FRI0180 SURVEY ON HELP-SEEKING AND DISEASE TRAJECTORY IN SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Few studies in Latin America have analysed the time lag since patients experience the first joint symptoms until they consult a physician, and a diagnosis is made, and most of them have dealt with patients sustaining Rheumatoid Arthritis (RA)1-2.

Objectives:

To study both patient and disease factors that have some bearing on the time lag until a physician is first consulted and a diagnosis is made.

Methods:

Multiple-choice survey to patients of 18 years of age or older who metSystemic Lupus Erythematosus (SLE) Classification Criteria (2012). The following aspects were measured:time lag from symptom onset to first medical consultation (Time 1), time lag since first medical consultation until a diagnosis is made (Time 2), and time lag until the first consultation with a rheumatologist.

Patients were interviewed at the time or within 6 months of diagnosis, and asked about the physician they first consulted and the one who made the diagnosis. They were also requested to describe one disease onset out of 4 trajectories: acute, acute with temporary remissions, chronic with partial improvements, or sustained chronic. Patients were required to recount their response to the first symptoms, the limitations brought about by the disease (employing the Steinbrocker scale), and whether help-seeking was first aimed at consulting a physician or they decided to wait. A group of patients with Rheumatoid Arthritis (RA) answered the same survey. Every patient signed an informed consent form, and the study was approved by the Hospital Bioethics Committee.

Results:

Twenty-eight patients with SLE and 29 patients with RA filled in the survey. SLE patients were younger as expected (32 years vs 49 years; p <0.001). Acute was the most common disease trajectory in SLE patients (36% vs 34%; p 0.8) and chronic in RA (38% vs 32%; p 0.8). The first professional consulted was an on-duty physician in SLE (36% vs 24% in RA; p 0.5). Except for the matter of computer at home and/or a mobile phone with an Internet connection at home, both groups were similar, although SLE patients showed a trend to better level education and lesser impact of the disease on daily life at the beginning (see Table 1).

Table 1.SLERAPn2829Education (median)SecondarySecondary0.07Had a job11 (39%)15 (52%)0.5Had health insurance8 (29%)15 (52%)0.1Had computer/mobile phone with an Internet connection25(89%)18(62)%0.04Steinbrocker (median with range 25-75%)3(2-3)3(3-4)0.06Immediately sought medical help15 (54%)16 (56%)0.9Did not know what to do when the first symptoms appeared7 (25%)13(45%)0.2Diagnosis made by a rheumatologist20 (71%)23 (80%)0.7

Time 1 in patients with SLE was significantly lower with a median of 7 days, range(25-75%)1-30 days vs 30 days in RA, range 14-180 (p 0.01), and the former also showed a trend to lower median Time 2: 81 days, range 25-209 vs 185 days in RA, range 60-275 (p 0.1). Besides, they showed a significantly shorter time lag until the first visit to a rheumatologist with a median of 120 days, range 35-225 vs 330 days, range 120-450 in patients with RA (p 0.005).

Conclusion:

SLE patients consult a physician and visit a rheumatologist sooner than RA patients do, and they also show a trend to obtain a faster diagnosis. Education, health insurance, employment, the disease impact on their daily life and initial response to the symptoms do not appear to account for their swiftness in seeking medical help.

References:

[1]Mussano E, Missakian S, Onetti CM (2007) Estudio demográficosocial de pacientes con artritis reumatoidea en la provincia de Córdoba (Argentina). Rev Argent Reumatol 4:13–22.

[2]Rodríguez-Polanco E, Al Snih S, Kuo YF et al (2011) Lag time between onset of symptoms and diagnosis in Venezuelan patients with rheumatoid arthritis. Rheumatol Int 31:657–665. doi:10.1007/s00296-009-1358-9.

Disclosure of Interests:

None declared

AB1145 PRESCRIPTION PATTERNS AND DISEASE ACTIVITY IN PORTUGUESE WOMEN OF CHILDBEARING AGE WITH RHEUMATOID ARTHRITIS, PSORIATIC ARTHRITIS, ANKYLOSING SPONDYLITIS AND JUVENILE IDIOPATHIC ARTHRITIS

Background:

Disease activity (DA) at conception is one of the main predictors of pregnancy outcomes in women of childbearing age (WoCBA) with rheumatic diseases. Teratogenicity and unawareness about pregnancy compatibility of some disease-modifying anti-rheumatic drugs might limit the choice of treatment in WoCBA.

