FC002: Humoral and Cellular Immune Responses After a Three-Dose Course of Mrna-1273 Covid-19 Vaccine in Kidney Transplant Recipients: A Prospective Cohort Study

BACKGROUND AND AIMS

Seroconversion after a two-dose course of mRNA COVID-19 vaccination in kidney transplant recipients ranges between 30% and 50% in different series. We previously demonstrated that a substantial proportion of patients (35%) without a humoral response, develop a cellular response after the second dose assessed by the ELISpot technique. We aim to study the evolution of both humoral and cellular responses in the same cohort before and 1 month after the administration of the third dose of 100 mcg of mRNA-1273 COVID-19 vaccine.

METHOD

Final population included 129 KTRs studied at four time-points: at baseline before the first dose, after the second dose (median 42 days) and before (203 days) and after (232 days) the third dose. At all the time-points, IgG and IgM were assessed as well as N- and S-protein specific ELISpot. The main outcome was seroconversion after the third dose.

RESULTS

After the second dose, 26.7% of naïve cases experienced seroconversion. Before the third dose and in the absence of clinically evident COVID-19, this percentage increased to 61.9%. After the third dose, seroconversion was observed in 80.0% of patients. S-ELISpot positivity after the second dose was significantly associated with final seroconversion [OR (95% CI) 3.14 (1.10–8.96); P = .032], while transplantation < 1 year and previous kidney transplant were negatively associated with [OR (95% CI) 0.23 (0.07–0.80); P = .021 and OR (95% CI) 0.22 (0.06–0.78); P = .020, respectively). IgG after third dose were significantly higher (P < .001) in patients who maintained S-ELISpot positivity throughout the study (34.3%) and were correlated with S-spots after the second dose (r = 0.344, P < .001).

CONCLUSION

A substantial proportion of KTRs vaccinated with mRNA-1273 develops a late seroconversion after two doses and only a fifth remained seronegative after a third. Cellular immunity seems to play a major role in the development of a final strong humoral response.

P0664CKDSENS, A NOVEL HEALTHCARE PLATFORM FOR CHRONIC KIDNEY DISEASE

Background and Aims

The 10% of the global adult population, more than 730 million people, suffers from some degree of chronic kidney disease (CKD). From that population, a 30% is suffering from an advanced stage of the disease. Approximately 38 million of the European population is affected by an advanced stage renal disease with 1 million of new cases every year. These patients require close monitoring, which increase the burden of the disease. New tools and methods are required to improve the patients’ well-being, the perception and management of their disease, decrease the impact of the complications, as well as to delay of the progression of the disease.

Method

Seven partners have joined in the CKDSens consortium and are contributing to the project with different expertise and technical resources (medical, technological, educational, business and management): CreatSens Health SL, Hospital Clínic de Barcelona – Fundació Privada Clínic per a la Recerca Biomèdica, Genesis Biomed, Eurecat, Universitat de Barcelona, Universidad Politécnica de Madrid, and Madopa. This consortium is a novel and unique technological platform, combining in vitro diagnostic devices and software components, that connects patients with CKD and healthcare professionals to improve the well-being of people and the efficiency of the healthcare system by monitoring relevant biomarkers out of the hospital in a simple and cost- effective connected paper-based sensors. The proposal aims to increase the quality of life of CKD patients through early diagnostics, real time monitoring and personalization of therapies.

Results

The CKDSens consortium is developing a novel technological platform for real-time and low-cost diagnostics for two key biomarkers in renal diseases (creatinine and potassium), which include a new point-of-care device that allows monitoring by remote control these biomarkers. The technology has been patented for both biomarkers, and it has been transferred to CreatSens, a spinoff from Universitat Rovira i Virgili. The product integrates paper-based sensors in a drop of blood analysis, wireless connectivity and a digital platform as data analytics. The aim of the consortium is to validate the use of a new medical device as a product that can fit and truly generate value and business. Through that perspective, the optimization, manufacturing and validation of the tool and the business case will be performed as a first step, while usability, end user interaction and regulatory pathway will be developed in the second step. CKDSens will afford a novel approach to embed healthcare in daily life and routine. This new strategy implies production and commercialization for prevention and diagnose where markets are well known and validated. The aim is to mimic a well-known business model such as glucometer, translating this one into renal diseases. CKDSens has risen funding for this purpose through a grant of the European Institute of Innovation and Technology (EIT Health, ID Project 19579), and it is working to have validated this device at the end of the year. This requires also a clinical validation, which will be performed in a clinical trial in the second half of the year.

Conclusion

CKDSens consortium has been created as a novel technological platform to develop and validate a new medical device for a remote control of patients with CKD, in order to increase the quality of life of CKD patients through early diagnostics, real time monitoring and personalization of therapies. It is expected to have this device designed and validated by the end of the year 2020 and ready for further commercialization.

P0515BRD4 PROTEIN REGULATES THE RESPONSES TO HYPOXIA TRIGGERED IN THE EXPERIMENAL RENAL DAMAGE

Background and Aims

Renal hypoxia is not only one of the most common causes of acute kidney injury, but also a critical mediator in the transition to chronic kidney disease. When the kidney is exposed to an insufficient supply of oxygen to meet demand, some adaptive mechanisms are triggered by the cells to maintain homeostasis. Induction of HIF-1α transcription factor and activation of unfolded protein response (UPR) pathway, as consequence of ER dysfunction, are both essential to mediate the cell survival. The UPR pathway is regulated by three major protein sensors (IRE1α, PERK and ATF6) which under ER stress initiate the activation of the XBP1, ATF4 and ATF6 transcription factors, respectively. However, inappropriate activation of these mechanisms could lead to the enhanced transcription of genes involved in key processes in renal damage (inflammation, cell death or autophagy). On the other hand, BRD4 is an epigenetic reader that recognizes acetylated lysine residues on histone and other proteins, and mediates the binding of transcription factors to the transcriptional machinery. Our aim was to investigate whether BRD4-mediated epigenetic mechanisms could modulate the response to hypoxia triggered in acute renal damage.

