Mortality patterns among patients with restrictive cardiomyopathy referred for CMR in a tertiary care center in Latin-America

Background

Restrictive Cardiomyopathies (R-CMP) represent a wide array of conditions characterized by diastolic heart failure with important impairment in left ventricle filling pressures. These entities require different treatments, rendering etiological diagnosis a key component during the evaluation of these patients.

Purpose

Report the mortality of a select group of patients with R-CMP referred to CMR in a tertiary care center in Latin-America.

Methods

We analyzed all patients with CMR performed in our institution, including hospitalized and ambulatory patients, between 2016 and 2021. We extracted data of patients diagnosed by CMR with amyloidosis, hypertrophic cardiomyopathy (HCM), and endomyocardial fibrosis (EMF). All-cause mortality was extracted from national census data and analyzed using Kaplan-Meier survival estimates and log-rank test.

Results

Between June 1st, 2016, and December 31st, 2021, 5000 CMRs were performed at our institution. Among these, 317 (6.3%) patients were diagnosed with R-CMP by CMR as follows: 52 patients (16.4%) had amyloidosis, 250 patients had HCM (78.9%) and 15 patients (4.7%) had EMF. Of these, 40.7% were female (n=129), the median age was 63 yar-old (IQR 51–71) and 64.7% (n=205) were out-patients. At a mean follow-up of 33.3 months, there was a statistically significant difference in mortality between patients with amyloidosis (49,0%) and those with HCM and EMF (7,1% and 13,3%, respectively; P<0.001), as described in Figure 1.

Conclusions

R-CMP represent a meaningful percentage of patients referred for CMR in our institution with different survival rates. Amyloidosis patients had a significantly higher mortality rate compared to HCM and EMF, at a relatively short follow-up. Increased access to CMR in our region for optimal diagnosis and early treatment may optimize prognosis in these types of patients.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Self funding

POS1427 CLINICAL COURSE IN PATIENTS WITH INTERSTITIAL PNEUMONIA WITH AUTOIMMUNE FEATURES (IPAF): REAL-LIFE DATA FROM A MULTICENTER ILD REGISTRY

Background

Several patients with Interstitial Lung Disease show autoimmune characteristics but do not meet the classification criteria for a connective tissue disease. In order to define this condition, the classification of patients with interstitial pneumonia with autoimmune features (IPAF) has been adopted (Fischer’s criteria).

Objectives

To describe the sociodemographic, clinical, functional characteristics and therapeutic management of IPAF in clinical practice and to evaluate the incidence rate of functional respiratory impairment.

Methods

A longitudinal observational study was performed (NEREA registry). Patients diagnosed with IPAF according to Fischer’s criteria were included from ILD diagnosis (Feb 2007 to Dec 2019) and followed until loss of follow-up or Jan 2021. The study was carried out by a multidisciplinary team (pneumologists and rheumatologists) in seven Hospitals of Madrid. The relative functional respiratory impairment, defined as a ≥ 5% decline in percent predicted forced vital capacity (FVC%) compared to the previous visit was set as main outcome. Respiratory function was measured at baseline and every 6-12 months. Covariates included: a) sociodemographic, b) clinical, c) radiological pattern (non-specific interstitial pneumonia [NSIP]; usual interstitial pneumonia [UIP], others); d) FVC% DLCO%; e) laboratory tests; f) therapy used. Survival techniques were used to estimate the incidence rate (IR) of relative functional respiratory impairment, expressed per 100 patient-semester with their respective confidence interval [95 % CI].

Results

79 IPAF were included, with a follow up of 462.8 patients-semester and a maximum follow-up of 12.3 years. 79% were women with a mean age of 66±11 years. Along with obesity (40%), the most frequent comorbidities at baseline were hypertension, hypercholesterolemia, followed by ischemic heart disease. Baseline FVC% and DLCO% were 88.5±22.7 and 64.2±19.3, respectively. Distribution of IPAF classification criteria was: a) clinical domain: arthritis (46.2%), Raynaud`s phenomenon (35.8%) and mechanic hands (9.3%); b) serological domain: 80.8% positive ANA at >1/320 titer; 29% RF (> 40 IU/ml); 25% positive anti-Ro; c) morphological domain: 46.8% of NSIP and 36.7% of UIP. During the study period, 77.2% of patients (n=61) received treatment: glucocorticosteroids (n=52), mycophenolate (n=25), azathioprine (n=21), rituximab (n=15) and antifibrotics (n=11).

During the follow-up, 50 patients presented 111 relative functional respiratory impairment events over time. The estimated IR was 23.9 [19.9-28.8] per 100 patient-semester, and 50% of the patients developed functional respiratory impairment at 16 months from diagnosis.

IR was similar between patient gender, baseline overall comorbidity, baseline pulmonary functional tests, and age strata, with slight difference in patients >80 years of age. Patients with baseline associated emphysema (IR: 17.6 [10-31]) or without baseline associated fibrosis (IR: 21.1 [15-28]) had lower IR compared to the opposite (IR without emphysema: 24.5[19.3-31]; IR with fibrosis emphysema: 27.5 [19.9-37.9]). As expected, IR was higher in UIP (32.2 [24-42]) compared to NSIP or any other pattern. With respect to serologic markers, patients with ANA titers >=1/320 had a higher IR (26.7 [21-33]) in comparison with those with lower or non-titers of ANA (IR: 15.7 [9.9-25.1]).

Conclusion

In a multicenter registry of Madrid, we have performed a descriptive longitudinal study. IPAF were mostly women in their sixties. The most frequent clinical criteria were arthritis and Raynaud`s phenomenon. An NSIP radiological pattern predominated. At onset, patients have a slightly diminished lung function. The incidence rate of functional deterioration was estimated in 23.9% patient-semester and 50% of the patients developed pulmonary functional deterioration at 16 months from ILD diagnosis. This Incidence rate was higher in patients with an UIP pattern, baseline fibrosis or ANA at medium-high titers.

