Test performance and clinical utility of expanded non-invasive prenatal test: Experience on 71,883 unselected routine cases from one single center

OBJECTIVE

The balance between benefits and risks of discordant outcomes makes the Genome-Wide Non-Invasive Prenatal Test (GW-NIPT) controversial. This study aims to evaluate performance and clinical utility in a wide cohort of unselected clinical cases from a single center when a standardized protocol is applied and integrated with a secondary algorithm for data interpretation.

METHOD

In 2 years, over 70,000 pregnant patients underwent GW-NIPT for fetal common trisomies, sex chromosome aneuploidies, rare autosomal aneuploidies, segmental abnormalities (CNVs ≥ 7 Mb) and microdeletions (CNVs < 7 Mb). All samples were uniformly processed with Veriseq NIPT Solution v2 and analyzed using all data metrics along with a home-made algorithm for sequencing data analysis. Results were retrospectively reviewed for clinical outcomes.

RESULTS

Among 71,883 eligible cases including twin pregnancies, 1011 (1.4%) received a positive result and 781 were confirmed by invasive prenatal diagnosis. Clinical sensitivity ranged from 99.65% for common trisomy (T21, T18, T13) to 83.33% for microdeletions, while specificity remained high (99.98%) for each class of fetal abnormalities detected.

CONCLUSIONS

Integrating a standardized protocol with an internal algorithm allowed discordant results to be reduced, yielding high accuracy. Observed reliability in detecting genome-wide chromosomal conditions reinforced the expanded NIPT utility in clinical practice.

Non-Ceruloplasmin Copper Identifies a Subtype of Alzheimer’s Disease (CuAD): Characterization of the Cognitive Profile and Case of a CuAD Patient Carrying an RGS7 Stop-Loss Variant

Alzheimer’s disease (AD) is a type of dementia whose cause is incompletely defined. Copper (Cu) involvement in AD etiology was confirmed by a meta-analysis on about 6000 participants, showing that Cu levels were decreased in AD brain specimens, while Cu and non-bound ceruloplasmin Cu (non-Cp Cu) levels were increased in serum/plasma samples. Non-Cp Cu was advocated as a stratification add-on biomarker of a Cu subtype of AD (CuAD subtype). To further circumstantiate this concept, we evaluated non-Cp Cu reliability in classifying subtypes of AD based on the characterization of the cognitive profile. The stratification of the AD patients into normal AD (non-Cp Cu ≤ 1.6 µmol/L) and CuAD (non-Cp Cu > 1.6 µmol/L) showed a significant difference in executive function outcomes, even though patients did not differ in disease duration and severity. Among the Cu-AD patients, a 76-year-old woman showed significantly abnormal levels in the Cu panel and underwent whole exome sequencing. The CuAD patient was detected with possessing the homozygous (c.1486T > C; p.(Ter496Argext*19) stop-loss variant in the RGS7 gene (MIM*602517), which encodes for Regulator of G Protein Signaling 7. Non-Cp Cu as an add-on test in the AD diagnostic pathway can provide relevant information about the underlying pathological processes in subtypes of AD and suggest specific therapeutic options.

Sudden winter iloprost withdrawal in scleroderma patients during COVID-19 pandemic

Introduction

Intravenous iloprost is currently recommended in the treatment of Raynaud's phenomenon (RP) refractory to oral therapy and of digital ulcers (DUs) related to systemic sclerosis (SSc). In real-life practice there is a huge heterogeneity about the Iloprost regimens used.

Methods

A survey was carried out on SSc patients that interrupted Iloprost infusion to compare acral vascular symptoms just before Iloprost withdrawal and just after the missed infusion. Severity, and frequency of RP, new DUs onset or aggravation of those pre-existing were reported. Last available capillaroscopic images were also evaluated.

Results

The analysis includes 50 patients. After iloprost withdrawal, 11 patients reported a RP worsening because of enhanced intensity (p = 0.007). Only 8 patients of them also complained of an increased frequency (p = 0.07). None of the patients experienced digital ulcers for the first-time during quarantine. Among the 27 patients with a history of digital ulcers, 9 reported worsening and 7 recurrence of DUs. Overall, 17 patients (34.0 %) complained of a worsening of SSc vascular acral manifestations, namely RP or DUs. Reduced capillary density was associated with RP worsening, in particular, each unit increase of capillary density corresponds to an average 44 % decrease in the odds of RP worsening (OR 0.56, CI 95 % 0.36–0.97, p = 0.037). As for RP worsening, the aggravation of DU was associated with a lower capillary density.

Conclusions

Low capillary density can predict a worsening of both RP and DUs in controlled quarantine conditions within a month after iloprost discontinuation in SSc patients.

P-563 The effect of embryo culture time on concordance rates between invasive and non-invasive preimplantation genetic testing for aneuploidies (niPGT-A) in spent culture media (SCM) analysis

Study question

To evaluate different embryo culture times (day5 versus day6) to understand the ideal time-frame for the performance of concordance analysis between invasive and non-invasive PGT-A(niPGT-A)

Summary answer

Different levels of ploidy concordance rates were observed between day5 and day6 groups: 72,6% versus 84,8%, respectively

What is known already

The recent data supports that a non-invasive approach for evaluating embryo ploidy status may be an alternative to standard invasive methods. Embryo cell-free DNA(cfDNA) released into culture media during in-vitro embryo development represents the potential source for this analysis. The release of cfDNA from embryos is expected to be directly proportional to embryo culture time and late-stage released cfDNA may be more representative of the embryo. Therefore, it is important to estimate the most effective time frame of the culture that will provide the most conclusive data from spent-culture-media(SCM) without adversely affecting the development of the embryo

Study design, size, duration

A total of 334 SCM from blastocyst stage embryos have been included in this study. The SCM samples were divided in 2 subgroups according to the embryo culture time as day5 (n = 154) and day6 (n = 180). The cfDNA of SCM samples were amplified by whole genome amplification(WGA) and analyzed by next generation sequencing(NGS) in parallel to day5 or day6 trophectodermal(TE) biopsied samples of their corresponding embryos. Ploidy status and concordance were compared between two groups

Participants/materials, setting, methods

Day3 embryos were washed and transferred in 20µl fresh culture media until the biopsy. SCM samples were collected in PCR tubes and stored at -20 °C while embryos were biopsied for standard PGT-A analysis. Both SCM and corresponding TE biopsy samples were amplified by Sureplex(Vitrolife). Then TE and SCM samples were analyzed by next-generation sequencing(NGS) using MiSeq® System (Illumina). Data analysis has been done by Bluefuse Multi Software 4.5(Illumina) for all SCM and TE samples

