A systematic review of the nutritional status of adults experiencing homelessness

OBJECTIVES

To identify, appraise, and describe studies focussing on the nutritional characteristics of people experiencing homelessness (PEH).

STUDY DESIGN

Systematic (narrative) review.

METHODS

We identified full-text studies of any design and in the English language of adults (≥18 years) fulfilling the European Typology criteria for homelessness, based in community or hospital settings, and which report nutritional measures. Five electronic databases, 13 grey literature sources, reference lists, and forward citations were searched. Data on study characteristics and nutrition measures were collected and synthesised narratively. Risk of bias was assessed using relevant checklists for each study type.

RESULTS

A total of 1130 studies were identified and retrieved. After screening, six studies were included for review: three cross-sectional studies; two case-control studies; and one randomised control trial, involving a total of 1561 participants from various settings including shelters, drop-in centres, hospitals, and hostels. All included studies were from high-income countries. Studies reported a range of nutrition measures including anthropometry (e.g., body mass index (BMI)), serum micronutrients and biomarkers, and dietary intake. Between 33.3% and 68.3% of participants were overweight or obese; 3.5%-17% were underweight; and low blood levels of iron, folate, vitamins C, D, and B12, and haemoglobin were prevalent. PEH consumed high amounts of dietary fats and alcohol, and low amounts of fruits and vegetables compared with national guidelines and housed individuals. There was moderate to high risk of selection and measurement bias and confounding in included studies.

CONCLUSIONS

A majority of PEH are within unhealthy BMI ranges and are deficient in serum micronutrients and nutritional biomarkers. Studies using large data sets that examine multiple aspects of nutrition are needed to describe the nutritional characteristics of PEH.

REGISTRATION

This systematic review is based on a prespecified protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42021218900).

POS1292 REAL-WORLD EFFECTIVENESS OF ETANERCEPT AND ADALIMUMAB IN CHILDREN AND YOUNG PEOPLE WITH JUVENILE IDIOPATHIC ARTHRITIS (JIA) WITHOUT UVEITIS

Background:

Biologic therapies have revolutionised treatment pathways and outcomes for patients with juvenile idiopathic arthritis (JIA). Although there is a choice of approved TNF inhibitors available as a first biologic, there lacks data to inform treatment choices in clinical practice.

Objectives:

To compare short-term outcomes on etanercept and adalimumab in children and young people with JIA without uveitis, including drug survival, arthritis disease activity and function ability at 1 year.

Methods:

All patients starting a first biologic (etanercept/adalimumab including biosimilars) from 2010 in the UK JIA biologic registers (BCRD and BSPAR ETN) were included. Those with systemic JIA or with any history of uveitis were excluded. Data were collected at start of therapy, 6 months, 1 year, and then annually, including patient demographic, disease activity and drug therapy. In this analysis, drug survival and arthritis disease activity / function ability at 1 year (range 3-15 months) were investigated; comparing between therapies using logistic / linear regression, adjusted for propensity deciles.

Results:

There were 550 patients with outcome data available (to 30 Sept 2020); 384 etanercept, 166 adalimumab. At registration, 68% female, median age 12 years old (IQR 8-14), median disease duration 1 year (IQR 1-4), 72% on concomitant methotrexate. Disease activity was similar between both therapies at baseline and one year. At one year, 70% were still on biologic therapy; most stopping therapy for ineffectiveness (45%), adverse events (31%), or patient / family choice (15%). Inactive disease and minimal disease activity was achieved in 26% and 46% respectively, 48% achieved a minimally clinical important improvement in their functional ability (CHAQ improvement >0.13).

