Generation of two iPSC lines from patient with Mucopolysaccharidosis IV B type and autosomal recessive non-syndromic hearing loss 12

We generated two human induced pluripotency stem cell (hiPSC) lines, RCMGi011-A and 11-B, from skin fibroblast from patient with Mucopolysaccharidosis IV B type and autosomal recessive non-syndromic hearing loss 12 using non-integrating, viral CytoTune™-iPS 2.0 Sendai Reprogramming Kit. We verified variant c.808 T > G and insertion in GLB1 gene, as well as two mutations, c.6992 T > C and c.805C > T, in CDH23 gene which lead to autosomal recessive hearing loss type 12. We have demonstrated normal karyotype of hiPSCs and capacity for cell differentiation into three germ layers.

Factors influencing kidney transplantation rates: a study from the ERA Registry

BACKGROUND

Large international differences exist in kidney transplantation (KT) rates. We aimed to investigate which factors may explain the total, deceased donor, and living donor KT rates over the last decade.

METHODS

KT experts from 39 European countries completed the Kidney Transplantation Rate Survey on measures and barriers and their potential effect on the KT rate in their country. In the analyses, countries were divided into low, middle, and high KT rate countries based on the KT rate at the start of study period in 2010.

RESULTS

Experts from low KT rate countries reported more frequently to have taken measures regarding staff, equipment and facilities to increase total KT rate compared with middle and high KT rate countries. For donor type specific KT, the largest international differences in measures taken were reported for deceased donor KT, with middle and high KT rate countries taking more measures, such as the use of expanded criteria donor kidneys, the presence of transplantation coordinators, and (inter)national exchange of donor kidneys. Once a measure was taken, experts' opinion on its success was similar across the low, middle and high KT rate countries. Experts from low KT rate countries more often reported potential barriers, such as patients' lack of knowledge and distrust in the health care system.

CONCLUSIONS

In particular in low KT rate countries, KT rate might be stimulated by optimizing staff, equipment, and facilities. In addition, all countries may benefit from deceased and living donor specific measures.

O-209 Separating spermatozoa from debris, non-germ and red blood cells during differential centrifugation as a new effective approach of sperm recovery from surgically-retrieved specimens

Study question

What is a more efficient method to separate spermatozoa from debris, non-germ and red blood cells in surgically-retrieved testicular and epididymal specimens?

Summary answer

The newly method  based on differential centrifugation is able to recover a pure fraction of spermatozoa from the supernatant; no sperm are contaminated with sediment.

What is known already

Conventional methods of processing testicular and epididymal specimens are based on simple washing so that spermatozoa are contaminated with non-germ cells, large numbers of red blood cells and debris and  difficult to identify and recover from the sediment. Thus, even if the sample contains spermatozoa, it is not always possible to recover and use them for ICSI. The newly method is based on differential centrifugation, which has never been used for sperm before. Cell particles are separated according to their sedimentation rate so that spermatozoa remain in the  supernatant, whereas the sediment with extra cells and debris is removed.

Study design, size, duration

A total of 223 testicular open biopsies with microdissection (micro-TESE) was performed in patients with NOA. The recovered spermatozoa were used to fertilize the fresh spouse's oocytes (synchronous IVF cycle) and/or cryopreserved ones for delayed transfer in the IVF/ICSI program (non-synchronous IVF cycle). Surplus embryos obtained in IVF programs were cryopreserved for delayed transfer in the FET (frozen-thawed embryo transfer) programs.

Participants/materials, setting, methods

The biopsy material was first processed mechanically. In all cases, the further processing of cell suspensions was carried out by differential centrifugation, with parameters of force and time set individually (on average 200-350 g for 1-2 min, 8-12 times).

Main results and the role of chance

The microscopic examination of  cell suspensions, mechanically processed, revealed at least one spermatozoon in all fields of view in 89 patients (39.9%). The further processing of cell suspensions by differential centrifugation was 100% efficient: spermatozoa for ICSI were recovered from the testicular sample in all the 89 cases. Pregnancy occurred in 47 out of 89 patients, in 147 ART cycles (52.8% per patient, 31.9% per ART cycle).