Main results and the role of chance

A successful DNA amplification rate (&gt;30ng/µl) was obtained in both day5 and day6 groups with 95,5% (147/154) and 99,4% (179/180) respectively. The DNA concentration after WGA was ranging between 30.1-122.5ng/µl and 38.5-123.2ng/µl in day5 and day6 groups respectively. Not conclusive (NC) results including a noisy NGS profile and chaotic chromosome aneuploidies (&gt;5 chromosomes) were excluded in both groups. Therefore, 64,6% (95/147) of SCM samples in day5 group and 81,0% (145/179) of SCM samples in day6 group were conclusive for NGS analysis. The ploidy concordance rate between SCM and TE samples (euploid vs euploid, aneuploid vs aneuploid) was 72,6% (69/95) in day5 and 84,8% (123/145) in day6 group. In day5 group, the false-negative rate was 10.5% (10/95), and false-positive rate was 16.8% (16/95) while in day6 group the false-negative rate was 6,8% (10/145), and false-positive rate was 8,2% (12/145). Sensitivity and specificity were calculated as 83,6% and 52,9% in day5 group, and 90,9% and 65,7 in day6 group respectively

Limitations, reasons for caution

We have high number of samples in our study, but larger prospective studies may change the significance of ploidy concordance. One of the important issues in SCM analysis is the maternal DNA contamination risk which cannot be revealed always. Therefore the use of molecular markers would increase the reliability

Wider implications of the findings

A non-invasive approach for aneuploidy screening may be an alternative to standard PGT-A procedure with invasive embryo biopsy but the evaluation of ideal culture time is crucial for the performance of niPGT-A method. Our study demonstrates that the late collection time of SCM provides significantly better ploidy concordance rates

Trial registration number

Not applicable

AB0704 LOW BODY MASS INDEX IN PATIENTS WITH RAYNAUD PHENOMENON IS ASSOCIATED WITH ENLARGED CAPILLARIES AND REDUCTION IN CAPILLARY DENSITY AT NAILFOLD VIDEOCAPILLAROSCOPY

Background

Increased prevalence of peripheral vascular symptoms like Raynaud’s phenomenon (RP) and acrocianosis is reported in anorexia nervosa (AN) and correlates with a more severe malnutrition.

Objectives

We aimed to characterize nailfold video capillaroscopy (NVC) abnormalities in patients with RP and BMI<18.5 kg/m2, according to adipokine levels, compared to subjects with RP and normal BMI.

Methods

We performed NVC in 21 female patients with primary RP with BMI<18.5 kg/m2, in 18 patients with primary RP and normal BMI, and in 18 patients classifiable as VEDOSS (Very Early Diagnosis of Systemic Sclerosis) and normal BMI, using a video-capillaroscope. Fingers two to four were evaluated bilaterally. Mean and minimum capillary density were registered for each patient, as well as maximum diameter and number of enlarged and giant capillaries, number of micro-haemorrhages and micro-thrombosis. We scored the frequency of enlarged capillaries considering the percentage of dilated capillaries out of the total. Demographic and clinical features of all patients were recorded.

Results

Patients with RP and low BMI presented a great number of elementary alterations on NVC; some of these modifications were typical of the scleroderma pattern. The percentage of enlarged capillaries was more than 33% of the total in 17(81%) patients with RP and low BMI with respect to 9(50%) of patients with RP and normal BMI (p=0.041). Furthermore, the number of megacapillaries was higher in patients with RP and low BMI compared to patients with normal BMI, while the maximum diameter of capillaries was comparable. Eight patients with low BMI presented a picture resembling an early scleroderma pattern (44%). The frequency of micro-thrombosis, micro-hemorrhages and microaneurysms were comparable in the twogroups. Patients with RP and low BMI presented a lower mean capillary and minimum capillary density compared to patients with RP and normal BMI (mean density: 7.4±1.4vs8.2±1.4,p=0.031; minimum density:4.8±1.0vs5.4±1.0,p=0.05). Patients with RP and low BMI presented a comparable frequency of enlarged capillaries, number of megacapillaries when compared with patients with VEDOSS. Leptin and chemerin levels were lower in patients with low BMI with respect to patients with normal BMI (57.5±35.6vs124.2±92.0pg/mL, p<0.001; 46.9±11.9vs58.3±17.2 ng/mL, p=0.017, respectively); adiponectin levels were comparable.

Conclusion

Patients with low BMI and primary RP presented a great frequency of enlarged capillaries and a reduction of capillary density when compared with patients with normal BMI. The increased number of microvascular abnormalities on NVC in patients with low BMI reminds the NVC findings typical of early scleroderma, supporting the hypothesis of an endothelial dysfunction in such patients

Disclosure of Interests

None declared

AB0698 IMPACT OF ILOPROST WITHDRAWAL IN SCLERODERMA PATIENTS DUE TO COVID-19 PANDEMIC

Background

Intravenous iloprost is currently recommended in the treatment of Raynaud’s phenomenon (RP) refractory to oral therapy and of digital ulcers (DUs) related to systemic sclerosis (SSc). In real-life practice there is a huge heterogeneity about the Iloprost regimens used, because of a lack of specific recommendations. Coronavirus pandemic resulted in an unexpected emergency leading to sudden and synchronous withdrawal of programmed iloprost infusions for most SSc patients in March 2020, in order to limit virus dissemination. At the same time, lockdown forced people to stay at home, thus reducing the exposure to coldness. Both these unavoidable circumstances were close to an experimental condition, clearly non-replicable in routine conditions.

Objectives

The aim of the survey was to evaluate the consequences related to a sudden and simultaneous iloprost discontinuation in a cohort of SSc patients.

Methods

A telephone survey was carried out on SSc patients that interrupted Iloprost infusion at our centre. They were specifically asked to compare acral vascular symptoms just before Iloprost withdrawal, in February and just after the missed infusion in March (0-10 scale). Demographic and disease characteristics, severity and frequency of RP, new DUs onset or aggravation of those pre-existing were reported for each patient. Last available capillaroscopic images were also evaluated to assess the pattern.

Results

The analysis included 50 patients. After iloprost withdrawal, 11 patients reported a RP worsening because of enhanced intensity (4.6±2.1 vs 5.2±2.3, p=0.007). Only 8 patients of them also complained of an increased frequency (4.5±2.3 vs 5.0±2.4, p=0.07). None of the patients experienced digital ulcers for the first time during quarantine. Among the 27 patients with a history of digital ulcers, 9 reported worsening and 7 recurrences of DUs. Overall, 17 patients (34.0%) complained of a worsening of SSc vascular acral manifestations, namely RP or DUs. Disease and general features did not statistically correlate with worsening of RP except for reduced capillary density. Of note, each unit increase of capillary density corresponds to an average 44% decrease in the odds of RP worsening (OR 0.56, CI 95% 0.36-0.97, p=0.037). History of DUs - either active or former at the time of iloprost discontinuation - was the only clinical predictor of worsening of DU severity. As for RP worsening, the worsening of DU was associated with a lower capillary density.

Conclusion

Low capillary density can predict a worsening of both RP and DUs within a month after iloprost discontinuation in SSc patients. Further studies are needed to assess whether the capillaroscopy should be used to personalize iloprost regimen in SSc patients.

