disease/CKD (%)7 (24.1)4 (66.6)3 (13)0.006Diabetes mellitus /DM (%)7 (24.1)3 (50)4 (17.4)0.001Previous or current smokers (%)9 (31)3 (50)6 (26)0.26

Conclusion:

The rate of COVID19 hospitalization in our patients was comparable to the general population’s (between 19-24% from 60 years plus) and the risk of in-patient death is also similar, around 24%1. Our study suggests that neither their ID nor their treatment influences their risk of a worse outcome.

COPD, DM and previous heart disease were associated with worse outcome; however it seems that the main prognostic factor was the overall impact of comorbidities associated; as measured by the Charlston’s index, being significantly higher in the patients with a fatal outcome.

A fatal outcome was more likely in IV biologics, however it could be explained by indication bias probably due to higher comorbidity and disability in these patients rather than an independent prognostic variable.

References:

[1]Mesas AE et al. Predictors of in-hospital COVID-19 mortality: A comprehensive systematic review and meta-analysis exploring differences by age, sex and health conditions. PLoS One. 2020 Nov 3;15(11)

[2]Jovani, V et al.Incidence of severe COVID-19 in a Spanish cohort of 1037 patients with rheumatic diseases treated with biologics and JAK-inhibitors. ARD 2020–218152.

Disclosure of Interests:

None declared

POS1264 IMMUNE-MEDIATED DISEASES (IMID) AND CORONAVIRUS DISEASE 2019 (COVID-19): RESULTS FROM AN OBSERVATIONAL RETROSPECTIVE MULTICENTER STUDY

Background:

The novel coronavirus emerged in 2019 in Wuhan has caused a global pandemic of coronavirus disease (COVID-19). Immune-mediated diseases (IMID), as inflammatory arthritis or inflammatory bowel disease (IBD), have some special implications due to their pathogenesis and treatments. Some treatments employed in IMID are now being used in the treatment of severe COVID-19. There still exists controversy about IMID behavior and its complications.1, 2

Objectives:

To assess COVID-19 severity in IMID patients and its prognosis predictors.

Methods:

An observational retrospective multicenter study was performed in two Spanish Hospitals (Clinical University Hospital in Santiago de Compostela and Gregorio Marañón Hospital). Patients were selected if they were diagnosed of an IMID (rheumatoid arthritis, psoriatic arthritis, espondyloarthritis, ulcerative colitis and Crohn’s disease) and had COVID-19 infection between February and April 2020.

Demographic, clinical, analytical and treatment data were collected. Logistic regression was used to evaluate potential predictors.

Stata 15.1 was used to perform statistical analysis.

Results:

91 patients were recruited. 55 suffered from a rheumatic disease and 36 suffer IBD. Baseline characteristics are shown in Table 1.

Univariable analysis reached age, comorbidity, female gender, flu vaccine, arthropathy, basal classical synthetic anti-rheumatic drugs (csDMARD), pneumonia and basal C-reactive protein (CRP) as potential predictors of non-severe (absence of death, respiratory insufficiency, intensive care unit admission or sepsis) COVID-19 disease (p < 0.2). After multivariable analysis, only female gender (OR 4.60 [CI95% 1.00, 21.2] p=0.050), lower age (OR 0.94 [CI95% 0.88, 1.00] p=0.042) and lower basal levels of CRP (OR 0.87 [CI95% 0.77, 0.97] p=0.010) were predictors for non-severe disease (p < 0.005).

Mean time of healing (symptoms solved in outpatient and hospital discharge in admitted) from COVID-19 was 13.8 days (SD 16.3). Univariable analysis showed arthropathy, COVID-19 symptomatic and basal glucocorticoids (GC) dose as potential predictors of higher time-to-healing from COVID-19 disease (p < 0.2). After multivariable analysis, only lower GC basal dose predicts higher time-to-healing (OR -1.83 [CI95% -2.81, -0.84] p=0.001).

11 patients deceased because of COVID-19. Univariable analysis reached age, basal csDMARD, pneumonia and basal CRP as potential predictors of COVID-19 mortality (p < 0.2). After multivariable analysis, only higher age was a predictor for mortality (OR 1.14 [CI95% 1.04,1.25] p=0.006).

Conclusion:

IMID patients showed similar predictors of mortality than general population involving COVID-19. Immune-modulating agents did not seem to overshadow the prognosis of COVID-19 infection. Female gender, lower age and lower basal CRP could select a cohort of “good” prognosis patients with mild COVID-19 disease as well higher age points out the worst prognosis. Even that, each case should be individiualized.

References:

[1]Ceribelli A, et al. Recommendations for coronavirus infection in rheumatic diseases treated with biologic therapy. J Autoimmun. 2020;109:102442.

[2]Micaela F, et al. COVID-19 in patients with rheumatic diseases in northern Italy: a single-centre observational and case-control study. Lancet Rheumatol 2020;2:e549-56.

Table 1.

baseline characteristics between non-severe and severe COVID-19 patients.

VariablesNon-severe (67)Severe (24)p-valueAge, mean (SD)56.8 (14.6)70.2 (13.7)0.000Female, n (%)38 (63.3)10 (41.7)0.070HLA-B27 +, n (%)9 (17.7)2 (10.0)0.423Disease evolution (years), median (IQR)12.5 (5;24)14 (9;20)0.891Comorbidity, n (%)35 (59.3)21 (87.5)0.013Flu vaccine, n (%)51 (85.0)23 (95.8)0.166Basal GC, n (%)18 (30.0)12 (50.0)0.084csDMARD, n (%)32 (47.8)16 (66.7)0.111b/tsDMARD, n (%)35 (52.2)11 (45.8)0.590COVID-19 symptoms, n (%)55 (93.2)24 (100)0.191Pneumonia, n (%)31 (51.7)21 (87.5)0.002Admission, n (%)30 (50.0)23 (95.8)0.000CRP, median (IQR)3.5 (2;9)10.0 (3;20)0.005

Disclosure of Interests:

None declared

Efficacy of complementary treatment with autologous platelet concentrates and/or mesenchymal stem cells in chemical osteonecrosis of the jaw. Systematic review of the literature

The aim of this systematic review was to establish the current status of the subject and find out what scientific evidence we have on the use of autologous plasma concentrates (APCs) and mesenchymal stem cells (MSCs) as complementary therapies at the management of Medication-related Osteonecrosis of the jaw (MRONJ). We performed a literature search of articles published between December 2019 to January 2020 in electronic databases, in accordance to PRISMA system. The variables analyzed were: the number of patients, age, sex, medical history, origin of MRONJ, imaging studies, treatment performed, and evolution of MRONJ. The articles included in the review were grouped into two groups (Group A "Therapy with APCs" and Group B "Therapy with APCs and MSCs"). Newcastle-Ottawa scale (NOS) was used to assess the quality of the articles. Fisher's exact test was used to evaluate eventual differences between groups. Of the 306 patients who were included, 297 belonged to Group A and 9 to Group B. In our sample, women predominated against men and no significant differences in age were observed. Osteoporosis was the most frequent underlying disease in both groups. The most common origin of MRONJ was oral surgery in group A. Conservative surgery was performed in all patients, but complementary treatment was applied in different ways in each group. The resolution of the pathology was achieved in 90% of cases in both groups without significant differences between them. The mean score of the reviewed studies at NOS was 4. There are currently no published scientific data that can sufficiently support the use of APCs and MSCs for the treatment of established MRONJs.

