Th2 cell clonal expansion at diagnosis in human type 1 diabetes

Soon after diagnosis with type 1 diabetes (T1D), many patients experience a period of partial remission. A longer partial remission is associated with a better response to treatment, but the mechanism is not known. The frequency of CD4+CD25+CD127hi (127-hi) cells, a cell subset with an anti-inflammatory Th2 bias, correlates positively with length of partial remission. The purpose of this study was to further characterize the nature of the Th2 bias in 127-hi cells. Single cell RNA sequencing paired with TCR sequencing of sorted 127-hi memory cells identifies clonally expanded Th2 clusters in 127-hi cells from T1D, but not from healthy donors. The Th2 clusters express GATA3, GATA3-AS1, PTGDR2, IL17RB, IL4R and IL9R. The existence of 127-hi Th2 cell clonal expansion in T1D suggests that disease factors may induce clonal expansion of 127-hi Th2 cells that prolong partial remission and delay disease progression.

Chronic pain, chronic stress and substance use: overlapping mechanisms and implications

Chronic pain is among the most common reasons adults in the U.S. seek medical care. Despite chronic pain's substantial impact on individuals' physical, emotional, and financial wellness, the biologic underpinnings of chronic pain remain incompletely understood. Such deleterious impact on an individuals' wellness is also manifested in the substantial co-occurrence of chronic stress with chronic pain. However, whether chronic stress and adversity and related alcohol and substance misuse increases risk of developing chronic pain, and, if so, what the overlapping psychobiological processes are, is not well understood. Individuals suffering with chronic pain find alleviation through prescription opioids as well as non-prescribed cannabis, alcohol, and other drugs to control pain, and use of these substances have grown significantly. Substance misuse also increases experience of chronic stress. Thus, given the evidence showing a strong correlation between chronic stress and chronic pain, we aim to review and identify overlapping factors and processes. We first explore the predisposing factors and psychologic features common to both conditions. This is followed by examining the overlapping neural circuitry of pain and stress in order to trace a common pathophysiologic processes for the development of chronic pain and its link to substance use. Based on the previous literature and our own findings, we propose a critical role for ventromedial prefrontal cortex dysfunction, an overlapping brain area associated with the regulation of both pain and stress that is also affected by substance use, as key in the risk of developing chronic pain. Finally, we identify the need for future research in exploring the role of medial prefrontal circuits in chronic pain pathology. Critically, in order to alleviate the enormous burden of chronic pain without exacerbating the co-occurring substance misuse crisis, we emphasize the need to find better approaches to treat and prevent chronic pain.

Alcohol withdrawal symptoms predict corticostriatal dysfunction that is reversed by prazosin treatment in alcohol use disorder

Chronic alcohol use increases risk of alcohol withdrawal symptoms (AW) and disrupts stress biology and resilient coping, thereby promoting excessive alcohol intake. Chronic alcohol intake and multiple alcohol detoxifications are known to impair brain medial prefrontal cortex (mPFC) and striatal functioning, regions involved in regulating stress, craving and alcohol intake. In two related studies, we examined whether AW predicts this functional brain pathology and whether Prazosin versus Placebo treatment may reverse these effects. In Study 1, patients with Alcohol Use Disorder (AUD) (N = 45) with varying AW levels at treatment entry were assessed to examine AW effects on corticostriatal responses to stress, alcohol cue and neutral visual images with functional magnetic resonance imaging (fMRI). In Study 2, 23 AUD patients entering a 12-week randomised controlled trial (RCT) of Prazosin, an alpha1 adrenergic antagonist that decreased withdrawal-related alcohol intake in laboratory animals, participated in two fMRI sessions at pretreatment and also at week 9-10 of chronic treatment (Placebo: N = 13; Prazosin: N = 10) to assess Prazosin treatment effects on alcohol-related cortico-striatal dysfunction. Study 1 results indicated that higher AW predicted greater disruption in brain mPFC and striatal response to stress and alcohol cues (p < 0.001, family-wise error [FWE] correction) and also subsequently greater heavy drinking days (HDD) in early treatment (p < 0.01). In Study 2, Prazosin versus Placebo treatment reversed mPFC-striatal dysfunction (p < 0.001, FWE), which in turn predicted fewer drinking days (p < 0.01) during the 12-week treatment period. These results indicate that AW is a significant predictor of alcohol-related prefrontal-striatal dysfunction, and Prazosin treatment reversed these effects that in turn contributed to improved alcohol treatment outcomes.