Disclosure of Interests

None declared

POS0289 CANCER RISK IN IMMUNOSUPPRESSED SCLERODERMA PATIENTS: A PROPENSITY SCORE MATCHING ANALYSIS

Background:

An increased incidence of cancer in patients with systemic sclerosis (SSc) is well-established1. Current knowledge about the onco-transforming power of immunosuppressive treatments in both non-rheumatological and rheumatological pathologies, suggests an increased incidence of hematological and solid neoplasms2. Evidences on the possible role of the immunosuppressants in the onset of cancer during SSc are lacking.

Objectives:

To evaluate the incidence of malignancies in SSc patients exposed to immunosuppressive therapy.

Methods:

The incidence of neoplasia in a cohort of 600 patients with SSc was evaluated retrospectively. Patients diagnosed with malignancy within 36 months from SSc onset were excluded from the analysis since suspected for paraneoplastic form. Patients exposed to methotrexate, cyclophosphamide, azathioprine and mycophenolate were confronted with a group comparable for age at onset, sex, disease variant, autoantibodies and exposure to other disease-specific therapies, using propensity score matching analysis. The considered follow-up was between the clinical onset and the diagnosis of cancer or the last available visit or the twenty-fifth year of illness.

Results:

The analysis was carried out on 526 patients observed for an average period of 12.1 ± 6.0 years (males 9.5%, age at onset 49.0 ± 15.3 years); 24.9% had diffuse cutaneous variant of the disease and 39.0% and 34.8% were respectively positive for anti-centromere and anti-Scl70 antibodies. During the follow-up, 19.0% of patients were exposed to cyclophosphamide, 15.3% to azathioprine, 14.4% to methotrexate and 11.6% to mycophenolate mofetil. Sixty-five cancer diagnoses were made after the 36th month from onset (incidence 1.02: 100 patients/year), comprising 16 mammary cancers, 12 cancers of the gastro-intestinal tract, 11 cancers of the head-neck area, 10 cancers of the lungs, 9 cases of skin-cancer, 5 haematological malignancies and 1 brain tumour. The incidence of cancers did not differ in relation to treatment with cyclophosphamide (X2 = 0.001, p = 0.961), azathioprine (X2 = 2.141, p = 0.143), mycophenolate mofetil (X2 = 0.001, p = 0.993) or methotrexate (X2 = 0.920, p = 0.337) (Figure 1).

Conclusion:

Our data are consistent with an increased incidence of neoplasms in the course of SSc, with a rate that appears almost doubled compared to the general Italian population with similar sex and age distribution (0.55: 100 patients/year; Italian Association of Tumor Registries data3). In our SSc cohort this risk is independent of exposure to immunosuppressive drugs commonly used for the treatment of scleroderma disease.

References:

[1]Akira O et al. Cancer Incidence in Systemic Sclerosis: Meta-Analysis of Population-Based Cohort Studies. Arthritis & Rheumatism. 2013

[2]Zitvogel L et al. Cancer despite immunosurveillance: immunoselection and immunosubversion. Nat Rev Immunol. 2006

[3]Registri Tumori di popolazione in Italia: la Banca Dati AIRTUM (Associazione Italiana Registri Tumori). 2020

Disclosure of Interests:

None declared

POS0864 ELIGIBILITY FOR ANTI-FIBROTIC TREATMENT WITH NINTEDANIB OF PATIENTS WITH SYSTEMIC SCLEROSIS RELATED INTERSTITIAL LUNG DISEASE

Background:

Pulmonary involvement is the main determinant of disease-related mortality in systemic sclerosis (SSc). The SENSCIS and INBUILD trials have documented the efficacy of the antifibrotic drug Nintedanib (NTN) in the treatment of SSc-related interstitial lung disease (SSc-ILD) and progressive forms of ILD other than Idiopathic Pulmonary Fibrosis1,2. The criteria for the use of this drug in patients with SSc-ILD in clinical practice are currently being defined.

Objectives:

To evaluate the proportion of patients eligible for NTN treatment based on the enrollment criteria fof the SENSCIS and INBUILD studies in a real-life cohort of SSc-ILD patients.

Methods:

We considered consecutive patients with ILD extension on CT ≥10% and disease duration ≤7 years with at least one visit in the period between September 2016 and December 2019. Data of the clinical visits were retrospectively evaluated. For each patient, we examined the visits during which a well-tolerated immunosuppressive therapy was modified because of progression of SSc-ILD and the most recent follow-up visit. Eligibility of patients for NTN was defined according to the inclusion criteria of the SENSCIS and INBUILD trials. Patients with more than 2 acral ulcers at the time of evaluation, history of digital amputation, pulmonary hypertension (functional class III-IV) and increased hemorrhagic or thrombotic risk were judged not eligible to NTN in trials.

Results:

A total of 177 visits regarding 78 patients were examined (females 80.8%, diffuse skin disease 51.3%, anti-Scl70 antibodies positivity 55.7%, age 54.8±16.0 years, disease duration 4.0±2.4 years). Considering the visits in which indication for a therapeutic change was given, 54 patients (54.5%) were eligible for NTN according to SENSCIS criteria and of these 31 (31.3%) also according to INBUILD criteria (Figure 1). In this group, 25 patients were treated with mycophenolate mofetil, 11 with azathioprine, 10 with cyclophosphamide, 7 with methotrexate and 8 with rituximab (2 in combination). At the latest available evaluation, 42 patients (62.8%) were eligible for NTN according to SENSCIS criteria and of these 12 (15.4%) also according to INBUILD criteria (Figure 1). In this group, 30 patients were in mycophenolate mofetil (6 in combination with biologic treatment), 5 in azathioprine, 1 in cyclophosphamide, 1 in methotrexate, 6 in rituximab, 2 in tocilizumab and 1 in pirfenidone. Overall, the factors limiting NTN start according to the trial enrollment criteria would have been: uncompromised (19.2%) or too low (6.4%) DLco values, too low FVC (3.4%), severe acral disease with ulcers (16.9%), severe pulmonary arterial hypertension (6.2%), increased thrombotic or haemorrhagic risk (6.2%). In the scenario of eligibility, skin progression was detectable in 43.4% of all visits.

Conclusion:

Treatment that can modify the progression of SSc-ILD are currently limited. Based on our retrospective analysis, the use of NTN in accordance with current clinical evidence could be considered in a significant percentage of patients with SSc-ILD.

References:

[1]Flaherty KR, et al. Nintedanib in Progressive Fibrosing Interstitial Lung Diseases. N Engl J Med. 2019.

[2]Distler O, et al. Nintedanib for Systemic Sclerosis-Associated Interstitial Lung Disease. N Engl J Med. 2019.

Disclosure of Interests:

None declared

Treatment strategy introducing immunosuppressive drugs with glucocorticoids ab initio or very early in giant cell arteritis: A multicenter retrospective controlled study

Objective

Glucocorticoids (GC) are associated with side effects in giant cell arteritis (GCA). Immunosuppressive therapies (ITs) have given conflicting results in GCA, regarding GC sparing effect. Primary endpoint is to evaluate whether very early introduction of ITs in GCA minimize the rate of GC-induced adverse events, in terms of infections, new onset systemic arterial hypertension, GC-induced diabetes and osteoporotic fractures.

