POS0226 DEFICIENT CHAPERONE-MEDIATED AUTOPHAGY CONTRIBUTES TO JOINT DAMAGE IN OSTEOARTHRITIS

Background

In Osteoarthritis (OA), defects in macroautophagy are evident and precede joint damage. Indeed, pharmacological activation of macroautophagy protects against joint damage and disease.

Objectives

Therefore, identifying hallmarks associated with specific autophagy subtypes could shed light to fundamental mechanisms of joint disease and facilitate the development of therapeutic strategies to prevent OA progression.

Methods

A gene expression analysis of 35 autophagy genes was performed from blood from a Prospective OA Cohort of A Coruña (PROCOAC) of non-OA (Age:61,44±1,16 years; BMI:25,25±0,52; Females, n=18) and knee OA subjects (Age:65,50±1,05 years; BMI:29,55±0,67; Females, n=18, OA grade III-IV) by using SYBR green array. The differential expression of candidate genes in blood (n=30/group) and knee cartilage (Non-OA, n=12; Knee OA donors, n=21) was confirmed by using Taqman Technology. HSP90AA1, a chaperone mediated autophagy (CMA) mediator, was evaluated in human knee joint tissues (i.e. cartilage, meniscus, ACL and synovium) with different KL grades (0, 2 and 4, n=3/each KL grade) and in both spontaneous aging mice (2, 6, 12, 18, and 30 months old, n=3/each time) and surgically-induced OA mice (10 weeks after surgery, n=4/each) by immunohistochemistry. The functional consequences of HSP90AA1 deficiency on inflammation, oxidative stress, senescence and apoptosis were studied in human OA chondrocytes by gene and protein expression and flow cytometry. The potential contribution of CMA to chondrocyte homeostasis was studied by assessing the capacity of CMA to restore proteostasis upon macroautophagy deficiency by ATG5 knockdown. To study the therapeutic potential of targeting CMA, HSP90AA1 was overexpressed in human OA chondrocytes.

Results

16 autophagy-related genes were significantly downregulated in knee OA subjects (p<0.05). Macroautophagy-related genes ATG16L2, ATG12, ATG4B and MAP1LC3B, were significantly downregulated (p<0.05). Interestingly, HSP90AA1 and HSPA8, CMA mediators involved in stress response and protein folding, were significantly downregulated (p<0.001). Confirmatory studies showed a downregulation of MAP1LC3B and HSP90AA1 in blood (p<0.001) and cartilage (p<0.05) from knee OA subjects. Moreover, HSP90A was reduced in human joint tissues (i.e. cartilage, meniscus, ACL, p<0.05) and associated to OA severity. In mice, HSP90A reduction was observed not only in OA (p<0.05) but also in aging (p<0.01). LAMP2A, a key CMA mediator, was also reduced in human OA cartilage and associated with aging in mice (p<0.05). Remarkably, HSP90AA1 deficiency was functionally linked to inflammation, oxidative stress, senescence and apoptosis (p<0.05). Moreover, LAMP2A activity was decreased upon HSP90AA1 deficiency, while mTOR signaling pathway, p62 and active caspase 3 were increased (p<0.05), indicating a failure in the autophagy flux that may lead to impaired lysosomal degradation and apoptosis. Human OA chondrocytes with impaired macroautophagy through ATG5 knockdown show reduced LC3II expression and induced activation of prbs6, p16 and p21 (p<0.05). Interestingly, HSP90A was increased, suggesting a compensatory activation of CMA in response to specific macroautophagy defects. Remarkably, HSP90AA1 overexpression itself is sufficient to protect against joint damage by decreasing mTOR signaling and senescence in human OA chondrocytes.

Conclusion

Taking together, we identified HSP90A, a marker of CMA, as a key regulator of chondrocyte homeostasis underlying a relevant mechanism in OA. A better definition of the cross-talk between CMA and macroautophagy defects might reveal its role as a hallmark of OA.

References

[1]Caramés B, et al. Arthritis Rheum. 2010, 2015; 2. Caramés B, et al. Ann Rheum Dis. 2012

Disclosure of Interests

None declared

POS0375 CHAPERONE-MEDIATED AUTOPHAGY IS A HALLMARK OF JOINT DISEASE IN OSTEOARTHRITIC PATIENTS

Background:

In Osteoarthritis (OA), defects in macroautophagy (autophagy) are evident and precede joint damage. Indeed, pharmacological activation of autophagy protects against joint damage.

Objectives:

Therefore, identifying hallmarks associated with specific autophagy subtypes could shed light to fundamental mechanisms of joint disease.

Methods:

A comparative analysis of 35 autophagy genes was performed from blood from the Prospective OA Cohort of A Coruña (PROCOAC). Non-OA subjects (Age:61,44±1,16 years; BMI:25,25±0,52; Females, n=18) and Knee OA subjects (Age:65,50±1,05 years; BMI:29,55±0,67; Females, n=18, OA grade III-IV) were profiled using an autophagy gene expression array by SYBR green qPCR. Confirmatory studies were performed in blood from Non-OA subjects (Age:60,13±1,12 years; BMI:24,85±0,59; Females; n=30) and Knee-OA subjects (Age:68,4±1,11 years; BMI:29,65±0,55; Females; n=30, OA grade III-IV) by Taqman qPCR. The candidate gene was evaluated in human knee joint tissues (cartilage, meniscus, ligaments, synovium) with different KL grades (Age: KL0=28,3±4,50; KL2=77±6,08; KL4=62,3±3,05, n=3) and in both spontaneous aging (2, 6, 12, 18, and 30 months old, n=3) and surgically-induced OA (10 weeks after surgery, n=4) in mice by IHC. The functional consequences were studied in T/C28a2 and primary human OA chondrocytes. Autophagy, FOXO, Chaperone-mediated autophagy (CMA), inflammation, and cellular senescence were analyzing by gene and protein expression. Moreover, oxidative stress and cell death were evaluated by FACS. The contribution of CMA to chondrocyte homeostasis was evaluated by studying the capacity of CMA to restore proteostasis upon autophagy deficiency by siATG5.