Objectives:

To assess differences in prescription patterns between WoCBA with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and juvenile idiopathic arthritis (JIA) and comparator groups, namely postmenopausal women (PMW) and age-matched men. Evaluate DA in WoCBA comparing to the aforementioned groups.

Methods:

Observational transversal study, using data from the portuguese registry of rheumatic diseases (Reuma.pt) from 3 portuguese centers. Adult patients (pts) with the diagnosis of RA, PsA, AS or JIA were allocated to the following groups: WoCBA (aged 18–44y), young men (YM) (18–44y), PMW (≥ 45y) and matched men (≥45y). Demographic and clinical variables are described as means or frequencies. Differences between groups regarding therapy and DA were assessed with Chi-square and ANOVA tests. Linear and logistic regression models were used to find predictors of DA and prescription patterns.

Results:

2133 pts were included, 69.9% female with a mean age of 55.96±15.85 y. 1437 pts were diagnosed with RA, 305 with PsA, 254 with AS and 137 with JIA. Patterns of prescription are detailed in table 1. WoCBA were less likely to be treated with glucocorticoids than PMW (OR 0.66 95%CI 0.44-0.99). WoCBA were 1.76 times more likely to be treated with MTX than YM (95%CI 1.04-2.97). Certolizumab was specially prescribed in WoCBA (OR 13.8, 95%CI 1.4-132.8). WoCBA had significantly higher DA scores than YM (DAS28 3.03±1.39 vs 2.32±1.18 and BASDAI 3.55±2.0 vs 2.43±1.66).

Table 1.

Prescription patterns

Medications, n (%)A -WoCBA(N=256)B - Young Men(N=161)C - Post menopausal Women(N=927)D - MenN=340Chi-square testNSAIDs143 (55.9)111(68.9)472 (50.9)169 (49.7)p<0.001Glucocorticoids106 (41.4)31 (19.3)625 (67.4)154 (45.3)p<0.001csDMARDs- Methotrexate149 (58.2)60 (37.3)663 (71.5)197 (57.9)p<0.001- Leflunomide12 (4.7)4 (2.5)45 (4.9)2 (0.6)p=0.003- Sulfassalazine9 (3.5)5 (3.1)39 (4.2)9 (2.7)NS- Hydroxychloroquine36 (14.1)4 (2.5)117 (12.6)18 (5.3)p<0.001bDMARDs- Etanercept48 (18.8)29 (18.0)140 (15.1)66 (19.4)NS- Infliximab9 (3.5)11 (6.8)36 (3.9)30 (8.8)p=0.002- Adalimumab17 (6.6)15 (9.3)47 (5.1)27 (7.9)NS- Golimumab15 (5.9)18 (11.2)37 (4.0)30 (8.8)p<0.001- Certolizumab10 (3.9)0 (0)2 (0.3)2 (0.6)p<0.001- Tocilizumab12 (4.7)2 (1.2)71 (7.7)10 (2.9)p<0.001- Rituximab5 (1.9)0 (0)50 (5.4)4 (1.2)p<0.001- Abatacept0 (0)0 (0)9 (1)0 (0)NS- Secukinumab1 (0.4)4 (3.5)8 (0.9)2 (0.6)NS- Ustekinumab1 (0.4)3 (1.9)5 (0.5)0 (0)NStsDMARDs4 (1.6)1 (0.6)9 (0.9)0 (0)NS

bDMARDs – biologic disease modifying antirheumatic drugs, csDMARDs – conventional synthetic disease modifying antirheumatic drugs, NSAIDs – non-steroidal anti-inflammatory drugs, tsDMARD – targeted synthetic disease modifying antirheumatic drugs, WoCBA – women of childbearing age

Conclusion:

Certolizumab was prescribed preferentially in WoCBA, who alsoreceived more MTX than YM. Nevertheless, DA in this group was not well controlled, which may influence future pregnancy outcomes. Ensuring tight DA control in WoCBA through proper and ideally no teratogenic medication remains an unmet clinical need.