Relationship between type 2 diabetes mellitus and markers of cutaneous melanoma aggressiveness: an observational multicentric study in 443 patients with melanoma

BACKGROUND

Some studies have suggested a relationship between type 2 diabetes mellitus (T2DM) and increased incidence of melanoma. Efforts are under way to identify preventable and treatable factors associated with greater melanoma aggressiveness, but no studies to date have examined the relationship between T2DM and the aggressiveness of cutaneous melanoma at diagnosis.

OBJECTIVES

To explore potential associations between T2DM, glycaemic control and metformin treatment and the aggressiveness of cutaneous melanoma.

METHODS

We conducted a cross-sectional multicentric study in 443 patients diagnosed with cutaneous melanoma. At diagnosis, all patients completed a standardized protocol, and a fasting blood sample was extracted to analyse their glucose levels, glycated haemoglobin concentration and markers of systemic inflammation. Melanoma characteristics and aggressiveness factors [Breslow thickness, ulceration, tumour mitotic rate (TMR), sentinel lymph node (SLN) involvement and tumour stage] were also recorded.

RESULTS

The mean (SD) age of the patients was 55·98 (15·3) years and 50·6% were male. The median Breslow thickness was 0·85 mm. In total, 48 (10·8%) patients were diagnosed with T2DM and this finding was associated with a Breslow thickness > 2 mm [odds ratio (OR) 2·6, 95% confidence interval (CI) 1·4-4·9; P = 0·004)] and > 4 mm (OR 3·6, 95% CI 1·7-7·9; P = 0·001), TMR > 5 per mm² (OR 4·5, 95% CI 1·4-13·7; P = 0·009), SLN involvement (OR 2·3, 95% CI 1-5·7; P = 0·038) and tumour stages III-IV (vs. I-II) (OR 3·4, 95% CI 1·6-7·4; P = 0·002), after adjusting for age, sex, obesity, alcohol intake and smoking habits. No significant associations emerged between glycated haemoglobin levels, metformin treatment and melanoma aggressiveness.

CONCLUSIONS

T2DM, rather than glycaemic control and metformin treatment, is associated with increased cutaneous melanoma aggressiveness at diagnosis.

30. Antimicrobial Resistance Genes Are Reduced Following Administration of Investigational Microbiota-based Therapeutic RBX7455 to Individuals with Recurrent clostrioides Difficile Infection

Background

Antimicrobial resistance (AMR) is a challenge in individuals at risk for recurrent Clostrioides difficile infection (rCDI). Recognizing that AMR bacteria colonize the intestinal microbiota, therapeutic approaches that decolonize the gut of AMR bacteria would be valuable. Herein, we assessed the microbial resistome before and after treatment with RBX7455—a room temperature-stable, orally-administered investigational microbiota-based therapeutic—in a Phase 1 trial for reducing CDI recurrence.

Methods

This investigator-sponsored trial enrolled 30 rCDI patients in 3 open-label treatment groups (n=10 per group): 1) Four RBX7455 capsules BID for 4 days, 2) Four RBX7455 capsules BID for 2 days, 3) Two RBX7455 capsules BID for 2 days. RBX7455 administration began 48 hours after finishing CDI antibiotics. Participants were asked to submit stool samples at baseline, 1, 7, 28 and 56 days after treatment. These were extracted and sequenced using a shallow shotgun method. Relative taxonomic abundances at the class level and the presence of AMR genes were determined for 148 participant samples and 11 product samples using 90% K-mer sequence coverage based on the MEGARes database.

Results

Ninety percent of participants met the primary endpoint of no CDI recurrence through 8 weeks after treatment, and participant microbiome compositions became more similar to RBX7455 after treatment. The total AMR counts per participant decreased from before to after treatment (p< .05, mixed effects model), with the pattern of AMRs identified (resistome) becoming more like the RBX7455 resistome (Figure 1). Most notably, AMRs associated with multi-drug, fluoroquinolone, and betalactam resistance decreased from before to after treatment. There was no significant difference among the groups with respect to clinical response or changes in microbiome composition and AMR content.

Figure 1 Average total and per-class AMR gene counts in participant samples before and after RBX7455 treatment.

Conclusion

In a Phase 1 trial of RBX7455 for rCDI, AMR gene content decreased after treatment. This underscores the potential of microbiota-based therapies for decolonizing AMR bacteria from the gut microbiota. Continued clinical evaluation of RBX7455 is underway.

Disclosures

Dana Walsh, PhD, Rebiotix Inc. (Employee) Carlos Gonzalez, MS, BioRankings, LLC (Employee) Bill Shannon, PhD MBA, BioRankings, LLC (Employee) Ken Blount, PhD, Rebiotix Inc. (Employee)

Gold Chain Formation via Local Lifting of Surface Reconstruction by Hot Electron Injection on H2(D2)/Au(111)

The hexagonal close packed surface of gold shows a 22 × 3 "herringbone" surface reconstruction which makes it unique among the (111) surfaces of all metals. This long-range energetically favored dislocation pattern appears in response to the strong tensile stress that would be present on the unreconstructed surface. Adsorption of molecular and atomic species can be used to tune this surface stress and lift the herringbone reconstruction. Here we show that herringbone reconstruction can be controllably lifted in ultrahigh vacuum at cryogenic temperatures by precise hot electron injection in the presence of hydrogen molecules. We use the sharp tip of a scanning tunneling microscope (STM) for charge carrier injection and characterization of the resulting chain nanostructures. By comparing STM images, rotational spectromicroscopy and ab initio calculations, we show that formation of gold atomic chains is associated with release of gold atoms from the surface, lifting of the reconstruction, dissociation of H₂ molecules, and formation of surface hydrides. Gold hydrides grow in a zipper-like mechanism forming chains along the [11̅0] directions of the Au(111) surface and can be manipulated by further electron injection. Finally, we demonstrate that Au(111) terraces can be transformed with nearly perfect terrace selectivity over distances of hundreds of nanometers.

RBX7455, a Non-frozen, Orally Administered Investigational Live Biotherapeutic, Is Safe, Effective, and Shifts Patients' Microbiomes in a Phase 1 Study for Recurrent Clostridioides difficile Infections

Background

Recurrent Clostridioides difficile infections (rCDI) are a global public health threat. To reduce rCDI, microbiota-restoring therapies are needed, particularly standardized, easy-to-administer formulations.

