Biological correlates of treatment resistant depression: a review of peripheral biomarkers

Introduction

Many patients fail to respond to multiple antidepressant interventions, being defined as "treatment-resistant depression" (TRD) patients. TRD is usually associated with increased severity and chronicity of symptoms, increased risk of comorbidity, and higher suicide rates, which make the clinical management challenging. Efforts to distinguish between TRD patients and those who will respond to treatment have been unfruitful so far. Several studies have tried to identify the biological, psychopathological, and psychosocial correlates of depression, with particular attention to the inflammatory system. In this paper we aim to review available studies assessing the full range of biomarkers in TRD patients in order to reshape TRD definition and improve its diagnosis, treatment, and prognosis.

Methods

We searched the most relevant medical databases and included studies reporting original data on possible biomarkers of TRD. The keywords "treatment resistant depression" or "TRD" matched with "biomarker," "inflammation," "hormone," "cytokine" or "biological marker" were entered in PubMed, ISI Web of Knowledge and SCOPUS databases. Articles were included if they included a comparison with healthy controls (HC).

Results

Of the 1878 papers identified, 35 were included in the present study. Higher plasma levels of IL-6 and TNF-α were detected in TRD patients compared to HC. While only a few studies on cortisol have been found, four papers showed elevated levels of C-reactive protein among these patients and four articles focused on immunological cells. Altered kynurenine metabolism in TRD patients was reported in two studies, while contrasting results were found with regard to BDNF.

Conclusion

Only a few biological alterations correlate with TRD. TNF-α seems to be the most relevant biomarker to discriminate TRD patients from both HC and treatment-responsive MDD patients. Moreover, several discrepancies among studies have been found, due to methodological differences and the lack of a standardized diagnostic definition of TRD.

Deep learning for asbestos counting

The PCM (phase contrast microscopy) method for asbestos counting needs special sample treatments, hence it is time consuming and rather expensive. As an alternative, we implemented a deep learning procedure on images directly acquired from the untreated airborne samples using standard Mixed Cellulose Ester (MCE) filters. Several samples with a mix of chrysotile and crocidolite with different concentration loads have been prepared. Using a 20x objective lens coupled with a backlight illumination system a number of 140 images were collected from these samples, which along with additional 13 highly fibre loaded artificial images constituted the database. About 7500 fibres were manually recognised and annotated following the National Institute for Occupational Safety and Health (NIOSH) fibre counting Method 7400 as input for the training and validation of the model. The best trained model provides a total precision of 0.84 with F1-Score of 0.77 at a confidence of 0.64. A further post-detection refinement to ignore detected fibres < 5 µm in length improves the final precision. This method can be considered as a reliable and competent alternative to conventional PCM.

A new approach to deposit homogeneous samples of asbestos fibres for toxicological tests in vitro

In this paper we describe the results obtained with a novel method to prepare depositions of asbestos fibres for toxicological tests in vitro. The technique is based on a micro-dispenser, working as an inkjet printer, able to deposit micro-sized droplets from a suspension of fibres in a liquid medium; we used here a highly evaporating liquid (ethanol) to reduce the experimental time, however other solvents could be used. Both the amount and spatial distribution of fibres on the substrate can be controlled by adjusting the parameters of the micro-dispenser such as deposition area, deposition time, uniformity and volume of the deposited liquid. Statistical analysis of images obtained by optical and scanning electron microscopy shows that this technique produces an extremely homogeneous distribution of fibers. Specifically, the number of deposited single fibres is maximized (up to 20 times), a feature that is essential when performing viability tests where agglomerated or untangled fibrous particles need to be avoided.

AB0570 CLINICAL AND IMMUNOLOGICAL MANIFESTATIONS IN SLE PATIENTS IN A THIRD LEVEL HOSPITAL IN ROSARIO, ARGENTINA

Background

Systemic lupus erythematosus (SLE) is a chronic and complex inflammatory disease which predominantly affects young females during reproductive ages. Its prognosis is worse in males, young people, Afro-American and Latin patients. Clinical and immunological features had been described around the world but few reports had been done in Argentinian patients.