Methods

A multicenter retrospective case-control study included 165 patients. One group included 114 patients who were treated with at least one IT given at diagnosis or within 3 months from the start of GC. A second group included 51 GCA who received only GC or an IT more than 3 months later.

Results

The most frequently used ITs were: methotrexate (138 patients), cyclophosphamide (48 patients) and tocilizumab (27 patients). No difference was observed as concerns the follow-up time between groups [48.5 (IQR 26-72) vs 40 (IQR 24-69), p ​= ​0.3)]. The first group showed a significantly lower incidence of steroid-induced diabetes (8/114, 7% vs 12/51, 23.5%; p ​= ​0.003) and no differences for the rate of infections (p ​= ​0.64). The group was also exposed to lower doses of GC at first (p ​< ​0.0001) and third (p ​< ​0.0001, rank-sum test) month. Forty-four patients in the first group (38.6%) compared with 34 in the second one (66.7%) experienced at least one relapse (p ​= ​0.001).

Conclusion

Very early introduction of IT in GCA lowered the incidence of steroid-induced diabetes, possibly due to the lower doses of GC in the first three months. Relapse rate was even lower.

Sarilumab use in severe SARS-CoV-2 pneumonia

BACKGROUND

Interleukin-6 signal blockade showed preliminary beneficial effects in treating inflammatory response against SARS-CoV-2 leading to severe respiratory distress. Herein we describe the outcomes of off-label intravenous use of Sarilumab in severe SARS-CoV-2-related pneumonia.

METHODS

53 patients with SARS-CoV-2 severe pneumonia received intravenous Sarilumab; pulmonary function improvement or Intensive Care Unit (ICU) admission rate in medical wards, live discharge rate in ICU treated patients and safety profile were recorded. Sarilumab 400 mg was administered intravenously on day 1, with eventual additional infusion based on clinical judgement, and patients were followed for at least 14 days, unless previously discharged or dead.

FINDINGS

Of the 53 SARS-CoV-2pos patients receiving Sarilumab, 39(73·6%) were treated in medical wards [66·7% with a single infusion; median PaO2/FiO2:146(IQR:120-212)] while 14(26·4%) in ICU [92·6% with a second infusion; median PaO2/FiO2: 112(IQR:100-141.5)].Within the medical wards, 7(17·9%) required ICU admission, 4 of whom were re-admitted to the ward within 5-8 days. At 19 days median follow-up, 89·7% of medical inpatients significantly improved (46·1% after 24 h, 61·5% after 3 days), 70·6% were discharged from the hospital and 85·7% no longer needed oxygen therapy. Within patients receiving Sarilumab in ICU, 64·2% were discharged from ICU to the ward and 35·8% were still alive at the last follow-up. Overall mortality rate was 5·7%.

INTERPRETATION

IL-6R inhibition appears to be a potential treatment strategy for severe SARS-CoV-2 pneumonia and intravenous Sarilumab seems a promising treatment approach showing, in the short term, an important clinical outcome and good safety.

Nailfold capillaroscopy findings in patients with coronavirus disease 2019: Broadening the spectrum of COVID-19 microvascular involvement

Objective

Increasing evidence points to endothelial dysfunction as a key pathophysiological factor in coronavirus disease-2019 (COVID-19). No specific methods have been identified to predict, detect and quantify the microvascular alterations during COVID-19. Our aim was to assess microvasculature through nailfold videocapillaroscopy (NVC) in COVID-19 patients.

Methods

We performed NVC in patients with a confirmed diagnosis of COVID-19 pneumonia. Elementary alterations were reported for each finger according to a semi-quantitative score. Capillary density, number of enlarged and giant capillaries, number of micro-hemorrhages and micro-thrombosis (NEMO score) were registered.

Results

We enrolled 82 patients (mean age 58.8 ± 13.2 years, male 68.3%) of whom 28 during the hospitalization and 54 after recovery and hospital discharge. At NVC examination we found abnormalities classifiable as non-specific pattern in 53 patients (64.6%). Common abnormalities were pericapillary edema (80.5%), enlarged capillaries (61.0%), sludge flow (53.7%), meandering capillaries and reduced capillary density (50.0%). No pictures suggestive of scleroderma pattern have been observed. Acute COVID-19 patients, compared to recovered patients, showed a higher prevalence of hemosiderin deposits as a result of micro-hemorrhages (P = .027) and micro-thrombosis (P < .016), sludge flow (P = .001), and pericapillary edema (P < .001), while recovered patients showed a higher prevalence of enlarged capillaries (P < .001), loss of capillaries (P = .002), meandering capillaries (P < .001), and empty dermal papillae (P = .006).

Conclusion

COVID-19 patients present microvascular abnormalities at NVC. Currently ill and recovered subjects are characterized by a different distribution of elementary capillaroscopic alterations, resembling acute and post-acute microvascular damage. Further studies are needed to assess the clinical relevance of NVC in COVID-19.

•

We assessed and accurately described peripheral microvasculature in COVID-19 patients through nailfold videocapillaroscopy.

•

Capillary alterations at the nailfold bed suggest a broad COVID-related microvascular involvement.

•

Different alterations in acutely-ill and recovered patients resemble a transition from acute to post-acute injury.

AB1234 MICRO-RNA 155 AND MIR-34A: POSSIBLE BIOMARKERS OF INFLAMMATORY BURDEN AND DISEASE ACTIVITY IN ANCA-ASSOCIATED VASCULITIS WITH RENAL INVOLVEMENT

Background:

Predicting clinical outcomes in ANCA-related glomerulonephritis remains a major challenge. To date, there is no reliable biomarker able to predict renal prognosis in patients with ANCA-associated vasculitis (AAV). Micro-RNA (miRNA) are non-coding RNAs involved in the fine tuning of immune cells biology and this epigenetic modulation associates with different phenotypes and prognosis in several diseases.

Objectives:

To investigate the expression of miR-155 and miR-34a in kidney biopsies of AAV patients according with renal outcome.

Methods:

Fifteen patients with AAV and renal involvement (mean age 63.0 ±13.3 years, disease duration 4.9±2.2 months), who underwent renal biopsy. Demographic, clinical and autoimmune parameters were recorded for each patient. Each kidney biopsy was classified according to the Berden Classification, Risk group (according to the ANCA Renal Risk Score) and the chronicity Classification of the Mayo Clinic’s proposed score.

MiR-155 and miR-34a expression was investigated on kidney biopsy tissue using the miRNeasy FFPE kit (Qiagen). The quantitative expression of miR-155, miR-34a and housekeeping gene U1, used as control, was assessed by Real Time-PCR. MiR-155 and miR-34a expression was correlated with histopathological and clinical-laboratory parameters.

Each patient was followed for 12 months and renal outcome was considered according toKDIGO CKDClassification. Markers of inflammation (ESR, CRP) and urine analysis data were recorded at baseline and after 12 months.

Results:

Six (40%) patients were p-ANCA positive and 9 (60%) c-ANCA positive. Eight patients (53%) also had pulmonary involvement. The mean baseline GFR was 30.7±28.8 ml/min/1.73 m2and 10 patients (66%) showed an active urinary sediment.