Disclosure of Interests

None declared

Prevalence of Intracranial Aneurysms in Hereditary Hemorrhagic Telangiectasia: Report from a Single Reference Center

BACKGROUND AND PURPOSE

Neurologic manifestations in hereditary hemorrhagic telangiectasia include an increased incidence of brain abscesses and ischemic strokes due to paradoxic embolization in addition to a wide spectrum of symptoms and complications due to typical brain vascular malformations. Intracranial aneurysms are not part of this brain vascular malformation spectrum. The aim of this study was to determine their prevalence in patients with hereditary hemorrhagic telangiectasia.

MATERIALS AND METHODS

This was a single-center, retrospective study. Adult patients from the institutional Hereditary Hemorrhagic Telangiectasia registry with a definitive diagnosis of hereditary hemorrhagic telangiectasia and an available report or angiographic imaging study were included and reviewed to determine the intracranial aneurysm prevalence. In addition, the morphologic characteristics of intracranial aneurysms and possible associated risk factors were collected.

RESULTS

Two hundred twenty-eight patients were analyzed. Thirty-seven aneurysms in 33 patients (14.5%; 95% CI, 9.9%-19%) were found. The median diameter of intracranial aneurysms was 3.2 mm (interquartile range, 2.6-4.4 mm). No association between intracranial aneurysm and sex, age, or genetic background was noted. There were no subarachnoid hemorrhagic events due to intracranial aneurysm rupture.

CONCLUSIONS

Due to the high prevalence of intracranial aneurysms in adult patients with hereditary hemorrhagic telangiectasia, further studies regarding bleeding risks and monitoring should be addressed.

POS1430 WATCH OUT FOR THE INFLAMMATORY RESPONSE IN AUTOIMMUNE DISEASES WITH INTERSTITIAL PNEUMONIA. A RETROSPECTIVE STUDY

Background

Chronic interstitial pneumonia (IP) is often a feature of autoimmune rheumatic diseases (ARD). While potentially a life-threatening complication, it is however highly heterogeneous both as regards its presentation and its progression over time. Some patients may have a predominantly lung involvement, a context which hampers their classification and/or management. The recently coined concept of interstitial pneumonia with autoimmune features (IPAF) may help to identify these cases, albeit some others might remain unclassified (UAIP). Either with or without an overt underlying ARD, real-life data are regarded fundamental to shed light on the natural course of autoimmune IP (AIP) and to identify prognostic markers in order to tailor follow-up and therapeutic approaches

Objectives

To find prognostic markers in our cohort of patients with autoimmune diseases with AIP (comprising ARD-IP, IPAF and UAIP), which may guide our therapeutic strategies.

Methods

We set a retrospective study including all patients diagnosed with AIP from our Clinic with a minimum follow-up of 3 yr -or until death-. The end of the study was set at January 2020. We collected demographic data and classified the disease according to the updated criteria for the ARDs, Fischer’s preliminary criteria of IPAF and Solomon’s proposed criteria of anti synthetase (ARS) syndrome. We registered morphological, serological and clinical features of the disease. Besides, available laboratory parameters were recorded as dichotomous variables (absent/present; normal/increased). The dependent variable of our study was death. Student’s t, Fisher’s exact test and survival techniques were employed in the univariate analysis. Logistic regression analysis was done to assess death prediction models. One way ANOVA and Dunnett 2 sided t were employed in multi-group comparisons of means.

Results

A total of 118 patients (69% women), comprising 63 patients (53%) with ARD-IP, 37 (31%) with IPAF and 18 (15%) with UAIP, were included. There were 22 patients fulfilling RA criteria, 16 patients SSc criteria and 20 patients meeting criteria for IM. Twenty one patients could be diagnosed with ARS syndrome. Disease duration was not different between subgroups, with a total follow-up of 984 patient-years. Age at onset was significantly younger in ARD-IP cases (54 ± 2), than in IPAF (61,7 ± 2,7), p 0.035, and also in 2 group comparison with UAIP (72,1 ± 1,9), p < 0.001, p 0.019, respectively. Thirty one deaths occurred during follow-up. In the univariate analysis, older age at presentation (difference: -11,2 ± 3,3 y.o. [CI95: -17.9; -4.6] p 0,001), a shorter course of the disease (difference: 4,5 ± 1,1 y [CI95: 2,3; 6,8] p < 0.001) and the presence of pulmonary hypertension (OR 6,08 ± 1,69 [CI95 2,18; 16,96] p 0.001) were associated to fatal cases. On the other hand, none of clinical subgroups, morphological patterns or autoantibodies conveyed death risk. As regards laboratory parameters, increases of ferritin, triglycerides, ESR, CRP and LDH were strong predictors of death (Table 1). With logistic regression, the combination of older age, pulmonary hypertension, increased ferritin an increased ESR was the best model for death prediction (OR 14,57, p < 0.001), while the elevation of LDH and CRP could be explained by the mentioned 4-factor model.

Table 1.Laboratory parameteralivedeadORpincreased ferritin19p (22,9%)16p (51,6%)3,59 ± 1,56 [CI95 1,50; 8,58]0,004increased ESR47p (55,3%)24p (77,4%)2,77 ± 1,62 [CI95 1,08; 7,13]0,034increased CRP49p (57,6%)27p (87,1%)4,96 ± 1,78 [CI95 1,59: 15,43]0,006increased triglycerides6p (7%)7p (22,6%)3,84 ± 1,83 [CI95 1,18: 12,53]0,026increased LDH34p (40%)23p (74,2%)4,31 ± 1,59 [CI95 1,73; 10,76]0,002

Conclusion

According to our data, markers of macrophage activation and the activation of acute phase response could be taken as risk factors of a poor outcome in patients with AIP, regardless of clinical diagnosis and process-related features. Nonetheless, due to our study design and sample, these resutls warrant replication in other cohorts.

Acknowledgements

This study has been conducted with a Grant from the Carlos III Health Institute AES2020 program, Spanish Ministry for Science and Innovation (PI20/00250)

Disclosure of Interests

None declared

Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset

BACKGROUND

Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension.