Limitations, reasons for caution

Not applicable

Wider implications of the findings

The newly proposed method of processing cell suspensions for spermatozoa recovery is based on differential centrifugation and allows obtaining male germ cells from biopsy samples and using them for fertilization, especially if they are critically low in number and conventional methods for sperm recovery do no work or are inefficient.

Trial registration number

not applicable

SAT0539 MUCKLE-WELLS SYNDROME IN RHEUMATOLOGY PRACTICE, FAMILY CASES: FEDERAL CENTER EXPERIENCE

Background:

Muckle-Wells syndrome (MWS) is a monogenic autoinflammatory disease caused by a NLRP3 gene mutation. It is the most common variant of cryopyrin-associated periodic syndromes (CAPSs) and can be observed in rheumatology practice. It manifests itself in fever, urticaria-like rash, arthralgias/arthritides, conjunctivitis/uveitis, sensorineural hearing loss, acute-phase markers (ESR, CRP). The disease’s onset usually takes place in infancy. There are examples of family cases. Targeted therapy: interleukin-1 inhibitors (anakinra, canakinumab).

Objectives:

to provide characteristics of MWS patients, family cases in the rheumatology practice of the Federal Rheumatology Center in Russia.

Methods:

in a 10-year period (2009 to 2019), MWS was diagnosed in 42 outpatient and inpatient patients, among them were 24 children, 18 adults, and 9 family cases. All of them underwent a standard rheumatology examination, including a ECR, CRP, ophthalmologist examination, and an audiogram. A molecular genetic test of the NLRP3 gene was carried out for all patients, the diagnosis was confirmed in all of them.

Results:

Out of 18 adult patients aged between 19 and 59 years, women were prevalent (16 to 2), the onset age was 0 to 53 years, in 88,9% cases the onset took place before a patient was 18 years old. When diagnosed, the disease duration varied from 6 to 46 years. Most patients demonstrated fever, urticarial-like rash, arthralgias/arthritides, which were observed in 16 patients (88.9%), conjunctivitides were observed in 15 patients (83,3%), sensorineural hearing loss – in 8 patients (44,4%), abdominal pain, nausea, vomiting – in 4 patients, headache, dizziness – in 6 patients. There also were rare manifestations, such as: recurrent oral ulcers (8), genital ulcers (3), erythema nodosum (3), sore throat and raids on the tonsils (PFAPA-like phenotype) was observed in 2 patients. In 3 patients manifestations were triggered by cold temperature. All patients had an increased ESR and C-reactive protein concentration. Eight family cases of MWS were identified (in total 26 family members aged between 2.5 and 62 years) with a number of affected in one family ranging from 2 to 6 people of different age (8 children, 18 adults, out of which 20 were female, and 6 were male). Most patients had fever (17), urticarial-like rash (18), conjunctivitides (12), oral ulcers (7), articular syndrome (14), sensorineural hearing loss (5), and 2 patients died of renal insufficiency (probably due to amyloidosis of the kidneys). The heterozygous mutations in NLRP3 have been identified in pts: T348M (3 families), R262W (2 families), A439V (1), V198M (1), Pro294Ser (1). Ten patients received canakinumab for a period of 6 months to 6.5 years, and 5 patients received anakinra before canakinumab.

Conclusion:

MWS is an orphan autoinflammatory disease, however it sometimes can be observed in rheumatology practice. It is very important to acquire family medical history to identify affected family members and prescribe therapy in a timely manner. IL-1 inhibitors are an effective and safe treatment option for MWS patients.

