Serum biomarkers and their relationship to axial spondyloarthritis associated with inflammatory bowel diseases

Spondyloarthritis (SpA) constitute a group of chronic inflammatory immune-mediated rheumatic diseases characterized by genetic, clinical, and radiological features. Recent efforts have concentrated on identifying biomarkers linked to axial SpA associated with inflammatory bowel disease (IBD), offering predictive insights into disease onset, activity, and progression. Genetically, the significance of the HLA-B27 antigen is notably diminished in ankylosing spondylitis (AS) associated with IBD, but is heightened in concurrent sacroiliitis. Similarly, certain polymorphisms of endoplasmic reticulum aminopeptidase (ERAP-1) appear to be involved. Carriage of variant NOD2/CARD15 polymorphisms has been demonstrated to correlate with the risk of subclinical intestinal inflammation in AS. Biomarkers indicative of pro-inflammatory activity, including C-reactive protein (CRP) along with erythrocyte sedimentation rate (ESR), are among the consistent predictive biomarkers of disease progression. Nevertheless, these markers are not without limitations and exhibit relatively low sensitivity. Other promising markers encompass IL-6, serum calprotectin (s-CLP), serum amyloid (SAA), as well as biomarkers regulating bone formation such as metalloproteinase-3 (MMP-3) and Dickkopf-related protein 1 (DKK-1). Additional candidate indicators of structural changes in SpA patients include matrix metalloproteinase-3 (MMP-3), vascular endothelial growth factor (VEGF), tenascin C (TNC), and CD74 IgG. Fecal caprotein (f-CLP) levels over long-term follow-up of AS patients have demonstrated predictive value in anticipating the development of IBD. Serologic antibodies characteristic of IBD (ASCA, ANCA) have also been compared; however, results exhibit variability. In this review, we will focus on biomarkers associated with both axial SpA and idiopathic intestinal inflammation, notably enteropathic spondyloarthritis.

Myointimoma (angiocentric myofibroblastic tumor) of the glans penis in an adolescent: a case report and review of the literature

Background

Soft tumors of the penis are extremely rare in childhood and adolescence. Because there are no guidelines, each such case raises embarrassment over the extent and degree of aggressiveness of the diagnostic and therapeutic procedures. Herein, we describe a case of a teenager with a penile myointimoma along with a review of the literature. So far, only 10 cases have been reported in this age group.

Case presentation

The 15-year-old boy presented with a 6-months history of a slowly growing, palpable firm nodule in glans penis. Physical examination revealed a palpable, well circumscribed, firm, whitish painless mass, around 1 cm in diameter within the glans. Ultrasound revealed hypoechogenic, hypoperfused poorly defined area inside the glans. MRI did not confirm any other pathologic mass inside the glans and corpora cavernosa. An excisional biopsy was performed; its immunohistological features indicated myointimoma.

Discussion and conclusion

Given the rarity of this benign entity, the main importance is to distinguish myointioma from more clinically aggressive neoplasms. The key to a correct diagnosis is a careful histological examination, including immunohistochemistry. Local excision is safe and effective treatment modality.

OP0105 miRNOME PROFILE IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

Background

microRNAs (miRNAs) are small non-coding RNAs regulating up to 60 % of human mRNAs, including genes related to axial spondyloarthritis (axSpA) (1).

Objectives

This study aims to profile miRNome and to identify candidate miRNAs determining disease severity in patietns with non-radiographic (nr) and radiographic (r) axSpA.

Methods

The miRNome profiling experiment included peripheral blood mononuclear cells (PBMCs) of 96 subjects (38 patients with nr-axSpA, 38 patients with r-axSpA and 20 healthy controls). Firstly, massive parallel sequencing on NextSeq 500 (MPS, Illumina) was performed for miRNA screening. Selected candidate miRNAs were further validated using the qRT-PCR system (SmartChip) on the validation cohort of 141 subjects (47 patients with nr-axSpA, 44 patients with r-axSpA and 50 healthy controls). We employed the DESeq2 algorithm and generalized linear modelling with a negative binomial assumption (GLM-NB) to evaluate the association of candidate miRNAs to axSpA subtype and clinical disease activity (ASDAS and CRP).

Results

MPS revealed 432 unique miRNAs in all samples. We identified 13 differently expressed miRNAs in axSpA patients compared to healthy controls, and 14 differently expressed miRNAs in axSpA patients with high to very high ASDAS compared to patients with inactive disease. Data from validation cohort revealed that the expression level of miR-4286 was higher in patients with very high disease activity compared to patients with inactive disease. Simultaneously, miR-4286 positively correlated with ASDAS. miR-4286 has been recently associated with osteogenesis and angiogenesis (2). None of the validated miRNAs was associated with the levels of CRP.

