AB1173 INCIDENT CASES OF COVID-19 AND VACCINATION ADHERENCE IN A MULTICENTRIC COHORT OF INFLAMMATORY ARTHRITIS IN BRAZIL

Background

The SARS-CoV-2 virus has caused a worldwide health crisis. Patients with inflammatory arthritis are at higher risk of hospitalization and death by COVID-19 due to comorbidities or immunosuppressive treatments. Vaccination is one the most important strategies to control the pandemic.

Objectives

To evaluate the incident cases of SARS-CoV-2 infection in a multicentric cohort of inflammatory arthritis in Brazil.

Methods

BiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients with rheumatic diseases starting their first bDMARD or tsDMARD (1). The present analysis is a retrospective evaluation of adult patients with inflammatory arthritis (rheumatoid arthritis – RA, spondylarthritis -SpA and psoriatic arthritis-PsA) that were alive since the beginning of the COVID-19 pandemics in Brazil in February 2020. We evaluated the incidence and severity of COVID-19 infection and the adherence to anti- SARS-CoV-2 vaccines schedules, up to January 2022.

Results

A total of 300 patients were interviewed and 69 (23.0%) reported confirmed anti-SARS-CoV infection and 5 (1.7%) had a second infection. Among known infected patients, 18.8% need hospitalization and oxygen support, 7.2% were admitted at ICU, and 5.8% died. After COVID-19 infection, 31.8% reported worsening of disease activity but only 6.1% had modification in medication due to disease activity. Distribution of cases followed the pattern of waves observed in Brazil (Figure 1). Regarding vaccination, 285 (95%) reported to have received at least one dose of any anti-SARS-CoV-2 vaccine: 43% received the first with the adenovirus ChAdOx1 nCoV-19 (AstraZeneca) adenovirus vaccine, 32% received the Sinovac-CoronaVac inactivated vaccine, 22% received the BNT162b2 (Pfizer-BioNtech) mRNA vaccine and 3% received the BNT162b2 (Pfizer-BioNtech) adenovirus vaccine. Almost all (98.1%) of these patients had already received the second dose of vaccine and after the first and second vaccine doses, 6% and 4% of patients, respectively, reported worsening of articular disease activity, while, after the third dose, no patient reported disease activity worsening.

Figure 1.

Conclusion

During the pandemics, patients with inflammatory arthritis had a pattern of distribution of cases very similar to general population. Adherence to vaccination is high and well tolerated.

References

[1]Bredemeier et al. J Rheumatol 2021;48:1519-27

Disclosure of Interests

None declared

POS0650 THE IMPACT OF OLD AGE ON THE PERSISTENCE AND SAFETY OF TREATMENT WITH BIOLOGIC AGENTS OR JAK INHIBITORS IN RHEUMATOID ARTHRITIS

Background

The effect of age on persistence and safety of treatment with biologic disease modifying anti-rheumatic drugs (bDMARDs) in rheumatoid arthritis has been a subject to research interest. Two recently published studies did not observe significantly different survival of treatment with bDMARDs among older age (≥ 65 years) individuals (1,2); incidence of serious adverse events was higher in these patients (2).

Objectives

to evaluate association of the age with treatment survival and overall safety among patients receiving one or multiple courses of bDMARDs or targeted synthetic (ts-) DMARDs.

Methods

BiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients with rheumatic diseases starting their first bDMARD or tsDMARD (3). The present analysis includes RA patients recruited from Jan 2009 to Oct 2019, followed-up over one or multiple (up to six) courses of treatment necessarily involving a bDMARD or tsDMARD (latest date, Nov 19, 2019). Treatment course is defined as a period during which the medication scheme does not change, except for dose adjustments. Primary outcome was the incidence treatment interruption for any reason (except for pregnancy or disease remission), while interruption due to adverse events (AEs; including death) and due to inefficacy served as secondary outcomes. Incidence of serious adverse events (SAEs) also served as a secondary outcome. Extended (frailty) multivariate Cox proportional hazards models and negative binomial regression with generalized estimating equations (to calculate incidence rate ratios [IRRs]) were used for statistical analyses (both types of analyses including time-varying covariates over multiple courses of treatment).

Results

In total, 1316 patients (2335 treatment courses, 6508 patient-years [PY]) were enrolled. Of these, 160 patients (643 PY; 237 treatment courses) were ≥ 65 years old, mean age at starting treatment = 71 ± 5 yrs (84% female). Old age was not significantly associated with treatment interruption for any reason, but presented higher risk of interruption due to adverse events (after multivariate adjustment) and lower risk of stopping because of inefficacy (see Table 1). Older patients presented higher incidence of SAEs than younger ones (16.0 vs 8.4/100 PY, respectively; multivariate IRR: 2.06, 95% CI: 1.51 to 2.80, P<0.001). Among old patients, tocilizumab (HR: 2.73, 95% CI: 1.13 to 6.64, P=0.026), etanercept (2.13, 1.12 to 4.07, P=0.022), and infliximab (2.39, 1.19 to 4.79, P=0.014) presented higher risk of treatment termination as compared with adalimumab. In this subgroup (age ≥65 yrs), there was no significant difference in the risk of SAEs between different bDMARDs/tsDMARDs.

Table 1.

Univariate and multivariate hazard ratios (HRs) of interruption of treatment course comparing older (≥65 years) versus younger patients (reference category). Results are HRs, 95% CIs, and P values.

Cause of interruption (n of events)Crude analysisAdjusted covariates*Interruption - any reason (1321)0.96 (0.75 to 1.23), P=0.7601.09 (0.82 to 1.43), P=0.550Interruption - adverse events (368)1.33 (0.75 to 0.89), P=0.1601.59 (1.07 to 2.35), P=0.020Interruption - inefficacy (680)0.56 (0.39 to 0.80), P=0.0020.57 (0.38 to 0.87), P=0.009

* Age, baseline DAS28, disease duration, gender, smoking, RF or anti-CCP, previous malignancy, interstitial lung disease, diabetes, hypertension, hypercholesterolemia, renal failure, ischemic cardiomyopathy, COPD, heart failure, concomitant use of each cs-, b-, and tsDMARDs, corticosteroids, starting year, osteoporosis, hepatitis B,C, treatment sequence.

Conclusion

The overall risk of treatment interruption with biologic or targeted synthetic DMARDs is not higher in older patients. Higher risk of interruption due to AE was balanced by a lower risk of stopping treatment due to inefficacy. Older patients had a higher incidence of SAEs.

References

[1]Mathieu et al. Rheumatol Int 2021;41:879-85.

[2]Freitas et al. Drugs Aging 2020;37:899-907.

[3]Bredemeier et al. J Rheumatol 2021;48:1519-27.