Comparison of major histocompatibility complex-B variability in Sri Lankan indigenous chickens with five global chicken populations using MHC-B SNP panel

In the present study, we investigated the major histocompatibility complex (MHC)-B haplotypes diversity of Sri Lankan indigenous chickens from three different geographical sites consisting of highly mixed populations using 90 SNPs in the MHC-B region. A total of 48 haplotypes were identified. Those included 37 novel haplotypes and 11 previously identified 'standard' haplotypes. The MHC-linked marker, LEI0258, had 23 alleles showing less diversity than defined by MHC-B SNP haplotypes. Among those identified haplotypes, five standard haplotypes-BSNP-O02, BSNP-M01, BSNP-A04, BSNP-K03, BSNP-T04-were most commonly observed, suggesting past introgression of imported breeds. Comparison of the MHC-B haplotypes of Sri Lankan and four other global populations with previously defined haplotypes indicated the sharing of 23 standard haplotypes with common origins. Novel haplotypes are population-specific and not shared among the geographical boundaries. Backyard indigenous chickens are unselected, highly crossbred, and generally thrive under dynamic environmental conditions. Hence free-range production systems may be responsible for maintaining high diversity in the MHC-B region with novel haplotypes.

A Novel Interdisciplinary Iterative Approach for Optimizing the Electronic Health Record to Improve Perioperative Efficiency

OBJECTIVE

We present a holistic perioperative optimization approach led by a CI team with the goal to optimize the workflow within our EHR, improve operative room metrics and user satisfaction.

SUMMARY OF BACKGROUND DATA

The EHR has become integral to perioperative care. Many approaches are utilized to improve performance including systems-based approaches, process redesign, lean methodology, checklists, root cause analysis, and parallel processing. Although most reports describe strategies improving day or surgery productivity, few include perioperative interventions to improve efficiencies.

METHODS

An interdisciplinary CI team consisting of clinicians, informatics specialists, and analysts spent 6 weeks assessing users and optimizing all perioperative areas (scheduling, day of surgery, postop discharge/admission). Elbow-to-elbow retraining and simultaneous content development was performed utilizing an Agile workflow process optimization with the Scrum framework. This iterative approach averaged 1 week from build to change implementation. Pre/post optimization surveys were sent.

RESULTS

Two hundred forty-two perioperative enhancements were completed. While most impacted documentation, all areas were enhanced including billing, reporting, registration, device integration, scheduling, central supply, and so on. FCOTS improved from <70% to >85% and total delay was halved. These parameters were consistently sustained for over 1 year after the 6-week optimization. While only 5% of pre-optimization users agreed to proficiency in the EHR system, this improved to 70% post-optimization. Furthermore, EHR confidence and acceptance improved from 40% to 90%.

CONCLUSIONS

To improve workflow efficiency, all who contribute to the perioperative process must be assessed. This IT driven initiative resulted in improved FCOTS, perioperative workflows, and user satisfaction.

Social determinants of health score: does it help identify those at higher cardiovascular risk?

OBJECTIVES

Cardiovascular disease (CVD) continues to disproportionately affect disadvantaged populations, leading to calls to address social determinants of health (SDOH) as a preventive strategy. Our aim is to create a weighed SDOH score and to test the impact of each SDOH factor on the Framingham risk score (FRS) and on individual traditional CVD risk factors.

STUDY DESIGN

We conducted a retrospective cohort study.

METHODS

We included patients seen at a primary care clinic at UHealth/University of Miami Health System who answered a SDOH survey between September 16, 2016, and September 10, 2017. The survey included SDOH domains recommended by the American Heart Association position statement and by the National Academy of Medicine. We selected the FRS as well as all traditional CVD risk factors as our outcome metrics.

RESULTS

We included 2876 patients. The mean (SD) age of our cohort was 53.8 (15.8) years, 61% were female, 9% were Black, 38% were Hispanic, and 87% reported speaking English. The statistically significant β coefficients in the FRS model corresponded to being born outside of the United States, being a racial minority, living alone, having a high social isolation score, and having a low geocoded median household income (P < .01). Increasing quartile of SDOH score was significantly associated with higher systolic blood pressure, FRS, glycated hemoglobin, and smoking pack-years (P < .05). It was also associated with fewer minutes spent exercising weekly (P < .01).

CONCLUSIONS

The addition of self-reported SDOH data has a dose effect on CVD risk factors. Future studies should address how to intervene to address social factors.