Results:

15 autophagy-related genes were significantly downregulated in blood from knee OA patients compared to non-OA patients. No significant upregulation was found for any studied gene, although a trend towards upregulation was found in genes involved in the mTOR pathway. Four key autophagy-related genes, including ATG16L2, ATG12, ATG4B and MAP1LC3B were found downregulated in knee OA patients. Interestingly, HSP90AA1 and HSPA8, CMA markers involved in stress response and protein folding, were downregulated. Confirmatory studies showed a significant downregulation of MAP1LC3B and HSP90AA1 in blood from knee OA patients. Remarkably, HSP90A was found reduced in femoral cartilage (medial and lateral), meniscus and ACL. Moreover, this reduction was higher in medial cartilage compared to lateral cartilage and meniscus, while in synovial membrane, HSP90A expression was found increased. This expression signature was dependent on OA grade severity. In addition, we observed a decrease of HSP90A with aging and OA in mice. The functional consequences of HSP90AA1 gene silencing are related to an increase in NFκB, MMP13, and p16 expression. Interestingly, LAMP2A, a key CMA mediator, HSPA8, MAP1LC3B and FoxO1 expression were upregulated in chondrocytes with HSP90AA1 deficiency, which might indicate an early response to maintain homeostasis. On the other hand, LAMP2A protein is decreased upon HSP90AA1 deficiency, while LC3II and p62 were increased, indicating a failure in the autophagy flux that leads to impaired lysosomal degradation.

Moreover, p21, p16 and prbS6 were increased upon HSP90AA1 deficiency, besides increasing mitochondrial ROS production and apoptosis. ATG5 silencing blocks autophagy by reducing LC3II and increasing prbs6, p62, p16 and p21. Interestingly, LAMP2A and HSP90A were found increased, indicating a possible compensative activation of CMA in response to autophagy defects. These results support that HSP90A has an important role in chondrocyte homeostasis by participating in the cross-talk between CMA and autophagy.

Conclusion:

Taking together, we identified HSP90A, a CMA regulator, as critical in chondrocyte homeostasis. These disease mechanisms are relevant in OA and constitute hallmarks potentially useful to prevent OA progression.

References:

[1]Caramés B, et al. Arthritis Rheum. 2010, 2015;

[2]Caramés B, et al. Ann Rheum Dis. 2012.

Disclosure of Interests:

None declared

Effectiveness of a Weight-Loss Intervention in Preventing Frailty and Functional Decline in Community-Dwelling Obese Older People. A Randomized Controlled Trial

Background: Obesity is a risk factor for frailty and muscle weakness, so weight loss in obese older adults may prevent frailty and functional decline. Objective: To assess the safety and efficacy of a multimodal weight-loss intervention in improving functional performance and reducing frailty risk in obese older adults. Design: Randomized controlled trial with 2 parallel arms. Setting and participants: Community-dwelling obese adults aged 65-75 years with body mass index (BMI) 30-39 kg/m2. Intervention: 6-month multimodal intervention based on diet and a physical activity program. Control group: Usual care. Main and secondary outcome measures: Frailty (Fried criteria) rate and functional performance at 6, 12, and 24 months of follow-up, respectively. Intermediate outcome measures: Weight loss, body composition changes, and metabolic and inflammatory biomarker changes. Results: N=305. The study intervention increased gait speed at 12 and 24 months of follow-up, but had no significant effect on frailty prevention. It was effective in reducing weight, BMI, fat mass, interleukin 6, and insulin resistance and improving self-reported quality of life. Conclusions: The study intervention was not demonstrated to be effective in preventing frailty in obese people aged 65-75 years at 24 months of follow-up. However, it allowed weight loss and a reduction in inflammatory and insulin resistance markers, which could have a long-term effect on frailty that requires further research.

1 Assessing the energy status of porcine embryos by means of biodynamic imaging

Assisted reproductive technologies are powerful tools for enhancing production in livestock or treating infertility in humans. Unfortunately, the success rate of the technologies is rather low. A major reason for the poor efficiency is the lack of methods to reliably assess the developmental potential of the embryos before transfer into recipients. Therefore, a noninvasive method to ensure the selection of only the best embryos for transfer would be highly desirable. Biodynamic imaging is a compelling new microscopy that uses intracellular Doppler spectroscopy to perform label-free, noninvasive optical measurements of cellular fitness. The aim of this study was to investigate whether biodynamic imaging can be used to assess the energy status of the embryos, which may be indicative of their viability. Porcine oocytes matured invitro were parthenogenetically activated by an electrical pulse and cultured for 2 days. The parthenotes were then divided into two groups, and approximately half of them were incubated for an additional 2 days in the presence of 20mM sodium azide. Sodium azide is an inhibitor of oxidative phosphorylation and is known to block ATP production. The rest of the embryos were cultured without sodium azide and used as a control to indicate normal ATP levels. At the end of the culture period embryos that reached the 8- to 16-cell stage were evaluated by our biodynamic imaging system to assess their energy status, after which they were lysed and their ATP contents were determined by means of a bioluminescence assay. A total of 68 embryos (32 treated with the inhibitor and 36 control) were evaluated. The ATP content analysis showed that the control embryos had significantly more ATP than those treated with sodium azide as determined by Student's t-test (5.04±1.07 vs. 1.31±0.57; P&lt;0.05). A correlative study was then completed where biodynamic biomarkers were used to classify embryos to estimate the ability of biodynamic imaging to identify embryos with high or low energy status. A set of 13 biomarkers representing each embryo as a feature vector was used to train a classifier. We found that the cross-validated classifier had a sensitivity and specificity of ~80%. In addition, a receiver-operator curve constructed by varying the ATP threshold of the independent bioluminescence assay had an area-under-the-curve of 0.81. These results indicate that biodynamic imaging is able to determine the energy status of the embryos noninvasively and has great potential in the assessment of embryo viability.