AIM

To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis.

METHODS

Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed.

RESULTS

Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained.

CONCLUSION

In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.

Participative approach to elicit water quality monitoring needs from stakeholder groups - An application of integrated watershed management

Water quality monitoring programs (WQMPs) must be based on monitoring objectives originating from the real knowledge needs of all stakeholders in a watershed and users of the resource. This paper proposes a participative approach to elicit knowledge needs and preferred modes of communication from citizens and representatives of organized stakeholders (ROS) on water quality and quantity issues. The participative approach includes six steps and is adaptable and transferable to different types of watersheds. These steps are: (1) perform a stakeholder analysis; (2) conduct an adaptable survey accompanied by a user-friendly public participation geographical information system (PPGIS); (3) hold workshops to meet with ROS to inform them of the results of the survey and PPGIS; discuss attainment of past monitoring objectives; exchange views on new knowledge needs and concerns on water quality and quantity; (4) meet with citizens to obtain the same type of input (as from ROS); (5) analyze the data and information collected to identify new knowledge needs and modes of communication and (6) identify, in collaboration with the individuals in charge of the WQMPs, the short-, medium- and long-term monitoring objectives and communication strategies to be pursued. The participative approach was tested on two distinct watersheds in the province of Quebec, Canada. It resulted in a series of optimization objectives of the existing WQMPs, new monitoring objectives and recommendations regarding communication strategies of the WQMPs' results. The results of this study show that the proposed methodology is appreciated by all parties and that the outcomes and monitoring objectives are acceptable. We also conclude that successful integrated watershed management is a question of scale, and that every aspect of integrated watershed management needs to be adapted to the surface watershed, the groundwater watershed (aquifers) and the human catchment area.

The clinical and immunological effects of Pru p 3 sublingual immunotherapy on peach and peanut allergy in patients with systemic reactions

BACKGROUND

The peach non-specific lipid transfer protein, Pru p 3, is the primary sensitizer in fruits and responsible for severe reactions in the Mediterranean area. Peach allergy is frequently associated with other allergies such as peanut. Therefore, it is important to assess how specific immunotherapy to Pru p 3 could affect both peach and peanut tolerance.

OBJECTIVES

To evaluate peach and peanut desensitization and immunological changes after 1 year of Pru p 3 sublingual immunotherapy (SLIT) in patients with systemic allergic reactions to peach and/or peanut.

METHODS

Forty-eight peach allergic patients, 36 treated with SLIT and 12 non-treated, were monitored for 12 months. Treated patients were subclassified as peanut allergic (Group A), sensitized (Group B) or tolerant (Group C). SLIT effect was evaluated by skin prick test (SPT) reactivity and food challenge. Immunological changes were evaluated by monitoring sIgE and sIgG4 levels and basophil reactivity.

RESULTS

After 1 year of SLIT, the weal area in SPT significantly decreased and a significant increase in peach threshold in treated patients was observed (P < 0.001). Patients in Group A showed a significant decrease in peanut SPT weal area and an increase in peanut threshold (P < 0.001). Immunological changes were observed in treated patients only, with a significant decrease in sIgE and a parallel increase in sIgG4, sIgG4/sIgE and basophil reactivity for both Pru p 3 and Ara h 9.

CONCLUSIONS AND CLINICAL RELEVANCE

After 1 year, Pru p 3 SLIT induces both desensitization and immunological changes not only for peach but also for other food allergens relevant in the induction of severe reactions such as peanut.

Dermatophagoides pteronyssinus immunotherapy changes the T-regulatory cell activity

Subcutaneous specific immunotherapy (SCIT) has been shown to modify the Dermatophagoides pteronissinus (DP) allergic response, characterized by generation of Treg cells. However, studies have reported no changes in the proportion of Treg cells after immunotherapy, indicating that the effects may be due to modifications in their regulatory activities. We aimed to determine whether Tregs generated by DP-SCIT can switch the allergic response to tolerant and study the involvement of suppressive cytokines on it. Twenty-four DP-allergic rhinitis patients were recruited, 16 treated with DP-SCIT and 8 untreated. Treg and T effector cells were isolated before and after DP-SCIT, and cocultured in different combinations with α-IL-10, α-TGF-β blocking antibodies and nDer p 1. Treg cells after DP-SCIT increased Th1 and decreased Th2 and Th9 proliferation. Similarly, they increased IL-10 and decreased IL-4 and IL-9-producing cells. α-IL-10 affected the activity of Treg cells obtained after DP-SCIT only. Finally, DP-specific IgG4 levels, Treg percentage and IL-10 production were correlated after DP-SCIT. These results demonstrate that DP-SCIT induces Treg cells with different suppressive activities. These changes could be mediated by IL-10 production and appear to play an important role in the induction of the tolerance response leading to a clinical improvement of symptoms.

Biodegradable Porous Silk Microtubes for Tissue Vascularization

Cardiovascular diseases are the leading cause of mortality around the globe, and microvasculature replacements to help stem these diseases are not available. Additionally, some vascular surgeries needing small diameter vascular grafts present different performance requirements. In this work silk fibroin scaffolds based on silk/polyethylene oxide blends were developed as microtubes for vasculature needs and for different tissue regeneration times, mechanical properties and structural designs. Systems with 13, 14 and 15% silk alone or blended with 1 or 2% of polyethylene oxide (PEO) were used to generate porous microtubes using gel-spinning. Microtubes with inner diameters (ID) of 150-300 μm and 100 μm wall thickness were fabricated. The systems were assessed for porosity, mechanical properties, enzymatic degradability, and in vitro vascular endothelial cell attachment and metabolic activity. After 14 days all tubes supported the proliferation of cells and cell attachment increased with porosity. The silk tubes with PEO had similar crystallinity but higher elastic modulus compared with the systems without PEO. The silk (13%)/PEO (1%) system showed the highest porosity (20 μm pore diameters on average), highest cell attachment and fastest degradation profile. There was a good correlation between these parameters with silk concentration and the presence of PEO. The results demonstrate the ability to generate versatile and tunable tubular biomaterials based on silk-PEO-blends with potential for microvascular grafts.