All PatientsAdalimumabEtanerceptN550166384Females68%59%71%Age (years), median (IQR)12 (8-14)12 (10-14)11 (8-14)Disease duration (years), median (IQR)1 (1-4)1 (0-3)1 (1-4)ILARPersistent oligo9%6%11%Extended oligo20%14%23%RF negative37%32%39%RF positive11%11%12%Psoriatic5%8%4%Enthesitis-related16%27%11%Undifferentiated1%2%1%Concomitant oral steroids16%20%15%Concomitant methotrexate72%84%66%Follow-up time, yearsMedian (IQR)2.5 (1.4-3.8)2.1 (1.2-3.1)3.0 (1.6-4.0)Min-Max0.4 - 8.20.4 - 7.30.4 - 8.2Drug SurvivalStill on drug at one year70%67%71%Still on drug at two years47%50%46%CHAQBaseline, mean (SE)0.9 (0.04)0.8 (0.06)1.0 (0.04)One Year, mean (SE)0.7 (0.03)0.5 (0.06)0.7 (0.04)Change, mean (SE)-0.2 (0.04)-0.2 (0.06)-0.2 (0.04)Regression coef (95% CI)--0.09 (-0.2, 0.04)RefPD Adjusted coef (95% CI)--0.08 (-0.2, 0.07)RefMCID (CHAQ)Proportion achieved48%48%48%OR (95% CI)-1.0 (0.6, 1.5)RefPD Adjusted OR (95% CI)-1.2 (0.8, 1.9)RefJADASBaseline, mean (SE)14 (0.4)14 (0.7)14 (0.4)One Year, mean (SE)5 (0.3)4 (0.5)6 (0.3)Change, mean (SE)-9 (0.4)-9 (0.7)-8 (0.5)Regression coef (95% CI)--1.1 (-2.3, -0.01)*RefPD Adjusted coef (95% CI)--1.0 (-2.8, 0.8)RefInactive Disease (JADAS<1)Proportion achieved26%32%24%OR (95% CI)-1.5 (1.0, 2.4)RefPD Adjusted OR (95% CI)-1.5 (0.9, 2.4)RefMinimal Disease Activity (MDA) [excludes enthesitis-related JIA]N=473N=121N=352Proportion achieved46%49%45%OR (95% CI)-1.2 (0.8, 1.9)RefPD Adjusted OR (95% CI)-1.2 (0.8, 2.0)Ref

Childhood Health Assessment Questionnaire (CHAQ), confidence interval (CI), International League Against Rheumatism (ILAR), interquartile range (IQR), odds ratio (OR), propensity decile (PD), rheumatoid factor (RF), standard error (SE). *p<0.05

Conclusion:

This is the first comparative effectiveness analysis of adalimumab and etanercept within UK children receiving TNFi therapies for JIA. Despite large patient numbers, there was no evidence of difference between adalimumab and etanercept regarding arthritis disease control or treatment persistence. For children without uveitis, both adalimumab and etanercept can be considered as effective treatment options for children and young people with JIA.

Disclosure of Interests:

None declared

[From the bench to the clinic: The challenge of translating platelet production in vitro]

Platelet transfusions, which are currently totally dependent on altruistic donations, are absolutely necessary to the treatment of patients with thrombocytopenia following trauma, surgery or other pathologies (especially malignancies). Producing platelets in vitro represent a major technological and scientific breathrough that would address logistical issues (supply chain, stock holding…) and medical concerns (compatibility and biosafety). The translation of this innovation will need to be accompanied by rigorous quality control, harmonised between laboratory when it comes to functionality and biosafety for use in the clinic.

OP0259-PARE WORLD YOUNG RHEUMATIC DISEASES (WORD) DAY: THE FIRST INTERNATIONAL AWARENESS DAY FOR PAEDIATRIC RHEUMATIC DISEASES

Background:

There is a lack of awareness of paediatric rheumatic diseases (PRDs), among the public, and certain groups of healthcare professionals, such as general practitioners [1]. To help improve awareness and understanding of PRDs, World Young Rheumatic Diseases Day (WORD Day) was established in 2019.

Objectives:

The aim of WORD Day, which took place on 18 March 2019, was to raise awareness of PRDs, while informing young people, families, healthcare professionals, teachers, and the public about the importance of timely referral plus early diagnosis and access to appropriate treatment and support.

Methods:

A steering committee was established for the inaugural campaign. An external agency was appointed to provide digital support, with an official social media campaign launching in December 2018. Social media analytics were used to measure the impact of official social media platforms. A range of branded materials were also made available (Fig 1), including an official campaign video. In addition, a specific engagement activity (#ButtonChallenge2019) was launched. This challenged participants to button up a piece of clothing while wearing gloves, to simulate the difficulties that young people with PRDs face undertaking daily activities. As part of the campaign launch, a list of suggested activities were provided, along with template press releases.