At disease onset, the mean expression of miR-155 was 9.5±21.1, while the expression of mir-34a was 13.1±46.2. Considering the autoimmune profile, kidney tissue of p-ANCA positive patients was enriched of mir-155 (19.6±30.6 fold) compared to c-ANCA positive patients (1.9±2.9 fold; p=0.001). Particularly, considering the renal function, kidney tissue of patients with greater impairment of renal function (KDIGO stage 5) was enriched of miR-155 (21.5±38.3 fold) compared to patients with less renal impairment (KDIGO stage 1-4) (4.72±8.16 fold, p=0.004).

Tissue expression of miR-155 and miR-34a did not correlated with the abovementioned histopathological classifications.

After 12 months from kidney biopsy, 3(20%) patients had a worsening of renal function, 5 (33%) still presented elevated markers of inflammation and 3 (20%) still had proteinuria at urine analysis. At baseline, kidney tissue of patients with higher CRP plasma levels and proteinuria at follow-up presented higher expression of miR-155 (p=0.002 and p=0.001), whereas no significant differences were found about miR-34a kidney tissue expression.

Conclusion:

MiRNAs may play a potential role in the pathogenesis of ANCA-related glomerulonephritis. MiR-155 kidney enrichment seems to mirror the disease inflammatory burden and activity at the onset and after 12 months representing a possible biomarker in ANCA vasculitis with renal involvement. This finding may represent the basis for further studies on miRNA expression in blood samples, aiming to identify a non-invasive biomarker of kidney damage, predicting disease’s relapses and patients’ prognosis.

References:

[1]Renauer et al, Clin Rev Allergy Immunol. 2016

Disclosure of Interests:

Dario Bruno: None declared, Pier Giacomo Cerasuolo: None declared, Clara Di Mario: None declared, Silvia Laura Bosello Speakers bureau: Abbvie, Pfizer, Boehringer, Laura Gigante: None declared, Alessia Musto: None declared, Gisella Vischini: None declared, Stefano Costanzi: None declared, Stefano Alivernini: None declared, Barbara Tolusso: None declared, Giuseppe Grandaliano: None declared, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB

SAT0259 ANCA-ASSOCIATED VASCULITIS WITH RENAL INVOLVEMENT: THE ROLE OF A COMBINED HISTOPATHOLOGICAL ASSESSMENT AS PREDICTOR OF PATIENTS’ PROGNOSIS

Background:

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis often affect the kidney and renal involvement has a considerable clinical impact on patient’s prognosis. Currently used histopathological classifications are basically focused on the glomerular damage and assessing chronic damage progression, but their prognostic role presented some limitations.

Objectives:

To combine the Berden Classification, the ANCA Renal Risk Score (ARRS) and the Mayo Clinic-Renal Chronicity Score (RCS) with the inflammatory interstitial infiltrate and to evaluate the prognostic value of the combined assessment in patients with AAV

Methods:

We included 19 AAV patients with renal involvement (mean age 63±13.2 years; disease duration 4.9±5.2 months) who underwent renal biopsy. Patients were classified according to age, sex, disease duration, ANCA positivity. The histopathological evaluation was performed assessing the Berden category, Risk group (low, medium, high) according to the ARRS and Chronicity class according to the RCS; we also assessed the % of inflammatory interstitial infiltrate. Each patient was followed-up for 12 months; we considered the stage IV (eGFR < 30 ml/min/m2) of theKDIGO CKDClassification as renal outcome.

Results:

8 (42.1%) AAV patients were p-ANCA and 11 (57.9%) c-ANCA. 12 months after renal biopsy, 8 patients (42.1%) had a GFR <30 ml/min. According to the ARRS, 10 (52.6%) patients were in low, 7 (36.8%) in medium and 2 (10.5%) in high risk group. According to the RCS, 2 (10.5%) biopsies had minimal, 10 (52.6%) mild and 7 (36.8%) moderate chronic changes, no one presented severe chronic changes. According to the Berden classification, 6 (31.6%) samples represented the focal, 2 (10.5%) the crescentic and 11 (57.9%) the mixed category, no one represented the sclerotic class. The mean % of inflammatory infiltrate was 37.4±25.2. The interstitial inflammatory infiltrate showed a direct correlation with the severity of the Berden category (R=0.51; p=0.025), the % of sclerotic glomeruli (R=0.6; p=0.007) and the number of fibrocellular crescents (0.46; p=0.05) and an inverse correlation with the GFR at 12 months (R=-0.48; p=0.045). A ROC curve study identified a 22.5% cut-off of inflammatory infiltrate to predict the outcome of GFR at 12 months < 30 ml/min (sensitivity 88%, specificity 97.5%). Patients in focal class developed less frequently a GFR<30 (χ2=9.1; p=0.003), but there were no differences in the outcomes between the crescentic and mixed class. ARRS could differentiate risk group with regard to the renal outcome stage IV (χ2=9.0 e p=0.01) as well as the chronicity Score (χ2=8.1; p=0.017). Finally, we built a matrix combining the different histopathological scores and the % of inflammatory infiltrate to predict the outcome; we found that an inflammatory infiltrate wider than 22.5% characterizes most of patients developing stage IV chronic renal failure at the 12th month. In fact, more than 75% of patients with eGFR < 30 ml/min had inflammatory infiltrate wider than 22.5% at biopsy, despite they were in the low risk class (ARRS) and in minimal changes class (RCS).

Conclusion:

Our results underline the importance of the inflammatory infiltrate in renal outcome and histology. Despite the limited number of patients, our data suggest that a combined histological score assessing the chronicity and activity of renal disease from both glomerular and interstitial perspective could better predict patients’ global and renal prognosis.

References:

[1]Berden, J Am Soc Nephrol, 2010 Berti, Nephrol Dial Transplant 2018 Brix, Kidney Int. 2018

Disclosure of Interests:

Laura Gigante: None declared, Pier Giacomo Cerasuolo: None declared, Gisella Vischini: None declared, Francesco Federico: None declared, Dario Bruno: None declared, Alessia Musto: None declared, Stefano Costanzi: None declared, Silvia Laura Bosello Speakers bureau: Abbvie, Pfizer, Boehringer, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB

THU0306 ROLE OF 18-FDG PET/CT IN DIAGNOSIS AND FOLLOW UP OF LARGE VESSELS VASCULITIS

Background:

18-FDG PET/CT is a functional imaging method which allows to identify inflammation of vessel walls. The use of PET in large vessels vasculitis(LVV) at disease onset and during follow up is still debate either to confirm clinical remission either to drive the therapy choice. American Society of Nuclear Cardiology (ASNC) recently advanced recommendations aimed to standardize the application of PET in LVV(1).

Objectives:

The aim of our study was to assess the clinical role of PET performed in patients affected by LVV at the diagnosis and during the follow up.