Methods

This phase I open-label trial assessed the safety, efficacy in preventing rCDI recurrence, and intestinal microbiome effects of RBX7455, a room temperature-stable, orally administered investigational live biotherapeutic. Adult participants with 1 or more prior episodes of rCDI received: 4 RBX7455 capsules twice daily for 4 days (group 1); 4 RBX7455 capsules twice daily for 2 days (group 2); or 2 RBX7455 capsules twice daily for 2 days (group 3). For all groups, the first dose was administered in clinic, with remaining doses self-administered at home. Adverse events were monitored during and for 6 months after treatment. Treatment success was defined as rCDI prevention through 8 weeks after treatment. Participants’ microbiome composition was assessed prior to and for 6 months after treatment.

Results

Nine of 10 group 1 patients (90%), 8 of 10 group 2 patients (80%), and 10 of 10 group 3 patients (100%) were recurrence-free at the 8-week endpoint with durability to 6 months. Seventy-five treatment-emergent adverse events were observed in 27 participants with no serious investigational product-related events. Prior to treatment, participants’ microbiomes were dissimilar from the RBX7455 composition with decreased Bacteroidia- and Clostridia-class bacteria, whereas after treatment, responders’ microbiomes showed increased Bacteroidia and Clostridia.

Conclusions

Three dosing regimens of RBX7455 were safe and effective at preventing rCDI. Responders’ microbiomes converged toward the composition of RBX7455. These results support its continued clinical evaluation.

Clinical Trials Registration

NCT02981316.

CO0003 TREATMENT WITH BIOLOGICAL THERAPIES AND RISK OF BEING ADMITTED TO THE HOSPITAL FOR COVID19 INFECTION

Objectives:

To analyze the risk of admission for COVID19 infection and outcome of patients treated with bDMARD or tsDMARD from our biologic therapy center, to compare with all patients admitted for COVID-19 infection in our hospital.

Methods:

Records of the patients from our center admitted for COVID-19 infection between March 8 and May 8, 2020 were analyzed retrospectively. Age, gender, and outcome of all patients admitted for COVID19 infection to our hospital on the same dates were collected. Chi-square, Student’s t and Man-Whitney U tests were used for comparisons when appropriate.

Results:

1,668 patients with inflammatory diseases treated with bDMARD or tsDMARD were included. Median age 53.0 years (range 17-91), 52.4% women. Diagnoses and DMARD distribution are shown in tables 1 and 2. 19/1668 (1.1%; 6.8 patient-years) were admitted for severe COVID19 infection. Mortality ratio: 4/19 (21.1%). Median age of the admitted patients was higher: 61.0y (SD 14.2) vs 53.0y (SD 15.0); p <0.009. Median age of deceased patients was also higher 69.5y (SD 20.3) vs 53.0y (SD 15.0); p: NS. Female gender had a worse prognosis trend: 52.4% of all group, 68.4% of those hospitalized, 75.0% of those who died. Females had a higher median age than men: 55.0y (SD 14.9) vs. 50.0y (SD 14.9); p <0.001.

When comparing patients treated with DMARD admitted for COVID19 infection with all patients hospitalized for the same reason (4,601patients), no differences were found neither in age (61.0y [SD 14.2] vs 58.3y [SD 18.1]; NS) nor gender (female: 68.4% vs 54.7%; NS). However, DMARD group seemed to have higher mortality: 4/19 (21.1%) vs 551/4601 (12.0%); p: NS, at a younger age: 69.5y (SD 20.3) vs 82.4 (SD 11.4); p: NS.

Rheumatoid arthritis patients were admitted more frequently: (9/392 (2.3%) vs 10/1276 (0.8%); p <0.025. And were older: median 62y (SD 13.5) vs 50.0y (SD 14.4); p <0.001.

Patients treated with anti-TNF suffered less admissions: 6/1055 (0.6%) vs 13/613 (2.1%); p<0.001 and were younger: median 51.0y (SD 15.0) vs 55.0y (SD 14.7); p <0.001. Anti-TNF were less used in patients with rheumatoid arthritis 188/392 (48.0%) vs 867/1276 (67.9%); p<0.001.

DiseaseN (%)AdmitteddeathsRheumatoid arthritisSpondylarthritisPsoriatic arthritisJIACTDVasculitisIBDPsoriasisOthers392 (23.5%)277 (16.6%)124 (7.4%)30 (1.8%)31 (1.9%)20 (1.2%)582 (34.9%)202 (12.1%)10 (0.6%)9/392 (2.3%)2/277 (0.7%)1/124 (0.8%)0/30 (0.0%)1/31 (3.2%)0/20 (0.0%)4/578 (0.7%)2/202 (1.0%)0/10 (0.0%)110010100TOTAL1,668 (100%)19/1668 (1.1%)4/19 (21.1%)

JIA: Juvenile Idiopathic Arthritis; CTD: Connective Tissue Disease; IBD: Inflammatory Bowel Disease

TreatmentN (%)AdmitteddeathsAnti-TNFAnti-CD20Anti-IL6CTLA4-IgAnti-IL17Anti-IL12/23Anti-integrinJAK inhibitorPDE4 inhibitorAnti-IL231055 (63.2%)79 (4.7%)96 (5.8%)44 (2.6%)92 (5.5%)143 (8.6%)79 (4.7%)34 (2.0%)32 (1.9%)14 (0.8%)6/1055 (0.6%)3/79 (3.8%)3/96 (3.1%)3/44 (6.8%)2/92 (2,2%)1/143 (0.7%)0/79 (0.0%)1/34 (2.9%)0/32 (0.0%)0/14 (0.0%)2101000000TOTAL1,668 (100%)19/1668 (1.1%)4/19 (21.1%)

Conclusion:

It seems reasonable that patients with inflammatory diseases treated with bDMARD or tsDMARD continue their treatment during the COVID19 epidemic. The different rates of hospitalization based on the diagnosis or DMARD may be due to comorbidity, confounding by indication and other bias. The study is not powerful enough to study these confounders.

Disclosure of Interests:

Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Luis Alberto Menchén Viso Grant/research support from: Abbvie, Janssen, MSD, Takeda, Consultant of: Abbvie, Janssen, Takeda, MSD, Medtronic, Tillotts, Pfizer, Dr. Falk Pharma, Speakers bureau: Abbvie, Janssen, Takeda, MSD, General Electric, Tillotts, Pfizer, Ferring, General Electric, Fresenius, Ofelia Baniandrés Rodríguez: None declared, Ana Herranz Alonso: None declared, Carmen Lobo Rodríguez: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Indalecio Monteagudo Sáez: None declared, Ignacio Marín Jiménez: None declared, Amparo López: None declared, Ana López: None declared, Arantza Ais Larisgoitia: None declared, Esther Chamorro de Vega: None declared, Paloma Morales de los Ríos: None declared, Maria Jesus Lizcano: None declared, Jose Maria Alvaro Gracia: None declared, Sonia García de San José: None declared

AB0506 GIANT CELL ARTERITIS: IS ROUTINE CLINICAL PRACTICE COMPREHENSIVE ENOUGH?