Association of Plasma Oligomerized Beta Amyloid with Neurocognitive Battery Using Korean Version of Consortium to Establish a Registry for Alzheimer's Disease in Health Screening Population

The increasing prevalence of Alzheimer’s disease (AD) has become a global phenomenon presenting serious social and health challenges. For detecting early molecular changes in the disease, several techniques to measure varied species of amyloid beta in the peripheral blood have been recently developed, but the efforts to associate them with cognitive assessments have yet to produce sufficient data. We prospectively collected participants from the consecutive population who visited our center for brain health screening. In total, 97 participants (F:M = 58:39) aged 69.4 ± 7.52 were assessed. Participants performed the Korean version of the Consortium to Establish a Registry for Alzheimer’s disease (CERAD-K), the clinical dementia rating (CDR), plasma oligomeric amyloid-β (OAβ) level tests, routine blood tests, ApoE genotype, and brain MRI. Among total population, 55.7% had a CDR of 0, and 40.2% had a CDR of 0.5. The results showed that word memory and word recall, and the total scores of the CERAD-K were negatively correlated with the plasma OAβ level. With a cut-off value of 0.78 ng/mL for the OAβ level and a −1.5 standard deviation of age/sex/education adjusted norms for the CERAD-K; naming, word memory, word recall, word recognition, and total score were significantly correlated with the OAβ level. No correlation between the OAβ level and mini-mental status examination was found. Our results demonstrate that the level of plasma OAβ was well correlated with the measure of cognitive function through the CERAD-K in the field data collected from consecutive populations. Studies on longitudinal comparisons with large cohorts will further validate the diagnostic value of plasma OAβ as a useful biomarker for screening AD and predicting progression.

Abstract 3196: Combination immunotherapy with PD-1 and CXCR4 blockade activates antitumor immunity against pancreatic neuroendocrine tumors

Introduction: Although pancreatic neuroendocrine tumors (PNET) are less common and less deadly than pancreatic adenocarcinoma, they remain a considerable source of morbidity and mortality. The cases increasingly discovered due to advanced cross sectional imaging and the majority of PNETs are malignant when diagnosed. Immunotherapy for PNET has not yet been successfully demonstrated, although we and others have previously shown that they often contain robust T cell infiltrates. We hypothesized that combined immunotherapy could reactivate endogenous antitumor activity in organotypic tumor slice cultures of human PNET.

Methods: Human PNET tumors were collected from the operating room and 250μm slices were cut using a vibratome and place on 0.4μm pore size membrane inserts (6 tumors). Slice culture survival testing was conducted using immunohistochemistry (IHC), the 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) assay, or live immunofluorescence imaging. To test the combining immunotherapeutic effects, slices were treated with a PD-1 blocking monoclonal antibody or isotype control, with or without the CXCR4 inhibitor, AMD3100. For time-lapse live imaging, slices were stained with fluorescently conjugated antibodies for CD8 and EpCAM, as well as a reagent that binds to activated caspase 3/7 enzymes to indicate induction of apoptosis. The live slice was first imaged alone to serve as a non-treated control, then anti-PD1 antibody and AMD3100 were applied, and the slice imaged immediately afterward to monitor response after treatment.

Results: We confirmed that cultured slices maintain their baseline morphology and architecture over 9 days in culture. The MTT assay showed stable metabolic activity over the same period. The demonstration of the live and dynamic microenvironment was performed first via live multicolor IF including PNET cells (EpCAM+) and immune cells (both CD45+ and CD4+ cells) within the microenvironment. IHC demonstrated 10% or 12% increased of cleaved-Caspase-3+ cells with combined PD-1 and CXCR4 blockade, as compared to control, after 2 days or 7 days in culture. To confirm the role of cytotoxic T cells, live stained slices were imaged before and after addition of PD-1 blockade and AMD3100. We demonstrated that caspase activation was increased in EpCAM+ cells proximal to CD8+ T cells immediately following combination drug treatment. Furthermore, CD8+ cells proximity to EPCAM+ cells (&lt;20 µm) was significantly increased after addition of PD-1 blockade and AMD3100. There was no difference in the proportion of apoptotic EpCAM+ cells that did not have a CD8+ cell nearby, suggesting that apoptosis induction is specifically due to cytotoxic T cell function.

Conclusion: Our study demonstrates that combination PD-1 and CXCR4 blockade enhances CD8+ T cell migration and antitumor activity in human PNET tumor slice cultures.

Citation Format: Xiuyun Jiang, Kevin Sullivan, Kevin Labadie, Sara K. Daniel, David Seo, Arezou Abbasi, Teresa Kim, Raymond Yeung, Venu Pillarisetty. Combination immunotherapy with PD-1 and CXCR4 blockade activates antitumor immunity against pancreatic neuroendocrine tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3196.

Sealing of superior semicircular canal dehiscence is associated with improved balance outcomes postoperatively versus plugging of the canal in middle fossa craniotomy repairs: a case series

OBJECTIVE

The authors compared postoperative symptoms between patients with sealed and those with plugged semicircular canal dehiscence repairs.