Disclosure of Interests:

None declared

Microcephaly-capillary malformation syndrome: the newly reported cases

Microcephaly-capillary malformation syndrome (MICCAP: OMIM 614261) is a severe monogenic disorder inherited in an autosomal recessive manner caused by mutations in the STAMBP gene. There are less than 20 published cases of the syndrome to date. The paper reports three new cases of rare MICCAP syndrome. The cause of the disorder was confirmed in three affected individuals from two unrelated families by pedigree analysis, biochemical analysis, RFLP analysis and automated Sanger sequencing. The two brothers were homozygous for the potentially pathogenic STAMBP gene variant c.188A>G (p.Tyr63Cys). Clinical phenotype of the girl from the second family resulted from the combination of two genetic disorders: galactosemia caused by the compound heterozygosity for the pathogenic GALT gene variants (c.563A>G and c.855G>T), and MICCAP caused by the STAMBP gene variants (c.204-5c>g and с.668_669delCA), one of which originated de novo. The prevalence of microcephaly-capillary malformation syndrome in Russia is evaluated, it is one per 120,000 people (CI: 1/356 724–1/62 691). The carrier frequency is one per 173 people. The target STAMBP gene analysis makes the genetic confirmation of the MICCAP syndrome quicklier. When determining the tactics of diagnosis and therapy in each particular case, the possibility of combination of two rare genetic disorders in one patient should be considered.

P1516 Detecting right ventricular systolic dysfunction in patients with acute ST-elevation myocardial infarction: echocardiography is good enough

Background

Many recent years" studies confirm the impact of the right ventricle (RV) dysfunction on morbidity and mortality in patients with an acute ST segment elevation myocardial infarction (STEMI). Earlier echocardiography (Echo) was not accurate enough in detecting RV dysfunction. The newest Echo methods allow to directly and accurately assess the RV systolic function.

Purpose

The aim of this study was to estimate the frequency of both RV segmental and global dysfunction in patients with STEMI using three-dimensional (3D) Echo and myocardial longitudinal strain (LS).

Methods

A group of 73 patients with first-time acute STEMI of different localization was selected. A control group of 32 people was formed of healthy individuals. As a standard for determining RV systolic dysfunction, changes in the traditional Echo parameters of the RV were accepted. In our study RV 3D ejection fraction (EF) less than 49% (AUC = 0.88, p < 0.001, sens 73%, spec 78%, PPV 50%, NPV 91%) and RV free wall LS less than 24.5% (AUC = 0.95, p < 0.001, sens 88%, spec 89%, PPV 74%, NPV 96%) best predicted RV involvement in STEMI. RV involvement frequency in STEMI was analyzed in 4 levels: 1 - visual estimation only (RV segmental or global dysfunction); 2 – visually + pathologically changed conventional Echo parameters; 3 – visually + pathological conventional Echo parameters + pathological RV EF and RV LS defined by current guidelines; 4 - visually + pathological conventional Echo parameters + new pathological 3D RV EF and RV LS cut-off levels, defined in our study.

Results

RV involvement in patients with STEMI was found in 26%, if estimation was only visual (presence of segmental and/or global dysfunction). By adding in algorithm pathologically changed conventional Echo parameters, RV dysfunction was detected already in 36% of cases. New Echo parameters (3D RV EF and RV LS) added 6% more to RV involvement cases, resulting in 42% in total, if current guideline-recommended pathological cut-off levels were used. But the highest number of RV involvement cases - 62%, was reached, if visual evaluation and conventional Echo parameters were combined with 3D RV EF and RV LS, using higher pathology cut-off levels, defined in our study. This number is much closer to the data, provided by cardiac magnetic resonance and autopsy.

Conclusion

Modern echocardiography can provide greatly improved RV dysfunction diagnostics. In the case of STEMI current echocardiography methods show much closer results to the gold standard – cardiac magnetic resonance imaging and autopsy data, detecting RV involvement in more than 60% cases of acute STEMI.

What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman's Day

Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants.  In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.

[What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman's Day]

On behalf of the World Kidney Day Steering Committee Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.

What we know and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman's Day

Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically women's kidney health on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state in which acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. Various autoimmune and other conditions are more likely to impact women, with profound consequences for child bearing and the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we know and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.

What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day

Chronic kidney disease (CKD) affects approximately 10% of the world’s adult population; it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women’s Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women’s health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world’s population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, which not only offers an opportunity for diagnosis of kidney disease, but also states where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for childbearing, and on the fetus. Women have different complications on dialysis than men and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease and what we might learn in the future to improve outcomes worldwide.