Conclusion

In this study, we identified that miR-4286 is related to disease activity and could play a role in the pathogenesis of axSpA.

References

[1]Prajzlerová K, Grobelná K, Hušáková M, et al. Association between circulating miRNAs and spinal involvement in patients with axial spondyloarthritis. PLoS One. 2017 Sep 22;12(9):e0185323.

[2]Yu H, Wang K, Liu P, et al. miR-4286 functions in osteogenesis and angiogenesis via targeting histone deacetylase 3 and alleviates alcohol-induced bone loss in mice. Cell Prolif. 2021 Jun;54(6):e13054.

Acknowledgements

Supported by MHCR No. 023728, BBMRI-CZ LM2018125 and SVV 260 523.

Disclosure of Interests

None declared

POS0995 VALIDATION OF THE SPARCC MRI-RETIC E-TOOL FOR INCREASING SCORING PROFICIENCY OF MRI LESIONS IN AXIAL SPONDYLOARTHRITIS

Background

The web-based Spondyloarthritis Research Consortium of Canada (SPARCC) real-time iterative calibration (RETIC) modules for scoring MRI lesions in axial spondyloarthritis (axSpA) have been created by SPARCC developers to enable remote training of readers to appropriately use the SPARCC MRI inflammation and structural damage instruments and to attain adequate scoring proficiency.

Objectives

We aimed to test the performance of these modules in enhancing scoring proficiency in comparison to SPARCC developers.

Methods

The SPARCCRETIC SIJ inflammation and structural damage modules are each comprised of 50 DICOM axSpA cases with baseline and follow up scans and an online scoring interface based on SIJ quadrants. Continuous visual real-time feedback regarding concordance/discordance of scoring per SIJ quadrant with expert readers is provided by a color-coding scheme. Reliability is assessed in real-time by intra-class correlation coefficient (ICC), ICC data being provided every 10 cases, which are scored until proficiency targets for ICC are attained. In the present exercise, participants (n=15) from the EuroSpA Imaging project were randomized, stratified by reader expertise in scoring with SPARCC, to one of two reader training strategies (groups A and B) that each comprised 3 stages (25 patients per stage, 2 timepoints, blinded to chronology; independent assessment of Inflammatory and structural lesions): Group A. 1. Review of original SPARCC manuscript describing scoring method. 2. Review of PowerPoint summary of SPARCC method plus completion of SPARCCRETIC module. 3. Re-review of PowerPoint summary. Group B. Same 3-step strategy as A except SPARCCRETIC module completed at stage 3. The reliability of scoring was compared to an expert radiologist (SPARCC developer).

Results

Very good scoring proficiency for status and change scores was evident for SPARCC BME even by non-experienced readers with similar levels of reliability irrespective of prior expertise. The beneficial impact of the SPARCCRETIC module on scoring proficiency was most consistently evident for the scoring of structural lesions and for Strategy B, where the impact was evident for all structural lesions, level of reader expertise, and status as well as change scores (Table 1). Scoring proficiency improved the most for the least experienced readers (Figure 1).

Table 1.

Inter-rater reliability (Status/Change ICC) compared to radiologist SPARCC developer

MRI LesionReader expertiseStrategy AStrategy BStage 1 cases (n=25)Stage 2 cases (n=25)Stage 3 cases (n=25)Stage 1 cases (n=25)Stage 2 cases (n=25)Stage 3 cases (n=25)BMENone (n=4)0.91 / 0.940.83/0.820.77/0.780.82/0.880.65/0.820.88/0.90Intermediate (n=6)0.88/0.880.90/0.900.85/0.900.93/0.940.78/0.800.83/0.80Experienced (n=5)0.92/0.940.90/0.880.92/0.930.83/0.880.84/0.900.89/0.89ANKYLOSISNone (n=4)0.86/0.660.83/0.280.86/0.780.66/0.410.69/0.340.88/0.80Intermediate (n=6)0.89/0.570.83/0.370.92/0.810.82/0.680.74/0.470.93/0.84Experienced (n=5)0.96/0.760.93/0.640.94/0.860.97/0.240.83/0.410.91/0.79BACKFILLNone (n=4)-0.08/-0.050.38/0.220.59/0.380.64/0.130.05/-0.090.47/0.27Intermediate (n=6)0.41/0.130.44/0.420.69/0.390.50/0.220.30/0.300.70/0.42Experienced (n=5)0.82/0.380.55/0.400.91/0.640.65/0.240.21/0.260.71/0.30EROSIONNone (n=4)0.13/-0.080.67/0.420.51/0.330.34/0.330.23/0.080.38/0.37Intermediate (n=6)0.42/0.180.56/0.120.51/0.440.33/0.270.45/0.180.53/0.39Experienced (n=5)0.61/0.330.64/0.340.64/0.420.51/0.270.58/0.110.62/0.31FAT METAPLASIANone (n=4)0.62/0.540.30/0.170.57/0.290.43/0.530.38/0.070.83/0.63Intermediate (n=6)0.49/0.380.59/0.300.79/0.510.57/0.780.50/0.420.81/0.47Experienced (n=5)0.75/0.620.81/0.340.91/0.700.84/0.900.56/0.130.78/0.37

Conclusion

Attaining scoring proficiency for MRI structural lesions in axSpA is difficult but can be consistently improved by using the SPARCCRETIC module, even for experienced readers.