METHODS

In total, 136 ears from 118 patients who underwent surgical repair for semicircular canal dehiscence were identified via chart review. Data from postoperative MRI scans showing preservation or loss of semicircular canal fluid signal and postoperative reports of autophony, amplification, aural fullness, tinnitus, hyperacusis, hearing loss, vertigo, dizziness, disequilibrium, oscillopsia, and headache were amalgamated and analyzed.

RESULTS

Patients with preservation of fluid signal were far less likely to have dizziness postoperatively (p = 0.007, OR 0.158, 95% CI 0.041-0.611). In addition, these patients were more likely to have tinnitus postoperatively (p = 0.028, OR 3.515, 95% CI 1.145-10.787).

CONCLUSIONS

The authors found that superior semicircular canal dehiscence patients who undergo sealing without plugging have improved balance outcomes but show more tinnitus postoperatively than patients who undergo plugging.

Provider Perspectives on the Collection of Social Determinants of Health

Social determinants of health (SDH) impact health outcomes. Medical centers have begun to collect SDH data, urged by government and scientific entities. Provider perspectives on collecting SDH are unknown. The aim is to understand differences in views and preferences according to provider characteristics. A cross-sectional survey of University of Miami clinical faculty was conducted in late 2016. The survey contained 11 questions: 8 demographic and departmental responsibilities questions and 3 Likert scale questions to capture collection and use of SDH perspectives. The main outcome was whether providers thought the benefit of collecting SDH outweighs the burden and risks. In all, 240 faculty members were included. The majority were men (64%), with a mean age of 51 years. Among participants, 53.5% were non-Hispanic white, 32% were Hispanic, 5% were Black/African American, and 5% were Asian. The majority agreed that SDH are important predictors of health outcomes and quality of care (83%). When comparing minority to nonminority faculty, 25% believed that SDH should only be available to PCPs, compared to 8% of nonminorities (P < 0.01). In a multivariate model, belonging to a racial ethnic minority was the only characteristic associated with believing that benefits of collecting SDH outweigh the risks (odds ratio 1.87, 95% confidence interval 1.02- 3.5) after adjusting for age, sex, minority status, health care provider type, type of responsibilities, and department. This study reveals that although most providers of a health system believe social risks impact health outcomes and quality metrics, the buy-in to collect SDH varies according to the racial/ethnic composition of the faculty.

Coronary collateralization shows sex and racial-ethnic differences in obstructive artery disease patients

Background

Coronary collateral circulation protects cardiac tissues from myocardial infarction damage and decreases sudden cardiac death. So far, it is unclear how coronary collateralization varies by race-ethnicity groups and by sex.

Methods

We assessed 868 patients with obstructive CAD. Patients were assessed for collateral grades based on Rentrop grading system, as well as other covariates. DNA samples were genotyped using the Affymetrix 6.0 genotyping array. To evaluate genetic contributions to collaterals, we performed admixture mapping using logistic regression with estimated local and global ancestry.

Results

Overall, 53% of participants had collaterals. We found difference between sex and racial-ethnic groups. Men had higher rates of collaterals than women (P-value = 0.000175). White Hispanics/Latinos showed overall higher rates of collaterals than African Americans and non-Hispanic Whites (59%, 50% and 48%, respectively, P-value = 0.017), and especially higher rates in grade 1 and grade 3 collateralization than the other two populations (P-value = 0.0257). Admixture mapping showed Native American ancestry was associated with the presence of collaterals at a region on chromosome 17 (chr17:35,243,142-41,251,931, β = 0.55, P-value = 0.000127). African ancestry also showed association with collaterals at a different region on chromosome 17 (chr17: 32,266,966-34,463,323, β = 0.38, P-value = 0.00072).

Conclusions

In our study, collateralization showed sex and racial-ethnic differences in obstructive CAD patients. We identified two regions on chromosome 17 that were likely to harbor genetic variations that influenced collateralization.

Abstract 3692: Long-lived pancreatic ductal adenocarcinoma slice cultures enable precise study of the immune microenvironment

Introduction

Pancreatic ductal adenocarcinoma (PDA) remains a deadly disease that is rarely cured. Given the recent successes with immunotherapy for other malignancies and the fact that PDA is heavily infiltrated by effector T cells, we postulate that accurate modeling of the PDA immune microenvironment would allow us to unveil mechanisms of immunosuppression that could be overcome for therapeutic benefit.