Disclosure of Interests:

None declared

Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update

BACKGROUND

Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.

METHODS

SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey.

RESULTS

The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

Effect of Comedication With Conventional Synthetic Disease-Modifying Antirheumatic Drugs on Retention of Tumor Necrosis Factor Inhibitors in Patients With Spondyloarthritis: A Prospective Cohort Study

OBJECTIVE

To evaluate whether use of comedication with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) influences the retention of tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA).

METHODS

Patients with SpA from the Rheumatic Diseases Portuguese Register who started treatment with their first TNFi between 2001 and 2014 were included in this study. Cox regression analysis was used to estimate the effect of comedication with csDMARDs on TNFi retention in 2 types of models: a model in which baseline (time-fixed) variables were included, and a second model incorporating time-varying variables, including sociodemographic features, measures of disease activity, measures of physical function, and cotreatment with other drugs (nonsteroidal antiinflammatory drugs and oral steroids). To control for possible confounding by indication, the effect of csDMARD comedication on TNFi retention was also tested after adjustment for the treatment propensity score.

RESULTS

In total, 954 patients were included in the study, of whom 289 (30.3%) discontinued treatment with their first TNFi after a median follow-up time of 2.5 years (range 0.08-13 years). Inefficacy was the most common reason for TNFi discontinuation (55.7% of patients). In the multivariable analyses, comedication with csDMARDs had no measurable effect on TNFi retention, neither in the baseline model (hazard ratio [HR] 0.83, 95% confidence interval [95% CI] 0.59-1.16) nor during follow-up in the model adjusted for time-varying covariates (HR 1.07, 95% CI 0.68-1.68). The effect of csDMARD comedication remained nonsignificant after propensity score adjustment.

CONCLUSION

Comedication with csDMARDs does not prolong TNFi retention in patients with SpA in clinical practice, suggesting that there is no benefit conferred by the concomitant use of these drugs.

Clinical features and long-term outcomes of systemic lupus erythematosus: comparative data of childhood, adult and late-onset disease in a national register

Systemic lupus erythematosus (SLE) affects predominantly women at reproductive age but may present at any age. Age at disease onset has a modulating effect on presentation and course of disease, but controversies persist regarding its impact on long-term outcome. Our aims were to characterize clinical features, co-morbidities and cumulative damage in childhood-onset, adult-onset and late-onset SLE. Patients with childhood-onset SLE fulfilling ACR 1997 criteria were identified in a nationwide register-Reuma.pt/SLE (N = 89) and compared with adult-onset and late-onset counterparts matched 1:1:1 for disease duration. 267 SLE patients with mean disease duration of 11.9 ± 9.3 years were analyzed. Skin (62 %), kidney (58 %), neurological (11 %) and hematologic involvement (76 %) were significantly more common in childhood-onset SLE and disease activity was higher in this subset than in adult- and late-onset disease (SLEDAI-2K 3.4 ± 3.8 vs. 2.2 ± 2.7 vs. 1.6 ± 2.8, respectively; p = 0.004). Also, more childhood-onset patients received cyclophosphamide (10 %) and mycophenolate mofetil (34 %). A greater proportion of women (96 %), prevalence of arthritis (89 %) and anti-SSA antibodies (34 %) were noted in the adult-onset group. There was a significant delay in the diagnosis of SLE in older ages. Co-morbidities such as hypertension, diabetes and thyroid disease were significantly more frequent in late-onset SLE, as well as the presence of irreversible damage evaluated by the SLICC/ACR damage index (20 vs. 26 vs. 40 %; p < 0.001). Greater organ involvement as well as the frequent need for immunosuppressants supports the concept of childhood-onset being a more severe disease. In contrast, disease onset is more indolent but co-morbidity burden and irreversible damage are greater in late-onset SLE, which may have implications for patients' management.