Disclosure of Interests

None declared

POS0242 THE EFFECT OF ANTIMALARIALS ON THE OVERALL SAFETY AND PERSISTENCE OF TREATMENT WITH BIOLOGIC AGENTS OR JAK INHIBITORS IN RHEUMATOID ARTHRITIS

Background

Antimalarials (AM) are frequently part of the initial scheme of conventional synthetic DMARDs in the treatment of rheumatoid arthritis (RA), and have been associated with lower incidence of diabetes and better lipid profile in these patients (1). However, the role of AM in schemes involving biologic (b-) or targeted synthetic (ts-) DMARDs has been much less extensively studied. In addition, a recent large scale study (2) and a consensus article (1) casted doubt on the long-term cardiovascular safety of AM.

Objectives

To evaluate the association of concomitant use of AM with the overall safety and survival of

treatment course among patients receiving one or multiple courses of bDMARDs or tsDMARDs

Methods

BiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients with rheumatic diseases starting their first bDMARD or tsDMARD (3). The present analysis includes RA patients recruited from Jan 2009 to Oct 2019, followed-up over one or multiple (up to six) courses of treatment (latest date, Nov 19, 2019). A treatment course is defined as a period during which the medication scheme does not change. The primary outcome was the incidence of serious adverse events (SAEs). Total and system-specific adverse events (AEs), treatment interruption for any reason, interruption due to AEs and due to inefficacy served as secondary outcomes. Negative binomial regression with generalized estimating equations (to calculate the incidence rate ratios [ÌRRs]) and extended (frailty) Cox proportional hazards models were used for statistical analyses (both types of analyses including time-varying covariates over multiple courses of treatment).

Results

In total, 1316 patients (2335 treatment courses, 6711 patient-years [PY]) were enrolled. The overall incidence of serious adverse events was 9.2/100 PY. AM were used over 354 courses (1254.5 PY) of therapy. The IRRs for the primary and secondary outcomes are presented in Table 1. AM were also associated with better treatment course survival (Figure 1), reducing the risk of interruption due to AEs (multivariate hazard ratio: 0.56, 95% CI: 0.39 to 0.81, P=0.002) and inefficacy (0.65, 0.48 to 0.87, P=0.003).

Figure 1.Table 1.

Univariate and multivariate incidence rate ratios (IRRs) of adverse events comparing use versus non-use (reference category) of antimalarials. Results are IRRs, 95% CIs, and P values.

Type of adverse event (n of events)Crude analysisAdjusted covariates*Serious adverse events (617)0.60 (0.41 to 0.87), P=0.0070.51 (0.37 to 0.69), P<0.001Any adverse event (3494)0.65 (0.54 to 0.77), P<0.0010.68 (0.57 to 0.81), P<0.001Cardiovascular‡Serious (52)1.04 (0.49 to 2.20), P=0.9241.06 (0.45 to 2.50), P=0.891Total (163)0.90 (0.59 to 1.38), P=0.6420.93 (0.59 to 1.45), P=0.737InfectionsSerious (277)0.78 (0.44 to 1.39), P=0.4040.53 (0.34 to 0.83), P=0.006Total (1400)0.77 (0.61 to 0.98), P=0.0330.75 (0.60 to 0.94), P=0.014Hepatic‡Total (66)0.20 (0.07 to 0.64), P=0.0070.16 (0.04 to 0.57), P=0.005Glicemic control-relatedTotal (34)0.74 (0.29 to 1.92), P=0.5400.73 (0.26 to 2.00), P=0.535DyslipidemiaTotal (83)0.60 (0.31 to 1.13), P=0.1140.55 (0.28 to 1.06), P=0.074

*Age, baseline DAS28, disease duration, gender, smoking, seropositivity (RF or anti-CCP), previous malignancy, interstitial lung disease, diabetes, hypertension, hypercholesterolemia, renal failure, ischemic cardiomyopathy, COPD, heart failure, concomitant use of each cs-, b-, and tsDMARDs, corticosteroids, starting year, osteoporosis, hepatitis B and C, and treatment sequence. ‡ Excluding infections.

Conclusion

Among RA patients on treatment with bDMARDs or tsDMARDs, concomitant use of antimalarials reduced the incidence of serious and total AEs, including infections and hepatic AEs, and prolonged treatment course survival. No significant increase in the risk of cardiovascular AEs was observed.

References

[1]Desmarais et al. Arthritis Rheumatol 2021;73:2151-60.

[2]Lane et al. Lancet Rheumatol 2020;2:e698–e711

[3]Bredemeier et al. J Rheumatol 2021;48:1519-27.

Disclosure of Interests

None declared

POS0676 SURVIVAL OF THE FIRST COURSE OF BIOLOGIC OR JAK INHIBITOR IN RHEUMATOID ARTHRITIS: ASSOCIATION WITH THE CHOICE OF AGENT AND CONCOMITANT CONVENTIONAL SYNTHETIC DMARDS

Background:

After failure of conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) in the therapy of rheumatoid arthritis (RA), treatment may be escalated to biologic (bDMARDs) or JAK inhibitors (JAKi) (1). Analysis of drug survival can provide useful information on the effectiveness of these therapeutic schemes.

Objectives:

to evaluate the association of the choice of therapeutic agent with the survival of treatment course in RA patients receiving their first bDMARD or JAKi.

Methods:

BiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients starting their first bDMARD/JAKi (2). This analysis includes RA patients recruited from Jan 2009 to Oct 2019, followed-up over the first course of treatment with a bDMARD/JAKi until censoring (latest date, Nov 19, 2019) or occurrence of the outcome of interest. A treatment course is defined as a period during which the medication scheme does not change, except for dose adjustments. The primary outcome was the interruption of treatment course for any reason (except for pregnancy or disease remission); interruption of treatment due to adverse events (AEs) or death and due to inefficacy served as secondary outcomes. Multivariate Cox proportional hazards models were used for analyses.

Results:

In total, 1177 patients (3800 patient-years [PY]) were enrolled. The overall incidence of treatment interruption was 17.5/100 PY. Adalimumab was the most frequently prescribed agent, followed by infliximab (n= 267). The hazards ratios (HR) of the primary and secondary outcomes are presented in Table 1. Figure 1 compares the survival of treatment curves of different bDMARDs/JAKi.

Table 1.

Hazard ratios (HR) of interruption of therapy course of each therapeutic agent (the reference category for bDMARDs/ JAKi is infliximab). Results are HR, 95% CIs, and P values*.