Analysis of Kidney Donation and Its Relationship With Graft Failure of the Recipient at 1 Year

INTRODUCTION

Currently, the shortage of organs available for kidney transplantation and a change in donors' and recipients' profiles (elderly, with cardiovascular risk, donors after cardiac death), it is becoming necessary to assess grafts from expanded-criteria donors (ECD) in order to have methods that allow us to predict viability and graft survival.

OBJECTIVE

The aim of this study was to analyze the different methods of renal donor assessment (estimated glomerular filtration rate [eGFR], preimplantation biopsy, and Kidney Donor Profile Index [KDPI] score) as predictors of graft survival and renal function of our recipient at 1 year.

METHODS

We performed a descriptive and retrospective study of 183 deceased donor kidney transplantations performed at our center between 2011 and 2015. We calculated the KDPI scores, donor eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration Formula equation, and biopsies were evaluated using Banff classification.

RESULTS

ECDs comprised 59.60%, 93% of donors had an eGFR ≥ 60 mL/min/1.73 m², and 41% presented with a KDPI score ≥ 90%. The most frequent range in the biopsy score was 0-3. The 1-year graft survival rate was 86.90%. Factors that negatively influenced graft survival were donor/recipient age, ECD, KDPI, and cold ischemia time (CIT).

CONCLUSION

Prolonged CIT and KDPI ≥ 90% were donor variables that were related to graft failure at 1 year in our center.

Total Body Water and Intracellular Water Relationships with Muscle Strength, Frailty and Functional Performance in an Elderly Population

BACKGROUND

As a person ages, total body water (TBW), intracellular water (ICW), muscle mass and muscle strength tend to decline. The decline in ICW may reflect losses in the number of muscle cells but may also be responsible for less hydrated muscle cells.

AIM

To assess whether TBW and ICW are associated with muscle strength, functional performance and frailty in an aged population, independently of muscle mass.

METHODOLOGY

Design: An observational cross-sectional study of community-dwelling individuals aged 75 years and older. TBW, ICW, fat mass, lean mass and muscle mass were assessed by bioelectrical impedance analysis, frailty status was measured according to Fried criteria, handgrip strength was measured using the hand-held JAMAR dynamometer, and functional performance was measured according to the Barthel index and gait speed.

RESULTS

A total of 324 subjects were recruited (mean age 80.1 years, 47.5% women). TBW and ICW were closely correlated with muscle mass in both sexes. ICW was also associated with Barthel score, gait speed and frailty in both sexes and with handgrip in men. Considerable variability in ICW was observed for the same muscle mass. Multivariate analysis showed a positive effect of ICW on handgrip, functional performance and gait speed and a protective effect of ICW on frailty, independently of age, sex, body mass index and number of comorbidities.

CONCLUSIONS

In elderly individuals with similar muscle mass, those with higher ICW had a better functional performance and a lower frailty risk, suggesting a protective effect of cell hydration, independently of muscle mass.

[Prefrontal Symptoms Inventory (PSI): ecological validity and convergence with neuropsychological measures]

INTRODUCTION

The Prefrontal Symptoms Inventory (PSI) is a self-reported questionnaire, created in Spain, which asks about cognitive, emotional and behavioural alterations in activities of daily living and which can be applied in both the general population and in multiple clinical populations. There is a shorter 20-item version (PSI-20) with excellent psychomotor properties for screening.

AIM

To study the convergent and divergent validity of the PSI and PSI-20, by analysing how their scales reflect the day-to-day consequences of real deficits found in neurological assessment performed by means of performance tests.

PATIENTS AND METHODS

A sample of 52 persons undergoing treatment for substance addiction (31 males and 21 females) were administered the PSI together with an abbreviated neuropsychological examination battery focused on describing attentional, mnemonic and executive processes.

RESULTS

Both versions of the PSI present optimal psychometric properties (0.78 > alpha > 0.94 for the complete 46-item version and 0.7 > alpha > 0.89 for the abbreviated 20-item version). The results confirm the hypotheses regarding their validity: the performance problems scale is related with the capacity to resolve tests that supposedly rate the executive functions of a prefrontal origin (convergent validity), whereas the scales of problems in emotional control and problems with social behaviour are not related with those cognitive capabilities (discriminant validity).

CONCLUSIONS

The PSI is a test that is clinically useful, psychometrically valid and applicable in multiple clinical populations.

Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis

Studies that analyze the epidemiology and risk factors for invasive fungal disease (IFD) after engraftment in alloSCT are few in number. This single-center retrospective study included 404 alloSCT adult recipients surviving >40 days who engrafted and were discharged without prior IFD. All patients who received ⩾20 mg/day of prednisone were assigned to primary oral prophylaxis (itraconazole or low-dose voriconazole). The primary end point was the cumulative incidence (CI) of probable/proven IFD using the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. The independent prognostic factors after multivariate analyses were used to construct a post-engraftment IFD risk score. The 1-year CI of IFD was 11%. The non-relapse mortality was 40% in those developing IFD and 16% in those who did not. The intent-to-treat analysis showed that 17% of patients abandoned the assigned prophylaxis. Age >40 years, ⩾1 previous SCT, pre-engraftment neutropenia >15 days, extensive chronic GVHD and CMV reactivation were independent risk factors. The post-engraftment IFD score stratified patients into low risk (0-1 factor, CI 0.7%), intermediate risk (2 factors, CI 9.9%) and high risk (3-5 factors, CI 24.7%) (P<0.0001). The antifungal prophylaxis strategy failed to prevent post-engraftment IFD in 11% of alloSCT. Our risk score could be useful to implement risk-adapted strategies using antifungal prophylaxis after engraftment.

Heart rate recovery in elite Spanish male athletes

AIM

During postexercise recovery, heart rate (HR) initially falls rapidly, followed by a period of slower decrease, until resting values are reached. The aim of the present work was to examine the differences in the recovery heart rate (RHR) between athletes engaged in static and dynamic sports.