Results:

Several face-to-face and virtual events took place globally on or around WORD Day 2019, with 34 countries reporting events (Fig 2). Examples of events included lectures, social gatherings and media appearances. An official WORD Day tweet chat was also hosted. Regarding social media impact, between December 2018 and March 2019, a total of 2,585 and 660 individuals followed the official Facebook and Twitter accounts, respectively. Facebook posts were seen 646,000 times since the start of the campaign, with over 60,000 of Facebook reach from posts published on 18 March 2019 exclusively. A total of 270,800 impressions were observed on Twitter. The official #WORDDay2019 hashtag was seen by 533,955 unique accounts on 18 March 2019 alone, with 3,334,699 impressions. Posts with the hashtag were retweeted 1,112 times on WORD Day, with a total of 1,568 tweets recorded that day. With regards to the #ButtonChallenge2019, the challenge video was viewed for 6,700 minutes and received participation from across the world. Compared to the industry benchmark, the average engagements per post for WORD Day-related content was significantly higher compared to other medical and non-for-profit social media pages.

Conclusion:

WORD Day 2019 was the first international campaign focused solely on PRDs. Organic and paid social media content aided the dissemination of the WORD Day message, with Facebook proving to be the most popular social platform. Despite a wealth of different content published, authentic materials, namely video content, proved to be the most popular with users, particularly when it featured material designed by and with young people with PRDs. It was demonstrated that awareness events can often be resource-light and easily implemented across a range of diverse countries. It is anticipated that the global reach of WORD Day will increase over time as the campaign becomes more established.

References:

[1]Egert Y et al. Children and young people get rheumatic disease too. The Lancet Child & Adolescent Health. 2019;3(1):8-9.

Acknowledgments:

PReS for their financial support.

Disclosure of Interests:

Simon Stones Consultant of: I have been a paid consultant for Envision Pharma Group and Parexel. This does not relate to this abstract., Speakers bureau: I have been a paid speaker for Actelion and Janssen. These do not relate to this abstract., Eve Smith: None declared, Sammy Ainsworth: None declared, Veerle Buys: None declared, Wendy Costello: None declared, Yona Egert: None declared, Helen Foster: None declared, Lovro Lamot: None declared, Berent J. Prakken: None declared, Christiaan Scott: None declared

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Patients' Perspectives on and Experiences of Home Exercise Programmes Delivered with a Mobile Application

Purpose: We explored patients' perspectives on home exercise programmes (HEPs) and their experiences using a mobile application designed to facilitate home exercise. Method: Data were generated using qualitative, semi-structured, face-to-face interviews with 10 participants who were receiving outpatient physiotherapy. Results: Establishing a therapeutic partnership between physiotherapists and patients enabled therapists to customize the HEPs to the patients' lifestyles and preferences. Analysis suggests that using the mobile application improved participants' ability to integrate the HEP into their daily life and was overwhelmingly preferred to traditional paper handouts. Conclusions: The results suggest that efforts to engage patients in HEPs need to take their daily lives into account. To move in this direction, sample exercise prescription questions are offered. Mobile applications do not replace the clinical encounter, but they can be an effective tool and an extension of delivering personalized HEPs in an existing therapeutic partnership.

Abstract P1-03-10: Breast tumour kinase and its role in mTOR signalling

Background: The development of distal metastases and the acquisition of resistance to chemotherapeutic agents are one of the leading causes of cancer related death in breast cancer patients. There is both a scientific and clinical need to understand the alterations in cellular signalling pathways that could contribute to chemotherapeutic resistance in breast cancer, thereby identifying novel targets for therapy. The intracellular tyrosine kinase Brk/PTK6 enhances coupling of ErbB signalling to PI3K/Akt and we hypothesise that Brk plays a role in chemo-resistance and activation of downstream effectors such as mTOR.

Methods: The protein and activation levels of mTOR pathway components and expression levels of Brk, in both Taxol-sensitive and resistant breast cancer cells, were examined by western blotting and immunofluorescence. Brk transfected cells were treated with BEZ-235 for 72 hours and relative cell numbers determine by MTT assay. Immunoprecipitation studies were carried out on lysates from T47D cells, transfected to express FLAG-tagged Brk, with ANTI-FLAGM2 agarose beads. Sequence alignment was done using the NCBI BLAST Tool.