Methods

PDA tumors were collected from the operating room and transported in cold media to the laboratory, where 250μm slices were cut using a vibratome and placed on 0.4μm pore size membrane inserts pre-coated with collagen gel and culture. Proliferation was measured using MTT assay and weight-adjusted optical density. Slices were fixed in 4% PFA for imaging after live immunofluorescence (IF) staining or for subsequent immunohistochemistry (IHC) prior to imaging. For proteomic analysis, slices were digested with trypsin and analyzed by mass spectrometry. To assess for immune cell migration into the tumor slices, isolated autologous splenocytes were stained with CFSE and added to the slice culture and imaged using IF after 6 days.

Results

Using light microscopy, we confirmed that cultured slices maintain their baseline morphology, architecture and surface area over 9 days in culture. The MTT assay showed stable growth over the same period; IHC for Ki-67 and cleaved Caspase-3 corroborated a similar pattern of proliferation and apoptosis after 6 days culture when compared to day 1. T cells (CD3+, CD8+ and FOXP3+), macrophages (CD68+, CD163+, and HLA-DR+), and stromal myofibroblasts (αSMA+) were confirmed to be present through day 6 using IHC. Quantitative proteomic analysis of over 3000 proteins showed that only 2-3% of proteins showed significant changes of abundance greater than 2 fold after 6 days in culture. However, when slice were challenged with cytotoxic drugs (staurosporine and cyclohexamide), there was a time- and dose-dependent response in proliferation and apoptosis compared with controls.

The demonstration of the live and dynamic microenvironment was performed first via live multicolor IF including PDA cells (EpCAM+), fibroblasts (fibronectin+) and immune cells (both CD11b+ and CD8+ cells) within the microenvironment. Furthermore, co-culture of CFSE-labeled splenocytes on top of slices for 6 days. Z-stacked live confocal imaging confirmed their migration from the surface into the slice microenvironment.

Conclusion

Our study demonstrates that the PDA slice culture maintains original tumor microenvironment, and overall proteomic production and dynamic function response in vitro. The slice culture model thus represents a novel platform to evaluate both pharmaceutical and cell-based immunotherapies for mechanisms of action and potential synergism, effects on specific cell types of the microenvironment, and tumor-specific immunogenic potential.

Citation Format: Xiuyun Jiang, David Seo, Jae Chang, Eslam Nigjeh, Sheng Pan, Florencia Jalikis, Venu Pillarisetty. Long-lived pancreatic ductal adenocarcinoma slice cultures enable precise study of the immune microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3692. doi:10.1158/1538-7445.AM2017-3692

Electrostatic Screening of Charged Defects in Monolayer MoS2

Defects in monolayer transition-metal dichalcogenides (TMDCs) may lead to unintentional doping, charge-carrier trapping, and nonradiative recombination. These effects impair electronic and optoelectronic technologies. Here we show that charged defects in MoS₂ monolayers can be effectively screened when they are in contact with an ionic liquid (IL), leading to an increase in photoluminescence (PL) yield by up to two orders of magnitude. The extent of this PL enhancement by the IL correlates with the brightness of each pretreated sample. We propose the existence of two classes of nonradiative recombination centers in monolayer MoS₂: (i) charged defects that relate to unintentional doping and may be electrostatically screened by ILs and (ii) neutral defects that remain unaffected by the presence of ILs.

Novel deletion mutation of HLA-B*40:02 gene in acquired aplastic anemia

Despite prevalence of clonal evolution in patients with aplastic anemia (AA), somatic mutation of human leukocyte antigen (HLA) gene is rarely reported. Herein, we reported a case of acquired AA (aAA) harboring a new four-base-pair deletion mutation within exon 4 of HLA-B*40:02 leading to frameshift and premature stop codon. The HLA-B*40:02 mutant allele was detected in the patient's peripheral blood sample not in patient's buccal epithelial cells. The patient received allogenic hematopoietic stem cell transplantation (HSCT) from HLA-matched sibling donor. On day 30 after HSCT, the mutant HLA allele was not detected by high-resolution sequence-based HLA typing. Serial chimerism analyses showed mixed chimeric status indicative of coexisting donor and recipient hematopoietic cells. Our data could provide additional support in view of pathophysiology of aAA that somatic mutation of HLA-B*40:02 allele is one of the possible origin of clonal escape to evade immune attack in patient with aAA.

Food image-induced brain activation is not diminished by insulin infusion

Background/Objective

The obesity epidemic appears to be driven in large part by our modern environment inundated by food cues, which may influence our desire to eat. While insulin decreases food intake in both animals and humans, the effect of insulin on motivation for food in the presence of food cues is not known. Therefore, the aim of this study was to evaluate the effect of an intravenous insulin infusion on the brain response to visual food cues, hunger and food craving in non-obese human subjects.