Abstract P4-09-13: Breast cancer recurrence risk: A role for the progesterone receptor isoforms

Progesterone receptor (PR) is currently used as a surrogate marker for functional estrogen receptor activity in breast cancer. Two PR isoforms have been described, PRB and PRA. PRA (94 kDa) is a truncated protein that lacks the first 164 amino acids of the NH2 terminal of PRB (115 kDa), making difficult the development of antibodies that discriminate PRA from PRB by standard immunohistochemistry (IHC). There are few studies describing the expression of PR isoforms in breast cancers. While there is a general consensus that PRA is the prevailing isoform expressed in breast cancer tissues as compared with normal mammary gland, there is controversial data regarding the association between their deregulated expression and endocrine response or aggressiveness. We are currently studying the expression of the PR isoform ratio in breast cancer samples obtained during surgical resection in order to test their antiprogestin responsiveness in tissue cultures. The study has been approved by the IRB (2012-028). Selected samples were studied by RNAseq and the data was used to analyze the PAM50 genes to predict risk of recurrence, and interestingly, almost all the genes related to proliferation were up-regulated in samples categorized as having higher levels of PRB than PRA, being also these patients those with a high risk of recurrence (May and Rojas et al., ASCO Annual Meeting, poster#11016, 2015). These observations are in agreement with data obtained in hormone resistant breast cancer xenografts with higher levels of PRB than PRA (Wargon and Riggio et al, International Journal of Cancer: 2680, 2015). The aim of this study is to evaluate a possible correlation between the PR isoform ratio, proliferation as evaluated by Ki67 or HER2 expression, and clinical outcome in selected breast cancer samples. Ki67 was evaluated by IHC using standard protocols in 80 PR+ samples. The PRA/PRB ratio was also evaluated in nuclear extracts, performed from frozen tissue, from the same patients, by Western Blot. A negative correlation was observed between the Ki67 score and the log2 value of the PRA/PRB ratio (Spearman R:-0.3418; p&lt; 0.0029). Samples were considered PRA+ if PRA/PRB ≥ 1.2 and PRB+, if PRA/PRB ≤ 0.83. Seven out of 62 PRA+ (11.29%), and 7 out of 35 (20%) of PRB+ samples were HER2+. The differences between both groups, although not significant, correlate directly with the Ki67 evaluation. The results of this ongoing project lend support to the hypothesis that the ratio of PRA/PRB is associated with prognosis and highlight the role of PR as key players regulating breast cancer growth.

Citation Format: Gass HD, May M, Rojas P, Abba M, Sequeira G, Martinez Vazquez P, Gonzalez PL, Elía A, Alvarez MM, Molinolo A, Lanari CL. Breast cancer recurrence risk: A role for the progesterone receptor isoforms. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-09-13.

Characterization of damage in Portuguese lupus patients: analysis of a national lupus registry

Background: Although the survival rate has considerably improved, many patients with systemic lupus erythematosus (SLE) develop irreversible organ damage. Objectives: The objectives of this paper are to characterize cumulative damage in SLE patients and identify variables associated with its presence and severity. Methods: A cross-sectional analysis of SLE patients from the Portuguese Lupus register Reuma.pt/SLE in whom damage assessment using the SLICC/ACR-Disability Index (SDI) was available was performed. Predictor factors for damage, defined as SDI ≥ 1, were determined by logistic regression analyses. A sub-analysis of patients with severe damage (SDI ≥ 3) was also performed. Results: In total, 976 patients were included. SDI was ≥1 in 365 patients, of whom 89 had severe damage. Musculoskeletal (24.4%), neuropsychiatric (24.1%) and ocular (17.2%) domains were the most commonly affected. Older age, longer disease duration, renal involvement, presence of antiphospholipid antibodies and current therapy with steroids were independently associated with SDI ≥ 1. The subpopulation with severe damage had, in addition, a greater interval between the first manifestation attributable to SLE and the clinical diagnosis as well as and more frequently early retirement due to SLE. Conclusions: This large lupus cohort confirmed that demographic and clinical characteristics as well as medication are independently associated with damage. Additionally, premature retirement occurs more often in patients with SDI ≥ 3. Diagnosis delay might contribute to damage accrual.