Background:

Recommendations to collect the most relevant information on disease course, treatment and outcomes in giant cell arteritis (GCA) has been proposed by EULAR to facilitate clinical research and to improve clinical care.

Objectives:

To assess the quality of data collection in routine clinical practice according to EULAR recommendations and to describe baseline and follow-up characteristics of a retrospective cohort of patients with GCA.

Methods:

We reviewed medical records of patients diagnosed with GCA in a tertiary academic center between 2004-2018. We included patients with available data at diagnosis and one year of follow-up. Data extraction included: demographics, diagnosis, GCA-related signs and symptoms, laboratory, imaging modalities, comorbidities and treatment. Data in the chart was then compared with the core set of parameters proposed for GCA registries and databases by EULAR. Major relapse, according to the EULAR 2018 definition, was independently assessed by two rheumatologists.

Results:

58 patients were identified, 39 met predefined inclusion criteria with 151 visits during first-year follow-up. Headache (100%; 80.4%), ocular symptoms (89.7%; 81.2%), constitutional symptoms (89.7%; 80.4%), polymyalgia rheumatica (89.7%; 82%) and jaw claudication (87%; 81.2%) were the most frequently collected items at baseline and follow-up. Weight and height (2.6%; 2.6%), peripheral pulses (8%; 4.5%), smoking status (41%; 21%), and blood pressure (61.5%; 4.5%) were the less frequently collected. Most patients lacked differential pressure measurement. Myocardial infarction, malignancy, serious infections, arterial hypertension, diabetes and osteoporosis were collected in every patient (39, 100%). Only 2 mayor relapses were identified (5%). Two (2) patients died during the one-year follow-up period. Table 1 provides information on GCA-related signs and symptoms, laboratory and therapeutic data.

Table 1.

GCA-related signs and symptoms, laboratory and therapeutic data.

ItemPerformed BaselineBaselinen=39Performed Follow-upFollow-upn=112Ocular symptoms35/39 (89.7%)15/35 (42.9%)91/112 (81.2%)29/91 (31.9%)Permanent ocular symptoms34/39 (87%)9/34 (26.5%)92/112 (82%)28/92 (30.4%)Headache39 (100%)30/39 (77%)90/112 (80.4%)13/90 (14.4%)Scalp tenderness31/39 (79.5%)9/31 (29.8%)88/112 (78.6%)4/88 (4.5%)Jaw claudication34/39 (87%)19/34 (55.85)91/112 (81.2%)6/91 (6.6%)Cranial artery abnormality27/39 (69.2%)17/27 (63%)69/112 (61.6%)3/69 (4.3%)Constitutional symptoms35/39 (89.7%)19/35 (54.3%)90/112 (80.4%)11/90 (12.2%)PMR35/39 (89.7%)18/35 (51.4%)92/112 (82%)9/92 (9.8%)ESR mean (SD)33/39 (84.6%)58.7 (32.1)83/112 (74%)14.6 (18.8)CRP mean (SD)31/39 (79.5%)8.4 (7.9)70/112 (62.5%)1.3 (3.3)Haemoglobin mean (SD)38/39 (97.4%)12.0 (1.7)90/112 (80.4%)12.9 (1.5)Peripheral pulses9/39 (8%)3/9 (33.3%)5/112 (4.5%)2/5 (40%)Large vessel involvement8/39 (20.5%)5/8 (62.5%)7/112 (6.25%)3/7 (42.8%)Glucocorticoids median (IQR)39 (100%)102.5 (50-250)112 (100%)10.0 (5-15)Synthetic DMARD39 (100%)8/39 (20.5%)111/112 (99%)17/39 (43.6%)Biological DMARD39 (100%)0/39 (0%)111/112 (99%)3/39 (7.7%)Antiplatelet agents39 (100%)6/39 (15.4%)110/112 (98%)25/110 (22.7%)

PMR: polymyalgia rheumatica, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, SD: standard deviation, IQR: interquartile range, DMARD: disease modifying antirheumatic drugs

Conclusion:

Although data collection in routine care is usually comprehensive enough according to EULAR proposed data set, key components in physical exam mostly those aiming to detect large vessel involvement, should be addressed more carefully.

References:

[1]Ehlers L, et al. Ann Rheum Dis. 2019;78(9):1160–6.

[2]Hellmich B, et al. Ann Rheum Dis. 2019;1–12.

Disclosure of Interests:

Julia Martínez-Barrio Consultant of: UCB Pharma, Belén Serrano Benavente: None declared, Tamara Del Río Blasco: None declared, Alfonso Ariza: None declared, Juan Ovalles: None declared, Juan Molina Collada: None declared, Teresa González: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Isabel Castrejon: None declared, Jose Maria Alvaro Gracia: None declared

AB0357 USE OF TOFACITINIB AND REASONS FOR DISCONTINUATION IN CLINICAL PRACTICE

Background:

Tofacitinib is an oral JAK 1 and 3 inhibitor for the treatment of moderate to severe active rheumatoid arthritis (RA) or psoriatic arthritis (PsA) in adults with inadequate response or intolerant to one or more conventional disease-modifying antirheumatic drugs (cDMARDs). Since its approval by the European Medicines Agency (EMA), there is limited data about its use in daily practice in Europe.

Objectives:

To describe rates and reasons for discontinuation of Tofacitinib in patients with RA and other inflammatory conditions

Methods:

We identified patients with a prescription for tofacitinib at our academic center from January 2017 to January 2020. Patients were treated according to their rheumatologist evaluation following standards of care. The following variables were retrospectively collected from the electronic medical chart: age, gender, diagnosis, date of treatment initiation, date and reasons for treatment discontinuation, the use of concomitant or previous cDMARDs and of biologics. A comparison between patients continuing and stopping tofacitinib was performed through chi2or t-test for qualitative and quantitative variables, respectively. Survival analysis was done by Kaplan-Meier method

Results:

Ninety patients receiving tofacitinib were identified, 81 with RA, 6 with PsA, 1 with Dermatomyositis, 1 with Sjögren´s and 1 with juvenile idiopathic arthritis. Table 1 shows the baseline characteristics. 84% percent patients were women and the mean (SD) age was 58.5 (14.2) years. 51% patients started tofacitinib in monotherapy. When used, methotrexate was the most frequent cDMARD (61.3%); 10% patients used tofacitinib as first line after cDMARD and the majority used it after 1 or 2 previous biologics (46.7%).

Table 2.