METHODS

The study subjects were 294 federated sportsmen competing at the national and international level in sports classified using the criteria of Mitchell et al. as either prevalently static (N.=89) or prevalently dynamic (N.=205). Within the dynamic group, the subjects who practised the most dynamic sports were assigned to further subgroups: triathlon (N.=20), long distance running (N.=58), cycling (N.=28) and swimming (N.=12). All athletes were subjected to a maximum exertion stress test and their HR recorded at 1, 2, 3 and 4 min (RHR1,2,3,4) into the HR recovery period. The following indices of recovery (IR) were then calculated: IR1=(HRpeak-RHR1,2,3,4)/(HRmax-HRrest)*100, IR2=(HRpeak-RHR1,2,3,4)/(HRmax/HRpeak), and IR3=HRpeak-RHR1,2,3,4. The differences in the RHR and IR for the static and dynamic groups were examined using two way ANOVA.

RESULTS

The RHR at minutes 2 (138.7±15.2 vs. 134.8±14.4 beats·min⁻¹) and 3 (128.5±15.2 vs. 123.3±14.4 beats·min⁻¹) were significantly higher for the static group (Group S) than the dynamic group (Group D), respectively. Significant differences were seen between Group D and S with respect to IR1 at minutes 1 (26.4±8.7 vs. 24.8±8.4%), 2 (43.8±8.1 vs. 41.5±7.8%), 3 (52.1±8.3 vs. 49.1±8%) and 4 (56.8±8.6 vs. 55.4±7.4%) of recovery. For IR2, significant differences were seen between the same groups at minutes 2 (59.7±12.5 vs. 55.9±10.8 beats·min⁻¹) and 3 (71.0±13.5 vs. 66.1±11.4 beats·min⁻¹) of recovery. Finally, for IR3, the only significant difference between Group D and S was recorded at minute 3 of recovery (72.2±12.5 vs. 66.2±11.5 beats·min⁻¹).

CONCLUSION

This work provides information on RHR of a large population of elite Spanish athletes, and shows marked differences in the way that HR recovers in dynamic and static sports.

EBV-associated post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in adults with hematological diseases

We analyzed the incidence, clinicopathological features, risk factors and prognosis of patients with EBV-associated post-transplant lymphoproliferative disorder (EBV-PTLD) in 288 adults undergoing umbilical cord blood transplantation (UCBT) at a single institution. Twelve patients developed proven EBV-PTLD at a median time of 73 days (range, 36-812). Three-year cumulative incidence (CI) of EBV-PTLD was 4.3% (95% CI: 1.9-6.7). All patients presented with extranodal involvement. Most frequently affected sites were the liver, spleen, central nervous system (CNS), Waldeyer's ring and BM in 7, 6, 4, 3 and 3 patients, respectively. One patient had polymorphic and 11 had monomorphic EBV-PTLD (7 diffuse large B-cell lymphomas not otherwise specified, 4 plasmablastic lymphomas). We confirmed donor origin and EBV infection in all histological samples. EBV-PTLD was the cause of death in 11 patients at a median time of 23 days (range, 1-84). The 3-year CI of EBV-PTLD was 12.9% (95% CI: 3.2-22.5) and 2.6% (95% CI: 0.5-4.7) for patients receiving reduced-intensity conditioning (RIC) and myeloablative conditioning, respectively (P<0.0001). In conclusion, adults with EBV-PTLD after UCBT showed frequent visceral and CNS involvement. The prognosis was poor despite routine viral monitoring and early intervention. An increased risk of EBV-PTLD was noted among recipients of RIC regimens.

Docetaxel as single-agent treatment in elderly patients with advanced breast cancer

OBJECTIVE

To assess the efficacy and safety profile of docetaxel, as a single agent, in the treatment of elderly patients with advanced breast cancer.

METHODS

Twenty-eight patients, with a median age of 72 (range 66-84) years, were included in the study and received docetaxel (50-100 mg/m(2)) every 3-4 weeks as first- or second-line treatment of advanced breast cancer. Granulocyte colony-stimulating factor (G-CSF) was administered as primary prophylaxis in 97% of cycles.

RESULTS

The overall response rate was 50% (95% CI 32, 69). The median time to disease progression was 10.7 months (95% CI 10.0, 11.5), and the median overall survival was 26.6 months (95% CI 16.6, 36.7). Neutropenia was the most frequent grade 3/4 toxicity (18% of patients and 5% of cycles). There was just one case of febrile neutropenia that resulted in toxic death. Severe neutropenia only occurred in patients who did not receive G-CSF support from the start of the study treatment. Vomiting was the most frequent grade 3/4 non-haematological toxicity (11% of patients and 2% of cycles).

CONCLUSION

Docetaxel as a single agent is active in elderly patients with advanced breast cancer. The use of prophylactic G-CSF allowed the administration of high doses of docetaxel with minimal myelosuppression.

Autoimmune hemolytic anemia following allogeneic hematopoietic stem cell transplantation in adult patients

Autoimmune hemolytic anemia (AIHA) after allogeneic hematopoietic stem cell transplantation (HSCT) is still not well characterized. The aim of this study was to analyze the incidence and risk factors for the development of AIHA, as well as its prognosis and response to treatment in a series of patients undergoing allogeneic HSCT at a single institution. Between 1996 and 2004, 272 adult patients with a variety of malignant hematopoietic disorders underwent allogeneic HSCT. Direct antiglobulin testing was performed in routine pretransfusion compatibility testing or after clinical suspicion of AIHA. Twelve patients developed AIHA after HSCT at a median time of 147 days (range, 41-170). The 3-year cumulative incidence of AIHA was 4.44%. Eight cold antibodies and four warm antibodies were detected. Multivariate analysis shows that HSCT from unrelated donors (P=0.02) and the development of chronic extensive graft-versus-host disease (GVHD) (P=0.0004) were the only independent factors associated with AIHA. Two patients are still alive. AIHA was never the primary cause of death but added morbidity in patients with other concomitant complications. Patients undergoing HSCT from unrelated donors and those who develop chronic extensive GVHD are especially predisposed for this complication.