Objectives

The purpose of this study was to describe the clinical and immunological pattern in SLE patients, characteristics of lupus nephritis (LN), disease male’s course of SLE, treatments and causes of hospitalization.

Methods

Retrospective study including patients (>18 years) followed in Rheumatology Department, which had unless two visits in the last year before data collection, its clinical reports were complete, and fulfilled SLICC or EULAR/ACR SLE criteria. We recorded data from the medical reports.

Results

Of the 70 patients, 63 were female (90%). The mean age at diagnosis was 27,86 ± 9,4 years. The most frequent manifestations were arthritis (75,7%), malar rash (65,7%), photosensitivity (31,4%), leukopenia (31,4%), alopecia (31,4%), Raynaud’s phenomenon (24,3%) and nasal and oral ulcerations (21,4%).

94,3% of patients were positive for antinuclear antibodies, 45,7% had anti-Ro/SSa, 28,6% anti-RNP and 21% anti-Smith. 75% had low complement and 45,7% anti-DNA antibodies.

LN occurred in the 50% of patients, and class IV was the most prevalent in this group. 66% of patients developed LN in the first year of SLE diagnosis. Autoantibodies in this manifestation were: anti-DNA 60%, anti-Ro/SSa 37%, 31% anti-RNP and 26% anti-Smith.

The most common comorbidity was high blood pressure followed by hypothyroidism (34,3% and 25,7% respectively). All patients received hydroxychloroquine and 62,9% prednisone; half of the patients who were into prednisone treatment received 5mg or less. Other treatments were cyclophosphamide (42,9%), mycophenolate (28,6%) and methotrexate (15,7%). 60% of patients had been hospitalized because of SLE flares and 15,7% due to infections. 75% of flares were due to LN and 8% because of serositis.

Is known that SLE in male patients is more aggressive and with poor prognosis. Although this study had only 7 men, 86% had LN, 29% had pericardial and pleural effusion and 29% thrombocytopenia, were we found several differences in female’s SLE presentation.

Conclusion

This study shown similar results reported in other populations. We found that 50% of SLE patients developed LN, which is the most important cause of hospitalization. Although cutaneous and musculoskeletal manifestations were the most frequent, it’s important to take into account the clinical and prognostic differences between male and female.

References

[1]Pons Estel B et al. The GLADEL, multinational Latin American prospective inception cohort of 1214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among Hispanics. Medicine 2004;83;1-17

[2]Alarcón GS, Friedman AW, Straaton KV, et al. Systemic lupus erythematosus in three ethnic groups: III. A comparison of characteristics early in the natural history of the LUMINA cohort. LUpus in MInority populations: NAture vs. Nurture. Lupus 1999;8:197–209

[3]Aringer M et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis & Rheumatology. 2019;71;1400-1412

[4]Cervera R et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period. Medicine 2003; 82: 299-308

Disclosure of Interests

None declared

AB1358 AN OLD METHOD FOR CURRENT CHALLENGES: SKIN TEST CONVERSION OF PURIFIED PROTEIN DERIVATIVE (PPD) IN RHEUMATOLOGICAL PATIENTS TREATED WITH ANTI-TNF-α

Background

Anti-TNF-α are a cornerstone for the treatment of multiple rheumatic diseases. They are associated with an increased risk of developing tuberculosis (TB), which is endemic in several countries and an important burden across the globe. Purified protein derivative (PPD) is one of the tests used to demonstrate a latent TB infection (LTBI). Screening is recommended for TB prior to the onset of anti-TNF-α and monitoring evaluating possible conversion of PPD during treatment, defined as the change from a negative (<5 mm) to positive result (≥5 mm). Identification and treatment of LTBI can reduce the risk of disease development by up to 90%. Currently the results of PPD conversion and its interpretation during anti-TNF-α treatment are variable and that is why we set out to know the frequency of conversion of PPD in this group of patients in our environment.

Objectives

To identify PPD conversion in patients with rheumatological diseases undergoing anti-TNF-α treatment.