Clinical coutcome of patients who developed HZ at initiation of baricitinib

All patients(n=90, 100%)Continue Tofacitinib(n=58; 64%)Not continue Tofacitinib(n=32; 35.5%)p-valueFemale (%)76 (84.4)48 (82.7)28 (87.5)0.55Age (year) – mean (SD)58.5 (14.2)58 (12.9)59.5 (16.5)0.63Diagnosis0.66Rheumatoid arthritis81 (90)52 (89.6)29 (90.6)Psoriatic arthritis6 (6.7)4 (6.8)2 (6.2)Other3 (3.3)2 (3.4)1 (3.1)Treatment duration (months) – mean (SD)10.6 (6.9)11.9 (7.3)8.2 (5.5)0.02Prednisone (mg) – mean (SD)1.75 (3.2)1.20 (2.5)2.73 (4.1)0.03Monotherapy (%)46 (51.1)28 (48.2)18 (56.2)0.244Concomitant csDMARDs (%)44 (48.8)30 (51.7)14 (43.7)0.62Methotrexate (%)27 (30)17 (29.3)10 (31.2)Leflunomide (%)10 (11.1)8 (13.7)2 (6.2)Other (%)7 (7.7)5 (8.6)2 (6.2)Prior biologic treatment0.13None (%)9 (10)6 (10.3)3 (9.3)1-2 (%)42 (46.6)28 (48.2)14 (43.7)≥3 (%)39 (43.3)24 (41.3)15 (46.8)

Survival rates when used as first or second line were 85% at 6 months and 70% at 12 months; when used as third line or further, 76% and 70%, respectively (graphic 1).

Factors associated to tofacitinib discontinuation were treatment duration and baseline prednisone dose. In contrast concomitant csDMARD and number of previous biologics were not. Reasons for tofacitinib discontinuation were: lack/loss of efficacy 46.9%, adverse events 50% (including intolerance -22%- herpes zoster -16%-, other infections 12%) and others.

Conclusion:

Tofacitinib in our experience is mostly used in RA patients after biologic failure. Overall survival rate at 12 months was good regardless line of therapy. Adverse event rates were similar to other biologic treatments. Herpes zoster was the most common infectious AE.

Graphic 1:

References:

[1]Wollenhaupt J, Lee EB, Curtis JR, et al. Safety and efficacy of tofacitinib for up to 9.5 years in the treatment of rheumatoid arthritis: final results of a global, open-label, long-term extension study. Arthritis Res Ther. 2019;21(1):89.

Disclosure of Interests:

Christian Y Soleto: None declared, Belén Serrano Benavente: None declared, Luis A Torrens Cid: None declared, Julia Martínez-Barrio Consultant of: UCB Pharma, Juan Molina Collada: None declared, Javier Rivera: None declared, Teresa González: None declared, Indalecio Monteagudo: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Isabel Castrejon: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB

AB0205 PREDICTORS OF ULTRASOUND DETECTED INFLAMMATORY FINDINGS IN PATIENTS WITH INFLAMMATORY ARTHRALGIA

Background:

Patients with inflammatory arthralgia (IA) are considered to be at increased risk for progression to RA. US has shown high sensitivity to detect synovitis compared with physical examination. Thus, US is recommended to identify subclinical synovitis in patients without clinical signs of inflammation.

Objectives:

The objective of our study is to determine the frequency and pattern of US detected inflammatory findings in patients with IA and investigate factors contributing to predict these findings.

Methods:

An US clinic is scheduled in an academic center running three days every week. A retrospective analysis of our US unit cohort during a period of 6 months was undertaken. Patients with IA and no previous diagnosis of inflammatory arthropathies were included for analysis. Inclusion criteria of IA definition included: severe symptoms presenting in the morning, duration of morning stiffness ≥60 min, symptoms predominantly located in MCP joints and abscense of clinically detected synovitis by the referral rheumatologist. The following routinely collected variables were included in the analysis: demographics, clinical features and laboratory tests. Patients underwent bilateral US examination in GS and PD mode of hands and/or feet according to the European League Against Rheumatism (EULAR) guidelines. The presence of synovitis, tenosynovitis and enthesitis was assessed on a semi quantitative scale (0–3) for Grey Scale(GS)/Power Doppler(PD) or using enthesitis OMERACT definition, respectively. Patients were stratified in two groups based on the presence of US inflammatory findings (synovitis, tenosynovitis or enthesitis with PD signal). First, differences between groups were tested using chi-squared and Student-t tests in the univariate analysis. Second, multivariate logistic regression models were employed to investigate the association between possible predictive factors of US detected inflammatory findings.

Results:

A total of 57 patients were included in the analysis. Mean age was 55.8±15.2 years, 41 (71.9%) were females, and mean symptoms duration was 11.4±10.4 months (Table 1). A total of 42 (73.7%) patients presented with a polyarticular arthralgia pattern. US inflammatory findings were present in 20 (35.1%) patients (26.3% PD synovitis, 21.1% PD tenosynovitis and 3.5% PD enthesitis). Hands were most commonly involved with PD synovitis at wrists in 19.3% and at MCP in 12.3% of patients (Table 2). For PD tenosynovitis, the flexor MCP 2-5 (5.3%) and compartment IV tenosynovitis (1.8 %) were the most frequent affected locations. Only two patients had PD enthesitis at feet and 6 (10.5%) had erosions in hands or feet at baseline examination. In the univariate analysis, the higher ESR values and the shorter time from symptoms onset were significantly associated with US detected inflammatory findings (p=0.044 and 0.049, respectively). In the multivariate analysis, only ESR values (OR=1,04; 95%CI 1,002-1,078), remained significantly associated with the presence of US inflammatory findings (Table 3).

Table 3.

Independent predictors of US detected inflammatory findings

pOdds ratio95% C.I.LowerUpperESR (mm/h)0.0391.041.0021.078Time (months) from symptoms onset0.10.9240.8411.015

Conclusion:

PD US inflammatory findings are found in 1 over 3 patients with IA being PD synovitis the most common finding, specially at the wrists and MCP joints. Higher ESR values were significantly associated with the presence of US inflammatory findings. Our data highlights how the use of PD US may be useful to detect subclinical synovitis in patients with IA.

Disclosure of Interests:

Katerine López Gloria: None declared, Isabel Castrejon: None declared, Laura Trives Folguera Speakers bureau: ROCHE, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Belén Serrano Benavente: None declared, Julia Martínez-Barrio Consultant of: UCB Pharma, Javier Rivera: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Indalecio Monteagudo: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Juan Molina Collada: None declared

SAT0607-HPR MULTIDISCIPLINARY CARE CLINIC FOR PATIENTS WITH IMMUNITY MEDIATED INFLAMMATORY DISEASES. FIRST YEAR OF COORDINATED MANAGEMENT

Background:

Patients with immunity mediated inflammatory diseases (IMID) often have clinical manifestations and comorbidity in the field of various medical specialties. A center has been created in our hospital for the comprehensive care of patients with IMID who are being treated with biological therapies (BT) or targeted synthetic molecules (TSM). It is an innovative healthcare model, that incorporate patients into its governance. Physicians, pharmacists and advanced practice nurses (APN), collaborates in consultation or in the day hospital (DH).