Figure 1.

Disclosure of Interests

Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, Boehringer Ingelheim, Celgene, Eli-Lilly, Galapagos, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer, UCB, Anna Enevold Fløistrup Hadsbjerg Grant/research support from: Novartis, Mikkel Østergaard Consultant of: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly and Company, Galapagos, Gilead, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, UCB, Grant/research support from: AbbVie, BMS, Merck, Celgene, Novartis, Raphael Micheroli: None declared, Susanne Juhl Pedersen Grant/research support from: Novartis, Adrian Ciurea: None declared, Nora Vladimirova Grant/research support from: Novartis, Michael J Nissen Speakers bureau: Eli-Lilly, Janssen, Novartis, Consultant of: Abbvie, Celgene, Eli-Lilly, Janssen, Novartis, Pfizer, Kristyna Bubova: None declared, Stephanie Wichuk: None declared, Manouk de Hooge: None declared, Ashish Jacob Mathew Grant/research support from: Novartis, Karlo Pintaric: None declared, Monika Gregová: None declared, Ziga Snoj: None declared, Marie Wetterslev: None declared, Karel Gorican: None declared, Joel Paschke: None declared, Iris Eshed: None declared, Robert G Lambert Paid instructor for: Novartis

Uterine cellular leiomyomas are characterized by common HMGA2 aberrations, followed by chromosome 1p deletion and MED12 mutation: morphological, molecular, and immunohistochemical study of 52 cases

Cellular leiomyoma (CL) represents an uncommon variant of uterine leiomyoma with limited data concerning its immunohistochemical and molecular profile. We performed a comprehensive analysis of 52 CL cases all of which were analyzed immunohistochemically. Molecular analysis was possible in 32 cases with sufficient DNA, and 38 cases with sufficient RNA. The immunohistochemical results showed a high expression of smooth muscle markers (calponin (100%), desmin (100%), smooth muscle actin (98.1%), caldesmon (96.1%), transgelin (96.1%), smooth muscle myosin heavy chain (86.5%), and smoothelin (61.5%)). Concerning markers of endometrial stromal differentiation, the expression of CD10 was observed in 65.4% cases (42.2% with H-score > 50), and IFITM1 in 36.5% cases (1.9% with H-score > 50). 36.5% showed HMGA2 overexpression at the IHC level, associated with increased mRNA expression in 14/14 cases. The rearrangement of the HMGA2 gene was detected in 13.2%. Chromosome 1p deletion was found in 19.3%, while 9.4% of tumors showed a pathogenic mutation in the MED12 gene. In conclusion, CL is immunohistochemically characterized by a high expression of "smooth muscle" markers commonly associated with a co-expression of "endometrial stromal" markers, where IFITM1 shows superior performance compared to CD10 regarding its specificity for differentiation from endometrial stromal tumors. The sensitivity of smoothelin in CL seems rather low, but no data is available to assess its specificity. On a molecular level, the most common mutually exclusive aberration in CL affects HMGA2, followed by chromosome 1p deletions and MED12 mutations.

Review of tumor infiltrating lymphocytes assessment in breast cancer in routine diagnostic practice

Evaluation of tumor infiltrating lymphocytes (TIL) is gaining importance in many cancers not only because of their prognostic, but also predictive significance. One of the tumors in which the evaluation of TIL is of prognostic importance and has potential predictive impact on the modification of treatment procedures is breast cancer, especially its so-called triple negative, and HER2 positive variants.The aim of this review is to provide an overview of the issue of TIL evaluation in breast cancer, focusing not only on the clinical significance of this evaluation, but especially on the methodological aspects of evaluation and standardized reporting of the results.

The value of immunohistochemical methods in diagnosing mesenchymal tumours of the uterus

The goal of this manuscript is to provide a comprehensive overview of the use of immunohistochemical methods in diagnosing mesenchymal tumours of the uterus. The main points discussed include, especially, the issue of determining smooth muscle differentiation, the differential diagnosis between smooth muscle and endometrial stromal tumours, and the diagnosis of inflammatory myofibroblastic tumour. The role of immunohistochemical examination in the diagnosis of some of the only recently definedentities such as YWHAE-altered high grade endometrial stromal sarcoma (HG-ESS), BCOR-altered HG-ESS, tumours with NTRK fusion, and SMARCA4-deficient sarcomas is also discussed. The last aspect of this work is an analysis of the significance of immunohistochemical methods in the determination of the biological behaviour of leiomyocellular tumours. The issue of their molecular classification for those lesions associated with the presence of recurrent molecular aberrations is also discussed.