Transplantation of CD34+ selected peripheral blood to HLA-identical sibling patients with aplastic anaemia: results from a single institution

We evaluated the use of CD34+ selected allogeneic peripheral blood as a source of hematopoietic progenitors for allogeneic transplantation in 11 patients with aplastic anemia (AA). The median age was 17 years (range, 6--9), and the median time between diagnosis and transplant 1 month (range, 1--4). Conditioning consisted of cyclophosphamide (50 mg/kg per day) on days--7 to--4 and antithymocyte globulin (30 mg/kg per day) on days--4 to--2 in nine patients. Total lymphoid irradiation was added to the preparative regimen for two. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine A and prednisone. Median doses of CD34+ and CD3+ cells infused were 3.91 x 10(6) and 0.3 x 10(6)/kg, respectively. The median time taken to achieve a neutrophil count >0.5 x 10(9)/l was 12 days and to recover a platelet count >20 x 10(9)/l, 13 days. Two patients developed acute GVHD grade I--II and one developed limited chronic GVHD. There were two treatment-related deaths. At a median follow-up of 44 months (range, 4--3), nine patients were alive with sustained and complete engraftment. This is a promising procedure in patients with AA, resulting in a rapid hematopoietic recovery, a low transplant-related mortality, and a low incidence of GVHD.

[Embolization of non-functioning renal allograft: efficacy and control of systemic inflammation]

BACKGROUND

The graft intolerance syndrome (fever, pain, haematuria) may lead to a chronic inflammatory disease, with cardiovascular repercussion. Nephrectomy is considered the classical treatment of these cases but nowadays renal vascular embolization has been suggested as a possible alternative treatment. The present study concerns seven cases trated with renal vascular embolization in our hospital summarizing data of graft intolerance syndrome and the chronic inflammatory disease.

MATERIAL AND METHODS

Between january 2000 and december 2003 seven renal vascular embolization were performed in nonfunctioning renal allograft. The procedure was made with calibrated particles of 300-500micron. Data about complications related to the technique the same as analitic inflammatory parameters before and after treatment (CRP, ferritin, serum albumin, hemoglobin, erythropoietin) were registered.

RESULTS

The patients were two men and five women, with median age of 39,7 +/- 8,8 years. The period beween the dialysis and the embolization was of 10,0 +/-8,2 months. Comparing the perion of admission in the hospital due to nephrectomy which was of 17,86+/-4,41 days, the period because of embolization was shorter, being 8,14 +/- 4,53 days. All analitic parameters studied, clearly improved after embolization with decrease of ferritin and CRP, increase of albumin and better hemoglobin level with lower erythropoietin dose. In five of the seven patients there was no renal captation with CT or gammagraphy. Four patients presented a postembolization syndrome, but no other important complication was registered. Neither reembolization nor renal nephrectomy was neccesary in any of the seven cases.

CONCLUSION

Percutaneous renal embolization is a simple, easy, safety and effective technique that must be considered as an alternative treatment to nephrectomy, resolving the chronic inflammatory disease secondary to the graft intolerance syndrome.

[Nephropathia caused by hantavirus puumala: a case report]

We present a patient from Germany with Hantavirus infection, admitted in the Emergency room of our hospital, with fever, thrombocytopenia, acute renal failure, oliguria, mild proteinuria and hematuria. Percutaneous renal biopsy revealed an acute interstitial nephritis without medulla haemorrhages. The virus infection confirmation was made by detection of IgM against Hantavirus Puumala. This infection should be considered in patients with thrombocytopenia, fever and acute renal failure, over all if they are from North and Central Europe.

Peripheral blood stem cell collection after intermediate-dose cytarabine in adult patients with acute myeloblastic leukemia undergoing autologous blood stem cell transplantation in first complete remission

Different strategies for collecting peripheral blood stem cells (PBSC) for autologous blood stem cell transplantation (ABSCT) have been reported for patients with acute myeloblastic leukemia (AML). We compared the clinical results of 2 consecutive protocols in 75 adult patients with AML in first complete remission who underwent ABSCT. In the first 56 patients (group A), PBSC were collected after induction and/or consolidation chemotherapy courses. In the subsequent 19 patients (group B), PBSC collection was done after a further intensification course with intermediate-dose cytarabine and mitoxantrone. Hematopoietic engraftment was similar in the 2 groups, with the median times to reach 0.5 x 10(9) neutrophils/L and 20 x 10(9) platelets/L being 13 days each in group A, and 12 days and 24 days, respectively, in group B. There were 3 graft failures (all in group A) and 5 transplantation-related deaths (6.6%, 4 in group A and 1 in group B). Although not statistically significant, the 3-year probabilities of both relapse (31% versus 66%; P = .12) and disease-free survival (60% versus 36%; P = .1) compared favorably for group B. Our study suggests that collection of PBSC after additional intensification can result in a better outcome for AML patients who undergo ABSCT.

[Porphyria and inappropriate antidiuretic hormone syndrome]

We report the case of a 37-years-old woman with inappropriate antidiuretic hormone syndrome due to an attack of acute porphyria. The patient was admitted to our hospital for abdominal pain, sleepiness and pink urine. Family and personal history were normal. Seven days before the admission the patient had a laparoscopy operation for endometriosis in her left ovary. The patient had had two normal pregnancies. The physical examination was normal, the skin turgor was good and no edema was present, the blood pressure was 140/90 mmHg. Her serum sodium was 114 mEq/L, serum osmolality 243 mOsm/kg, urine sodium 146 mEq/L and urine osmolality 457 mOsm/kg. Values from laboratory examination revealed a normal peripheral haematogram, a normal kidney function, normal liver, adrenal and thyroid function. The urine tested for amino-levulinic acid, coproporphyrin and uroporphyrin was strongly positive. These findings are compatible with Porphyria Variegata or Coproporphyria Hereditary. A diagnosis of Porphyria acute with SIADH was made, and water fluid restriction, i.v. hypertonic saline infusion and furosemide to correct the hyponatremia was begun. In 1966, lesions of the median eminence of the hypothalamus and both hypothalamic -hypophyseal tracts were described in a patient with Porphyria acute intermittent and SIADH. It was suggested that SIADH occurred because of damage to these areas of the brain from excessive exposure to porphyrins.