Water quality monitoring strategies - A review and future perspectives

The reliable assessment of water quality through water quality monitoring programs (WQMPs) is crucial in order for decision-makers to understand, interpret and use this information in support of their management activities aiming at protecting the resource. The challenge of water quality monitoring has been widely addressed in the literature since the 1940s. However, there is still no generally accepted, holistic and practical strategy to support all phases of WQMPs. The purpose of this paper is to report on the use cases a watershed manager has to address to plan or optimize a WQMP from the challenge of identifying monitoring objectives; selecting sampling sites and water quality parameters; identifying sampling frequencies; considering logistics and resources to the implementation of actions based on information acquired through the WQMP. An inventory and critique of the information, approaches and tools placed at the disposal of watershed managers was proposed to evaluate how the existing information could be integrated in a holistic, user-friendly and evolvable solution. Given the differences in regulatory requirements, water quality standards, geographical and geological differences, land-use variations, and other site specificities, a one-in-all solution is not possible. However, we advance that an intelligent decision support system (IDSS) based on expert knowledge that integrates existing approaches and past research can guide a watershed manager through the process according to his/her site-specific requirements. It is also necessary to tap into local knowledge and to identify the knowledge needs of all the stakeholders through participative approaches based on geographical information systems and adaptive survey-based questionnaires. We believe that future research should focus on developing such participative approaches and further investigate the benefits of IDSS's that can be updated quickly and make it possible for a watershed manager to obtain a timely, holistic view and support for every aspect of planning and optimizing a WQMP.

Seasonal and spatial variations of source and drinking water quality in small municipal systems of two Canadian regions

A one-year sampling program covering twenty-five small municipal systems was carried out in two Canadian regions to improve our understanding of the variability of water quality in small systems from water source to the end of the distribution system (DS). The database obtained was used to develop a global portrait of physical, chemical and microbiological water quality parameters. More precisely, the temporal and the spatial variability of these parameters were investigated. We observed that the levels of natural organic matter (NOM) were variable during different seasons, with maxima in the fall for both provinces. In the regions under study, the highest trihalomethane (THM) and haloacetic acid (HAA) levels were achieved in warmer seasons (summer, fall), as observed in previous studies involving large systems. Observed THM and HAA levels were three times higher in systems in the province of Newfoundland & Labrador than in the province of Quebec. Taste and odor indicators were detected during the summer and fall, and higher heterotrophic plate count (HPC) levels were associated with lower free chlorine levels. To determine spatial variations, stepwise statistical analysis was used to identify parameters and locations in the DS that act as indicators of drinking water quality. As observed for medium and large systems, free chlorine consumption, THM and HAA levels were dependent on their location in the DS. We also observed that the degradation of HAAs is more important in small systems than in medium or large DS reported in the literature, and this degradation can occur from the beginning of the DS. The results of this research may contribute to providing precious information on drinking water quality to small system operators and pave the way for several opportunities to improve water quality management.

Characterization of Escherichia fergusonii and Escherichia albertii isolated from water

AIMS

The aim of this study was to characterize Escherichia fergusonii and Escherichia albertii isolated from water.

METHODS AND RESULTS

The characterization of E. fergusonii and E. albertii isolated from water was determined using an Escherichia coli-specific uidA PCR, a tuf PCR, and with phylogenetic analysis using three housekeeping genes (adk, gyrB, and recA) from the E. coli MLST scheme, selected for their ability to discriminate among all Escherichia species. Among the 527 isolates tested, 25 (4·7%) were uidA PCR negative and tuf PCR positive. Phylogenetic analysis using adk, gyrB and recA genes showed that 6, 18 and 1 of these 25 non-E. coli Escherichia spp. isolates grouped with reference strains of E. fergusonii, E. albertii, and E. coli, respectively. Finally, the 25 non-E. coli Escherichia spp. strains isolated were investigated for the presence of pathogenic factors, comprising intimin (eae gene), cytolethal distending toxin (cdtB gene) and shiga toxin (stx gene). With the PCR primers used, the presence of eae and stx genes was not detected. However, cdtB genes types I/IV were detected for 3 (16·7%) E. albertii strains, whereas 15 of 18 (83·3%) possessed the cdtB gene types II/III/V.

CONCLUSIONS

These results showed that MLST scheme allows a more accurate identification of non-E. coli species than phenotypic tests. We also showed that E. fergusonii and E. albertii represent, respectively, 0·8 and 2·5% of all Escherichia species isolated and the pathogenic cdtB genes were present in 83·3% of these strains.

SIGNIFICANCE AND IMPACT OF THE STUDY

The data presented in this study provided an efficient way to correctly identify non-E. coli species contributing to our understanding of the risks associated with Escherichia species in water consumed by humans and animals. Furthermore, the results give an insight about the natural habitats of these species.

Preoperative levosimendan. A new way for organoprotection

Preoperative use of levosimendan in cardiac surgery patients is one of the most attractive therapeutic alternatives in subjects with left or right ventricular dysfunction. Our review explores the pharmacological bases and clinical evidence for the use of levosimendan, with the intention of making a series of recommendations regarding its use in preoperative optimization prior to cardiac surgery. We carried out a survey of 102 Spanish anesthesiologists in order to shed light on the grey areas regarding the use of this drug prior to surgery. Our findings suggest that levosimendan is recommended for patients with severe left or right ventricular dysfunction, moderate left ventricular dysfunction in which Intra-aortic Balloon Counterpulsation (IABC) is necessary and severe pulmonary hypertension. Administration of levosimendan prior to surgical cardiac intervention without an initial bolus reduces the likelihood of complications.