Ovarian mesonephric-like adenocarcinoma arising in serous borderline tumor: a case report with complex morphological and molecular analysis

BACKGROUND

Mesonephric-like adenocarcinoma (M-LAC) is a rare, recently described tumor occurring in the uterine corpus and ovary, which shares the same morphological and immunohistochemical features with the more common mesonephric adenocarcinoma (MAC), which mostly arises the uterine cervix. Despite the similarities between these tumors, the histogenesis of M-LAC is still disputable.

CASE PRESENTATION

Sixty-one-year-old woman presented with an advanced tumor of the left ovary with intraabdominal spread and liver metastases. After receiving 5 cycles of neoadjuvant chemotherapy, she underwent a hysterectomy with bilateral salpingo-oophorectomy, and resection of the liver metastasis, omentum, and appendix. Histologically, the ovarian tumor consisted of two components, whose morphology and immunohistochemical results were typical of either a serous borderline tumor (immunohistochemical positivity for PAX8, WT1, ER and PR) or a mesonephric-like carcinoma (immunohistochemical positivity for PAX8, TTF1 and GATA3). Only the component of the mesonephric-like adenocarcinoma metastasized to the omentum and liver. A molecular analysis with a panel of 271 genes (size 1020 kbp) was performed separately on samples from the borderline tumor, primary ovarian mesonephric-like adenocarcinoma, and liver metastasis. The results showed the clonal origin of all samples, which shared the same KRAS (NM_004985.3:c.34G > T, p.(G12C)) and PIK3CA (NM_006218.2:c.1633G > A, p.(E545K)) somatic mutations. Moreover, in the sample from the primary mesonephric-like carcinoma and its liver metastasis a likely pathogenic somatic MYCN mutation (NM_005378.4:c.131C > T, p.(P44L) was found. In all samples, the deletion of exons 9-10 in the CHEK2 gene was present, which is in concordance with the previously performed genetic testing of the blood specimen which revealed the hereditary CHEK2 mutation in this patient.

CONCLUSIONS

Our result support the theory that at least some mesonephric-like ovarian adenocarcinomas are of Müllerian origin. The serous borderline tumor seems to be a precursor of mesonephric-like adenocarcinoma, which has been proven in our case by both tumors sharing the same mutations, and the presence of cumulative molecular aberrations in the mesonephric-like adenocarcinoma.

Secretory carcinoma of salivary type in a lymph node presenting as a neck cyst diagnosed by cytology: A case report

Secretory carcinoma (SC) is a relatively recently described salivary gland adenocarcinoma characterized by ETV6-NTRK3 gene fusion and, in most cases, indolent clinical behavior. Morphologically, the tumor shows a glandular architecture and the presence of monophasic tumor cells with vacuolated cytoplasm, low-grade nuclear atypia, and mucin production, with possibly a tubular, papillary, or cystic arrangement. In this article, we describe a case of a 52-year old man with SC involving a neck lymph node clinically manifesting as a slowly growing cystic neck mass without recent proof of the primary tumor, but with a history of a parotid gland "cystadenopapilloma," which had been removed 35 years prior. A fine-needle aspiration biopsy revealed a diagnosis of SC. Subsequent histopathological examination after lymph node dissection confirmed the diagnosis. The tumor showed typical features of SC, including immunohistochemical positivity for NTRK and NTRK3 gene rearrangement, detected using in situ hybridization. We discuss that the tumor may be a late metastasis occurring 35 years after resection of undiagnosed salivary SC or a primary SC arising from heterotopic salivary tissue within a lymph node. Differential diagnostic considerations and review of relevant literature are included.

Elevated tenascin-C serum levels in patients with axial spondyloarthritis

This study aimed to examine serum tenascin C (TNC) in different subsets of axial spondyloarthritis (axSpA) patients. Sixty-one patients fulfilling the Assessment of SpondyloArthritis international Society classification criteria for axSpA and 20 healthy subjects (HS) were included in study. Based on imaging, patients were classified as non-radiographic (n=16) and radiographic (n=45) axSpA. TNC serum levels were determined by ELISA. Disease-related factors including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and C-reactive protein (CRP) levels were determined. TNC levels were elevated in axSpA patients [535.3 (457.7–677.2) ng/ml] compared to HS [432.1 (329.1–565.9) ng/ml, p=0.007]. Dividing axSpA into radiographic and non-radiographic subsets, the difference in TNC was observed between the radiographic subset and HS [535.3 (434.5–677.2) vs. 432.1 (329.1–565.9) ng/ml, p=0.022]. TNC levels did not correlate with disease activity measures (serum CRP or BASDAI). Nevertheless, the weak correlation of TNC levels with different disease stages (r=0.25, p=0.025) was found, with the highest levels in patients with syndesmophytes. TNC levels are elevated across various subsets of axSpA, and although not related to systemic disease activity, TNC levels might reflect chronic structural spinal changes in axSpA patients. However, its specific role in bone metabolism should be elucidated in further studies.