Methods

A descriptive, analytical, observational, retrospective study was conducted from January 1, 2018 to January 1, 2022. Inclusion criteria: Patients >18 years old, diagnosed with rheumatological diseases and treated with anti-TNF-α for more than 3 consecutive months, with a negative PPD (<5 mm diameter) previous starting anti-TNF-α and a normal chest X-ray.

Results

62 patients (age 45.8 ± 12.5 years), with rheumatological diseases (41 rheumatoid arthritis, 7 juvenile idiopathic arthritis, 5 ankylosing spondylitis, 4 psoriatic arthritis, 4 uveitis and 1 interstitial keratitis) under anti-TNF-α therapy (35 adalimumab, 18 certolizumab, 9 etanercept) were included. Concomitant use of immunomodulators (52 methotrexate, 23 leflunomide, 10 hidroxicloroquine, 3 sulfasalazine, 2 azathioprine and 1 mycophenolate mofetil) and glucocorticoids (33/62) was observed. The conversion of PPD took place in 4 patients (6.5%) (Table 1).

Table 1.

“Patient’s characteristics”

SexAgeRDanti-TNF-αTime doing anti-TNF-αDMARDGCSPPDChest X-rayTB prophylaxis1Male66PsAadalimumab6 yearsmethotrexateNo5 mmNormalIsoniazid2Female56RAadalimumab10 yearsmethotrexateNo5 mmNormalIsoniazid3Female62RAadalimumab5 yearsmethotrexateYes10 mmNormalIsoniazid4Male45AScertolizumab1 yearNoNo20 mmNormalIsoniazid

AS, ankylosing spondylitis; DMARD, disease-modifying antirheumatic drugs; GCS, glucocorticosteroids; PPD, purified protein derivative; PsA, psoriatic arthritis; RA, rheumatoid arthritis; RD, rheumatological disease; TB, tuberculosis.

Conclusion

Considering the prevalence of TB in our country, this research showed a lower PPD conversion percentage compared to previous reports. Anti-TNF-α have radically changed the evolution of rheumatological diseases, considerably improving the patient’s quality of life. With the increase in the accessibility of anti-TNF-α worldwide, new challenges have arisen regarding infectious diseases such as TB, which is endemic in some countries. PPD is a well known, cheap, sensitive and widely available method, suitable for LTBI diagnosis. Although sensitivity could be increased using, in addition, other LTBI detection methods such as IGRAs (interferon gamma release assays), they are usually unavailable in developing countries (1-3).

References

[1]Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis 2017; 64(2):e1-e33.

[2]Cerda O, Correa M, Granel A, Marcos A, Giraldo C, Rillo O et al. Tuberculin test conversion in patients with chronic inflammatory arthritis receiving biological therapy. European Journal of Rheumatology. 2019;6(1):19-22

[3]Busquets-Pérez N, Ponce A, Ortiz-Santamaria V, de Agustín de Oro J, Hernández-Rico Y, Vidal I et al. How many patients with rheumatic diseases and TNF inhibitors treatment have latent tuberculosis? 2020; 13(5):282-286.

Disclosure of Interests

None declared

Mineralogical Characterization and Dissolution Experiments in Gamble's Solution of Tremolitic Amphibole from Passo di Caldenno (Sondrio, Italy)

In nature, asbestos is often associated with minerals and other non-asbestiform morphologies thought to be harmless, but not much is known about the potential toxic effects of these phases. Therefore, the characterization of natural assemblages should not be limited to asbestos fibers only. This paper combines a multi-analytical characterization of asbestos from Valmalenco (Italy) with data from dissolution experiments conducted in a simulated interstitial lung fluid (Gamble's solution), and a detailed dimensional study that compares the particle population before and after this interaction. The sample is identified as a tremolitic amphibole, exhibiting a predominance of fiber and prismatic habits at lower magnification, but a bladed habit at higher magnification. The results show that at different magnification, the dimensional and habit distributions are notably different. After the dissolution experiments, the sample showed rounded edges and pyramid-shaped dissolution pits. Chemical analyses suggested that a nearly stoichiometric logarithmic loss of Si and Mg occurred associated with a relatively intense release of Ca in the first 24 h, whereas Fe was probably redeposited on the fiber surfaces. A rearrangement of the more frequent habits and dimensions was recorded after the dissolution experiment, with a peculiar increase of the proportion of elongated mineral particles.