Agent (number of patients)Interruption for any reason (665 events)Interruption due to adverse events or death (196 events)Interruption due to inefficacy (319 events)Adalimumab (354)0.83 (0.68 to 1.01), P= 0.0620.68 (0.48 to 0.96), P=0.0291.08 (0.80 to 1.44), P=0.621Etanercept (257)0.81 (0.66 to 1.01), P=0.0630.56 (0.37 to 0.83), P=0.0040.93 (0.68 to 1.29), P=0.674Certolizumab (80)0.74 (0.47 to 1.16), P=0.1850.33 (0.13 to 0.86), P=0.0241.32 (0.74 to 2.35), P=0.350Golimumab (53)0.86 (0.53 to 1.38), P=0.5300.46 (0.18 to 1.19), P=0.1111.07 (0.53 to 2.15), P=0.849JAKi (tofacitinib) (59)0.54 (0.30 to 0.99), P=0.0470.19 (0.04 to 0.82), P=0.0260.89 (0.41 to 1.96), P=0.779Rituximab (48)0.87 (0.55 to 1.37), P=0.5400.48 (0.20 to 1.18), P=0.1090.58 (0.26 to 1.34), P=0.205Abatacept (30)0.52 (0.25 to 1.07), P=0.0770.46 (0.14 to 1.56), P=0.2150.46 (0.14 to 1.52), P=0.203Tocilizumab (29)0.29 (0.14 to 0.63), P=0.0020.40 (0.12 to 1.30), P=0.1260.28 (0.09 to 0.90), P=0.033Methotrexate (792)0.95 (0.79 to 1.14), P=0.5610.86 (0.62 to 1.19), P=0.3620.98 (0.75 to 1.28), P=0.860Leflunomide (497)1.17 (0.99 to 1.39), P=0.0611.44 (1.06 to 1.96), P=0.0201.02 (0.80 to 1.30), P=0.856Sulfasalazine (48)1.18 (0.80 to 1.75), P=0.4011.94 (1.07 to 3.54), P=0.0300.85 (0.45 to 1.59), P=0.605Antimalarials (230)0.80 (0.65 to 0.98), P=0.0270.67 (0.45 to 0.99), P=0.0430.67 (0.50 to 0.92), P=0.011

* All tests adjusted for other variables presented in the table and for age, baseline DAS28, disease duration, gender, smoking, seropositivity (RF/anti-CCP), previous malignancy, diabetes, hypertension, hypercholesterolemia, renal failure, ischemic cardiomyopathy, COPD, heart failure, use of corticosteroids, starting year, hypercholesterolemia, osteoporosis, hepatitis B and C.

Conclusion:

In our study, infliximab was related to an overall higher hazard of treatment course interruption than tolicizumab and tofacitinib, and higher hazard of interruption due to AEs than most other anti-TNF agents and tofacitinib. Maintaining antimalarials in patients receiving advanced therapies for RA may reduce interruption of treatment due to inefficacy and AEs.

Disclosure of Interests:

None declared

OP0063 QUANTITATIVE COMPUTED TOMOGRAPHY PREDICTS 10-YEAR MORTALITY IN INTERSTITIAL LUNG DISEASE RELATED TO SYSTEMIC SCLEROSIS

Background:

Interstitial lung disease (ILD) is the main cause of death in Systemic Sclerosis (SSc). Chest CT is the gold standard in detecting ILD although it is not easy to understand its prognostic value. ILD qualitative assessment is almost worthless. Goh et al. semi quantitative score of ILD extent is related to mortality risk but it is burdened by relevant inter/intra-readers variability. An operator independent algorithm based on voxel-wise analysis proved to identify SSc patients with an increased risk of mortality according to prediction models.

Objectives:

To verify if quantitative analysis of chest CT (QCT) predict 10 years-mortality in SSc patients.

Methods:

SSc patients with availability of a chest CT were enrolled in 13 different centers. The CT voxel-wise analysis with a free software (www.horosproject.com) provided QCT indexes: kurtosis, skewness, mean lung attenuation and standard deviation. Patients characteristics, autoimmune profile and pulmonary function test were collected. The follow-up interval lasted from the date of chest CT to the one of the last visit or death. Each QCT index cutoff, established in a previous study (1), clustered patients in two groups. Kaplan-Meier analysis estimated and compared survival in the above mentioned groups. p < 0.05 was considered statistically significant.

Results:

Five hundred sixty three SSc patients were enrolled (35938 patient-months); 52.4% had ILD detectable at CT scan. For each QCT index cutoff the cohort was split in two subgroups without differences in terms of sex, age, disease duration, autoimmune profile. All QCT indexes’ cutoff selected subgroups with statistically different survival rate (e.g in Figure 1).

Figure 1

Conclusion:

QCT can arise as the new gold standard in identifying SSc patients with poor prognosis. The real possibility to stratify SSc subjects according mortality risk will have a pivotal role in ILD treatment decisional process with the incoming anti-fibrotic drugs.

References:

[1]Ariani A et al. Rheumatology 2017

Disclosure of Interests:

Alarico Ariani: None declared, Elena Bravi: None declared, Maria De Santis: None declared, Vanessa Hax: None declared, Simone Parisi: None declared, Federica Lumetti: None declared, Francesco Girelli: None declared, Marta Saracco: None declared, Fabio De Gennaro: None declared, Alessandro Giollo: None declared, Masen Abdel Jaber: None declared, Francesco Bozzao: None declared, Mario Silva: None declared, Maria Chiara Ditto: None declared, Claudia Lomater: None declared, Flavio Mozzani: None declared, Daniele Santilli: None declared, eleonora Di Donato: None declared, Andrea Becciolini Speakers bureau: Sanofi-Genzyme, UCB and AbbVie, Francesco Pucciarini: None declared, Lorenzo Canziani: None declared, Flavio Cesare Bodini: None declared, eugenio arrigoni: None declared, M Bredemeier: None declared, Rafael Mendonça da Silva Chakr: None declared, Amelia Spinella: None declared, Luca Idolazzi: None declared, Roberto Bortolotti: None declared, Paola Tomietto: None declared, Elisa Baratella: None declared, Saverio Tollot: None declared, Dilia Giuggioli: None declared, Fabio Fischetti: None declared, Enrico Fusaro: None declared, Nicola Sverzellati: None declared, Carlo Alberto Scirè: None declared

THU0346 SARC-F PERFORMANCE FOR SARCOPENIA SCREENING IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

Because the method of diagnosing sarcopenia is complex and is considered to be difficult to introduce into routine practice, the European Working Group on Sarcopenia in Older People’s (EWGSOP) recommends use of the SARC-F questionnaire as a way to introduce assessment and treatment of sarcopenia into clinical practice1. Only recently, some studies have focused their attention on the presence of sarcopenia in systemic sclerosis (SSc) and there is no data about the performance of SARC-F in this population.

Objectives:

To test the diagnostic properties of the SARC-F questionnaire for sarcopenia screening in SSc patients.

Methods:

Cross-sectional study, including 94 SSc patients assessed by clinical evaluation, laboratory and pulmonary function tests. Sarcopenia was evaluated using the EWGSOP diagnostic criteria updated in 2019 (EWGSOP2): dual-energy X-ray absorptiometry, handgrip strength, and short physical performance battery (SPPB)1. Participants also completed the SARC-F questionnaire. The questionnaires’ performances were evaluated through receiver operating characteristic (ROC) curves and standard measures of diagnostic accuracy were computed using the EWGSOP2 criteria as the gold standard for diagnosis of sarcopenia.