FRI0041 ULTRASOUND-DETECTED SYNOVITIS AMONG INDIVIDUALS AT RISK OF RHEUMATOID ARTHRITIS INCREASES THE RISK OF DEVELOPING CLINICAL ARTHRITIS

Background:

During the transition to rheumatoid arthritis (RA) patients pass through several phases. In the preclinical phase, the presence of anti citrullinated protein antibodies (ACPA) can be detected [1]. A set of clinical characteristics for patients with arthralgia who are at risk of progression to RA was established (clinically suspected arthralgia; CSA) [2]. Ultrasound (US) is more sensitive diagnostic tool in detecting synovitis than clinical assessment and was recommended to use in diagnostics of RA.

Objectives:

To test if ultrasound-detected synovitis among patients at risk of progression to RA increases the risk of developing clinical arthritis (CA) in the future.

Methods:

ACPA+ individuals with arthralgia and/or those fulfilling CSA criteria were enrolled into the study and were assessed in 3 months interval (routine clinical investigation with laboratory tests, 68-joint count, US assessment). Tender and swollen joint counts were provided by an independent investigator. Sonographer was blinded to all clinical and laboratory data. CA was defined as clinically swollen and tender joint. All US assessments were provided by a single experienced investigator. Thirty joints US score was assessed bilaterally in wrist, MCP I-V, PIP II-V (dorsal and palmar approach), MTP II-V (dorsal approach), ankle (dorsal, medial and lateral approach). US synovitis was defined according the EULAR-OMERACT and scored separately in gray-scale (GS) 0-3 (zero to severe synovitis) and Power Doppler (PD) 0-3 (zero to high activity). Scores were calculated as sum scores. For the statistical analysis, we used GraphPad Prism 8.0.0 software (Wilcoxon-Mann-Whitney test), and relative risk ratio (RR).

Results:

93 patients were enrolled into the study (95% female). 58 patients were ACPA+ (all of them RF+), 35 were ACPA- (10 of them RF+). Of ACPA+ individuals, 100% fulfilled the CSA criteria, all seronegative individuals met the CSA criteria. At baseline, GS≥1 was detected in 69 patients (74%), PD≥1 was in 26 (28 %) patients. Single erosion was found by US in 1 patient (0,9%) at baseline. 14 patients (15%) developed CA within 30 months, 77% of them till month 10 from the baseline. No statistical difference in US synovitis score was found between ACPA+ vs. ACPA- and CSA+ vs. CSA- groups at baseline. RR to develop CA at the joint level in patients with GS≥1 at baseline was 1.37 (95% CI 0.99-1.89; p<0.05), with PD≥1 the RR was 2.5 (95% CI 1.3-4.8; p<0.05), in GS≥2 RR was 3.8 (95% CI 2.6-5.6; p<0.0001), in PD≥2 RR was 5.3 (95% CI 2.4-11.7; p<0.0001). US-detected synovitis preceded clinical finding of arthritis by 3 months (SD 1.2).

Conclusion:

US-detected synovitis in patients at risk of RA further increases the risk of developing clinical arthritis in the future. US detected synovitis in joints appear about 3 months prior synovitis detected by routine clinical assessment.

References:

[1]Bos, W. H., Wolbink, G. J., Boers, et al. Arthritis development in patients with arthralgia is strongly associated with anti- citrullinated protein antibody status: a prospective cohort study. Annals of the Rheumatic Diseases, 2010;69(3):490-4.

[2]van Steenbergen HW, Aletaha D, Beaart-van de Voorde LJJ, et al. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Annals of the Rheumatic Diseases 2017;76:491-6.