Methods:

We retrospectively evaluated PET/CT of 49 patients affected by clinically active LVV according to LVV visual grading (LVG, grading 0-3) and measured the standardized uptake value(SUV) of large vessels. 38 (77,6%) patients were affected by Giant Cells Arteritis and 11(22,4%) by Takayasu Arteritis. 32(65.3%) patients repeated the imaging after a mean follow-up of 11.5±5.4 months.

All baseline (T0) and follow up (T1) clinical data of disease activity were collected. Patients were treated according to EULAR LVV management recommendations(2). T0 PET/CT study was performed in patients with a clinically active disease defined by suggestive symptoms/signs and/or high inflammatory markers. The mean disease duration before T1 PET/CT examination was 4 months. T0 PET was performed in 25/49 patients(52%) at the diagnosis of LVV, whereas in 24/49(48%) patients with already diagnosed but active LVV disease.

Results:

Baseline PET was positive in 21 patients(42.9%). According to ASNC recommendations, 19 patients (38.8%) presented a LVG=3, 2(4.0%) a LVG=2, 6(12.2%) LVG=1 and 22 (44.9%) LVG=0. Patients performing PET at disease onset(75%) had higher LVG score than patients performing PET during the disease course (25%),p=0,002. At T0, aortic, carotid, axillary and subclavian SUV did not correlate with inflammatory markers.

Follow up PET/CT studies were performed in 32 patients, 13 (40.6%) with a clinically active disease despite therapy, while 19(59.4%) in clinical remission.

Follow up PET was still positive in 8 patients (25%) with a LVG=3, 10 (31.2%) patients presented LVG=1 and 14 (43.8%) LVG=0. T1 PET/CT study showed a significant reduction of SUV values in descending aorta, left and right subclavian arteries, and left and right axillary arteries when compared with first PET/CT study. According to LVG, 12 patients with active PET/CT study at T0 (19 pts) presented a reduction of LVG from score 2 and 3 to grade 1 or 0 (64.2%) at second PET/CT study. Only 3 patients presented an increased LVG score at T1, while in the other 17 patients T1 PET confirmed the previous score. No significant difference was found between LVG scores according with clinical characteristics, but among 8 patients presenting an active T1 PET, 4(50%) were in clinical remission.

Conclusion:

The use of ASNC recommendations for FDG PET/CT in LVV enables to confirm a metabolically active disease in 40% of patients and in 75% of patients at disease onset, suggesting that post-posing the exam could lead to underrate the real extension of disease. Our data, even if limited, suggest that PET/CT could be crucial in management of patients in clinical remission, detecting patients with still metabolically active LVV. Further prospective studies are necessary to evaluate the role of PET/CT in driving therapeutic strategies.

References:

[1]Slart R et all - Eur J Nucl Med Mol Imaging, 2018

[2]Hellmich et all – Ann Rheum Dis 2018

Disclosure of Interests:

Laura Gigante: None declared, Dario Bruno: None declared, Vanessa Feudo: None declared, Silvia Laura Bosello Speakers bureau: Abbvie, Pfizer, Boehringer, Lucia Leccisotti: None declared, Alessia Musto: None declared, Pier Giacomo Cerasuolo: None declared, Angelo Zoli: None declared, Alessandro Giordano: None declared, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB

CO0002 LOSS OF SELF-TOLERANCE IN SARS-COV-2 INFECTION: IMMUNOLOGICAL ASSESSMENT OF A CONVALESCENT COHORT

Background:

Some infectious agents may act as inducers of autoimmune conditions1. Despite SARS-CoV-2 infection can induce autoimmune phenomena in infected people2, individual risk factors or underlining mechanisms leading to loss of immunological tolerance are still unknown.

Objectives:

To assess the rate of development of autoantibodies in convalescent SARS-CoV-2 patients and their relation on infection clinical course and disease parameters.

Methods:

One-hundred and nine convalescent SARS-CoV-2 patients were studied and underwent multidisciplinary assessment in a Day Hospital clinical setting. For each patient, demographic, clinical and immunological data were collected and, at study entry, autoimmune profile [antinuclear antibodies (ANAs), antibodies reacting with extractable nuclear antigens (anti-ENA), antineutrophil cytoplasmic antibodies (ANCAs), Lupus anticoagulant (LA), anticardiolipin antibodies (aCL) IgM and IgG, anti-β2 glycoprotein I (anti-β2GPI) IgM and IgG] was assessed by Fluorescent immunoassay. Moreover, IL-6 plasma levels were assessed by ELISA (ELLA).

Results:

After a median time from hospitalization for SARS-CoV-2 infection of 53.3 ± 0.9 days, 55(50.5%) SARS-CoV-2 convalescent patients showed the positivity (ABpos) of at least one autoantibody. In particular, 31(28.4%) were positive for LA, 11(10.1%) for IgM-RF, 8(7.3%) for ANA and 6(5.5.%) for IgG-aCL whilst less than 2% showed other autoantibody positivities (IgM-aCL, IgG-anti-β2GPI, ENA, ACPA, c-ANCA, Scl70 and RNP). Analyzing the patient-related characteristics associated with the development of autoimmunity, convalescent male patients were more likely characterized by the development of antiphospholipid antibodies (aPL) (37.3%) than female (16.7%; p=0.02). Considering the disease-related characteristics, convalescent SARS-CoV-2 patients who experienced severe pneumonia (i.e., oxygen support need) during hospitalization, more likely received IL-6R-inhibitor administration (47.3%) and developed more than one autoantibody (87.5%) (aPL + another AB) than convalescent SARS-CoV-2 patients who did not need oxygen support [(12.5%; p=0.02) (OR95%IC: 9.5(1.4-109.1)] or IL-6R-inihibitor (1.9%; p<0.001). Finally, assessing cytokines plasma levels in convalescent SARS-CoV-2 patients stratified based on the development of autoantibodies we found that, despite a significant reduction of IL-6 plasma levels from hospitalization, convalescent SARS-CoV-2 patients who developed autoantibody positivity had higher IL-6 plasma levels (8.5 ± 2.5 pg/ml) than convalescent SARS-CoV-2 ABnegpatients (5.6 ± 1.5 pg/ml; p=0.07), mostly if considered autoantibodies other than aPL (15.4 ± 7.7 pg/ml)(p=0.01).

Conclusion:

Loss of self-tolerance is a common phenomenon in the medium-term follow-up of SARS-CoV-2 convalescent patients whose occurrence is dependent by a severe disease course and by an aberrant host inflammatory response. Long-term follow-up will reveal AB persistency and their clinical impact.

References:

[1]Barzilai O, et al. Current Opinion in Rheumatology 2007.

[2]Zhou Y, et al. Clin Transl Sci. 2020.

Disclosure of Interests:

None declared

AB0621 TOLERABILITY AND SAFETY OF ACETYLSALICYLIC ACID IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

Systemic Sclerosis (SSc) is characterized by an increased incidence of macro- and microvascular complications. Current evidences on efficacy, safety and tolerability of acetylsalicylic acid (ASA) in SSc patients are limited, and the indication to this treatment is based on the experience of each single centre or physician. Esophagus and stomach are the portions of the digestive tract that are more frequently affected by adverse events due to ASA exposure.