TMPRSS4 regulates levels of integrin α5 in NSCLC through miR-205 activity to promote metastasis

Background:

TMPRSS4 is a membrane-anchored protease involved in cell migration and invasion in different cancer types including lung cancer. TMPRSS4 expression is increased in NSCLC and its inhibition through shRNA reduces lung metastasis. However, molecular mechanisms leading to the protumorigenic regulation of TMPRSS4 in lung cancer are unknown.

Methods:

miR-205 was identified as an overexpressed gene upon TMPRSS4 downregulation through microarray analysis. Cell migration and invasion assays and in vivo lung primary tumour and metastasis models were used for functional analysis of miR-205 overexpression in H2170 and H441 cell lines. Luciferase assays were used to identify a new miR-205 direct target in NSCLC.

Results:

miR-205 overexpression promoted an epithelial phenotype with increased E-cadherin and reduced fibronectin. Furthermore, miR-205 expression caused a G₀/G₁ cell cycle arrest and inhibition of cell growth, migration, attachment to fibronectin, primary tumour growth and metastasis formation in vivo. Integrin α5 (a proinvasive protein) was identified as a new miR-205 direct target in NSCLC. Integrin α5 downregulation in lung cancer cells resulted in complete abrogation of cell migration, a decreased capacity to adhere to fibronectin and reduced in vivo tumour growth, compared with control cells. TMPRSS4 silencing resulted in a concomitant reduction of integrin α5 levels.

Conclusion:

We have demonstrated for the first time a new molecular pathway that connects TMPRSS4 and integrin α5 through miR-205 to regulate cancer cell invasion and metastasis. Our results will help designing new therapeutic strategies to inhibit this novel pathway in NSCLC.

Variations in trihalomethane levels in three French water distribution systems and the development of a predictive model

Epidemiological studies have demonstrated that chlorination by-products in drinking water may cause some types of cancer in humans. However, due to differences in methodology between the various studies, it is not possible to establish a dose-response relationship. This shortcoming is due primarily to uncertainties about how exposure is measured-made difficult by the great number of compounds present-the exposure routes involved and the variation in concentrations in water distribution systems. This is especially true for trihalomethanes for which concentrations can double between the water treatment plant and the consumer tap. The aim of this study is to describe the behaviour of trihalomethanes in three French water distribution systems and develop a mathematical model to predict concentrations in the water distribution system using data collected from treated water at the plant (i.e. the entrance of the distribution system). In 2006 and 2007, samples were taken successively from treated water at the plant and at several points in the water distribution system in three French cities. In addition to the concentrations of the four trihalomethanes (chloroform, dichlorobromomethane, chlorodibromomethane, bromoform), many other parameters involved in their formation that affect their concentration were also measured. The average trihalomethane concentration in the three water distribution systems ranged from 21.6 μg/L to 59.9 μg/L. The increase in trihalomethanes between the treated water at the plant and a given point in the water distribution system varied by a factor of 1.1-5.7 over all of the samples. A log-log linear regression model was constructed to predict THM concentrations in the water distribution system. The five variables used were trihalomethane concentration and free residual chlorine for treated water at the plant, two variables that characterize the reactivity of organic matter (specific UV absorbance (SUVA), an indicator developed for the free chlorine consumption in the treatment plant before distribution δ) and water residence time in the distribution system. French regulations impose a minimum trihalomethane level for drinking water and most tests are performed on treated water at the plant. Applied in this context, the model developed here helps better to understand trihalomethane exposure in the French population, particularly useful for epidemiological studies.

A methodology for identifying vulnerable locations to taste and odour problems in a drinking water system

In this research, methodology was developed to identify locations vulnerable to taste and odour problems in a distribution system. The methodology was based on a multicriteria procedure combining spatial information on consumer complaints and popular perception of tap water. The first step in the described methodology consisted of mapping complaints regarding tap water made by the population between 2002 and 2004 using a geographical information system (GIS). The second step consisted of analysing results of a questionnaire-based mail survey, also through GIS. The information generated using the above steps was integrated using a multicriteria and spatial approach allowing segregation of the distribution system into delineated zones, according to their vulnerability to occurrences of taste and odour problems. The identification of vulnerable sectors in a distribution system will help water managers to implement a better-targeted water quality monitoring programme--one that considers odours and tastes of drinking water--within the management process.

A comparative study of the expression of monoamine oxidase-A and -B mRNA and protein in non-CNS human tissues

The distributions of monoamine oxidase (MAO)-A and -B proteins and mRNAs in human heart, lung, liver, duodenum, kidney and vasculature were compared using immunohistochemistry and cRNA in situ hybridisation. MAO-A and -B mRNA were detected in all tissues, to differing extents, but particularly in glomeruli, hepatocytes, and the crypts, muscularis mucosa and muscularis externa of duodenum. Renal proximal and distal tubules and loops of Henle had more intense labelling for mRNA of MAO-B than MAO-A; this was reflected in MAO protein expression. Little immunoreactivity was detected in glomeruli. Hepatocytes expressed MAO-A moderately, but MAO-B strongly. In lungs, similar moderately intense labelling for both MAO mRNAs and immunoreactivities was evident in pneumocytes, and epithelial and smooth muscle cells. Cardiomyocytes contained both MAO isoforms, but with more, albeit moderate, labelling for MAO-A. Both isoforms were expressed equally in duodenal villi, crypts, muscularis externa and mucosa; lower level expression occurred in mucosal and submucosal cells. MAO-A and -B mRNA were detected in endothelia, adventitia and media of a renal interlobular artery, but protein immunoreactivities were chiefly in the adventitia. The data reveal widespread tissue distribution of MAO mRNAs and proteins, but indicate that presence of MAO mRNAs does not invariably reflect quantitatively its protein expression.

Epstein-Barr virus latent membrane protein-1 (LMP-1) expression in oral squamous cell carcinoma

OBJECTIVES

Epstein-Barr virus (EBV) is frequently associated with malignant cell transformation through the action of the oncoprotein latent membrane protein-1 (LMP-1). The present study aimed to determine the presence of EBV in oral squamous cell carcinomas (OSCCs) and the expression of LMP-1 in neoplastic cells of EBV-positive OSCCs.