Results:

Sarcopenia was identified in 15 (15,9%) SSc patients by the EWGSOP2 criteria. Area under the ROC curve of SARC-F screening for sarcopenia was 0.588 (95% confidence interval (CI) 0.482, 0.688) (figure 1). The results of sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR) with the EWGSOP2 criteria as the reference standard were 35.71 [95% CI, 12.76-64.86], 81.01 (95% CI, 70.62-88.97), 1.88 (95% CI, 0.81-4.35) and 0.79 (95% CI, 0.53-1.19), respectively. The optimal cut-off point of SARC-F in our sample was ≥ 4 (Youden index: 0.21), the same cut-off point recommended in the literature2,3. Only 6 (40%) out of the 15 participants with sarcopenia were identified by the SARC-F questionnaire in our population. However, the SARC-F properly identified 4 out of 5 patients who had severe sarcopenia.

Conclusion:

This is the first study to evaluate the performance of SARC-F questionnaire for sarcopenia screening in patients with SSc. Although it appropriately identifies severe cases of sarcopenia, the SARC-F alone may not be an adequate screening tool in high-risk populations, such as SSc, that may benefit from early intervention and treatment.

References:

[1]Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.

[2]Malmstrom TK, Morley JE. SARC-F: A simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc. 2013;14(8):531-532.

[3]Ida S, Kaneko R, Murata K. SARC-F for Screening of Sarcopenia Among Older Adults: A Meta-analysis of Screening Test Accuracy. J Am Med Dir Assoc. 2018;19(8):685-689.

Disclosure of Interests:

Vanessa Hax: None declared, Rafaela Santo: None declared, Leonardo Santos: None declared, Mirian Farinon: None declared, Marianne de Oliveira: None declared, Guilherme Levi Três: None declared, Andrese Aline Gasparin: None declared, M Bredemeier: None declared, Ricardo Xavier Consultant of: AbbVie, Pfizer, Novartis, Janssen, Eli Lilly, Roche, Rafael Mendonça da Silva Chakr: None declared

Establishment of a multimarker qPCR panel for the molecular characterization of circulating tumor cells in blood samples of metastatic breast cancer patients during the course of palliative treatment

Background

Circulating tumor cells (CTC) are discussed to be an ideal surrogate marker for individualized treatment in metastatic breast cancer (MBC) since metastatic tissue is often difficult to obtain for repeated analysis. We established a nine gene qPCR panel to characterize the heterogeneous CTC population in MBC patients including epithelial CTC, their receptors (EPCAM, ERBB2, ERBB3, EGFR) CTC in Epithelial-Mesenchymal-Transition [(EMT); PIK3CA, AKT2), stem cell-like CTC (ALDH1) as well as resistant CTC (ERCC1, AURKA] to identify individual therapeutic targets.

Results

At TP0, at least one marker was detected in 84%, at TP1 in 74% and at TP2 in 79% of the patients, respectively. The expression of ERBB2, ERBB3 and ERCC1 alone or in combination with AURKA was significantly associated with therapy failure. ERBB2 + CTC were only detected in patients not receiving ERBB2 targeted therapies which correlated with no response. Furthermore, patients responding at TP2 had a significantly prolonged overall-survival than patients never responding (p = 0.0090).

Patients and Methods

2 × 5 ml blood of 62 MBC patients was collected at the time of disease progression (TP0) and at two clinical staging time points (TP1 and TP2) after 8–12 weeks of chemo-, hormone or antibody therapy for the detection of CTC (AdnaTest EMT-2/StemCell Select™, QIAGEN Hannover GmbH, Germany). After pre-amplification, multiplex qPCR was performed. Establishment was performed using various cancer cell lines. PTPRC (Protein tyrosine phosphatase receptor type C) and GAPDH served as controls.

Conclusions

Monitoring MBC patients using a multimarker qPCR panel for the characterization of CTC might help to treat patients accordingly in the future.

Gene Expression Signatures in Circulating Tumor Cells Correlate with Response to Therapy in Metastatic Breast Cancer

BACKGROUND

Circulating tumor cells (CTCs) are thought to be an ideal surrogate marker to monitor disease progression in metastatic breast cancer (MBC). We investigated the prediction of treatment response in CTCs of MBC patients on the basis of the expression of 46 genes.

METHODS

From 45 MBC patients and 20 healthy donors (HD), 2 × 5 mL of blood was collected at the time of disease progression (TP0) and at 2 consecutive clinical staging time points (TP1 and TP2) to proceed with the AdnaTest EMT-2/StemCellSelectTM (QIAGEN). Patients were grouped into (a) responder (R) and non-responder (NR) at TP1 and (b) overall responder (OR) and overall non-responder (ONR) at TP2. A 46-gene PCR assay was used for preamplification and high-throughput gene expression profiling. Data were analyzed by use of GenEx (MultiD) and SAS.

RESULTS

The CTC positivity was defined by the four-gene signature (EPCAM, KRT19, MUC1, ERBB2 positivity). Fourteen genes were identified as significantly differentially expressed between CTC+ and CTC− patients (KRT19, FLT1, EGFR, EPCAM, GZMM, PGR, CD24, KIT, PLAU, ALDH1A1, CTSD, MKI67, TWIST1, and ERBB2). KRT19 was highly expressed in CTC+ patients and ADAM17 in the NR at TP1. A significant differential expression of 4 genes (KRT19, EPCAM, CDH1, and SCGB2A2) was observed between OR and ONR when stratifying the samples into CTC+ or CTC−.

CONCLUSIONS

ADAM17 could be a key marker in distinguishing R from NR, and KRT19 was powerful in identifying CTCs.