Acknowledgments:

Project AZV-17-32612A

Disclosure of Interests:

Petra Hanova: None declared, Klára Prajzlerová: None declared, Nora Petrovská: None declared, Monika Gregová Consultant of: Novartis, Abbvie, Paid instructor for: Novartis, Speakers bureau: Novartis, Abbvie, MSD, Heřman Mann: None declared, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Jiří Vencovský: None declared, Ladislav Šenolt: None declared, Mária Filková: None declared

AB0061 INVOLVEMENT OF CELL-FREE DNA IN THE DIFFERENTIATION OF OSTEOCLASTS – IMPLICATIONS FOR CLINICAL RESEARCH

Background:

Cell-free DNA (cfDNA) is a molecule with undisputable immunogenic potential[1]. Its role is well established in etiopathogenesis of systemic lupus erythematosus and many reports suggest it may play an important role in other rheumatic diseases[2]. Patients suffering from rheumatic diseases are at higher risk of osteoporosis[3], which may be a consequence of increased generation of osteoclasts (OC). Traditionally, increased formation of OC is attributed to changes in cytokine network[4]. It is not yet known whether cfDNA can also act on mononuclear precursors and influence their differentiation into OC.

Objectives:

The aim of this study was to assess role of cfDNA in differentiation of bone resorbing cells in rheumatic diseases. For this purpose, deoxyribonuclease I (DNAse) was employed to eliminate cfDNA from sera of patients and healthy controls (HC) used for cell culture.

Methods:

In order to evaluate effects of cfDNA on osteoclastogenesis, anin vitroexperiment of peripheral blood monocytes (PBM) cultures was designed. Axial spondyloarthritis (AxSpA) was chosen as a model of rheumatic disease. Sera of AxSpA patients (total n=13) and healthy controls (total n=13) were collected and subsequently used in cell cultures. PBM of 13 healthy donors were cultured in presence of 25 ng/ml macrophage colony-stimulating factor (M-CSF), 0,5 ng/ml receptor-activator of nuclear factor kappa B ligand (RANKL) and 10 % of pooled AxSpA or HC sera, respectively. Serum counterpart treated with DNAse was used in parallel. After 14 days, cells were stained for tartrate-resistant acid phosphatase (TRAP) and counted. TRAP positive cells with 3 or more nuclei were recognized as OC.

Results:

On average, differentiation of OC in presence of AxSpA sera led to higher osteoclastogenesis compared to DNAse-treated counterpart (137 vs. 61; p < 0.01). In a similar way, treatment of HC sera with DNAse greatly diminished osteoclastogenesis compared to untreated sera (17 vs. 111; p < 0.05). Overall, the effect of cfDNA depletion in HC sera regarding OC differentiation was more than 2,5× higher than the effect of cfDNA depletion in AxSpA sera (p < 0.001).

Conclusion:

Results of our pilot study indicate possible involvement of cfDNA in osteoclastogenesis. Decrease in number of OC after cfDNA depletion in both AxSpA sera and HC sera suggests that cfDNA effect in osteoclastogenesis is non-specific with respect to healthy condition and may represent universal link between innate immunity and bone metabolism. Lower effect of cfDNA depletion in AxSpA sera on osteoclastogenesis is very possibly owing to presence of other inflammatory molecules, which influence osteoclastogenesis. Future research might identify cfDNA as useful therapeutic target to decrease osteoporosis risk not only in patients with rheumatic and autoimmune diseases, where pathological bone resorption is imminent, but also in general aging population.

References:

[1]Pisetsky, D. S. (2012). The origin and properties of extracellular DNA: from PAMP to DAMP. Clinical Immunology, 144(1), 32-40.

[2]Lood, C. J., & Duvvuri, B. (2019). Cell-free DNA as a biomarker in autoimmune rheumatic diseases. Frontiers in immunology, 10, 502.

[3]Maruotti, N., Corrado, A., & Cantatore, F. P. (2014). Osteoporosis and rheumatic diseases. Reumatismo, 125-135.

[4]Amarasekara, D. S., Yu, J., & Rho, J. (2015). Bone loss triggered by the cytokine network in inflammatory autoimmune diseases. Journal of immunology research, 2015.

Acknowledgments:

Project MH CR 00023728 & MEYS CR Progres Q43

Disclosure of Interests:

Patrik Škubica: None declared, Jana Horinkova: None declared, Monika Gregová Consultant of: Novartis, Abbvie, Paid instructor for: Novartis, Speakers bureau: Novartis, Abbvie, MSD, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Marketa Husakova Speakers bureau: Novartis, Pavlina Dankova: None declared

AB0120 THE EFFECT OF INFLAMMATORY SERA FROM DIFFERENT FORMS OF AXIAL SPONDYLOARTHRITIS ON THE OSTEOCLASTOGENIC POTENTIAL OF MONONUCLEAR PRECURSORS IN BLOOD

Background:

Spondyloarthritis (SpA) is characterized by pathological bone resorption and higher risk of osteoporosis. Inflammation accompanying the disease may activate mononuclear precursors in blood that are able to differentiate into osteoclasts, bone resorbing cells[1,2], and thus substantially contribute to bone resorption and aggravation of symptoms characteristic for this chronic disease.