STUDY DESIGN/METHODS

In a retrospective study of 78 OSCCs, we investigated the presence of the DNA of EBV by polymerase chain reaction, the expression of the oncoprotein LMP-1 by immunohistochemistry, and the presence of EBV-encoded RNA (EBER) by in situ hybridization.

RESULTS

EBV DNA was detected in 19.2% of the cases. Expression of LMP-1 in neoplastic cells was found in 85.7% of the EBV-positive OSCCs. EBV presence was significantly more frequent (P <.05) in OSCCs localized on the lateral tongue. EBV-positive OSCCs more frequently presented (P <.05) greater nuclear atypia.

CONCLUSION

EBV can appear in latent form in OSCC and express its main oncoprotein, LMP-1.

Recurrent portopulmonary hypertension after liver transplantation: management with epoprostenol and resolution after retransplantation

We report a case of portopulmonary hypertension in which the pulmonary hypertension resolved after initial orthotopic liver transplantation. Portopulmonary hypertension recurred when the transplanted liver failed and again resolved after a second liver transplantation. Intravenous epoprostenol was administered perioperatively to control the pulmonary hypertension in both instances.

Spatial and temporal evolution of trihalomethanes in three water distribution systems

Spatial and seasonal changes in trihalomethane (THM) concentrations were investigated in three distribution systems of Quebec (Canada) which are supplied by different surface waters and which use a variety of physicochemical treatment strategies. The investigation was based on an intensive 25-week sampling programme, undertaken at a time of year when the temperature of southern Quebec surface waters exceeds 4 degrees C (April-November). THMs and other water quality and operational parameters were monitored at points along the distribution system--between the treatment plant and the system extremities--which represented variable residence times of water. Results showed that THM concentrations vary significantly (from 1.5 to 2 times, depending on the utility) between finished waters as they leave the plant and water at the system extremities. When water temperature exceeds 15 degrees C, spatial THM variations are particularly high (from 2 to 4 times, depending on the utility). The development of multivariate regression models showed that water temperature was a better predictor of THM seasonal variability than chlorine dose, surrogates of natural organic matter and pH. Also, initial THM formation (in finished waters leaving the plant) was a good predictor of THM levels at distribution system extremities.

Sequence of centromere separation: effect of 5-azacytidine-induced epigenetic alteration

The factors which control the sequential separation of the various chromosomes in a genome at the meta-anaphase junction are not well understood. In genomes in which separation is correlated with the quantity of pericentric heterochromatin one factor appears to be the epigenetic nature, namely condensation, of pericentric heterochromatin. When we induced decondensation of pericentric heterochromatin in mouse cells with 10(-6), 4x 10(-6) and 6x10(-6) M 5-azacytidine (5-AC) for 8 h, it resulted in alteration of the sequence of centromere separation. The centromeres which lacked pericentric heterochromatin appeared not to have been affected because there could not be an epigenetic alteration induced by 5-AC. The major effect was on chromosomes with the largest quantity of pericentric heterochromatin. These chromosomes separated at significantly higher frequency than in the untreated population. We also treated human cells, in which separation does not depend upon the quantity of heterochromatin, with 2x10(-5) and 6x10(-6) M 5-AC for 5 and 8 h. Compared with the control, 5-AC treatment resulted in an increased frequency of separated centromeres of acrocentric chromosomes in relation to those of non-acrocentric chromosomes. In the control the acrocentric chromosomes are the last to separate; in the treated population there was almost random separation of the two types of chromosomes. This epigenetic alteration might be another factor which results in genesis of aneuploidy.

The synthesis of pseudomycin C' via a novel acid promoted side-chain deacylation of pseudomycin A

The gamma hydroxyl present in the aliphatic side chain of the natural products pseudomycin A and C' provided a unique handle for the pH dependent side-chain deacylation. Low pH reaction conditions were used to cleave the side chain with minimal degradation of the peptide core. The pseudomycin nucleus intermediate obtained from the deacylation of pseudomycin A was pivotal in the synthesis of novel side-chain analogues. A practical synthesis of a minor fermentation factor pseudomycin C' and related analogues is reported.

The first case report of the use of a zoom videoendoscope for the evaluation of small bowel graft mucosa in a human after intestinal transplantation

BACKGROUND

Control of allograft rejection remains the most difficult dilemma in intestinal transplantation. Standard endoscopic surveillance to date has not been always accurate in the diagnosis of rejection. We describe the first application of a zoom video endoscope in monitoring graft mucosa in humans after intestinal transplantation.

METHOD

A zoom video endoscope, which can magnify the image up to 100-fold, was used in this study. The patient was a 31-year-old man who received an isolated intestinal transplant. Surveillance endoscopy with the zoom video endoscope was performed through the ileostomy. Endoscopic biopsies were done at the same time.

RESULTS

The zoom video endoscope showed the microscopic architecture of the graft mucosa such as villi and crypts with outstanding quality. We found that an enlargement of the crypt areas appeared to correlate with morphologic changes of early rejection. This finding was reversed with the treatment of rejection.

CONCLUSIONS

The zoom video endoscope successfully showed the detailed information of intestinal mucosa. The ability to visualize a more representative view of the graft mucosa could lead to better detection of early rejection. A greater experience with this unique method will provide more accurate assessment of the intestinal allograft.

The synthesis of water soluble prodrugs analogs of echinocandin B

A facile synthesis of phosphonate and phosphate ester prodrugs on the phenolic hydroxy of two echinocandin semisynthetic derivatives is reported. The water solubility and stability profiles of the ECB compounds varied with the choice of alkyl group used. In some cases, the ester prodrugs with small aliphatic side chains retained antifungal activity while enhancing water solubility.