Abstract P5-09-19: Progesterone receptor isoform A as a predictive marker of antiprogestin therapy in breast cancer: A tissue culture method to evaluate drug responsiveness

Two thirds of breast cancers express steroid hormone receptors and are susceptible to an endocrine therapy usually aimed to target the estrogen receptors (ER). There is however compelling evidence suggesting that progesterone receptors (PR) participate together with ER, modulating breast cancer growth. Based on our results obtained in an experimental breast cancer model in which antiprogestins induce complete regression of carcinomas with higher levels of PR isoform A (PR-A) than isoform B (PR-B), we propose that antiprogestins such as mifepristone (MFP) might be a possible therapeutic option for patients expressing high levels of PR-A. The goal of our study is to correlate the ratio of PR isoform expression, with the in vitro responsiveness of human breast cancer samples to MFP. Preliminary studies indicated that primary cultures of breast cancer samples overexpressing PR-A were responsive to MFP (10 nM) in vitro. However, since the rate of successful primary cultures was not encouraging (7%), we decided to develop a tissue culture assay to evaluate MFP responsiveness of breast cancer samples in vitro.

Forty five breast cancer samples obtained from the General Pacheco´s Hospital, Buenos Aires, were kept in culture medium at room temperature and in dry ice. The former were cut in slices of 100 μm using a tissue chopper usually used to slice mouse nervous tissue for short incubations, and were incubated on filters in the presence of growth medium (fetal calf serum 10%) with or without MFP (10 nM), for 48 hs at 37º C. The slices were then fixed, paraffin embedded, and processed for Ki-67 staining to evaluate proliferating cells. Frozen samples were processed for Western blotting and the ratio of both PR isoforms was determined in nuclear extracts. In 17/45 (38%) of the samples valuable information was obtained. This was related with the quality (size and amount of viable cells) of the sample. The number of Ki-67 positive cells over the total viable cells was evaluated by a pathologist (M. May) in at least six different control or MFP-treated slices. From nine cases in which the Ki-67 index in control slices doubled the value obtained in MFP-treated slices (p&lt;0.05), 8 were samples in which PR-A was higher than PR-B. MFP increased (p&lt;0.05) the Ki-67 index in one sample with higher levels of PR-B than PR-A. No significant differences were observed in the remaining cases (null, equimolar or higher levels of PR-B than PR-A). We still plan to increase the number of samples in our study. Our data suggest that the tissue culture method developed is much more efficient than the primary cultures to evaluate drug or hormone responsiveness in breast cancer tissue. The results obtained herein support the proposal of PR-A as a predictive marker of antiprogestin therapy in breast cancer patients.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-09-19.

Abstract P4-06-15: Mifepristone modifies the tumor microenvironment increasing the therapeutic efficiency of low doses of Doxorubicin liposomes or paclitaxel-albumin nanoparticles in a murine model of breast cancer

Chemotherapy is the standard treatment for metastatic breast cancer today. To overcome undesired side effects and improve drug efficacy in tumor cells, different nanoparticle formulations have been developed. Paclitaxel has been bound with human albumin (Nab-paclitaxel), and pegylated liposomes have been developed for doxorubicin delivery (PEG-LD). The aim of our study was to evaluate the effect of these therapeutic agents in experimental mammary carcinomas expressing different ratios of progesterone receptor (PR) isoforms and to evaluate the effect of combined treatments of chemotherapeutic agents with the antiprogestin mifepristone (MFP). Nab-paclitaxel (Abraxane, Abraxis), at a dosage of 30 and 60 mg/kg body weight administered in three doses every four days, completely inhibited the growth of the antiprogestin-resistant C4-2-HI mouse mammary carcinoma, which is associated with high levels of PR isoform B (PR-B) expression. C4-HI, an antiprogestin-responsive mouse tumor that shows high levels of PR isoform A (PR-A) expression, was not inhibited by the low Nab-paclitaxel dose. However, the combination of MFP (6 mg silastic pellet) with Nab-paclitaxel improved the efficacy of both single treatments. Similar experiments were conducted using PEG-LD (Doxopeg; Laboratorios Raffo). In this case, all tumors tested (C4-HI, CC4-3-HI, 59–2-HI and C4-2-HI) were all highly responsive to high (18 mg/kg/week) or low (9 mg/kg/week) PEG-LD doses. When PEG-LD concentrations were lowered to 4.5 mg/kg/week and they were combined with MFP, an improved response was observed with combined treatments only in tumors with high PR-A levels (p &lt;0.001). Using BALB/c-GFP mice, we demonstrated that MFP treatment induced tissue remodeling in PR-A positive tumors, increasing the stromal/tumor cell ratio and the number of vessels (as shown by CD31 positive cells; p &lt; 0.001). Taking advantage of doxorubicin's red autofluorescence, we showed increased levels of drug accumulation in tumor cells surrounding the stromal tissue. Using a human albumin antibody we demonstrated nab-paclitaxel accumulation in similar locations. However, because increased areas (p &lt; 0.001) of stromal tissue were observed in the antiprogestin-treated mice, the total amount of PEG-LD or Nab-paclitaxel was much higher in the combined-treated tumors. We propose that antiprogestins have the potential to enhance the efficacy of nanotherapeutics in patients with breast tumors with a high PR-A/PR-B ratio.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-06-15.