Objectives:

To analyze the activity developed during the first year of operation of the center, with special attention to effectiveness, efficiency, interdisciplinary relationships and patient satisfaction.

Methods:

Observational analysis with indicators of management and monitoring of patients, care activity, effectiveness, adverse effects, resource consumption and patient satisfaction using the hospital’s own information systems.

Results:

Center staff during 2019: two admission assistants, one nursing assistant, six nurses, seven part-time doctors and three pharmacists. 1,490 patients were included: 694 (46.6%) Rheumatology (Rheu), 585 (39.3%) Digestive (Dig) and 211 (14.1%) Dermatology (Der) generated 11,363 medical consultations, 14,850 APN consultations and 3,920 treatment sessions in the DH. IV treatment 529/1490 (35.5%) patients (45.0% Reu, 53.9% Dig, 1.1% Der). Patients with rheumatic diseases: rheumatoid arthritis: 339/694, 48.8%; Spondyloarthritis: 226/694, 32.6%; psoriatic arthritis: 117/694, 16.9%; and juvenile idiopathic arthritis: 12/694, 1.7%. 217/1490 (14.6%) patients needed multidisciplinary consultations.

Table 1. shows the most relevant indicators and table 2 shows the patient satisfaction survey for 2019.

Table 1.

relevant indicators

RHEUDIGDEROn demand consultations 2019 %21.0%34.2%14.3%Teleconsultations 2019 %17.8%41.9%0.0%BT, TSM tapering. %201931.9%0.2%45,5%201818.9%0.2%13.4%BT, TSM intensification. %20195.8%35.2%0.5%20182.6%36.5%0.5%Biosimilars %201943.1%48.5%15.9%201830.4%4.0%12.1%Adherence>90% 2019 %89.4%91.7%86.4%Remission 2019 %47.8%67.3%78.5%hospital admission, any cause pat-years20191.41.70.120181.51.50.04emergency admission, any cause pat-years20192.12.11.620182.12.01.5Table 2.

patient satisfaction survey

CategoríaMean and (DS) 1-5General aspects of the center4.3 (0.9)Physicians4.5 (1.1)DH and APN4.5 (1.2)Pharmacy4.6 (0.9)Health proffesional coordinaton4.4 (0.9)Hospital global satisfaction4.3 (0.8)

Conclusion:

From previous situation there is an increase in interdisciplinary consultations and HD activity maintenance without an increase in human resources. Efficiency (tapering, biosimilars) and patient and staff satisfaction have improved. However, no improvement in adverse effects has been observed, which is an area of improvement. Effectiveness is good, waiting to compare with the previous year. Nutrition and preventive medicine consultations has not been evaluated because have been recently established. Other indicators are being analyzed at the end of the submission deadline.

The impact of this pioneering management model, with a holistic approach and incorporating patients into its governance, is difficult to measure until its implementation is completed. Uveitis and psychology consultations and patient school starting in 2020 will improve the quality of IMID patient care, as well as their satisfaction and that of their relatives.

Disclosure of Interests:

Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Luis Alberto Menchén Viso Grant/research support from: Abbvie, Janssen, MSD, Takeda, Consultant of: Abbvie, Janssen, Takeda, MSD, Medtronic, Tillotts, Pfizer, Dr. Falk Pharma, Speakers bureau: Abbvie, Janssen, Takeda, MSD, General Electric, Tillotts, Pfizer, Ferring, General Electric, Fresenius, Ofelia Baniandrés Rodríguez: None declared, Ignacio Marín-Jiménez Consultant of: AbbVie,Chiesi,FAES Farma,Falk-Pharma,Ferring,Gebro Pharma, Hospira,Janssen,MSD,Otsuka Pharmaceutical,Pfizer,Shire,Takeda,Tillots and UCB Pharma, Speakers bureau: AbbVie,Chiesi,FAES Farma,FalkPharma,Ferring,Gebro Pharma,Hospira,Janssen,MSD,Otsuka Pharmaceutical,Pfizer,Shire,Takeda,Tillots and UCB Pharma, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Indalecio Monteagudo: None declared, Arantza Ais Larisgoitia: None declared, Esther Chamorro de Vega: None declared, Elena Lobato Matilla: None declared, Rosa Romero Jiménez: None declared, Ana Herranz Alonso: None declared, Carmen Lobo Rodríguez: None declared, María Prado Simón Moreno: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Sonia García de San José: None declared

AB0333 CLINICAL AND ULTRASONOGRAPHIC RESPONSE TO SUBCUTANEOUS METHOTREXATE IN EARLY RHEUMATOID ARTHRITIS. PRELIMINARY RESULTS

Background:

Metotrexate (MTX) is usually the first line therapy for Rheumatoid Arthritis (RA) because of its favorable efficacy-toxicity ratio. However the exact mechanism and treatment response time in both a clinical and ultrasonographic setting are still uncertain.

Objectives:

To describe the clinical and ultrasound response to MTX during the first 6 months of treatment in early RA patients who started subcutaneous methotrexate as the first disease-modifying drug (DMARD).

Methods:

Ongoing prospective cohort of patients with early RA (ACR-EULAR 2010 criteria), over 18 years and starting MTX-SC. Patients had a clinical and ultrasonographic evaluation at baseline, 1, 3 and 6 months. We collected demographic data, C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], rheumatoid factor [FR], anti-citrullinated protein antibody [ACPA]), inflammatory activity indexes (DAS28esr and DAS28crp) and EULAR’s response to treatment (delta value of -1.2 in DAS28 scores). Joints explored with ultrasound were elbows and wrists (radio-carpal and inter-carpal joint) counted as a single joint, 1st-5th metacarpophalangeal (MCF), proximal interphalangeal (IFP), knees, tibio-talar and subtalar joints and 2nd-5th metatarsophalangeal (MTF) joints. Bone erosions were evaluated in 2nd and 5th MCF, styloid, distal ulna and 5th MTF. Synovitis was graduated semi-quantitatively from 0 to 3 (OMERACT) and calculated on B mode and Doppler.

Results:

35 patients were included (mean age 61.2 years, 65.7% women) with a median of 0.8 (+/-8) months delay to diagnosis. 34 patients (97.1%) started 15mg MTX-SC/weekly. A higher DAS28esr was found in baseline data for the group that had a response by month 1 (DAS28esr baseline 5.5 vs 4.2 p=0.01), no other significant differences were found. During the first month, a significant response was achieved in 13 (41%) patients and remission in 11 (35%) (Table 1). 17 patients have 6thmonth data. 11 (64.7%) have achieved EULAR response compared to baseline(P=0.0005) out of which 7 (54.5%) had already reached it by month 1. A difference in MTX dose (month1 14.8 vs month6 17.1 p=0.003) was found between month 1 and 6, with no differences in disease activity. In the ultrasonographic baseline data; 8 patients (22.9%) had erosions, with a mean of 2,75 erosions/patient (22 of the 280 locations). During the follow up the global rating lowered, with no differences in B mode but significant differences in Doppler at the 6 month mark (Table 2). As of this report, 10 patients (28.5%) had stopped MTX treatment due to lack on response or adverse effects and 8 (22.9%) are waiting 6thmonth evaluation.