Results: We found that mTOR signalling was up-regulated in the Taxol-resistant cell line compared to parental Taxol-sensitive cells. This up-regulation was also accompanied by increased Brk levels. Transfection of a Brk-negative breast cancer cell line, MDA-MB-468 with wild-type Brk resulted in increased levels of both mTOR and, to a lesser extent, the downstream signalling component GβL at the protein level compared to cells transfected with vector only. Levels of the mTOR inhibitor DEPTOR were also decreased in response to Brk expression and mTOR co-precipitated in FLAG-Brk pull downs using FLAG M2 beads.

The Taxol resistant cells also showed altered responses to the mTOR inhibitor RAD-001/everolimus. Interestingly, sequence alignment revealed that there are common amino acid motifs between Brk and the mTOR regulatory molecule DEPTOR.

Conclusions: These data implicate Brk in up-regulating mTOR expression and indicate that Brk may influence mTOR signalling in the development of Taxol resistance. It is possible that Brk could substitute for DEPTOR in mTOR complexes providing a mechanism for elevated mTOR signalling in many breast cancers.

Citation Format: Harvey A, Foster H, Thorpe M, Karteris E. Breast tumour kinase and its role in mTOR signalling [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-03-10.

Development of a Paediatric Musculoskeletal Skills Workshop for Canadian Medical Students

BACKGROUND: Musculoskeletal (MSK) complaints in children account for up to 30% of visits to general practitioners. Doctors who see children with MSK complaints are often not confident in assessing them and MSK exams are poorly documented in medical records. There has been little published literature describing the logistics of teaching MSK skills in a group setting (which is how medical students are commonly taught). At our center, no MSK examination skills were previously taught during the undergraduate paediatrics clerkship.

OBJECTIVES: 1) To develop a hands-on, paediatric MSK workshop for medical students with direct observation and feedback. 2) To evaluate student/faculty satisfaction with the workshop. 3) To develop an MSK workshop protocol as a resource for medical educators.

DESIGN/METHODS: A 1-hour interactive workshop was designed for students to practice the paediatric Gait, Arms, Legs and Spine (pGALS) screening MSK exam. Students are given pre-reading, videos and pGALS checklists. Workshops include live demonstrations and videos/images of abnormal MSK findings for pGALS practice. Students practice pGALS with their peers with staff supervision(up to 5 physicians present)and receive feedback. All students complete a post-workshop evaluation. Teachers also complete a post-workshop evaluation discussing what went well and areas for improvement.

RESULTS: Workshops are delivered every 2 months for 25 students (5 iterations completed). Feedback has been positive (median rating 4.5 on a 5-point Likert scale) for all areas evaluated: objectives, handouts, preparation time, discussion, resources, etc. Comments include: “Helpful and applicable to personal clinical practice,” and, “The hands-on practice was really appreciated, as was the chance to get feedback.” Workshops have been modified according to faculty/student evaluations, resulting in a workshop protocol (organizational template) for future workshop leaders including a teaching checklist, preparation timeline, and PowerPoint to be modified by instructors as they wish.

CONCLUSION: The paediatric MSK workshop has been a welcome addition to our undergraduate paediatrics clerkship curriculum. We aim to further develop our workshop by explicitly including applied anatomy, e.g., land-marking for joints. We also aim to make our workshop protocol available on Paediatric Musculoskeletal Matters,www.pmmonline.org, as a resource for other medical educators. Further work will include evaluating its uptake, use and applicability by users in different contexts, and modifying it for different levels of learners, e.g., paediatricians.

Cultural contexts of swine-related infections in Polynesia

Pig-raising is an inherent element of ancestral Polynesian culture, but pigs constitute a reservoir of potentially severe diseases for humans. Little research in this area from a social science perspective has been performed, particularly in Oceania. The objective of this study was to assess swine brucellosis awareness and protection measures in two remote Polynesian French islands. We applied quantitative methods to a small clinic-based population selected according to the presence of a history of brucellosis serology, and semistructured interviews about public health measures and veterinary access were used among key informants for qualitative methods. Most individuals interviewed did not know about brucellosis, despite repeated public awareness campaigns. Standard hygiene recommendations to protect humans and animals were not compatible with traditional practice. Innovative approaches are required for effective awareness campaigns, and to gain the confidence and close cooperation of the community, in order to implement successful control measures for communicable diseases such as brucellosis.