[Influence of early or late referral to nephrologist over morbidity and mortality in hemodialysis]

OBJECTIVE

We studied the influence of early vs late referral to nephrologist of patients with chronic renal failure over clinical situation at the onset of hemodialysis and outcome.

SUBJECTS AND METHODS

From january 1994 to december 1998, 139 patients started hemodialysis for end-stage renal disease at the Hospital General de Albacete, all of them included in the study and clinical follow-up concluded in december 2001. Patients with rapidly progressive glomerulonephritis were excluded. Early (ER) and late referral (LR) were defined by the time of first nephrology encounter greater than or less than 6 months respectively, before iniciation of hemodialysis.

RESULTS

106 patients (76.25%) were referred early; mean follow-up time 6.3 +/- 4.5 years. 33 patients (23.74%) had late referral, follow-up time was less then six months, 18 patients were followed during less than 4 weeks. There were no differences in demographic data and comorbid conditions between LR and ER patients (age, cardiac and vascular disease, diabetes, neoplasia...). Mean plasma concentration of creatinine and urea was significantly greater, whereas hematocrit and albumin were less in the LRA than the ER group. Emergency dialysis through central vein catheterisation was more frequent in the LR group. Number of admissions and duration of hospital stay were higher in the LR group. No significant differences in nutrition, dialysis doses or anemia were found between the two groups after 6 and 12 months of hemodialysis. Long term outcome was similar in both groups: no significant differences were found in percentage of patients transplanted or deceased after 3 years of treatment. Survival analysis failed to show a difference between ER and LR groups (mean survival time was 73.6 +/- 4.3 months and 73.0 +/- 6 months respectively).

CONCLUSION

Late referral to the nephrologist is associated with increased early morbidity vs early referral, although long term outcome is not worse if predialysis comorbid conditions are comparable and dialysis care achieve equal results in dialysis doses, nutrition and anemia in both groups in the first months of treatment. Improvement of outcome of patients referred early to the nephrologist will depend on the adoption of preventive measures over comorbidity factors that should be applied in early stages of renal disease.

Early infections in adult patients undergoing unrelated donor cord blood transplantation

Early transplant-related mortality after cord blood transplantation from unrelated donors (UD-CBT) is close to 50%, mainly due to infectious complications. We have studied the incidence and characteristics of early infections (before day 100) in a series of 27 adult patients (median age 30 years, range 16-46) undergoing UD-CBT at a single institution. All 27 patients experienced at least one infectious episode and 18 (66%) suffered a severe infection. Bacteremia occurred in 55% of patients (13 with Gram-positive and 11 with Gram-negative microorganisms). Eleven of 19 CMV-seropositive patients (58%) developed CMV antigenemia and one patient had CMV disease. Fungal infections were documented in three patients (11%), comprising invasive fungal infections in two cases and a localized esophagitis in one. Ten patients (37%) died before day 100 after transplantation. Infection was considered the primary cause of death in four patients (sepsis by Acinetobacter spp. bacteremia in three cases) and contributed to death in another four. The most striking findings in this series were the high incidence of, and mortality due to multiresistant Acinetobacter spp. and the low incidence of and lack of mortality due to CMV disease. This report confirms that infection is a major complication in adults undergoing UD-CBT.

Effects of antihypertensive therapy on progression of diabetic nephropathy

There is a clear relationship between hypertension and the microvascular complications of diabetes. Genetic predisposition to hypertension has been correlated to the risk of diabetic nephropathy in type I diabetes, and hypertension is a well known risk factor for developing nephropathy in patients with type II diabetes. Multiple studies have emphasized the importance of hypertension on renal disease progression, and blood pressure control with conventional antihypertensive drugs slows the rate of renal function loss in diabetic nephropathy. Furthermore, evidence of the role of renin-angiotensin system (RAS) on progression of renal damage has focused much interest on the therapeutic action of the RAS blockade. In patients with type I diabetes, blocking the RAS with angiotensin converting enzyme (ACE) inhibitors prevents progression from microalbuminuria to overt nephropathy, and in overt nephropathy decreases the gradual loss of renal function beyond its blood pressure lowering effect. Less clinical information is available in type II diabetic nephropathy, but our experience and some recent studies suggest that ACE inhibitors also have a renoprotective action in type II diabetes. The role of calcium channel blockers in diabetic nephropathy is not clear. Several short-term studies with the first generation dihydropyridine calcium antagonists showed a lower effect on urinary albumin excretion and a more rapid progression to renal failure than with ACE inhibitors. However, other calcium channel blockers, particularly of the non-dihydropyridine type, have been shown to have a beneficial effect on diabetic nephropathy, decreasing proteinuria and slowing progression.

Spontaneous skin ulceration and defective T cell function in CD18 null mice

A null mutation was prepared in the mouse for CD18, the beta2 subunit of leukocyte integrins. Homozygous CD18 null mice develop chronic dermatitis with extensive facial and submandibular erosions. The phenotype includes elevated neutrophil counts, increased immunoglobulin levels, lymphadenopathy, splenomegaly, and abundant plasma cells in skin, lymph nodes, gut, and kidney. Very few neutrophils were found in spontaneously occurring skin lesions or with an induced toxic dermatitis. Intravital microscopy in CD18 null mice revealed a lack of firm neutrophil attachment to venules in the cremaster muscle in response to N-formyl- methionyl-leucyl-phenylalanine. A severe defect in T cell proliferation was found in the CD18 null mice when T cell receptors were stimulated either by staphylococcal enterotoxin A or by major histocompatibility complex alloantigens demonstrating a greater role of CD11/CD18 integrins in T cell responses than previously documented. The null mice are useful for delineating the functions of CD18 in vivo.