Objectives:

We evaluated the incidence of adverse events associated with low-dose ASA treatment in a cohort of patients affected by SSc.

Methods:

Demographic data and disease features of 302 patients affected by SSc treated with low-dose ASA were collected and patients were followed-up for a median period of 6.9 years (range: 0-20 years). The proportion of patients taking ASA for secondary prevention for cardiovascular disease was also noted. The incidence of discontinuation of the drug, gastrointestinal intolerance, bleeding and death in the observation period was recorded.

Results:

Patients had a median age of 54.0 years (19.6-89.4); 91.9% were female, 13.2% were smokers and 44.0% had a BMI≥30Kg/m2. The prevalence of ischemic heart disease, peripheral vascular disease and stroke was of 8.6%, 5.3% and 3.3%, respectively; 48.7% of the patient took ASA in primary cardiovascular prevention. Therapy started after a median disease duration of 4.8 years (range: 0.0- 30.1 years) since the first non-Raynaud symptom and 56.6% of patients had an early disease (less than three years of disease duration). During the observation period, 30 patients (14.3 per 1000 person-years) discontinued ASA after an average period of assumption of 4.6 years (range: 0.3-18.0 years). The main adverse events were heartburn, dyspepsia and hematochezia, recorded in 18 patients (8.6 per 1000 person-years). Eight of them (3.8 per 1000 person-years) had evidence of digestive tract bleeding. Five patients (2.4 per 1000 person-years) discontinued ASA due to recurrent epistaxis. Twenty-eight patients (13.4 per 1000 person-years) died in the follow-up period, 16 of these (7.6 per 1000 person-years) because of SSc-related causes. None of them had evidence of major bleeding. We used Kaplan-Meier analysis to evaluate the incidence of ASA discontinuation. The history of digital ulcers (Log rank test X24.7, p=0.037) and male sex (Log rank test X24.3, p=0.03) were associated with a higher cumulative ASA discontinuation rate due to gastrointestinal intolerance.

Conclusion:

In our cohort of SSc patients, ASA resulted safe and well tolerated in most cases, despite the risk of gastroesophageal abnormalities due to disease. Although this comforting results, taking in account the lack of controlled-randomized trials about efficacy and safety, the choice to start antiplatelet therapy with ASA should be mandatorily preceded by a careful evaluation of risks and benefits. Furthermore, an attentive monitoring for possible adverse effects is needed during ASA treatment. Patients with digital ulcers and male sex could present less drug tolerability.

References:

[1]Valentini G et al. Ann Rheum Dis 2019. Beckett VL et al. Arthritis Rheum 1984. Kavian N et al. Vascul Pharmacol 2015. Lavie CJ et al. Curr Probl Cardiol 2017.

Disclosure of Interests:

Lucrezia Verardi: None declared, Enrico De Lorenzis: None declared, Gerlando Natalello: None declared, Laura Gigante: None declared, Umberto La Porta: None declared, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Silvia Laura Bosello Speakers bureau: Abbvie, Pfizer, Boehringer

FRI0216 STEROID SPARING EFFECT, LOWER INCIDENCE OF DISEASE RELAPSE AND DIABETES IN GIANT CELL ARTERITIS TREATED WITH IMMUNOSUPPRESSORS AB INITIO OR VERY EARLY: A MULTICENTER RETROSPECTIVE CASE-CONTROL STUDY

Background:

Glucocorticoids (GC) are associated with serious side effects in giant cell arteritis (GCA). Immunosuppressive therapies (IT) gave conflicting results in GCA, regarding GC sparing effect. Recently, tocilizumab by blocking IL-6, has been licensed as first biologic treatment for GCA, being clinically effective and saving GC (1).

Objectives:

To evaluate the usefulness of IT for GCA in: 1) minimizing the rate of GC-induced adverse events (AEs) and 2) reducing the risk of relapse.

Methods:

A multicenter retrospective case-control study included 165 GCA was performed. The first group of patients (GCA-IT) included 114 patients who were treated with at least one IT given ab initio or within 3 months from the start of GC. The control group included 51 GCA who received only GC or an IT later than 3 months (GCA-steroid). The primary endpoints were the rate of GC-related side effects: infections, hospitalized infections, new onset systemic arterial hypertension, GC-induced diabetes and osteoporotic fractures.

Results:

Methotrexate up to 20 mg/week (138 patients), followed by cyclophosphamide (48 patients) and tocilizumab (27 patients) were the most frequently used IT. No difference was observed as concerns the follow-up time between the two groups [48.5 (IQR 26-72) vs 40 (IQR 24-69), p=0,3, rank-sum test)]. The two groups were similar as concerns sex (p=0,13), while the first group (69±8 yrs) was slightly younger than the second one (72±7 yrs) (p=0,005). Comorbidity was similar between groups. Patients in the GCA-IT group showed a significant lower incidence of GC-induced diabetes (8/114, 7% vs 12/51, 23,5%; p=0,003, chi-square test), while no differences were documented for rate of infections (p=0,64), including hospitalized infections (p=0,44), new onset systemic arterial hypertension (p=0,68), or osteoporotic fractures (p=0,32). Forty-four patients in the GCA-IT group (38,6%), while 34 patients in the GCA-steroid group (66,7%) experienced at least one relapse (p=0,001, chi square test). There was no difference in terms of time to first relapse between the two groups (p=0,53, log-rank test). GCA-IT group was exposed to lower dose of GC at first (p<0,0001, rank-sum test) and third (p<0,0001, rank-sum test) month, while no differences were recorded at the other time points. Clinical outcomes were similar between the two groups.

Conclusion:

Very early introduction of IT in GCA provided a greater steroid sparing in the first 3 months of treatment, leading to a lower incidence of diabetes. Relapse rate was even lower. IT was usually well tolerated without an increase incidence of infections. A randomized prospective trial is required to support this strategy in the management of GCA.

References:

[1]Hellmich B, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2020;79:19-30.

Disclosure of Interests:

Luca Quartuccio Consultant of: Abbvie, Bristol, Speakers bureau: Abbvie, Pfizer, Miriam Isola: None declared, Dario Bruno: None declared, Elena Treppo: None declared, Laura Gigante: None declared, Francesca Angelotti: None declared, Riccardo Capecchi: None declared, Gianfranco Vitiello: None declared, Elena Cavallaro: None declared, Antonio Tavoni: None declared, Silvia Laura Bosello: None declared, Daniele Cammelli: None declared, Salvatore De Vita Consultant of: Roche, GSK, Speakers bureau: Roche, GSK, Novartis, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB

Gut microbiota analysis in systemic sclerosis according to disease characteristics and nutritional status

OBJECTIVES

Systemic sclerosis (SSc) is a rare multi-organ disorder with a prominent gastrointestinal (GI) involvement. Altered gut microbiota is now considered a pivotal factor associated with the development of immune-mediated and inflammatory diseases. We performed a 16S ribosomal RNA (rRNA) gene-sequencing analysis of fecal microbiota in a cohort of SSc patients and matched healthy controls (HCs), with the aim to obtain some hints about a possible role of dysbiosis in the onset, progression, and severity of the disease.