Subjects/Methods

Thirty-four right-handed healthy non-obese subjects (19F/15M, age: 29±8 yrs.; BMI: 23.1±2.1 kg/m2) were divided in two groups matched by age, and BMI: the Insulin Group (18 subjects) underwent a hyperinsulinemic-euglycemic-clamp, and the control group (16 subjects) received an intravenous saline infusion, while viewing high and low-calorie food and non-food pictures during a functional MRI scan. Motivation for food was determined via analogue scales for hunger, wanting and liking ratings.

Results

Food images induced brain responses in the hypothalamus, striatum, amygdala, insula, ventromedial prefrontal cortex (PFC), dorsolateral PFC, and occipital lobe (whole brain correction, P<0.05). Wanting (P<0.001) and liking (P<0.001) ratings were significantly higher for the food than the non-food images, but not different between insulin and saline infusion groups. Hunger ratings increased throughout the MRI scan and correlated with preference for high-calorie food pictures (r=0.70; P<0.001). However neither brain activity nor food craving were affected by hyperinsulinemia or hormonal status (leptin and ghrelin levels) (P=NS).

Conclusion

Our data demonstrate that visual food cues induce a strong response in motivation/reward and cognitive-executive control brain regions in non-obese subjects, but that these responses are not diminished by hyperinsulinemia per se. These findings suggest that our modern food cue saturated environment may be sufficient to overpower homeostatic hormonal signals, and thus contribute to the current obesity epidemic.

Utility of blood pressure genetic risk score in admixed Hispanic samples

Hypertension is strongly influenced by genetic factors. Although hypertension prevalence in some Hispanic sub-populations is greater than in non-Hispanic whites, genetic studies on hypertension have focused primarily on samples of European descent. A recent meta-analysis of 200,000 individuals of European descent identified 29 common genetic variants that influence blood pressure, and a genetic risk score derived from the 29 variants has been proposed. We sought to evaluate the utility of this genetic risk score in Hispanics. The sample set consists of 1994 Hispanics from two cohorts: the Northern Manhattan Study (primarily Dominican/Puerto Rican) and the Miami Cardiovascular Registry (primarily Cuban/South American). Risk scores for systolic and diastolic blood pressure were computed as a weighted sum of the risk alleles, with the regression coefficients reported in the European meta-analysis used as weights. Association of risk score with blood pressure was tested within each cohort, adjusting for age, age squared, sex, and BMI. Results were combined using an inverse-variance meta-analysis. The risk score was significantly associated with blood pressure in our combined sample (p = 5.65 × 10⁻⁴ for systolic and p = 1.65 × 10⁻³ for diastolic) but the magnitude of the regression coefficients varied by degree of European, African, and Native American admixture. Further studies among other Hispanic sub-populations are needed to elucidate the role of these 29 variants and identify additional genetic and environmental factors contributing to blood pressure variability in Hispanics.

Abstract 220: Reduction in Atherosclerosis Plaque by Intravenous Injections of Engineered Bone Marrow Stem Cells With Low Notch Activity in Apo E-/- Mice

Objectives: We test a novel paradigm in the pathogenesis of atherosclerosis as an imbalance in the pro-repair function of circulating bone marrow-derived stem cells (BMDSC) that can be modulated by Notch activity.

Methods: Significance Analysis of Microarray (SAM) and PCRArray/immunoblotting were used to study Notch activity in empirically-derived repair-competent versus repair-incompetent BMDSC (RC-BMDSC vs. RI-BMDSC). In parallel experiments, BMDSC with low-Notch activity were generated by transducing cells with dominant-negative Master-mind like 1 (DN-MAML1)/lentivirus (Notch-inhibited). Mock/lentivirus transduced cells were used as control. 5 x 10^6 Lin- BMDSC were infused bi-weekly for 4 consecutive weeks i.v. into Apo E -/- mice under high fat diet (HFD); (N=5/group). Atherosclerosis plaque burden was assessed using Oil Red O staining and blinded computerized quantitative measurements.

Results: Of 289 genes with differential expression in RC-BMDSC vs. RI-BMDSC, by SAM, Notch1 expression was significantly elevated in RI-BMDSC compared to RC-BMDSC, p<0.0009. Notch activity was higher in BMDSC (EPC and MSC) from ApoE-/- mice before initiation of HFD (Notch target genes, Hes-1 and Hey-1, with 6.6- and 8.2-fold higher expression, respectively (p<0.05)). Compared to mice infused with control Lin-BMDSC, ApoE-/- mice treated with DN-MAML1/Lin-BMDSC had significantly decreased aortic plaque burden (p<0.05).