Oligomeric α-synuclein and glucocerebrosidase activity levels in GBA-associated Parkinson's disease

Alpha-synuclein oligomerization plays a key role in the development of Parkinson's disease (PD). Being the most common genetic contributor to PD, glucocerebrosidase 1 (GBA) mutations have been associated with decreased GBA enzymatic activity in PD patients with mutations in the GBA gene (GBA-PD). However, it is unknown whether the activities of other lysosomal hydrolases are being altered in GBA-PD patients and are accompanied by an increase in alpha-synuclein oligomerization. The aim of our study was to estimate GBA enzymatic activity as well as the activities of five other lysosomal hydrolases (galactocerebrosidase, alpha-glucosidase, alpha-galactosidase, sphingomyelinase, alpha-iduronidase) in dried blood spots with assessing plasma oligomeric alpha-synuclein levels in sporadic PD (sPD) patients, in GBA-PD patients and in controls. GBA enzymatic activity and plasma oligomeric alpha-synuclein levels were assessed in sPD patients (N=84), in GBA-PD patients (N=21) and controls (N=62) by LC-MS/MS and ELISA methods accordingly. GBA-PD patients showed lower GBA enzymatic activity compared to controls (p=0.001) and to sPD (p=0.0001). We also found the reduction of GLA enzymatic activity (but not of other lysosomal hydrolases) in GBA-PD (p=0.001). At the same time plasma oligomeric alpha-synuclein levels were increased in GBA-PD group compared to sPD and controls (p=0.002 and p<0.0001, respectively). Our results suggest that the decrease in enzymatic activity of lysosomal hydrolases in GBA mutation carriers may contribute to PD pathogenesis by increasing the level of neurotoxic oligomeric alpha-synuclein species.

Methods for a prompt and reliable laboratory diagnosis of Pompe disease: report from an international consensus meeting

Pompe disease is an autosomal recessive disorder of glycogen metabolism caused by a deficiency of the lysosomal enzyme acid alpha-glucosidase (GAA). It presents at any age, with variable rates of progression ranging from a rapidly progressive course, often fatal by one-year of age, to a more slowly, but nevertheless relentlessly progressive course, resulting in significant morbidity and premature mortality. In infants, early initiation of enzyme replacement therapy is needed to gain the maximum therapeutic benefit, underscoring the need for early diagnosis. Several new methods for measuring GAA activity have been developed. The Pompe Disease Diagnostic Working Group met to review data generated using the new methods, and to establish a consensus regarding the application of the methods for the laboratory diagnosis of Pompe disease. Skin fibroblasts and muscle biopsy have traditionally been the samples of choice for measuring GAA activity. However, new methods using blood samples are rapidly becoming adopted because of their speed and convenience. Measuring GAA activity in blood samples should be performed under acidic conditions (pH 3.8-4.0), using up to 2 mM of the synthetic substrate 4-methylumbelliferyl-alpha-D-glucoside or glycogen (50 mg/mL), in the presence of acarbose (3-9 microM) to inhibit the isoenzyme maltase-glucoamylase. The activity of a reference enzyme should also be measured to confirm the quality of the sample. A second test should be done to support the diagnosis of Pompe disease until a program for external quality assurance and proficiency testing of the enzymatic diagnosis in blood is established.

Fluorescence of 2-aminopurine reveals rapid conformational changes in the RB69 DNA polymerase-primer/template complexes upon binding and incorporation of matched deoxynucleoside triphosphates

We have used 2-aminopurine (2AP) as a fluorescent probe in the template strand of a 13/20mer primer/template (D) to detect deoxynucleoside triphosphates (N)-dependent conformational changes exhibited by RB69 DNA polymerase (ED) complexes. The rates and amplitudes of fluorescence quenching depend hyperbolically on the [dTTP] when a dideoxy-primer/template (ddP/T) with 2AP as the templating base (n position) is used. No detectable fluorescence changes occur when a ddP/T with 2AP positioned 5' to the templating base (n + 1 position) is used. With a deoxy-primer/template (dP/T) with 2AP in the n position, a rapid fluorescence quenching occurs within 2 ms, followed by a second, slower fluorescence quenching with a rate constant similar to base incorporation as determined by chemical quench. With a dP/T having 2AP in the n + 1 position, there is a [dNTP]-dependent fluorescence enhancement that occurs at a rate comparable to dNMP incorporation. Collectively, the results favor a minimal kinetic scheme in which population of two distinct biochemical states of the ternary EDN complex precedes the nucleotidyl transfer reaction. Observed differences between dP/T and ddP/T ternary complexes indicate that the 3' hydroxyl group of the primer plays a critical role in determining the rate constants of transitions that lead to strong deoxynucleoside triphosphate binding prior to chemistry.