Identification of a common antigenic site in the nucleocapsid protein of European and North American isolates of porcine reproductive and respiratory syndrome virus

Porcine reproductive and respiratory syndrome virus (PRRSV) nucleocapsid (N) protein has been identified as the most immunodominant viral protein. The N protein genes from two PRRSV isolates Olot/91 (European) and Quebec 807/94 (North American) were cloned and expressed in Escherichia coli using the pET3x system. The antigenic structure of the PRRSV N protein was dissected using seven monoclonal antibodies (MAbs) and overlapping fragments of the protein expressed in E.coli. Three antigenic sites were found. Four MAbs recognized two discontinuous epitopes that were present in the partially folded protein or at least a large fragment comprising the first 78 residues, respectively. The other three MAbs revealed the presence of a common antigenic site localized in the central region of the protein (amino acids 50 to 66). This hydrophillic region is well conserved among different isolates of European and North American origin. However, since this epitope is not recognized by many pig sera, it is not adequate for diagnostic purposes. Moreover, none of the N protein fragments were able to mimic the antigenicity of the entire N protein.

Novel glycopeptide antibiotics: N-alkylated derivatives active against vancomycin-resistant enterococci

LY264826 (A82846B) is a naturally-occurring glycopeptide antibiotic, differing from vancomycin in the stereochemistry of the amino-sugar of the disaccharide function, and the presence of a third sugar attached at the benzylic position of amino acid residue 6. Despite these seemingly subtle differences, LY264826 is approximately 10 times more active than vancomycin against the enterococci. In the pursuit of new antibiotics active against multiresistant Gram-positive organisms, an extensive side chain SAR was developed focusing on the reductive alkylation of LY264826 at the amino function of the disaccharide moiety. A new series of derivatives having varying degrees of structural diversity in the side chain (e.g. varying lengths and degrees of rigidity) was found to have potent activity against vancomycin-resistant enterococci (MIC's < 1.0 microgram/ml) as well as activity against staphylococci and streptococci as good or better than vancomycin.

Epitope mapping of the nucleocapsid protein of European and North American isolates of porcine reproductive and respiratory syndrome virus

Two major genotypes of porcine reproductive and respiratory syndrome virus (PRRSV) have been described, which correspond to the European and North American isolates. PRRSV nucleocapsid (N) protein has been identified as the most immunodominant viral protein. The N genes from two PRRSV isolates, Olot/91 (European) and Québec 807/94 (North American), were cloned and expressed in: (i) baculovirus under the control of the polyhedrin promoter and (ii) Escherichia coli using the pET3x system. The N protein from both isolates was expressed much more efficiently in E. coli as a fusion protein than in baculovirus. The antigenicity of the protein was similar in both systems and it was recognized by a collection of 48 PRRSV-positive pig sera. The antigenic structure of the PRRSV N protein was investigated using seven monoclonal antibodies (MAbs) and overlapping fragments of the protein expressed in E. coli. Four MAbs recognized two discontinuous epitopes that were present in the partially folded protein, or at least a large fragment comprising the first 78 residues. The other three MAbs revealed the presence of a common antigenic site localized in the central region of the protein (amino acids 50-66). This region is well conserved among different isolates of European and North American origin and is the most hydrophilic region of the protein. However, this epitope, although recognized by the MAbs and many pig sera, is not useful for diagnostic purposes. Moreover, none of the N protein fragments were able to mimic the antigenicity of the entire protein.

The synthesis and antifungal activity of N-alkylated analogs of echinocandin B

The synthesis and biological activity of a series of N-alkylated derivatives of echinocandin B are described and compared with the N-acylated analogs. The linear, rigid geometry of the side chain that was essential to improve the antifungal potency of the N-acylated series gave similar in vitro results with the N-alkylated derivatives. However the slight structural variation forfeited all in vivo activity.

Semisynthetic glycopeptide antibiotics derived from LY264826 active against vancomycin-resistant enterococci

Certain derivatives of the glycopeptide antibiotic LY264826 with N-alkyl-linked substitutions on the epivancosamine sugar are active against glycopeptide-resistant enterococci. Six compounds representing our most active series were evaluated for activity against antibiotic-resistant, gram-positive pathogens. For Enterococcus faecium and E. faecalis resistant to both vancomycin and teicoplanin, the MICs of the six semisynthetic compounds for 90% of the strains tested were 1 to 4 micrograms/ml, compared with 2,048 micrograms/ml for vancomycin and 256 micrograms/ml for LY264826. For E. faecium and E. faecalis resistant to vancomycin but not teicoplanin, the MICs were 0.016 to 1 micrograms/ml, compared with 64 to 1,024 micrograms/ml for vancomycin. The compounds were highly active against vancomycin-susceptible enterococci and against E. gallinarum and E. casseliflavus and showed some activity against isolates of highly vancomycin-resistant leuconostocs and pediococci. The MICs for 90% of the strains of methicillin-resistant Staphylococcus aureus tested were typically 0.25 to 1 micrograms/ml, compared with 1 microgram/ml for vancomycin. Against methicillin-resistant S. epidermidis MICs ranged from 0.25 to 2 micrograms/ml, compared with 1 to 4 micrograms/ml for vancomycin and 4 to 16 micrograms/ml for teicoplanin. The spectrum of these new compounds included activity against teicoplanin-resistant, coagulase-negative staphylococci. The compounds exhibited exceptional potency against pathogenic streptococci, with MICs of < or = 0.008 microgram/ml against Streptococcus pneumoniae, including penicillin-resistant isolates. In in vivo studies with a mouse infection model, the median effective doses against a challenge by S. aureus, S. pneumoniae, or S. pyogenes were typically 4 to 20 times lower than those of vancomycin. Overall, these new glycopeptides, such as LY307599 and LY333328, show promise for use as agents against resistant enterococci, methicillin-resistant S. aureus, and penicillin-resistant pneumococci.