Method

Tubular epithelial cell line, HK2, was cultured with thapsigargin (Tg) or in hypoxia chamber (1% O2, 5% CO2). In addition, these cells were treated with specific BET proteins inhibitors (JQ1, I-BET762) and with small interfering RNAs (siRNA BRD4, p300), or were subjected to knockdown of ATF4 and XBP1 by CRISPR/cas9 technology. Transcriptional changes were analyzed in each condition by RNA-sequencing. The binding of BRD4 to target genes and recruitment of the transcriptional machinery was analyzed by chromatin immunoprecipitation (ChIP) with specific antibodies against BRD4, RNA PolII, AcH3 and AcH4. Effect of JQ1 inhibitor was assayed in an ischemia/reperfusion injury (IRI) model, and analysis of gene expression, inflammatory cell infiltration, and epigenetic remodeling was carried out by quantitative PCR, IHQ and ChIP assay, respectively.

Results

Treatment of HK2 cells with BETs inhibitors, previously cultured with Tg or under hypoxia conditions, inhibits the gene expression of the GPR78 ER chaperon, and the XBP1 and ATF4 transcription factors modulating the downstream signaling pathways. Meanwhile, ATF6 expression remains unchanged. Gene silencing with siRNA and ChIP assays reveal that under activation of the UPR pathway or hypoxia, BRD4 recognizes acetylated histones in the GPR78, ATF4 and XBP1 promoters, recruits the pTEF-b complex and activates RNA-pol II allowing the gene transcription. Additionally, inhibition of BRD4 impairs the HIF-1α stabilization, downregulating the expression of hypoxia-induced genes. Results from whole-genome gene expression assays after stable knockdown of XBP1 and ATF4 reveal that most (86%) of the UPR genes regulated by BET proteins are dependent of XBP1 and only 32% by ATF4. Moreover, almost all genes regulated by ATF4 are also XBP1-dependent. This result may be due to the fact that ATF4 regulates IRE1α expression and thus modulates the XBP1 mRNA splicing. Administration of JQ1 in an IRI model supports that blockage of BRD4 ameliorates the renal damage (reducing BUN and creatinine levels) due to a decreased UPR activation and expression of HIF-1α target genes. As consequence, the expression of inflammatory genes and the inflammatory cell infiltration is diminished.

Conclusion

Our results show that BRD4 protein regulates two key processes, induction of HIF-1α transcription factor and UPR pathway activation triggered by renal hypoxia. Pharmacological inhibition of BET proteins reduces the activation these pathways, ameliorating renal damage and avoiding its progression.

Early transference interventions with male patients in psychotherapy

Transcripts of early sessions for 7 personality-disordered male subjects participating in an ongoing naturalistic long-term dynamic psychotherapy project were rated for therapist interventions and alliance. Early transference interpretations were followed by increased defensiveness even when there was a solid alliance. Omitting transference interpretations in the face of an early negative transference was equally problematic. However, the rapid sequence of early transference and defense interpretations, or early defense interpretations alone, enhanced therapeutic work without increasing defensiveness. Caretaking of the alliance after early interpretive work was also investigated. Two different styles of handling affect emerged from the sample.

Effectiveness of psychotherapy for personality disorders

OBJECTIVE

The authors examined the evidence for the effectiveness of psychotherapy for personality disorders in psychotherapy outcome studies.

METHOD

Fifteen studies were located that reported data on pretreatment-to-posttreatment effects and/or recovery at follow-up, including three randomized, controlled treatment trials, three randomized comparisons of active treatments, and nine uncontrolled observational studies. They included psychodynamic/interpersonal, cognitive behavior, mixed, and supportive therapies.

RESULTS

All studies reported improvement in personality disorders with psychotherapy. The mean pre-post effect sizes within treatments were large: 1.11 for self-report measures and 1.29 for observational measures. Among the three randomized, controlled treatment trials, active psychotherapy was more effective than no treatment according to self-report measures. In four studies, a mean of 52% of patients remaining in therapy recovered--defined as no longer meeting the full criteria for personality disorder--after a mean of 1.3 years of treatment. A heuristic model based on these findings estimated that 25.8% of personality disorder patients recovered per year of therapy, a rate sevenfold larger than that in a published model of the natural history of borderline personality disorder (3.7% recovered per year, with recovery of 50% of patients requiring 10.5 years of naturalistic follow-up).

CONCLUSIONS

Psychotherapy is an effective treatment for personality disorders and may be associated with up to a sevenfold faster rate of recovery in comparison with the natural history of disorders. Future studies should examine specific therapies for specific personality disorders, using more uniform assessment of core pathology and outcome.

Differential effects of interventions on the therapeutic alliance with patients with personality disorders

The goal of this study was to examine the relationship between clearly defined therapist interventions and the therapeutic alliance with personality-disordered patients. Transcripts of one psychotherapy session for each of 5 subjects taking part in a long-term psychotherapy research project were rated for therapist interventions and therapeutic alliance to determine if specific interventions were followed by enhanced or diminished therapeutic work. Transference interpretations were followed by a deterioration in the therapeutic alliance when the alliance was weak, but by enhanced work when the alliance was solid. In patients with both strong and weak alliances, defense interpretations and supportive interventions enhanced therapeutic work without increasing defensiveness. Supportive interventions seemed to prepare the way for exploration and to repair ruptured alliances.