Comparison of the PI3KCA pathway in circulating tumor cells and corresponding tumor tissue of patients with metastatic breast cancer

The aim of the present study was to compare the phosphatidylinositol 3-kinase (PI3KCA)-AKT serine/threonine kinase (AKT) pathway in circulating tumor cells (CTCs) and corresponding cancerous tissues. Stemness-like circulating tumor cells (slCTCs) and CTCs in epithelial-mesenchymal transition (EMT) have been implicated as the active source of metastatic spread in breast cancer (BC). In this regard, the PI3KCA-AKT signaling pathway was demonstrated to be implicated in and to be frequently mutated in BC. The present study compared this pathway in slCTCs/CTCs in EMT and the corresponding tumor tissues of 90 metastatic BC patients (pts). slCTCs and CTCs in EMT were isolated using the AdnaTest EMT-1/StemCell for the detection of aldehyde dehydrogenase 1 family member A1 (ALDH1) (singleplex PCR) and PI3KCA, AKT2 and twist family bHLH transcription factor 1 (multiplex PCR). Tumor tissue was investigated for PI3KCA hotspot mutations using Sanger sequencing of genomic DNA from micro-dissected formalin-fixed paraffin-embedded tissue, and for the expression of ALDH1 and phosphorylated AKT (pAKT), and phosphatase and tensin homolog (PTEN) loss, by immunohistochemistry. slCTCs were identified in 23% of pts (21/90 pts) and CTCs in EMT in 56% (50/90 pts) of pts. pAKT and ALDH1 positivity in tumor tissue was identified in 47 and 9% of cases, respectively, and a PTEN loss was observed in 18% of pts. A significant association was detected between pAKT expression in cancerous tissue and AKT2 expression in CTCs (P=0.037). PI3KCA mutations were detected in 32% of pts, most frequently on exons 21 (55%) and 10 (45%). Pts with PI3KCA mutations in tumor tissue had a significantly longer overall survival than pts with wild-type PI3KCA expression (P=0.007). Similar results were obtained for pts with aberrant PI3KCA signaling in CTCs and/or aberrant signaling in cancerous tissue (P=0.009). Therapy-resistant CTCs, potentially derived from the primary tumor or metastatic tissue, may be eliminated with specific PI3K pathway inhibitors, alone or in combination, to improve the prognosis of metastatic BC pts.

Matrix metalloproteinase gene polymorphisms and susceptibility to systemic sclerosis

The major pathological hallmark of the systemic sclerosis (SSc) is skin and internal organ fibrosis, which results from normal tissue architecture alterations and extracellular matrix (ECM) protein deposition. ECM components are degraded by matrix metalloproteinases (MMP). Promoter region polymorphisms in MMP genes may influence gene expression, resulting in an imbalance between ECM protein production and degradation. Here, we analyzed MMP1 -1607 1G/2G (rs1799750), MMP3 -1171 5A/6A (rs3025058), and MMP9 -1562 C/T (rs3918242) polymorphisms in relation to susceptibility to SSc and its clinical features. The patient group included 98 individuals with longstanding or recently diagnosed disease, meeting the American College of Rheumatology or LeRoy and Medsger criteria for SSc; the control group included 100 healthy blood donors. All participants were of European descent. Genotyping was performed by polymerase chain reaction followed by restriction digestion. Genotype and allele frequencies of MMP polymorphisms were similar between the two groups. In secondary analyses, significantly higher frequency of 1G/2G genotype from MMP1 polymorphism was observed for patients testing positive for antinuclear autoantibodies (P = 0.007), while 1G/1G genotype was associated with interstitial lung disease development (P = 0.018). The 6A/6A genotype from MMP3 polymorphism was absent in patients with calcinosis (P = 0.011), while the MMP3 5A/5A genotype correlated with the presence of anti-topoisomerase I antibodies (P = 0.009) and reduced diffusing capacity for carbon monoxide (P = 0.024). These results suggest that MMP polymorphisms are not associated with SSc susceptibility, although MMP1 and MMP3 variants are associated with specific SSc clinical and laboratory features.

Abstract 502: Gene expression signatures in circulating tumor cells are prognostic for metastatic lesions in breast cancer patients and correlate with response to therapy

Background: Circulating tumor cells (CTC) are discussed to be an ideal surrogate marker to monitor disease progression in metastatic breast cancer (MBC). Besides CTC characterization for targeted therapies, it would also be desirable to know where these cells derive from or to which organ site they are going to. Here we investigated whether it is possible to predict the origin of metastatic lesion based on the expression of 46 genes in CTC of MBC patients (pts).

Materials and Methods: 2×5 ml blood of 45 MBC pts and 20 healthy controls was collected at the time of disease progression (T0) and at two consecutive clinical staging (T1 and T2) for the detection of CTC applying immunomagnetic enrichment using the AdnaTest EMT-2/Stem Cell Select (QIAGEN Hannover GmbH, Germany). Pts were grouped a) into overall responders (OR) and overall non-responders (ONR), thus responding or not responding at T1 and T2 and b) according to sites of metastasis. PCR assays, targeting 46 transcripts and reference markers were used for a workflow based on pre-amplification and high throughput profiling (each samples in duplicates) with the full set of markers including also ValidPrime to correct for genomic background and InterPlate Calibrator to even out variations between runs. Data were analyzed using GenEx (MultiD, Sweden) and SAS. qPCR as well as technical reads were normalized using several normalization strategies.

Results: The multidrug resistant protein gene MRP1 was significantly differently expressed if OR and ONR groups were compared. In the following order of significance, VEGFR1, Keratin (KRT) 19, EGFR, MET1, ALDH, progesterone receptor (PR), UPA, Cathepsin D, KIT1 and Ki67 were differentially expressed in CTC of pts who had already developed liver metastasis as compared to pts without liver metastasis. Interestingly, a small group of pts, developing liver metastases in the course of disease, showed the estrogen receptor (ER), PR, HER2, mammaglobin, KRT19 on a significantly lower level as compared to the other pts. Similarly, once CTC were ER and PR positive, the probability of bone metastasis development decreased.

Conclusion: Our preliminary results indicate that the development of metastatic lesions is associated with site-specific CTC. Thus, besides using CTC as a monitoring tool to guide therapy, they might also indicate the site of metastasis which will allow a more precise decision concerning treatment strategy.

Citation Format: Maren Bredemeier, Philippos Edimiris, Pawel Mach, Mikael Kubista, Robert Sjoback, Marie Jindrichova, Eva Rohlova, Vendula Novosadova, Katarina Kolostova, Siegfried Hauch, Bahriye Aktas, Mitra Tewes, Rainer Kimmig, Sabine Kasimir-Bauer. Gene expression signatures in circulating tumor cells are prognostic for metastatic lesions in breast cancer patients and correlate with response to therapy. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 502.

Abstract 372: Expression profiling of circulating tumor cells: A prognostic and predictive biomarker in metastatic breast cancer

Background:

Circulating tumor cells (CTCs) are discussed to be an ideal surrogate marker to monitor disease progression in metastatic breast cancer (MBC) since response to therapy can only be assessed retrospectively after a therapy strategy has already failed. Here we established a new profiling method to characterize the heterogeneous CTC population and investigated if it is possible to predict treatment response based on expression of 46 genes in CTCs of MBC patients.