Mice deficient in the alpha7 neuronal nicotinic acetylcholine receptor lack alpha-bungarotoxin binding sites and hippocampal fast nicotinic currents

The alpha7 subunit of the neuronal nicotinic acetylcholine receptor (nAChR) is abundantly expressed in hippocampus and is implicated in modulating neurotransmitter release and in binding alpha-bungarotoxin (alpha-BGT). A null mutation for the alpha7 subunit was prepared by deleting the last three exons of the gene. Mice homozygous for the null mutation lack detectable mRNA, but the mice are viable and anatomically normal. Neuropathological examination of the brain revealed normal structure and cell layering, including normal cortical barrel fields; histochemical assessment of the hippocampus was also normal. Autoradiography with [3H]nicotine revealed no detectable abnormalities of high-affinity nicotine binding sites, but there was an absence of high-affinity [125I]alpha-BGT sites. Null mice also lack rapidly desensitizing, methyllycaconitine-sensitive, nicotinic currents that are present in hippocampal neurons. The results of this study indicate that the alpha-BGT binding sites are equivalent to the alpha7-containing nAChRs that mediate fast, desensitizing nicotinic currents in the hippocampus. These mice demonstrate that the alpha7 subunit is not essential for normal development or for apparently normal neurological function, but the mice may prove to have subtle phenotypic abnormalities and will be valuable in defining the functional role of this gene product in vivo.

Reduced susceptibility to collagen-induced arthritis in mice deficient in intercellular adhesion molecule-1

Intercellular adhesion molecule-1 (ICAM-1) plays an important role in the firm adhesion of leukocytes to venular endothelium and facilitates leukocyte extravasation from the vasculature into inflamed tissue. In addition, ICAM-1 is an important costimulatory molecule during Ag presentation to lymphocytes. Using mice deficient in ICAM-1, we have investigated the role of this molecule in the development of collagen-induced arthritis. After immunization with type II collagen, 71% of wild-type mice developed arthritis compared with 50% of ICAM-1 heterozygote mutants and 18% of ICAM-1 homozygous mutants. In those ICAM-1 mutants that developed arthritis, the mean day of onset, the mean number of involved paws, and the severity of paw inflammation were not significantly different from those in wild-type mice. The reduced incidence of arthritis in the ICAM-1 homozygous mutant mice was not due to lack of immunity to type II collagen, since these mice developed similar levels of anti-type II collagen IgG compared with wild-type mice and had a positive delayed-type hypersensitivity reaction to type II collagen. The reduction of arthritis in heterozygous as well as homozygous deficient mice indicates that expression of ICAM-1 can be a pivotal variable in the pathogenesis of collagen-induced arthritis in mice. The results suggest that naturally occurring genetic variation in the expression of ICAM-1 or related inflammatory cell adhesion molecules might influence susceptibility to the complex disease of rheumatoid arthritis in humans and support the concept that pharmacologic approaches to chronic reduction in the expression or the function of ICAM-1 may be of therapeutic value.

Reduced susceptibility to collagen-induced arthritis in mice deficient in intercellular adhesion molecule-1

Intercellular adhesion molecule-1 (ICAM-1) plays an important role in the firm adhesion of leukocytes to venular endothelium and facilitates leukocyte extravasation from the vasculature into inflamed tissue. In addition, ICAM-1 is an important costimulatory molecule during Ag presentation to lymphocytes. Using mice deficient in ICAM-1, we have investigated the role of this molecule in the development of collagen-induced arthritis. After immunization with type II collagen, 71% of wild-type mice developed arthritis compared with 50% of ICAM-1 heterozygote mutants and 18% of ICAM-1 homozygous mutants. In those ICAM-1 mutants that developed arthritis, the mean day of onset, the mean number of involved paws, and the severity of paw inflammation were not significantly different from those in wild-type mice. The reduced incidence of arthritis in the ICAM-1 homozygous mutant mice was not due to lack of immunity to type II collagen, since these mice developed similar levels of anti-type II collagen IgG compared with wild-type mice and had a positive delayed-type hypersensitivity reaction to type II collagen. The reduction of arthritis in heterozygous as well as homozygous deficient mice indicates that expression of ICAM-1 can be a pivotal variable in the pathogenesis of collagen-induced arthritis in mice. The results suggest that naturally occurring genetic variation in the expression of ICAM-1 or related inflammatory cell adhesion molecules might influence susceptibility to the complex disease of rheumatoid arthritis in humans and support the concept that pharmacologic approaches to chronic reduction in the expression or the function of ICAM-1 may be of therapeutic value.

Fatty acid composition of lipoprotein lipids in hepatobiliary diseases

Liver damage and alterations in the exocrine function of the gland lead to a profound alteration of the plasma lipoprotein profile. To determine whether hepatic disease results in changes in the lipoprotein fatty acid composition, i.e. to determine whether liver function influences the homeostasis of complex lipids in plasma, we studied the fatty acid profile of lipids from VLDL, LDL and HDL, as well as from total plasma, in thirty-one patients of both sexes with hepatobiliary pathology (compensated liver cirrhosis, uncompensated liver cirrhosis, primary biliary cirrhosis, other intrahepatic cholestasis, and acute viral hepatitis). We also studied a group of healthy adults as controls. We present the lipoprotein profile and the fatty acid composition (myristic C14, palmitic C16, palmitoleic C16: 1, stearic C18, oleic C18: 1, linoleic C18: 2, eicosatrienoic C20: 3 omega 6 and arachidonic C20: 4) of lipoprotein and total plasma triacylglycerols, cholesteryl esters and phospholipids. The main observation of this study is that, despite the profound changes in the lipoprotein profile and the lower abundance of polyunsaturated fatty acids in complex lipids, the composition of all triacylglycerols, cholesteryl esters and phospholipids is very similar for the corresponding lipoproteins of patients with hepatobiliary disease and of control subjects. This indicates that in the controls as in the studied patients, the exchange of lipids between plasmatic lipoproteins is very rapid and demonstrates the possible importance of the extrahepatic synthesis of cholesteryl ester transfer protein.