Conclusions: For the first time we demonstrate a direct correlation between Notch activity and pro-repair function in BMDSC that modulates atherosclerosis plaque burden. Lower Notch activity in BMDSC appears to confer a pro-repair or repair-competent BMDSC phenotype. These novel findings provide rationale for further studies into clinically-relevant cell-based therapy for atherosclerosis.

Cardiac performance, biomarkers and gene expression studies in previously sedentary men participating in half-marathon training

Background

The mechanisms through which exercise reduces cardiovascular disease are not fully understood. We used echocardiograms, cardiac biomarkers and gene expression to investigate cardiovascular effects associated with exercise training.

Methods

Nineteen sedentary men (22–37 years) completed a 17-week half-marathon training program. Serial measurements of resting heart rate, blood pressure, maximum oxygen consumption, lipids, C-reactive protein, cardiac troponin T, echocardiograms and blood for gene expression were obtained from baseline to peak training. Controls included 22 sedentary men who did not exercise.

Results

Among the training group, VO₂ max increased from 37.1 to 42.0 ml/kg/min (p < 0.001). Significant changes were seen in left ventricular wall thickness and mass, stroke volume, resting heart rate and blood pressure (p < 0.001). The control group demonstrated no significant changes. Expression profiling in the training group identified 10 significantly over-expressed and 53 significantly under-expressed loci involved in inflammatory pathways. Dividing the training group into high and low responders based on percent change in VO₂ max identified loci that differentiated these two groups at baseline and after training.

Conclusion

Intensive exercise training leads to significant increase in cardiac and hemodynamic performance, and significant changes in expression of genes involved in immune and inflammatory response.

Genomic signatures of a global fitness index in a multi-ethnic cohort of women

The rates of obesity and sedentary lifestyle are on a dramatic incline, with associated detrimental health effects among women in particular. Although exercise prescriptions are useful for overcoming these problems, success can be hampered by differential responsiveness among individuals in cardiovascular fitness indices (i.e. improvements in strength, lipids, VO(2) max). Genomic factors appear to play an important role in determining this inter-individual variation. We performed microarray analyses on mRNA in whole blood from 60 sedentary women from a multi-ethnic cohort who underwent 12 weeks of exercise, to identify gene subsets that were differentially expressed between individuals who experienced the greatest and least improvements in fitness. We identified 43 transcripts in 39 unique genes (FDR<10%; FC>1.5) whose expression increased the most in "high" versus "low" pre-menopausal female responders. These 39 genes were enriched in six biological pathways, including oxidative phosphorylation (p = 8.08 × 10(-3)). Several of the 39 genes (i.e. TIGD7, UQCRH, PSMA6, WDR12, TFB2M, USP15) have previously reported associations with fitness-related phenotypes. In summary, we identified gene signatures based on mRNA analysis that define responsiveness to exercise in a largely minority-based female cohort. Importantly, this study validates several genes/pathways previously associated with exercise responsiveness and extends these findings with additional novel genes.

Will periodic intravenous injections of conditioned bone marrow cells effectively reduce atherosclerosis?

Maintenance of healthy arteries requires a balance between injuries to the arterial wall and processes of intrinsic arterial repair. Such repair requires the availability of progenitor cells that are local to the wall itself. Progenitor cells from distant reservoirs like the bone marrow may also contribute to repair. Arterial repair seems to degrade over a lifetime, particularly with risk factors such as smoking and diabetes. Hence, a potential preventive/therapeutic strategy for atherosclerosis could be transfusion of competent bone marrow cells (BMCs) to restore effective repair in the face of arterial injury and depleted endogenous repair reservoirs. The challenge with this strategy has been the reliable collection and/or generation of BMCs that support arterial repair. In this study, we describe a set of experiments to elucidate a method of culturing BMCs that robustly retards atherosclerosis development in apolipoprotein E knockout mice. Identifying such a method would represent an important step in developing cell-based treatments for patients with proclivity for developing atherosclerosis.

Abstract P180: Comparison of the Framingham Risk Score With Coronary Artery Disease Burden in Hispanics

Background: The Framingham risk score (FRS) predicts the 10-year risk of having a myocardial infarction (MI). However, the accuracy of the FRS in hispanics has not been throughly evaluated. We compared coronary artery disease (CAD) severity with FRS by ethnic groups in patients undergoing cardiac catheterization.

Methods: We performed a cross-sectional analysis of 178 consecutive patients who were referred for elective coronary angiography at Jackson Memorial Hospital in Miami. We measured the components of the FRS and evaluated ethnicity by self-report. We evaluated CAD severity based on the coronary angiography results. We defined severe CAD if the patients had >= 70% luminal obstruction in a vessel or >=50% in the left main coronary artery. We also evalauted severity as a continuos score of the number of vessels with narrowings>=50%. We calculated the median and interquartile range (IQR) of FRS and correlated with the CAD severity and the p-value for trend as well as analysis of variance to determine if FRS differed by ethnicity adjusted for confounders.