Association between duration of symptoms and severity of disease at first presentation to paediatric rheumatology: results from the Childhood Arthritis Prospective Study

Objectives. To study the association between disease severity at first presentation to paediatric rheumatology (PRh) and length of time since symptom onset in children recruited to the Childhood Arthritis Prospective Study.

Methods. Children ≤16 yrs with inflammatory arthritis persisting ≥2 weeks were recruited from five UK hospitals. Data including demographics, disease features, Childhood Health Assessment Questionnaire (CHAQ), physician and parent global assessment and blood tests were collected at the first appointment with PRh (baseline). The association between symptom duration (defined as time from first reported symptom onset to presentation at PRh) and baseline disease characteristics was evaluated using non-parametric descriptive statistics and multivariable logistic regression analyses.

Results. Five hundred and seven children (65% female) were included: median age at onset was 6.8 yrs. Two hundred and thirty-three had oligoarthritis, 68 had RF-negative polyarthritis, 27 had systemic onset arthritis and 29 had arthritis that was not JIA. The median symptom duration was 4.6 months. Median symptom duration was shortest for children presenting with systemic arthritis (1.6 months) and longest for those with PsA (8.6 months). Children with a longer duration of symptoms were older and had higher median active joint counts but lower median ESR. Symptom duration did not correlate with CHAQ score at presentation.

Conclusions. Children who have systemic arthritis had the shortest delay to PRh presumably because they are profoundly unwell. Children with joint pain/stiffness but normal ESR had longer delays suggesting that if blood tests do not indicate inflammation, the diagnosis of JIA may be overlooked.

Costing juvenile idiopathic arthritis: examining patient-based costs during the first year after diagnosis

Objectives. There are few data on the treatment patterns and associated cost of treating children with inflammatory arthritis including juvenile idiopathic arthritis (JIA), in the short or long term. The aim of this study was to obtain patient-based costs for treating children with JIA in the UK, in the first year from diagnosis and from the secondary health care payer perspective.

Methods. The Childhood Arthritis Prospective Study (CAPS) is an ongoing longitudinal study recruiting children with inflammatory arthritis from four UK hospital centres. Included children are newly diagnosed, ≤16 years old with inflammatory arthritis of one or more joints, which has persisted for at least 2 weeks. Health service resource use data were collected as part of routine clinical care at study entry, 6 months and 1 year. Reference unit costs were applied to these data and the cost of treatment per child calculated for the first year from diagnosis.

Results. A total of 297 children attended a 12-month follow-up visit. The mean annual total cost per child was £1649 (s.d. £1093, range £401–£6967). The highest cost component was for appointments with paediatric rheumatologists. Mean total costs were highest for children with enthesitis-related, systemic JIA or extended oligoarthritis.

Conclusions. In the first 12 months after diagnosis, children with all JIA disease subtypes consume large, but highly variable quantities of health service resources. Individual patient costs are required to reflect the wide variation in cost between patients and allow appropriate recouping of costs for contracted services and for assessing the economic impact of interventions.

Derivation of infectious HIV-1 molecular clones with LTR mutations: sensitivity to the CD8+ cell noncytotoxic anti-HIV response

CD8(+) cells from healthy, asymptomatic HIV-1-infected individuals can inhibit HIV-1 replication in naturally or acutely infected CD4(+) cells in the absence of cell killing. This CD8(+) cell noncytotoxic anti-HIV response (CNAR) is mediated by a soluble CD8(+) cell antiviral factor (CAF). CNAR/CAF inhibits HIV-1 replication by blocking viral RNA transcription. HIV transcription is regulated by a variety of cis-acting DNA sequence elements within the proviral long terminal repeat (LTR). We hypothesized that one of the HIV-1 LTR proviral DNA sequence elements that binds host cell transcriptional factors is involved in this antiviral activity. To assess this possibility, we constructed full-length infectious HIV-1 molecular clones with mutations in the LTR elements NFAT, AP-1, IL-2 homology region, and the downstream ISRE. We also tested full-length infectious molecular clones that had deletions of either the NF-kappaB or Sp1 sites of the LTR or lacked functional Tat and TAR elements. Viruses generated from these molecular clones were used to acutely infect CD4(+) cells that subsequently were either co-cultured with CD8(+) cells from individuals that exhibited strong CNAR or cultured with CAF-containing fluids. The replication of all of the mutant HIV-1 viruses tested was substantially reduced in the presence of CNAR/CAF. These findings suggest that other regions in the viral LTR or other host cell processes are involved in the transcriptional block elicited by CNAR/CAF.