Materials and Methods:

2×5 ml blood of 45 MBC patients was collected at the time of disease progression (T0) and at two consecutive clinical staging (T1 and T2) after 8-12 weeks of chemo-, hormone or antibody therapy for the detection of CTCs applying positive immunomagnetic selection targeting EpCAM, EGFR and HER2 using the AdnaTest EMT-2/Stem Cell Select (AdnaGen GmbH, Germany). Patients were classified into responders and non-responders at the time of clinical staging according to RECIST criteria. PCR assays targeting 46 selected transcript comprising breast cancer, stem cell, EMT, and references markers were designed and extensively optimized for a workflow based on pre-amplification and high throughput profiling. Each sample was profiled in duplicates with the full set of markers including also ValidPrime to correct for genomic background and InterPlate Calibrator to even out variations between runs. The entire workflow was validated to establish excellent technical reproducibility from sample collection through extraction, pre-amplification and analysis. Measured data were analyzed using parametric as well as non-parametric statistics with GenEx and SAS. qPCR as well as technical reads were normalized using the average expression of the reference genes B2M and ActB.

Results:

A number of genes, including ADAM17, CD24L4, EPCAM, KRT19, MTOR, HER2, TOP2A, and CD44 were differentially expressed in MBC patients (n = 45) as compared to healthy controls (n = 20). A group of non-responders could be identified based on gene expression. Interestingly, expression of ADAM17 (tumor necrosis factor-α-converting enzyme) differed significantly when responders were compared with non-responders at T1 (p = 0.000567).

Conclusion:

It is possible to distinguish MBC patients from healthy controls based on the expression of the genes investigated. Preliminary results indicate that ADAM17 is a key marker, distinguishing responders from non-responders. For more detailed analysis, it is desirable to build up a larger patient cohort in order to correlate gene expression profiles of CTC enriched samples to a given therapy for individualized treatment.

Citation Format: Maren Bredemeier, Mikael Kubista, Robert Sjöback, Marie Jendrichova, Eva Rohlova, Vednula Novosadova, Katarina Kolostova, Siegfried Hauch, Bahriye Aktas, Mitra Tewes, Rainer Kimmig, Sabine Kasimir-Bauer. Expression profiling of circulating tumor cells: A prognostic and predictive biomarker in metastatic breast cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 372. doi:10.1158/1538-7445.AM2015-372

Abstract 3066: Establishment of a new method for the selection and detection of circulating tumor cells in metastatic breast cancer patients

Background: Circulating tumor cells (CTCs) are discussed to be an ideal surrogate marker for individualized treatment options in metastatic breast cancer (MBC) since metastatic tissue may be difficult to obtain for repeated analysis. Here we established a new method for selection and detection of the heterogeneous CTC population using immunomagnetic enrichment followed by multi-marker profiling of genes related to different CTC phenotypes.

Materials and Methods: Establishment of a nine gene qPCR panel was performed using various cancer cell lines for the markers EpCAM (epithelial); PI3K, AKT2 [epithelial-mesenchymal-transition (EMT)]; ALDH1 (stem cell); ERCC1, Aurora kinase (resistance markers); HER2, HER3, EGFR (receptors); CD45 (leucocyte control) and GAPDH (housekeeping gene) as well as the synthetic EpCAM fragment as an internal reference. 2x5 ml blood of 20 MBC patients was collected at the time of disease progression (T0) and at clinical staging (T1) after 8-12 weeks of chemo-, hormone or antibody therapy for the detection of CTCs applying a new positive immunomagnetic selection using anti-EpCAM, anti-HER2 and anti-EGFR coated magnetic beads (AdnaTest EMT-2/Stem Cell Select, AdnaGen AG Germany). cDNA was gene specifically pre-amplified using the TATAA Multiplex Grand Master Mix according to in-house designed assays. qPCR was performed using Bio-Rad iTaq Universal Supermix SYBR Green Mix. The cutoff was calculated for each gene separately in a way that the false positive rate in all healthy donors (n=18) was lower than 10% (specificity &gt;90%). Subsequently, delta delta Ct was calculated as Ct (cutoff)-Ct(sample) - [Ct(CD45 cutoff)-Ct(CD45sample)]. Results were correlated with clinical response to a given therapy.

Results: At T0, at least one of the studied markers was detected in 19/20 patients and at T1 in 16/20 patients, respectively. The distribution of the markers across all patients was highly variable at both time points. However, EpCAM, Aurora kinase as well as EGFR and HER3 were observed most frequently. Interestingly, some patients expressed only one CTC-subtype. Clinically, we observed an increased frequency for epithelial, EMT, stem cell and resistance markers in therapy resistant patients as compared to responders. Whereas EMT and stem cell like CTCs were only detected in the resistant group, CTCs still detectable in the responder group mainly represented an epithelial phenotype showing HER2, HER3 or EGFR expression. Interestingly, some of these persisting CTCs in responders were also positive for ERCC1 and Aurora kinase.

Conclusion: We successfully established a new method for the detection of the heterogeneous CTC population which might help to match the right therapy to the right patient in the future. Despite these promising preliminary findings, the qPCR panel has to be further optimized and needs to be verified in a larger patient population.

Citation Format: Maren Bredemeier, Bahriye Aktas, Jenny Wagner, Doreen Schellbach, Rainer Kimmig, Sabine Kasimir-Bauer. Establishment of a new method for the selection and detection of circulating tumor cells in metastatic breast cancer patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3066. doi:10.1158/1538-7445.AM2014-3066

Assessment of nailfold capillaroscopy in systemic sclerosis by different optical magnification methods

BACKGROUND

Systemic sclerosis (SSc) is characterized by target-organ fibrosis and microvascular dysfunction, which can be assessed using nailfold capillaroscopy. Dermoscopy is a useful and easily performed method for diagnosing skin lesions.

AIM

To compare conventional capillaroscopy, using the gold-standard method (conventional stereomicroscope nailfold capillaroscopy; SNFC), with polarized light noncontact dermoscopy (PNCD) and nonpolarized light contact dermoscopy (NPCD), and to evaluate their accuracy in diagnosing characteristic SSc-related alterations.

METHODS

The study enrolled 45 patients with SSc. Capillaroscopy images and photographs were taken with three devices, SNFC, NPCD and PNCD, and these images were randomly analysed by a blinded observer.

RESULTS

The scleroderma pattern was found in 83% of patients. PNCD and NPCD were highly sensitive in identifying the presence of focal capillary loss (96.4% and 100%, respectively), haemorrhage (96.2% and 92%, respectively), and scleroderma (91.9%, 94.6%), and showed high specificity for haemorrhage and enlarged loops. The intra-observer kappa values for detection of the scleroderma pattern by SNFC images, NPCD and PNCD were moderate to good: (κ = 0.71 (95% CI 0.44-0.95), κ = 0.60 (95% CI 0.35-0.83) and κ = 0.60 (95% CI 0.32-0.86), respectively. Evaluation of haemorrhage presence gave high kappa values for all methods: κ = 0.77 (95% CI 0.57-0.95), κ = 0.90 (95% CI 0.76-1.00) and κ = 0.95 (95% CI 0.85-1.00), respectively.