The NMDA receptor channel blocker memantine and opioid receptor antagonist naltrexone inhibit the saccharin deprivation effect in rats

Several drugs, such as N-methyl-D-aspartate (NMDA) receptor channel blockers (memantine), naltrexone (but not naloxone) and acamprosate, have previously been reported to attenuate the expression of the alcohol deprivation effect, a phenomenon seen as an increase in post-deprivation alcohol consumption. The present study aimed to evaluate the effects of these drugs on the development and expression of the saccharin deprivation effect in adult male Wistar rats. Memantine (13 mg/kg per day) and naltrexone (5 mg/kg, twice daily), but not naloxone (24 mg/kg per day) or acamprosate (200 mg/kg, twice daily), prevented the increase in the consumption of saccharin after a 1-week deprivation from free-choice, unlimited access to saccharin (0.1%, w/v). Taken together with the results of previous studies, these results suggest that naltrexone and memantine attenuate the expression of both the alcohol and saccharin deprivation effects.

The activity of selected RB69 DNA polymerase mutants can be restored by manganese ions: the existence of alternative metal ion ligands used during the polymerization cycle

Site specific mutants in the pol active center of RB69 DNA polymerase have been produced and studied using rapid chemical-quench techniques. Pre-steady-state kinetic analysis carried out with Mg(2+) and Mn(2+) has enabled us to divide the mutants into two groups. One group had greatly reduced k(pols) values in the presence of Mg(2+) but responded to Mn(2+) which restored the k(pol) values for the nucleotidyl transfer reaction to near wild-type levels. The other group of mutants also had lower k(pol) values, relative to that of the wild-type polymerase, but could not be rescued by Mn(2+). The behavior of these mutants was interpreted in terms of the crystal structures of the available RB69 pol complexes. Our results on the metal ion dependence of the D621A and E686A mutants, together with knowledge of the position of their side chains in two different RB69 pol conformations, suggest that these acidic residues serve as alternative ligands for the metal ions destined to occupy the A and B catalytic sites. We infer that this occurs prior to the conformational change that produces the ternary RB69 pol complex in which the A and B metal ions are ligated by D623 and D411 as the enzyme is poised for phosphoryl transfer.

Pre-steady-state kinetics of RB69 DNA polymerase and its exo domain mutants: effect of pH and thiophosphoryl linkages on 3'-5' exonuclease activity

DNA polymerases from the A and B families with 3'-5' exonucleolytic activity have exonuclease domains with similar three-dimensional structures that require two divalent metal ions for catalysis. B family DNA polymerases that are part of a replicase generally have a more potent 3'-5' exonuclease (exo) activity than A family DNA polymerases that mainly function in DNA repair. To investigate the basis for these differences, we determined pH-activity profiles for the exonuclease reactions of T4, RB69, and phi29 DNA polymerases as representatives of B family replicative DNA polymerases and the Klenow fragment (KF) as an example of a repair DNA polymerase in the A family. We performed exo assays under single-turnover conditions and found that excision rates exhibited by the B family DNA polymerases were essentially independent of pH between pH 6.5 and 8.5, whereas the exo activity of KF increased 10-fold for each unit increase in pH. Three exo domain mutants of RB69 polymerase had much lower exo activities than the wild-type enzyme and exhibited pH-activity profiles similar to that of KF. On the basis of pH versus activity data and elemental effects obtained using short double-stranded DNA substrates terminating in phosphorothioate linkages, we suggest that the rate of the chemical step is reduced to the point where it becomes limiting with RB69 pol mutants K302A, Y323F, and E116A, in contrast to the wild-type enzyme where chemistry is faster than the rate-determining step that precedes it.