Oral immunization of rabbits with VP60 particles confers protection against rabbit hemorrhagic disease

Rabbit hemorrhagic disease virus (RHDV) causes more than 90% mortality in adult rabbits. In this study, the cDNA of the VP60 coding sequence of RHDV was cloned under the control of the polyhedrin and p10 promoters of baculovirus to be expressed in insect cells. The expression of RHDV VP60 under the control of the p10 promoter was 5-10 times higher than using the polyhedrin promoter. The p10-derived VP60 was able to assemble into virus-like particles (VLPs). RHDV VLPs were successfully used to protect rabbits against the disease even at doses as low as 0.5 micrograms when injected intramuscularly or subcutaneously. The ability to elicit an immune response was independent of the adjuvant or the route of immunization. Remarkably, oral administration of RHDV VLPs efficiently induced protecting antibodies to RHD at doses as low as 3 micrograms. The use of binary ethylenimine for the stabilization of the VLPs was decisive for eliciting a good oral immunity. This report demonstrates the potential use of these procapsids in obtaining RHD oral vaccines and opens the door to the use of these capsids for the prevention of the disease in wild animals. Therefore, a new, and potentially important application of recombinant VLPs in the induction of protective immunity by the oral route is foreseen.

Reductive alkylation of glycopeptide antibiotics: synthesis and antibacterial activity

Reductive alkylation of the A82846 family of glycopeptide antibiotics has the potential of producing seven products. N-Alkylation of the disaccharide amino function can be accomplished selectively, and offers the greatest increase in antibacterial activity. Products resulting from N-alkylation of LY264826 (A82846B) provide the most potent derivatives as compared to other members of this class of antibiotics. Two of these derivatives, LY307599 and LY333328 are approximately 500 times more active than vancomycin against vancomycin-resistant enterococci.

Relationship between structure and biological activity of novel R106 analogs

The retro-aldol reaction at residue 8 of R106-1 produced a chemical handle, in the form of a sarcosine residue, that was amenable to classical aldol alkylation conditions. In vitro assay of several new hydroxylated analogs have shown that L isomers exhibit more potent antifungal activity than D isomers. However, all analogs exhibited a significant decrease in activity against Cryptococcus neoformans. By contrast, structural modifications of R 106 were tolerated by some Candida spp., but the potency of activity was diminished as compared to that of the natural product R106-1. The full structure-activity relationship of the new R106 analogs has provided important information about the steric and electronic requirements of binding to target receptors. Furthermore, comparison of the structural differences between R106-1 and other derivatives, suggested that the potential for hydrogen bonding (at residue 8) was a key structural feature that was required to maintain activity against Cryptococcus neoformans.

Corticosterone, prolactin and thyroid hormones as hormonal mediators of the stimulated phagocytic capacity of peritoneal macrophages after high-intensity exercise

The aim of this study was to evaluate the effect of high-intensity physical activity (swimming until exhaustion) with or without previous training on the phagocytosis and destruction of inert particle capacities of macrophages, and the role of corticosterone, prolactin and thyroid hormones as possible hormonal mediators. The results indicated that high-intensity exercise provokes a stimulation of both phagocytosis and destruction of inert particles when performed in absence of previous training. However, swimming until exhaustion after a one month training program (25 min/day) induced an increase in phagocytosis but not in the destruction of latex beads. Corticosterone, prolactin and thyroid hormones can be considered as hormonal mediators of the exercise-induced stimulation of phagocytosis, since these hormones increased plasma concentration, and the in vitro incubation of macrophages with the same higher physiological plasma concentrations of each hormone, as after exercise, also induced phagocytic stimulation of these cells.

Semisynthetic chemical modification of the antifungal lipopeptide echinocandin B (ECB): structure-activity studies of the lipophilic and geometric parameters of polyarylated acyl analogs of ECB

Echinocandin B (ECB) is a lipopeptide composed of a complex cyclic peptide acylated at the N-terminus by linoleic acid. Enzymatic deacylation of ECB provided the peptide "nucleus" as a biologically inactive substrate from which novel ECB analogs were generated by chemical reacylation at the N-terminus. Varying the acyl group revealed that the structure and physical properties of the side chain, particularly its geometry and lipophilicity, played a pivotal role in determining the antifungal potency properties of the analog. Using CLOGP values to describe and compare the lipophilicities of the side chain fragments, it was shown that values of > 3.5 were required for expression of antifungal activity. Secondly, a linearly rigid geometry of the side chain was the most effective shape in enhancing the antifungal potency. Using these parameters as a guide, a variety of novel ECB analogs were synthesized which included arylacyl groups that incorporated biphenyl, terphenyl, tetraphenyl, and arylethynyl groups. Generally the glucan synthase inhibition by these analogs correlated well with in vitro and in vivo activities and was likewise influenced by the structure of the side chain. These structural variations resulted in enhancement of antifungal activity in both in vitro and in vivo assays. Some of these analogs, including LY303366 (14a), were effective by the oral route of administration.

Cadang-cadang disease of coconut palm

Cadang-cadang disease has caused the death of over 30 million coconut palms, and no control measures are known. The causal viroid is the smallest known pathogen. Field diagnostic tests will soon be developed to allow mapping of the distribution and spread of the viroid and this should lead to the identification of appropriate control measures.

[Immobilization of Citrobacter freundii cells with tyrosine phenol-lyase activity by entrapment in natural gels]

A comparative study on immobilization of Citrobacter freundii cells by entrapment in carrageenan, agar, agar-agar, and gelatin gels (5, 10, and 15%) was carried out. Gelatin gels were treated with glutaraldehyde to make them more rigid. As a result, the tyrosine phenol-lyase activity of these samples was less than that of free cells (about 40%). The yield of TP-lyase activity was 40--60% when cells were immobilized in 5% and 7% agar and agar-agar gels. The cells entrapped in carrageenan gels, the concentration of which was varied from 2 to 10%, possessed the highest tyrosine phenol-lyase activity (up to 90%). The efficiency of cell entrapment was high for all the carrier and equal to 70--90%. The plastic strength and swelling of the above gels, as well as the phenol adsorption on the carriers and the release of the bacterial cells from them were studied under the conditions of tyrosine phenol-lyase reaction.