Results: We identified 110 patients who identified as Hispanic and 68 patients identified as non-hispanics. At baseline, Hispanics had a mean FRS of 10.0±3.8 and non-Hispanics had a mean FRS of 10.3±5.9 (p=0.70). In Hispanics the median FRS for patients with >= 70% stenosis was 10% (IQR 8.5-13) compared to <70% stenosis 9 % (IQR 5-13). In non-Hispanics with >= 70% stenosis the median FRS was 12.5% (IQR 10-16) compared to those with <70% stenosis 8 % (IQR 4-11). The same differences were seen when using >=50% stenosis (table).

Conclusions: The FRS does not correlate with coronary artery disease severity in Hispanics but does correlate with CAD severity in non-Hispanics.

Discovery of biomarker candidates for coronary artery disease from an APOE-knock out mouse model using iTRAQ-based multiplex quantitative proteomics

Due to the lack of precise markers indicative of its occurrence and progression, coronary artery disease (CAD), the most common type of heart diseases, is currently associated with high mortality in the United States. To systemically identify novel protein biomarkers associated with CAD progression for early diagnosis and possible therapeutic intervention, we employed an iTRAQ-based quantitative proteomic approach to analyze the proteome changes in the plasma collected from a pair of wild-type versus apolipoprotein E knockout (APOE(-/-) ) mice which were fed with a high fat diet. In a multiplex manner, iTRAQ serves as the quantitative 'in-spectra' marker for 'cross-sample' comparisons to determine the differentially expressed/secreted proteins caused by APOE knock-out. To obtain the most comprehensive proteomic data sets from this CAD-associated mouse model, we applied both MALDI and ESI-based mass spectrometric (MS) platforms coupled with two different schemes of multidimensional liquid chromatography (2-D LC) separation. We then comparatively analyzed a series of the plasma samples collected at 6 and 12 wk of age after the mice were fed with fat diets, where the 6- or 12-wk time point represents the early or intermediate phase of the fat-induced CAD, respectively. We then categorized those proteins showing abundance changes in accordance with APOE depletion. Several proteins such as the γ and β chains of fibrinogen, apolipoprotein B, apolipoprotein C-I, and thrombospondin-4 were among the previously known CAD markers identified by other methods. Our results suggested that these unbiased proteomic methods are both feasible and a practical means of discovering potential biomarkers associated with CAD progression.

Molecular targeting of CSN5 in human hepatocellular carcinoma: a mechanism of therapeutic response

Development of targeted therapy for hepatocellular carcinoma (HCC) remains a major challenge. We have recently identified an elevated expression of the fifth subunit of COP9 signalosome (CSN5) in early HCC as compared to dysplastic stage. In the present study, we explored the possibility of CSN5 being a potential therapeutic target for HCC. Our results show that CSN5 knockdown by small interfering (si) RNA caused a strong induction of apoptosis and inhibition of cell cycle progression in HCC cells in vitro. The downregulation of CSN5 was sufficient to interfere with CSN function as evidenced by the accumulation of neddylated Cullin1 and changes in the protein levels of CSN controlled substrates SKP2, p53, p27 and NF-kB, albeit to a different degree depending on the HCC cell line, which could account for the CSN5 knockdown phenotype. The transcriptomic analysis of CSN5 knockdown signature showed that the anti-proliferative effect was driven by a common subset of molecular alterations including downregulation of CDK6 and ITGB1, which were functionally interconnected with key oncogenic regulators MYC and TGFβ1 involved in the control of proliferation, apoptotic cell death and HCC progression. Consistent with microarray analysis, western blotting revealed that CSN5 depletion increased phosphorylation of Smad 2/3, key mediators of TGFβ1 signaling, decreased the protein levels of ITGB1, CDK6, and cyclin D1 and caused reduced expression of anti-apoptotic Bcl-2 while elevating the levels of pro-apoptotic Bak. A chemically modified variant of CSN5 siRNA was then selected for in vivo application based on the growth inhibitory effect and minimal induction of unwanted immune response. Systemic delivery of the CSN5 3/8 variant by stable-nucleic-acid-lipid-particles (SNALP) significantly suppressed the tumor growth in Huh7-luc⁺ orthotopic xenograft model. Taken together, these results indicate that CSN5 plays a pivotal role in HCC pathogenesis and maybe an attractive molecular target for systemic HCC therapy.