CONCLUSIONS

Both polarized and nonpolarized dermoscopy are reliable methods for valuation of nailfold capillaroscopy in patients with SSc. They are easy to perform, with good rates of accuracy and results that are comparable with traditional capillaroscopy.

Circulating U2 small nuclear RNA fragments as a novel diagnostic tool for patients with epithelial ovarian cancer

BACKGROUND

Ovarian cancer is the leading cause of death among malignancies in women. Despite advances in treatment, >50% of patients relapse. For disease monitoring, the identification of a blood-based biomarker would be of prime interest. In this regard, noncoding RNAs, such as microRNA (miRNA) or small nuclear RNA (snRNA), have been suggested as biomarkers for noninvasive cancer diagnosis. In the present study, we sought to identify differentially expressed miRNA/snRNA in sera of ovarian cancer patients and investigate their potential to aid in therapy monitoring.

METHODS

miRNA/snRNA abundance was investigated in serum (n = 10) by microarray analysis and validated in an extended serum set (n = 119) by reverse-transcription quantitative PCR.

RESULTS

Abundance of U2-1 snRNA fragment (RNU2-1f) was significantly increased in sera of ovarian cancer patients (P < 0.0001) and paralleled International Federation of Gynecology and Obstetrics stage as well as residual tumor burden after surgery (P < 0.0001 and P = 0.011, respectively). Moreover, for patients with suboptimal debulking, preoperative RNU2-1f concentration was associated with radiographic response after chemotherapy and with platinum resistance (P = 0.0088 and P = 0.0015, respectively). Interestingly, according to the RNU2-1f abundance dynamics, persistent RNU2-1f positivity before surgery and after chemotherapy identified a subgroup of patients with high risk of recurrence and poor prognosis.

CONCLUSIONS

This is the first report to suggest that a circulating snRNA can serve as an auxiliary diagnostic tool for monitoring tumor dynamics in ovarian cancer. Our results provide a rationale to further investigate whether this high-risk patient group may benefit from additional therapies that are directly applied after chemotherapy.

Abstract 1466: Establishment of a multimarker gene panel for the characterization of circulating tumor cells in metastatic breast cancer

Background: Improved treatment strategies for metastatic breast cancer (MBC) patients are urgently needed. Since metastatic tissue may be difficult to obtain for repeated analysis, circulating tumor cells (CTC) would be an ideal surrogate tissue to identify prognostic and predictive factors that will help to select the optimal therapeutic strategy for each individual patient. Assuming that the population of CTC contains epithelial-like, EMT (Epithelial-Mesenchymal-Transition)-like and stem cell-like cells, we established a multi-marker qPCR for the characterization of these cells.Materials and Methods: Establishment of a 16 gene qPCR panel was performed using various epithelial cancer cell lines for the markers: EpCAM, MUC1 (epithelial); PI3K, PTEN, TWIST, mTOR, KRAS, AKT2 (EMT); ALDH1, CD44, CD24L4 (stem cell); ER, PR, HER2 and EGFR (receptors) and CD45 as a leucocyte control. The prostate cancer cell line LNCAP, expressing most of these genes, was used for spiking experiments. 10 ml blood of eight healthy donors (HDs), five HDs spiked with 10 LNCAP cells and 25 MBC patients were selected for CTC using AdnaTest BreastCancerSelect (AdnaGen AG) resulting in cDNA1. Subsequently, the same sample (with removed target cells) was processed again using the same procedure resulting in cDNA2. cDNA1 and cDNA2 were gene specifically preamplified using TaqMan PreAmp Master Mix according to in house designed assays. qPCR was performed using Bio-Rad SYBR Green Mix. If the CD45 deltaCt was &gt; zero, deltaCt value of a given gene was calculated as the difference between Ct (cDNA2) and Ct(cDNA1). A gene with a deltaCt &gt; zero was considered positive.Results: When HDs were tested for all genes, no false positive findings were observed except for AKT2, CD24L4, CD44 (n=3 cases). All of the genes except for TWIST, ER and PR could be positively detected in samples spiked with 10 LNCAP cells. In patient samples, at least one of all studied markers was detected in 21/25 (84%) of the patients. The distribution of the markers across all patients was highly variable. However, PI3K expression was observed most frequently (n=8/21 patients), followed by the expression of CD44 (n=6/21 patients), HER2 (n=5/21 patients) and TWIST, KRAS, mTOR and EpCAM (4/21 patients), respectively. No expression was observed for MUC1, PR and CD45. In general, EMT- and stem cell-like CTC were predominantly detected. HER2 positive and epithelial-like CTC as well as CTC expressing ER, PR and EGFR were observed less frequently. Interestingly, some patients expressed only one CTC-subtype.Conclusion: Multi-gene expression profiling improves the characterization of CTC of an individual patient. Furthermore, it was possible to classify individual patient samples into CTC subtypes. Despite these promising preliminary findings, the method has to be further optimized and needs to be verified in a larger patient population.

Citation Format: Maren Bredemeier, Bahriye Aktas, Rainer Kimmig, Sabine Kasimir-Bauer. Establishment of a multimarker gene panel for the characterization of circulating tumor cells in metastatic breast cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1466. doi:10.1158/1538-7445.AM2013-1466

Killer cell immunoglobulin-like receptor (KIR) genes in systemic sclerosis

A previous study has suggested that the combination KIR2DS2(+)/KIR2DL2(-) was related to increased risk for systemic sclerosis (SSc), while others have failed to reproduce this finding. Our objective was to study this matter further and test the association of other KIR genes with SSc. One hundred and ten SSc patients and 115 healthy bone marrow donors were enrolled in a case-control study. Blood was collected for DNA extraction; typing of 15 KIR genes and human leucocyte antigen-C (HLA-C) was made by polymerase chain reaction with sequence specific primers (PCR-SSP), followed by electrophoresis on agarose gel. Patients underwent clinical evaluation, serology, Doppler echocardiography and chest high-resolution computed tomography. The frequency of the inhibitory KIR2DL2 was significantly lower in patients [29.1% versus 65.2% in controls, P < 0.0001; odds ratio (OR) = 0.22, 95% confidence interval 0.12-0.40]. When combinations of activating and inhibitory KIR genes were analysed, the presence of KIR2DS2 in the absence of KIR2DL2 (KIR2DS2(+)/KIR2DL2(-)) was more frequent in patients than in controls (25.5% versus 1.7%, respectively; P < 0.0001; OR = 19.29, 4.24-122.26). However, the presence of both KIR2DS2 and KIR2DL2 (KIR2DS2(+)/KIR2DL2(+)) was more frequent in controls (57.4%) than in patients (28.2%, P < 0.0001), suggesting a preponderant protective effect of KIR2DL2 over KIR2DS2. Stratification for HLA-C1 status did not change these results. No statistically significant associations were found between KIR phenotypes and clinical and laboratory features of SSc. Our results suggest a protective role of KIR2DL2(+) phenotype and confirmed the association of the combination KIR2DS2(+)/KIR2DL2(-) with increased risk for SSc.