Objectives:

The aim of this pilot study is i) to figure out whether the inflammatory factors present in blood sera of SpA patients activate the osteoclastogenic potential of peripheral blood monocytes (PBM) derived from healthy subjects; ii) to find out whether this effect differs among sera from three forms of SpA, short-term non-radiographic (nr-axSpA) and radiographic (r-axSpA) SpA, and long-term ankylosing spondyloarthritis (AS), and finally iii) to assess whether the stimulatory effect of serum from SpA patients on osteoclastogenesis of healthy PBM reflects the altered clinical markers of inflammation and bone metabolism.

Methods:

To simulate inflammatory condition characteristic for nr-axSpA, r-axSpA or AS, we created pool of 10 AS sera together with age- and sex-matched pools of nr-axSpA, r-axSpA and AxC (sera from healthy subjects). Disease duration of nr-axSpA and r-axSpA was set up to less than 2 years. The ASDAS score of AS form was significantly higher compared to the score of short-term forms of disease (P < 0.05). PBM from 6 healthy donors were cultured for 14 days in DMEM supplemented with 25 ng/ml macrophage colony-stimulating factor (M-CSF), 0.5 ng/ml receptor-activator of nuclear factor kappa B ligand (RANKL) and in parallel with 10% pooled human sera nr-axSpA, r-axSpA, AS and AxC. TRAP positive cells with 3 or more nuclei were recognized as osteoclasts and counted.

Results:

Cultivation of PBM in the presence of both, diseased and healthy human sera increases number of osteoclasts in comparison to cultures without human sera. The strongest osteoclastogenic capacity develop PBM affected by pooled AS sera (2.9 times increase in osteoclast number compared to culture without human sera, P < 0.05), the lowest osteoclastogenic potential was detected in culture with pooled sera from healthy donors (2.1 times, P = NS). Pooled nr-axSpA, r-axSpA and AS sera do not appear to differ significantly among each other in size of their effect on PBM; nevertheless, trend to lowest numbers of osteoclasts can be seen in culture with r-axSpA sera (P = NS).

Conclusion:

Cytokine milieu in human sera seems to have a pro-osteoclatogenic effect regardless of its origin with respect to healthy condition. However, inflammatory factors present in the sera of SpA patients enhance the osteoclastogenic potential of PBM, as documented especially in AS sera presenting with significant, 7fold increased serum CRP levels (P = 0.003), and thus may contribute to aggravation of the osteoporotic condition of SpA patients.

References:

[1]Amarasekara, DS, Yu, J, Rho, J (2015). Bone loss triggered by the cytokine network in inflammatory autoimmune diseases.J Immune Res.2015:832127

[2]Amarasekara, D S, Yun H, Kim S, Lee N, Kim H, Rho J (2018). Regulation of Osteoclast Differentiation by Cytokine Networks.Immune Netw.Feb 7;18(1):e8

Acknowledgments:

Project MH CR 00023728 and MEYS CR Progres Q43

Disclosure of Interests:

Pavlina Dankova: None declared, Eva Sebova: None declared, Patrik Škubica: None declared, Jana Horinkova: None declared, Monika Gregová Consultant of: Novartis, Abbvie, Paid instructor for: Novartis, Speakers bureau: Novartis, Abbvie, MSD, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Marketa Husakova Speakers bureau: Novartis

THU0083 THE DISPROPORTION OF NK CELLS AND NON-CONVENTIONAL NK-T CELLS AND ΓΔ-T CELLS IN INDIVIDUALS AT RISK OF DEVELOPING RHEUMATOID ARTHRITIS

Background:

Natural killer (NK) cells and non-conventional T cells (NK-T and γδ-T cells) are involved in the regulation of immune system and their alteration was previously described in patients with established rheumatoid arthritis (RA). The positivity of antibodies against citrullinated proteins (ACPA) significantly increases the risk of progression to RA. The clinical characteristics of individuals at risk of progression to RA (clinically suspect arthralgia, CSA) has recently been established by EULAR irrespective of the ACPA status.

Objectives:

We aimed to study lymphocyte subpopulations in individuals at risk of developing RA.

Methods:

Our study included 95 individuals with arthralgia at risk of developing RA based on ACPA positivity and/or meeting CSA definition and 70 age and gender matched healthy controls (HC). Whole blood samples were analysed by flow cytometry. The percentage and absolute count of CD3+ T cells, CD3-CD16/56+ NK cells, CD3+CD16/56+ NK-T cells and CD3bright γδ-T cells were evaluated in CD45+CD14- lymphocyte populations.