Table 2.

Ultrasound synovitis global rating.

BaselineMonth 1P ValueEULAR response013 (41)0.00005MTX Dose mg (SD)14.8 (+/-0.8)14.8 (+/-1.6)1Prednisone Dose mg(SD)5.9 (+/-6.5)2.9 (+/-3)0.02DAS28crp (SD)4.3 (+/-1.5)3,4 (+/-1.4)0.02DAS28esr (SD)(4.8 (+/-1.5)3.7 (+/-1.4)0.006Remission (DAS28<1.2)3(9.6)11(35.5)0.04Table 1.

Baseline characteristics of the patients with RA (n=102).

BaselineN=351 monthN=313 monthsN=256 monthsN=17B Mode:Median (interquartile range)8 (3.5-12)8 (3-12.5)6 (4-11)5 (2-11)p 0,16Doppler Mode: Median (interquartile range)2 (0.5-6)2 (0-6)2 (0-6)0 (0-2)p 0,005

Conclusion:

In this cohort half of the patients that responded to treatment had achieved this by month 1. A higher baseline inflammatory profile was related to the response. Little difference is found between month 1 and 6 on clinical data, however ultrasonographic results suggest that at least 6 months are needed for Doppler improvement. Perhaps MTX has a faster effect over joint pain and lowers DAS28 scores requiring longer to completely suppress inflammatory activity.

References:

[1]Braun, J. et al. Comparison of the clinical efficacy and safety of subcutaneous versus oral administration of methotrexate in patients with active rheumatoid arthritis. Arthritis Rheum 2008

Disclosure of Interests:

Liz R. Caballero Motta: None declared, Ana Melissa Anzola Alfaro: None declared, Luis A Torrens Cid: None declared, Christian Y Soleto: None declared, Belén Serrano Benavente: None declared, Iustina Janta: None declared, Juan Molina Collada: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Indalecio Monteagudo: None declared, Jose Maria Alvaro Gracia: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi

AB0431 SALIVARY GLAND ULTRASOUND IN CLINICAL PRACTICE

Background:

Sjogren’s syndrome (SS) is characterized by lymphocytic infiltration of the exocrine glands and marked B-lymphocytic cell hyperreactivity involving a variety of serum autoantibodies.1Salivary Gland Ultrasound (SGU) is a simple, fast, and well- tolerated examination, wich provides information about glandular structure and has proven to be very useful in the Sjögren Syndrome diagnosis2. A prognostic value has also been proposed due to its posible relationship with lymphomas and extra-glandular manifestations.

Objectives:

The objective of our study is to evaluate ultrasound results in patients who went through an SGU in clinical practice, its usefulness in the diagnosis of Sjögren’s syndrome and the presence of complications (lymphomas, extra-glandular manifestations or factors related to increased lymphoma risk).

Methods:

We conducted a retrospective cross-sectional study with review of clinical records that included all those patients coded as SGU in the Ultrasound unit of Rheumatology Department from 2016 to December 2019. Information collected included final diagnosis, laboratory results, clinical manifestations and ultrasound results. We performed an analysis on the frequency of pathological SGU and on the relationship between this lesions in patients with final SS diagnosis and the presence of lymphoma, extra-glandular manifestations and the laboratory values related with increased lymphoma risk (low complement levels, cryoglobulinemia, positive autoimmunity).

Results:

SGU was performed in 171 patients in four years, 162 women (94.7%). The previous diagnoses, reason for the request and final diagnosis are shown in Table 1. The vast majority of the SGU were normal, only 28 (16,3%) were pathological, 13 with a grade II and 8 with a grade III. In the other 7 patients grading was not available. Of the 28 patients with pathological SGU, none had lymphoma, only 3 had recurrent parotitis and 15 had had extra-glandular manifestations, mainly arthralgia / arthritis (12). Only 1 patient, with rheumatoid arthritis, had had a lymphoma and the SGU was normal. Antibody positivity was frequent in pathological SGU, 16/23 antinuclear antibodies, 13/22 anti-Ro and 9/23 rheumatoid factor. Of the 86 patients without previous diagnosis, 18 were diagnosed with Sjogren syndrome, 9 with pathological SGU and the rest were normal. No patient diagnosed with a dry non-autoimmune syndrome presented pathological SGU.

Table 1.

Previous diagnoses, reason for request and final diagnoses.

Previous diagnoses (n: 171)Reason for request (n: 171)Final diagnosis (n: 78)Without prior diagnosis (n: 86)Dry non- autoinmune syndrome (n: 127)Dry non-autoimmune syndrome (n: 60)Primary Sjögren’s syndrome (n: 11)Primary Sjögren’s syndrome (n: 12)Primary Sjögren’s syndrome (n: 18)Systemic Lupus Erythematosus (n: 9)Lymphoma (n: 0)Secondary Sjögren’s syndrome (n: 0)Rheumatoid arthritis (n: 24)Control (n: 13)Other diagnoses (n: 7)Other diagnoses (n: 18)Other reasons (n: 11)

Conclusion:

The impact of the SGU is low and its use cannot, for now, displace other methods (e.g. salivary gland biopsy) in the diagnosis of SS. Also our low number of patients with pathological SGU together with the low prevalence of the complications studied (e.g. lymphomas = 1) prevents the expected comparisons.

References:

[1]Ramos-Casals M, Solans R, Rosas J, et al. Primary Sjogren syndrome in Spain: clinical and immunologic expression in 1010 patients. Medicine (Baltimore) 2008; 87: 210–219.

[2]Damjanov N, Milic V, Nieto-Gonzalez JC, et al. Multiobserver Reliability of Ultrasound Assessment of Salivary Glands in Patients with Established Primary Sjogren Syndrome. J Rheumatology 2016; 43: 1858–1863.