Impact of molecular subtypes classification concordance between preoperative core needle biopsy and surgical specimen on early breast cancer management: Single-institution experience and review of published literature

BACKGROUND

Core needle biopsy (CNB) plays a crucial role as diagnostic tool for breast cancer (BC). The characterization of biomarkers status before surgical treatment is crucial when primary systemic therapy is a therapeutic option. The aim of this analysis was to report concordance between preoperative CNB and surgical specimen (SS) in evaluating biomarkers and molecular subtypes.

METHODS

Data have been collected from a cohort of 101 patients affected by early BC treated at Careggi Florence University Hospital, between January 2014 and March 2015. The conformity between molecular subtype classification was tested using kappa (κ) test.

RESULTS

Mean age was 57.5 years (range 29-86). There was concordance between the estrogen receptor (ER) assessment on CNB and SS in 95 cases (94.1%). Concordance of the progesterone receptor (PgR) assessment was observed in 89 cases (88.1%). Concordance for detecting immunohistochemistry-assessed BC molecular subtypes was 87.1% (κ = 0.78). Concerning Ki-67 evaluation, we report a concordance rate of 88.1% (κ = 0.68). The evaluation of luminal A plus luminal B/HER negative subgroup showed a κ-value of 0.65.

CONCLUSIONS

CNB showed good accuracy in evaluating hormonal receptors status, HER2, and BC molecular subtypes. Evaluation of Ki67 status was less accurate than other biomarkers; therefore, we recommend that it should be detected both on CNB and SS samples, especially in hormonal positive HER2 negative tumors, in order to avoid a misclassification of tumor subtypes that could lead to an omission of potential effective systemic therapy.

Bite of the cats: relationships between functional integration and mechanical performance as revealed by mandible geometry

Cat-like carnivorous mammals represent a relatively homogeneous group of species whose morphology appears constrained by exclusive adaptations for meat eating. We present the most comprehensive data set of extant and extinct cat-like species to test for evolutionary transformations in size, shape and mechanical performance, that is, von Mises stress and surface traction, of the mandible. Size and shape were both quantified by means of geometric morphometrics, whereas mechanical performance was assessed applying finite element models to 2D geometry of the mandible. Additionally, we present the first almost complete composite phylogeny of cat-like carnivorans for which well-preserved mandibles are known, including representatives of 35 extant and 59 extinct species of Felidae, Nimravidae, and Barbourofelidae. This phylogeny was used to test morphological differentiation, allometry, and covariation of mandible parts within and among clades. After taking phylogeny into account, we found that both allometry and mechanical variables exhibit a significant impact on mandible shape. We also tested whether mechanical performance was linked to morphological integration. Mechanical stress at the coronoid process is higher in sabertoothed cats than in any other clade. This is strongly related to the high degree of covariation within modules of sabertooths mandibles. We found significant correlation between integration at the clade level and per-clade averaged stress values, on both original data and by partialling out interclade allometry from shapes when calculating integration. This suggests a strong interaction between natural selection and the evolution of developmental and functional modules at the clade level.

Preliminary calculations and radioprotection considerations on prompt and delayed radiation from the DD-operated Frascati Tokamak Upgrade Tokamak

This work presents a preliminary evaluation of the expected dose rate levels from prompt and delayed radiation around the Frascati Tokamak Upgrade (FTU) Tokamak machine, a future fusion experimental device operated with 2H. Great care is devoted to the machine, activation. The dose rate levels from activated materials are calculated by an ad hoc code, based on a priori semi-empirical evaluations of the neutron spectra and fluences. The most relevant nuclides contributing to the dose at different cooling times are identified. Finally, the radiation shielding design, the radiation monitoring system and the safety system are discussed.