Differential gene expression in CD8(+) cells from HIV-1-infected subjects showing suppression of HIV replication

CD8(+) cells from healthy HIV-1-infected individuals suppress human immunodeficiency virus (HIV) replication in infected cells by a non-cytotoxic mechanism. This activity is associated with the production of a soluble CD8(+) cell antiviral factor (CAF) that inhibits viral replication at the level of transcription. Strong CD8(+) cell non-cytotoxic anti-HIV responses (CNARs) correlate with an asymptomatic state and long-term survival of HIV-infected individuals. This antiviral activity is lost when the infected individual advances to disease. In attempts to define the gene(s) mediating CNAR we have evaluated differential gene expression between CD8(+) cells from infected subjects with high CNAR and CD8(+) cells from uninfected controls that lack this activity. The expression analysis, using the Affymetrix GeneChip Human Genome U133 Set, indicated that 18% of the genes were differentially expressed (DE) of which 9.2% were up-regulated. A total of 568 genes were up-regulated with a >2.0-fold difference in expression levels and a >50% concordance of difference call. Stringent selection criteria narrowed down the list to 52 up-regulated 'high confidence genes' (> or = 75% concordance). These genes function in a wide variety of cellular processes and include 13 associated with immunologic activity.

Gene therapy progress and prospects: Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is a severe muscle wasting disorder affecting 1/3500 male births. There is currently no effective treatment, but gene therapy approaches are offering viable avenues for treatment development. The last 10 years have seen the development of a number of strategies and tools for muscle gene therapy. However, the major hurdle has been the inability to deliver vectors at high enough efficiency via a systemic route. The last 2-3 years (reviewed here) have seen unrivalled progress in efficient systemic delivery of viral and non-viral gene transfer agents and antisense oligonucleotides. This progress, coupled with the successful completion of the first gene therapy clinical trial for DMD, has led to three more clinical trials planned for the immediate future.

HIV-infected cells are major inducers of plasmacytoid dendritic cell interferon production, maturation, and migration

Plasmacytoid dendritic cells (PDC), natural type-1 interferon (IFN) producing cells, could play a role in the innate anti-HIV immune response. Previous reports indicated that PDC IFN production is induced by HIV. Our results show a more robust IFN induction when purified PDC (>95%) were exposed to HIV-infected cells. This effect was not observed with non-viable cells, DNA, and RNA extracted from infected cells, and viral proteins. The response was blocked by anti-CD4 and neutralizing anti-gp120 antibodies as well as soluble CD4. IFN induction by HIV-infected cells was also prevented by low-dose chloroquine, which inhibits endosomal acidification. PDC IFN release resulted in reduced HIV production by infected CD4+ cells, supporting an anti-HIV activity of PDC. Stimulated CD4+ cells induced PDC activation and maturation; markers for PDC migration (CCR7) were enhanced by HIV-infected CD4+ cells only. This latter finding could explain the decline in circulating PDC in HIV-infected individuals.

Dental disease in children with chronic illness

This article aims to raise awareness among paediatricians and specialist paediatric services that poor oral health, in particular children with chronic illness, is a major cause of morbidity and can be a risk factor for severe, even life threatening complications. Good oral health and dentition is important for efficient mastication, speaking and of course, cosmetically for smiling. If left untreated, dental caries can lead to pain and infection. Chronic infection around one or more teeth can result in damage to localised structures, such as the developing permanent teeth. Children who are medically compromised (such as being immunocompromised from disease and/or therapy) however are at increased risk of developing systemic complications from dental infections, which may prove fatal. We focus on the role of the general paediatrician in promoting the importance of good dental health for all children and in particular those children "at risk". We present preventive measures, evidence based where available, that may improve dental care and promote the role of paediatric dental services in the multidisciplinary management of chronic disease.