Disclosure of Interests:

Fernando Montero: None declared, Karen Carpio: None declared, Iustina Janta: None declared, Juan Molina Collada: None declared, Belén Serrano Benavente: None declared, Julia Martínez-Barrio Consultant of: UCB Pharma, Alfonso Ariza: None declared, Javier Rivera: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Indalecio Monteagudo: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi

AB1117 CLINICAL IMPACT OF MUSCULOSKELETAL ULTRASOUND ON RHEUMATOID ARTHRITIS IN ROUTINE CLINICAL PRACTICE

Background:

Musculoskeletal ultrasound (MSUS) is a useful tool to assess disease activity in rheumatoid arthritis (RA) patients. However, it has not yet been established if its use would change treatment decisions within a treat to target strategy or whether it would lead to better outcomes in RA patients

Objectives:

Our aim was to determine the impact of MSUS in the clinical management of RA patients and investigate factors associated with subsequent clinical actions by the referring rheumatologist

Methods:

A prospective analysis of RA patients seen at an MSUS clinic over a 6-month period was undertaken. Pre- and post-US follow-up data (± 3 months) were analyzed. Baseline assessment included clinical features, physical examination and laboratory tests. All MSUS examinations were performed according to EULAR guidelines and using an Esaote MyLab 8 (Esaote, Genoa) with a high frequency (8-15 MHz) transducer. Patients were stratified in groups based on the clinical impact of the MSUS visit: 1) No clinical impact and 2) US findings leading to subsequent clinical action by the referring rheumatologist (including changes in dosages of current rheumatologic treatments, addition/substraction of medications or interventional procedures based on the MSUS results). First, differences between groups were tested using chi-squared and Student-t tests in the univariate analysis. Second, multivariate logistic regression models were employed to investigate factors associated to a change in clinical management

Results:

A total of 61 RA patients were included for analysis. Mean age was 61.9± 11.4 years and 51 (83.6%) were female. Disease activity assessment was the most frequent referral reason (43; 70.5%). Overall, MSUS led to a subsequent therapeutic action by the referring rheumatologist in 39 (63.9%) patients, and to a change in the underlying diagnosis and/or in the clinical impression of the chief complaint that generated the referral in 7 (11.5%) patients. Baseline characteristics between both groups are compared in Table 1. In the univariate analysis, the detection of Power Doppler (PD) synovitis/tenosynovitis and 28 swollen joint count were significantly associated with a subsequent clinical action. In the multivariate analysis only PD synovitis/tenosynovitis (OR=3.28; 95%CI 1.06-10.27) remained significantly associated with a change in clinical management (Table 2)

Table 1.

Baseline characteristics of RA patients

Total n= 61Change in clinical management n= 39 (63.9%)No change in clinical management n= 22 (36.1%)pAge61.9±11.461.5±12.562.6±9.20.7SexFemale51(83.6%)35(89.7%)16(72.7%)0.09SmokingNon smoker33(54.1%)17(43.6%)16(72.7%)0.08Smoker13(21.3%)11(28.2%)2(9.1%)Former smoker15(24.6%)11(28.2%)13(21.3%)Radiographic erosions29(48.3%)22(57.9%)7(31.8%)0.0528 Tender Joint Count2.3±3.42.7±3.91.6±2.40.228 Swollen Joint Count2±32.6±3.51.1±1.6<0.05ESR (mm/h)28.1±20.626.1±15.531.7±27.40.4CRP (g/L)1±1.51±1.40.9±1.70.7RF (IU/mL)175.8±452.8139.9±249.5243.9±697.40.4ACPA (IU/mL)775.6±998.6619.4±797.11079.9±1,275.90.2US PD synovitis/tenosynovitis37(60.7%)28(71.8%)9(40.9%)<0.05Table 2.

Independent factors associated with a change in clinical management based on logistic regression model

pOdds ratio95% C.I.LowerUpper28 Tender Joint Count0.131.240.941.64US PD synovitis/tenosynovitis0.043.281.0610.17

Conclusion:

The most common indication of MSUS examination in RA patients was disease activity assessment. MSUS findings led frequent changes in therapeutic management and even to a change in the diagnosis in some of cases. The presence of PD synovitis/tenosynovitis was significantly associated to a change in the therapeutic management. These data highlight the impact of MSUS inflammatory findings in RA patients in daily clinical practice

Disclosure of Interests:

Juan Molina Collada: None declared, María Pérez: None declared, Isabel Castrejon: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Teresa González: None declared, Javier Rivera: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Indalecio Monteagudo: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB

Follow-up study of 67 first episode schizophrenic patients and their involvement in religious activities

We studied the characteristics of religious practice in a cohort of 67 first admission schizophrenic patients over 5 years. Thirty percent of these patients were involved in religious activities, either with an established religion or in a marginal group. They were mostly women, who had a good premorbid psychosocial adaptation and tended not to be substance abusers. Their social adaptation was improved at year 5. They were as compliant with their ambulatory treatment as the other patients. However, when controlling for the inclusion characteristics, a similar outcome was shown between the group of practicing patients and the nonpracticing group. Religious activity may not be by itself the cause of this favorable outcome, as it is probable that only the patients who are less symptomatic and relatively well adapted could actually join a religious movement. The fact that many schizophrenic patients find an occupation and relationships in religious activities that they would not find elsewhere should encourage the psychiatric community target its occupational goals.

Genetic characterization of mumps viruses associated with the resurgence of mumps in the United States: 2015-2017

Despite high coverage with measles, mumps, and rubella vaccine in the United States, outbreaks of mumps occur in close contact settings such as schools, colleges, and camps. Starting in late 2015, outbreaks were reported from several universities, and by the end of 2017, greater than 13,800 cases had been reported nation-wide. In 2013, the CDC and the Association of Public Health Laboratories contracted four Vaccine Preventable Diseases Reference Centers (VPD-RCs) to perform real-time reverse transcription PCR (RT-qPCR) to detect mumps RNA in clinical samples and to determine the genotype. Twelve genotypes of mumps virus are currently recognized by the World Health Organization, and the standard protocol for genotyping requires sequencing the entire gene coding for the small hydrophobic (SH) protein. Phylogenetic analysis of the 1862 mumps samples genotyped from 2015 through 2017 showed that the overall diversity of genotypes detected was low. Only 0.8 % of the sequences were identified as genotypes C, H, J, or K, and 0.5 % were identified as vaccine strains in genotypes A or N, while most sequences (98.7 %) were genotype G. The majority of the genotype G sequences could be included into one of two large groups with identical SH sequences. Within genotype G, a small number of phylogenetically significant outlier sequences were associated with epidemiologically distinct chains of transmission. These results demonstrate that molecular and epidemiologic data can be used to track transmission pathways of mumps virus; however, the limited diversity of the SH sequences may be insufficient for resolving transmission in all outbreaks.

Coupled Sublattice Melting and Charge-Order Transition in Two Dimensions

Two-dimensional melting is one of the most fascinating and poorly understood phase transitions in nature. Theoretical investigations often point to a two-step melting scenario involving unbinding of topological defects at two distinct temperatures. Here, we report on a novel melting transition of a charge-ordered K-Sn alloy monolayer on a silicon substrate. Melting starts with short-range positional fluctuations in the K sublattice while maintaining long-range order, followed by longer-range K diffusion over small domains, and ultimately resulting in a molten sublattice. Concomitantly, the charge order of the Sn host lattice collapses in a multistep process with both displacive and order-disorder transition characteristics. Our combined experimental and theoretical analysis provides a rare insight into the atomistic processes of a multistep melting transition of a two-dimensional materials system.