Time course of reaction time and EEG while performing a vigilance task during total sleep deprivation

Nine young adult male (23-30 years old) paid volunteers were subjected to total sleep deprivation (TSD), after two consecutive nights in the laboratory, for 40 hours (from 0800 hours on the first day to 2400 hours on the following day). Oral temperature (OT), reaction time (RT) in a visual vigilance task, and electroencephalogram (EEG; C3, C4, T3, and T4) while performing the task were recorded every 2 hours during TSD and after recovery sleep. One second of EEG, before target and non-target stimuli for every subject and condition was visually inspected, and artifact-free epochs were Fourier transformed. Absolute power (AP) was calculated for 4-20 Hz (full band) and for theta, alpha 1, alpha 2, and beta 1. Analyses of variance (ANOVAs), with TSD and time-of-day as factors, showed the following significant results. TSD induced an increase in RT and AP of the full band at C3 and C4, of all bands at C3, of theta at T3, and of beta 1 at T4 (p < 0.009 for all comparisons). No time-of-day effects nor interactions were found. OT was not affected by TSD. All variables returned to baseline values after recovery sleep. RT and EEG power showed a linear increase with accumulating hours of wakefulness. The increment in RT also correlated with the increase in EEG power. The results demonstrate that the increment in RT is associated with the increase in AP, particularly in the left central cortex; that the EEG may be used to identify sleepiness; and that EEG during task performance is more sensitive to TSD than during relaxed wakefulness.

Infectious susceptibility and severe deficiency of leukocyte rolling and recruitment in E-selectin and P-selectin double mutant mice

During the initial phase of the inflammatory response, leukocytes marginate and roll along the endothelial surface, a process mediated largely by the selectins and their ligands. Mice with mutations in individual selectins show no spontaneous disease and have mild or negligible deficiencies of inflammatory responses. In contrast, we find that mice with null mutations in both endothelial selectins (P and E) develop a phenotype of leukocyte adhesion deficiency characterized by mucocutaneous infections, plasma cell proliferation, hypergammaglobulinemia, severe deficiencies of leukocyte rolling in cremaster venules with or without addition of TNF-alpha, and an absence of neutrophil emigration at 4 h in response to intraperitoneal Streptococcus pneumoniae peritonitis. These mice provide strong evidence for the functional importance of selectins in vivo.

Use of erythropoietin in emergencies: massive intoxication by chloramines

Recombinant human Erythropoietin (rHuEPO) is normally used to correct anaemia in patients with End Stage Renal Disease (ESRD), that are in Regular Dialysis Treatment (RDT). This anaemia is usually due to the existence of two factors: A decrease in the erythropoiesis of the bone marrow and an increase in peripheral haemolysis and, consequently, a decrease in the life span of the red cells.

Effects of current and former pacifier use on the dentition of 24- to 59-month-old children

Two hundred eighteen children ages 24-59 months participated in a study to examine the effect of pacifier use on the occlusion of the primary dentition. A questionnaire was used to gain information on habit history. Eighty-two children were current or former users of functional exercisers, 38 had a history of conventional pacifier use, and 98 had no history of oral habits. Compared to children with no habit, those with a history of pacifier use had a significantly larger mean overjet (P < 0.001), as well as significantly higher occurrences of Class II primary canines (P = 0.015), distal step molars (P = 0.014), openbite (P = 0.001), and posterior crossbite (P = 0.025). Compared to users of conventional pacifiers, users of functional exercisers had a significantly higher occurrence of Class II primary canines (P = 0.013) and distal step molars (P = 0.037). Pacifier use time in months was significantly higher for children with openbite (P = 0.02) and posterior crossbite (P = 0.019). Compared to former pacifier users, those with current habits had a significantly higher prevalence of openbite (P = 0.002) and posterior crossbite (P = 0.001), and a greater mean openbite (P = 0.19). The reported number of hours use per day was not related to any aspect of the occlusion of pacifier users. African-American and European-American children began their habits at about the same age and used their pacifiers for an equivalent number of hours per day. Among those who had discontinued their habits, African-American children had maintained theirs for a significantly shorter period (P < 0.001), leading to a longer elapsed time between habit discontinuation and the examination.

Effect of total sleep deprivation on reaction time and waking EEG activity in man

Nine paid volunteers were sleep deprived over a period of 40 hours. Every 2 hours during total sleep deprivation (TSD) and after recovery sleep, oral temperature (OT), reaction time (RT) in a vigilance task and electroencephalogram (EEG) with eyes open and closed (C3, C4, T3 and T4) were recorded. Ten artifact-free samples from each condition were Fourier transformed. Absolute power was calculated for six bands. Analyses of variance with deprivation and time of day as factors showed the following significant results: 1) TSD induced an increase in RT, of theta power in all derivations, of beta power in both centrals and a decrease of alpha power with eyes closed; OT was not affected. 2) All bands showed a peak of power at 1800 hours, 2 hours in advance of the OT acrophase at 2000 hours. All variables recovered baseline values after 1 night of sleep. Significant linear correlations of hours of wakefulness with EEG and RT, and of EEG power with OT and RT, were observed. The present findings show a linear increase in EEG power and RT with TSD, and a diurnal oscillation of EEG power, which is independent of TSD.

Inter- and intrahemispheric EEG correlation during sleep and wakefulness

Inter- (INTERr) and intrahemispheric (INTRAr) electroencephalographic (EEG) correlations were assessed in eight young male adults during wakefulness with eyes closed before going to sleep, and during stage 2, stage 4 and paradoxical sleep (PS) on the second night spent at the laboratory. Pearson product-moment correlations were calculated between EEG signals of every pair of electrodes (C3, C4, F3, F4, T3, T4) for six bands and for every 0.5 Hz from 1.5 to 15 Hz. Previous results of higher INTERr during sleep compared to during wakefulness were confirmed for the delta and theta bands during stage 2 sleep and PS and for sleep spindles during stage 2 sleep. The present results extend these findings to INTERr between F3 and F4 and during stage 4 sleep. INTRAr of 1.5-6.5 and 11-15 Hz was significantly higher during stages 2 and 4, whereas during PS INTRAr did not change. These data show that cortical changes during sleep are also observed in functional differentiation between cortical sites. Inter- and intrahemispheric differentiation is attenuated during stage 2 and 4 sleep, whereas during PS only inter-hemispheric differentiation is attenuated but intrahemispheric differentiation maintains similar levels of wakefulness. The attenuation of cortical differentiation may be of relevance for the understanding of mental activity changes during sleep.