METHODS

We analysed stool samples from 63 SSc patients with different disease duration, phenotype, and nutritional status and from 17 HCs through 16S ribosomal RNA (rRNA) gene-sequencing.

RESULTS

Microbial richness was lower for patients with long-standing disease. A similar observation was made for patients with diffuse cutaneous SSc (dsSSc) compared to those with limited variant (lcSSc) and for patients who reported a recent weight loss. Consistent with previous reports, we noted a deviation of the intestinal microbial composition in patients with SSc compared to HCs, with a greater expression of Lactobacillus and Streptococcus and a depletion of Sutterella. Nutritional status, assessed using BMI as a surrogate, appeared to have a marked impact on the gut microbiota, with overweight patients showing lower richness compared both to underweight and normal-BMI patients.

CONCLUSIONS

Our findings expand the current knowledge of gut microbiota in SSc and could be useful to identify patients who would most benefit from treatments aimed at restoring the eu-biosis.

Genotypic Categorization of Loeys-Dietz Syndrome Based on 24 Novel Families and Literature Data

Loeys-Dietz syndrome (LDS) is a connective tissue disorder first described in 2005 featuring aortic/arterial aneurysms, dissections, and tortuosity associated with craniofacial, osteoarticular, musculoskeletal, and cutaneous manifestations. Heterozygous mutations in 6 genes (TGFBR1/2, TGFB2/3, SMAD2/3), encoding components of the TGF-β pathway, cause LDS. Such genetic heterogeneity mirrors broad phenotypic variability with significant differences, especially in terms of the age of onset, penetrance, and severity of life-threatening vascular manifestations and multiorgan involvement, indicating the need to obtain genotype-to-phenotype correlations for personalized management and counseling. Herein, we report on a cohort of 34 LDS patients from 24 families all receiving a molecular diagnosis. Fifteen variants were novel, affecting the TGFBR1 (6), TGFBR2 (6), SMAD3 (2), and TGFB2 (1) genes. Clinical features were scored for each distinct gene and matched with literature data to strengthen genotype-phenotype correlations such as more severe vascular manifestations in TGFBR1/2-related LDS. Additional features included spontaneous pneumothorax in SMAD3-related LDS and cervical spine instability in TGFB2-related LDS. Our study broadens the clinical and molecular spectrum of LDS and indicates that a phenotypic continuum emerges as more patients are described, although genotype-phenotype correlations may still contribute to clinical management.

Hazard assessment of substances produced from the accidental heating of chemical compounds

Accidental events concerning process industries can affect not only the staff working in, but also the environment and people living next to the factory. For this reason a regulation is imposed by the European Community to prevent accidents that could represent a risk for the population and the environment. In particular, Directive 96/82/CE, the so-called 'Seveso II directive', requests a risk analysis involving also the hazardous materials generated in accidental events. Therefore, it is necessary to develop simple and economic procedure to foresee the hazardous materials that can be produced in the case of major accidents, among which the accidental heating of a chemical due to a fire or a runaway reaction is one of the most frequent. The procedure proposed in this work is based on evolved gas analysis methodology that consists in coupling two instruments: a thermogravimetric analyzer or a flash pyrolyzer, that are employed to simulate accident conditions, and a FTIR spectrometer that can be used to detect the evolved gas composition. More than 40 materials have been examined in various accident scenarios and the obtained data have been statistically analyzed in order to identify meaningful correlations between the presence of a chemical group in the molecule of a chemical and the presence of a given hazardous species in the fume produced.

[Diagnostic reliability in mental disorders of the International Classification of Diseases in primary care]

INTRODUCTION

The objective is to evaluate the test version of Chapter V - "Mental and Behavioral Disorders reliability", of the 10th revision of the International Classification of Diseases, Version for Primary Care (ICD -10 PC), prepared by the Division of Mental Health of the World Health Organization (WHO).

METHODS

During September and October of 1994, Community General Physicians (CGP) from the Health and Environment Department of the State of Rio Grande do Sul were trained in the use of this version, prepared for the field trial, according to the design proposed by WHO.

RESULTS

The results refer to a study about reliability of diagnosis attributed by 9 pairs of CGP to 460 patients in their first appointments. Cohen's Kappa for Mental Health Disorder, present or absent, was 0,79 (CI 95%: 0,69 - 0,88).

CONCLUSION

The use of ICD-10 CP will give more specificity to the information and will allow a better communication between health workers at the level of primary care

Esophageal dysplasia and chronic esophagitis: detection at upper gastrointestinal tract endoscopy

Cancer of the esophagus becomes symptomatic at an advanced phase with a late diagnosis, when the tumor is already incurable. Early diagnosis has been shown to improve the survival rates. Conventional esophagoscopy is largely available but its sensitivity to detect early cancer or precancerous lesions remains controversial. In this study we tested the sensitivity of conventional esophagoscopy to identify suspicious areas and compared to histopathology of endoscopic biopsies to detect dysplasia and chronic esophagitis in a population at risk for cancer in southern Brazil. Adult males scheduled to have outpatient endoscopy were examined by two experienced endoscopists and any small (< 5 mm) plaque, nodule, erosion, hyperemia and or friable areas of the mucosa were biopsied and looked for the presence of early cancer or precancerous lesions. Normal appearing mucosa at the middle third of the esophagus was also biopsied and results compared for sensitivity, specificity, positive and negative predictive value. Of the 89 individuals with satisfactory biopsies, 3 had dysplasias, 29 moderate or severe chronic esophagitis and 57 normal findings at the histopathological study. We found no early cancer. We found two large, vegetating lesions confirmed to be advanced squamous cell carcinoma but they were excluded from analysis. To detect dysplasia or moderate/severe chronic esophagitis conventional esophagoscopy had a sensitivity of 40.6%, specificity of 78.9%, positive predictive value of 52% and negative predictive value of 70.3.

CONCLUSIONS

In this study, conventional esophagoscopy had a low sensitivity to detect dysplasias and/or chronic esophagitis and techniques to improve endoscopic identification of these lesions in individuals at risk for cancer are much needed.

Radical Prostatectomies in 1995 in Emilia Romagna with Related Diagnostic Evaluation

Fifteen hospital departments of Urology in Emilia Romagna took part in this study, which had two aims: to record the different approaches to clinically localised prostate cancer and make an overall assessment of the single series of radical prostatectomy. Multiple ultrasound-guided biopsy is performed in 13 departments, CT scan in 7, bone scan in 10 and laparoscopic lymphnode staging in 2. During 1995, 263 radical prostatectomies were performed, 233 being evaluable for this study. Mean age was 65.2 years. 107 cases (45.9%) proved to be organ-confined. Another 107 had locally advanced disease. 19 (8.1%) revealed node metastases. Post-operative incontinence rate was 5.5%. Radical prostatectomy is the first choice treatment for clinically localised prostate cancer at all the hospital departments participating in this study. In 1995, 28.3% of newly diagnosed patients underwent this operation. Clinical understaging is still a major issue, particularly in patients with high PSA.