Abstract P4-02-18: Antiprogestins as Possible Therapeutic Agents for Breast Cancer Patients Showing a High Expression of the Progesterone Receptor Isoform A

Near 75 percent of breast cancer patients express progesterone (PR) and estrogen (ER) receptors and are potential candidates to receive an endocrine therapy. Most of the endocrine therapies available have been designed to target ER and there is not much information about PR as a therapeutic target for breast cancer treatment. However, extensive clinical and experimental evidence suggest that progestins are associated with the induction and maintenance of the neoplastic phenotype in the mammary gland. Moreover, different antiprogestins including ZK 98299, ZK 230211 and RU-486 proved to exert excellent therapeutic effects in murine mammary carcinomas from the MPA-breast cancer model which express high levels of PR with an increased PR-isoform A/PR-isoform B ratio (PR-A/PR-B) (Lanari C et al, Endocrine Related Cancer, 2009 Feb, Jun;16(2):333-50).

The main goal of this study is to validate these experimental results using human breast cancer samples and to identify breast cancer patients that might benefit from an antiprogestin therapy. In the first part of this study our aim was to set up primary cultures from each breast cancer sample and to evaluate the in vitro response to antiprogestins, correlating this response with the PR-A/PR-B ratio. Tumor samples were obtained at surgery from patients diagnosed with breast cancer at the Magdalena V. de Martinez Hospital from General Pacheco and at the Rivadavia Hospital of Buenos Aires after signing the informed consent (n=70; median age 53.9 years). All tumor samples were processed by mechanical and enzymatic disaggregation and epithelial cells were purified by differential sedimentation techniques. Only 10 percent of the tumor samples succeeded in tissue culture and could be subcultured for further studies in 24 well plates. Cells were grown in culture medium in the presence of 10% fetal calf serum with or without RU-486 (10-8 M) or Tamoxifen (10-8 M). After one week of treatment, the cells were trypsinized and the total number of cells in each well was counted. Treatment with RU-486 or with Tamoxifen induced a decrease in the number of cells as compared to the controls (n=4, P&lt;0.05). In these patients PR-A expression was the same or higher than PR-B as observed by Western Blot. Our results suggest that RU-486 might be an alternative therapy to treat breast carcinomas showing a high expression of PR-A. We still need more successful cultures in order to correlate the in vitro responsiveness with the PR isoform ratio.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-02-18.

Inflammatory cell infiltrate and RANKL/OPG expression in rheumatoid synovium: comparison with other inflammatory arthropathies and correlation with outcome

OBJECTIVES

To evaluate if the immunofluorescence analysis of synovial tissue (ST) using antibodies against RANKL/OPG, conjugated with the immunophenotyping of lymphocytes and macrophages, could be of diagnostic and prognostic value in rheumatoid arthritis (RA) patients.

METHODS

3-year prospective study of 103 consecutive patients submitted to closed needle biopsy for diagnostic purposes. ST was analyzed with routine histologic techniques and immunofluorescence, using monoclonal antibodies against RANKL, OPG, CD163, CD68, CD4, CD8, interferon-gamma and CD19. Patients were prospectively evaluated with a clinical, laboratorial and radiological protocol. At the end of the follow-up patients were divided according to the final diagnosis. Results of the initial histologic evaluation were compared between the main diagnostic groups and in RA patients histologic data was correlated with clinical and radiologic outcome measures.