Results:

Out of 95 individuals with arthralgia (median age 47 years [IQR=16], 92% females), 58 were ACPA+ and 62 met CSA definition (26 of them were ACPA+). Median symptom duration was 12 months [IQR=53], CRP 2.43 [IQR=3.32]. As per definition, there was no evidence of clinical arthritis on examination of 66 joints at baseline. Fourteen individuals developed RA within a median of 3 months of follow up with CRP 4.34 [IQR=17.46] and DAS28(CRP) score 4.84 [IQR=2.43].

Analysis of lymphocyte subpopulations showed higher %CD3+ T cells (p=0.001) and lower %NK (p=0.002) as well as absolute count of NK (p≤0.001), NK-T (p=0.016) and γδ-T cells (p=0.025) and trend to lower %NK-T (p=0.054) in all individuals with arthralgia compared to HC. Similarly, higher %CD3+ T cells (p=0.005) and lower %NK (p=0.004), %NK-T (p=0.027), %γδ-T cells (p=0.050) and absolute count of NK (p=0.002), NK-T (p=0.016) and γδ-T cells (p=0.019) were confirmed in a subgroup of ACPA+ individuals compared to HC. In addition, individuals who met CSA criteria irrespective of ACPA status had higher %CD3 T cells (p=0.004) and lower %NK cells (p=0.002) and absolute count of NK (p≤0.001), NK-T (p=0.019) and γδ-T cells (p=0.042) compared to HC. We observed no differences either between ACPA- or CSA- and HC or between ACPA+ and ACPA- or CSA+ and CSA- individuals with arthralgia. In addition, there were no differences in lymphocyte subsets in individuals who have developed RA so far and patients with arthralgia or at the time of RA manifestation.

Conclusion:

We identified lower number of NK cells as well as NK-T and γδ-T cells in individuals at risk of developing of RA. The decrease in non-conventional T cells was observed despite the increased percentage of the classical T cells. We hypothesize that the disproportion of these lymphocyte subpopulations, described previously in established RA, observed here in at-risk individuals may reflect their predisposition for further development of RA.

Acknowledgments:

Projects AZV-17-32612A and MHCR 023728

Disclosure of Interests:

Klára Prajzlerová: None declared, Olga Kryštůfková: None declared, Nora Petrovská: None declared, Petra Hánová: None declared, Hana Hulejova: None declared, Monika Gregová Consultant of: Novartis, Abbvie, Paid instructor for: Novartis, Speakers bureau: Novartis, Abbvie, MSD, Heřman Mann: None declared, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Jiří Vencovský: None declared, Ladislav Šenolt: None declared, Mária Filková: None declared

Uterine leiomyomas with bizarre nuclei: analysis of 37 cases after laparoscopic or open myomectomy

OBJECTIVE

The aim of this study was to analyse the clinical outcome of patients with diagnosis of leiomyoma with bizarre nuclei (LBN) undergoing uterus saving surgery due to fertility preservation.

DESIGN

Retrospective clinical study.

SETTING

Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital, Prague.

METHODS

This was a retrospective clinical study of patients with LBN diagnosis after myomectomy between January 2002 and June 2017 which were searched in our database. The data were obtained from medical documentation and from correspondence with patients.

RESULTS

We identified 37 patients meeting the criteria in our database. The median age of the patients was 34.0 years. 30 patients (81.1%) underwent laparoscopic procedure, 7 (18.9.%) had open myomectomy. The perioperative appearance of fibroid was found normal in 27 cases (73.0%), in the rest the appearance was described somehow abnormal. The follow-up data were obtained from 35 women; the median follow-up time was 48 months. 9 patients (25.7%) needed re-intervention for fibroids with 2 specimens (22.2%) classified as LBN again. The overall pregnancy rate was 63.6% and life birth rate was 33.3%. We did not observe any distant recurrence of the disease or malignant recurrence or death related to the diagnosis.

CONCLUSION

Uterus sparing surgery for treatment of LBN seems to be safe and reasonable therapy for women wishing to preserve fertility.

[Meningothelial hamartoma of the scalp. A case report]

We report the case of a 34-year - old male with meningothelial hamartoma. The patient had a subcutaneous tumor of the scalp, clinically diagnosed as a lipoma. Histologically, the tumor consisted of mature connective tissue elements, adipose tissue, blood vessels and clusters of cuboidal or polygonal cells with scant eosinophilic or amphophilic cytoplasm and regular nuclei. Mitoses were absent. Immunohistochemically, these cells showed diffuse positivity for vimentin, epithelial membrane antigen (EMA) and progesterone receptors. Other markers examined, including α-smooth muscle actin, CD34, desmin, cytokeratin AE1/AE3, cytokeratin CAM 5.2, α-inhibin, estrogen receptors, synaptophysin, chromogranin A and S100 protein, were negative. Meningothelial hamartoma is a rare benign lesion known under many synonyms and the exact number of reported cases is difficult to establish.