RESULTS

The RANKL/OPG ratio and the inflammatory infiltrate were significatively higher in RA (n = 25) as compared to the same ratio observed in other inflammatory joint diseases (OIJD, n = 48) and in osteoarthritis (n = 17). The difference between RA and OIJD was specifically confirmed when the comparison involved spondyloarthropathy (n = 26). Final HAQ score and radiologic outcome were correlated with the density of intimal CD68+ macrophages. Radiologic progression was correlated with subintimal CD4+ lymphocytes and CD68+ macrophages and intimal CD68 and CD163+ macrophages.

CONCLUSION

The quantification of the RANKL/OPG ratio and of the number of lymphocytes in the ST might be useful to differentiate RA from other inflammatory joint diseases. The ST number of CD4+ lymphocytes and macrophages are probable predictors of radiologic progression in RA patients.

Associations between leptospiral infection and seropositivity in rodents and environmental characteristics in Argentina

Our objective was to look for associations between leptospiral infection in rodents and selected environmental and rodent characteristics in Santa Fe, Argentina. Rodents (n = 214) were trapped alive from January 1998 to December 1999 in three environmental settings. Kidneys from 118 rodents were cultured and serum samples from 201 were processed by enzyme-linked immunosorbent assay (ELISA). Logistic regression was performed with ELISA seropositivity as the dependent variable and rodent characteristics were offered as independent variables. Overall prevalence of positive ELISA reactions was 42% (84/201). In urban areas, leptospiral isolations belonged to the Ballum serogroup; in natural corridors, they belonged to the Icterohaemorragiae serogroup. M. musculus (house mouse) was the most-frequently captured species and the predominant one in urban areas. Most isolates and seropositivity results were obtained on this species. Adults and subadults had higher seroprevalences than juvenile rodents. Oligoryzomys flavescens had higher seroprevalence than Akodon azarae, Mus musculus, Rattus rattus and Rattus norvegicus.

[Report on a leptospirosis outbreak in the city of Santa Fe, Argentina, March-April 1998]

In March-April 1998 in a neighborhood in the city of Santa Fe, Argentina, there was an outbreak of an acute disease characterized by fever, headaches, and intense myalgias. This article presents the studies surrounding this outbreak and the attempts to identify the source and the mode of transmission. The epidemiological, serological, and clinical findings indicated that the causative agent was Leptospira interrogans. As a screening test, macroscopic agglutination with heat-resistant antigen was applied, followed by the ELISA test, and, as a confirmatory test, microscopic agglutination for 10 serotypes of L. interrogans. The study covered 32 persons, 8 dogs, and 8 water samples. Among the 32 persons, 12 cases were confirmed, 2 were suspicious, and 18 were negative. Six dogs were found to be infected, and motile spirochetes were found in the water samples. The human sera reacted with the ballum, canicola, icterohaemorrhagiae, and pyrogenes serotypes; the canine sera reacted with the ballum, canicola, and pomona serotypes. The coagglutination found in all the confirmed cases indicates that they were acute cases of leptospirosis, but it was impossible to identify the causal serotype. Except for the index case, the disease was not recognized clinically. Several facts suggest that the outbreak was caused by rain that had flooded the study area. The results of this study emphasize the need for active surveillance of leptospirosis when there are floods and other natural disasters.

[Concepts about AIDS among the adult population of Managua]

Nicaragua has the lowest prevalence of AIDS in Central America. In other countries where AIDS is more prevalent, the first epidemic of asymptomatic infections with human immunodeficiency virus (HIV) and the second of clinical cases of AIDS have been followed by a third epidemic of fear and discrimination. In December 1989 a study was conducted to investigate knowledge and attitudes about AIDS in a sample of 287 adults in Managua. Most of the interviewees had heard of the disease from newspapers and television, and more than 90% understood how HIV was principally transmitted. However, between one-third and one-half the interviewees believed that HIV could be transmitted by causal contact such as kissing (53%) or by mosquito bites (49%). In addition, the majority considered that isolation of HIV-infected persons and control of immigration into the country would be effective measures for preventing the spread of the disease. These results are similar to findings from studies carried out in other countries of Latin America where the HIV and AIDS epidemics started much earlier. This would suggest that the so-called "third epidemic" of discrimination and fear is affecting Nicaragua in advance of the other two.