Glu298Asp eNOS polymorphism is not associated with SLE

To examine potential associations of the Glu298Asp polymorphism in the coding region of the endothelial nitric oxide synthase (eNOS) gene with susceptibility to and clinical expression of systemic lupus erythematosus (SLE). One hundred thirteen consecutive patients of European ancestry with diagnosis of SLE, satisfying the American College of Rheumatology criteria, from the outpatient clinic of the Serviço de Reumatologia of the Hospital de Clínicas de Porto Alegre, and 206 healthy controls from the same geographic area were genotyped by polymerase chain reaction for the Glu298Asp polymorphism in the coding region of the eNOS gene. Clinical, demographic, and laboratorial data were collected. Clinical manifestations of SLE and related diseases were evaluated for the association with specific genotypes. The allelic and genotypic distribution of the Glu298Asp did not differ significantly between SLE patients and controls. We found no association of the polymorphism with lupus nephritis, antiphospholipid syndrome, cardiovascular disease (CVD), and risk factors to CVD. The presented results in this study do not provide support for a major role of eNOS Glu298Asp neither in the susceptibility for SLE or clinical manifestations, although there was low statistical power for the latter evaluation.

The chemokine receptor CCR5 genetic polymorphism and expression in rheumatoid arthritis patients

OBJECTIVES

To identify the genetic polymorphism of the chemokine receptor CCR5 (the Delta32 allelic variant) in patients with rheumatoid arthritis (RA) and compare the findings with healthy controls. To compare the CCR5 phenotypic expression in T cells and monocytes isolated from the peripheral blood and synovial fluid in a subgroup of RA patients.

METHODS

CCR5 genes of 92 RA patients and 160 healthy controls were genotyped using specific primers flanking the region of deletion. The ethnic distribution was similar between the groups. Flow cytometric analysis was used for immunophenotyping the T cells and monocytes isolated from the peripheral blood and synovial fluid of eight RA patients. The isolated cells were triple stained with CD4 or CD8, CD25 and CCR5 monoclonal antibodies.

RESULTS

There was no difference in the CCR5Delta32 genotypic frequency between the RA patients and the control group (0.055 and 0.063, respectively, p = 0.989). No homozygote for the CCR5Delta32 allele was seen in either group. Five heterozygotes were identified in the RA patient group, whose disease was shown to be aggressive. A significant enrichment of activated CCR5+ monocytes was seen in the synovial fluid of the RA patients subjected to arthrocentesis, who were all homozygotes for the CCR5 wild-type genotype.

CONCLUSION

A protective role for the CCR5 allelic variant in RA development was not observed. Disease severity in the heterozygotes suggests that other proinflammatory mechanisms might overcome this mutation in vivo. The activated CCR5+ monocyte enrichment in the rheumatoid synovial fluid might indicate that this cell population has an important role in the pathogenesis of the disease.

Oesophageal dysmotility in systemic sclerosis: comparison of HRCT and scintigraphy

The aim of this study was to compare oesophageal abnormalities observed in high-resolution CT with radionuclide transit in patients with systemic sclerosis. 76 patients with systemic sclerosis were evaluated by high-resolution CT and oesophageal transit scintigraphy. Residual activity > or =20% (in relation to peak activity) at 15 s after the beginning of the swallow of the labelled liquid (in supine position) was considered indicative of oesophageal dysfunction. Supra-aortic and infra-aortic oesophageal coronal diameters were measured in high-resolution CT. Oesophageal dilatation was deemed present when the diameters exceeded 10 mm. 19 patients (25%) had supra-aortic oesophageal dilatation and 48 patients (63.1%) had infra-aortic dilatation. The prevalence of radionuclide transit delay was 77.6%. All patients (19/19) with supra-aortic dilatation had oesophageal dysfunction, compared with 70.2% (40/57) of the patients with no supra-aortic dilatation (p = 0.004). Oesophageal dysfunction was present in 97.9% (47/48) of patients with infra-aortic dilatation, compared with 42.9% (12/28) in patients without it (p < 0.001). Receiver operating characteristic (ROC) curves have demonstrated that the supra-aortic and infra-aortic diameters had good discriminatory capacity for oesophageal dysfunction in systemic sclerosis (area under the curve, 95% confidence interval: 0.80, 0.70-0.89 and 0.92, 0.86-0.98, respectively). There is a clinically significant association between oesophageal dysmotility and high-resolution CT findings of oesophageal coronal dilatation. The evaluation of infra-aortic oesophageal coronal diameter can provide additional useful information about the functional and anatomic conditions of the oesophagus in systemic sclerosis.

Raised serum S100B protein levels in neuropsychiatric lupus

OBJECTIVE

To test serum S100B protein levels in patients with and without neuropsychiatric systemic lupus erythematosus (NPSLE) and controls.

METHODS

87 patients with SLE, 23 with and 64 without neuropsychiatric involvement, and 25 control subjects were prospectively evaluated. NPSLE diagnosis was made according to the American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Serum S100B protein levels were determined with a luminescence immunoassay. Statistical analysis was performed using Mann-Whitney and Kruskal-Wallis tests.

RESULTS

Among the patients with NPSLE, 9 presented psychosis; 4, cranial neuropathy; 3, cerebrovascular disease; 1, seizures; 1, chorea; 1, peripheral polyneuropathy; 1, multiplex mononeuropathy; 3, dementia. Serum concentrations of S100B protein were significantly higher in patients with NPSLE (median 0.164 ng/ml, interquartile range 0.113-0.332) than in non-NPSLE patients (0.062 ng/ml, 0.026-0.109) and controls (0.088 ng/ml, 0.013-0.124) (p<0.001). Patients with anti-dsDNA antibodies had higher S100B protein levels (p = 0.001). No significant associations were found of lupus activity (among non-NPSLE cases), antiphospholipid antibodies, and reduced complement levels with S100B concentration.

CONCLUSIONS

Serum S100B protein level is raised in NPSLE, reflecting continuing neurological damage. The association of anti-dsDNA antibodies with higher S100B protein concentration deserves further study.

Nailfold capillaroscopic findings in primary Sjögren's syndrome: clinical and serological correlations

OBJECTIVE

To describe the capillaroscopic abnormalities observed in patients with primary Sjögren's Syndrome (pSS), associating them with clinical and serologic features, and comparing these findings to those observed in normal controls.

METHODS

Sixty-one consecutive patients with pSS were studied by clinical evaluation, serology, and nailfold capillary microscopy (NCM). Twenty-one normal controls were also examined. Capillaroscopic findings were recorded in a standardized way by a blinded observer Capillary loss on NCM was evaluated using a deletion score.

RESULTS

NCM was normal in 59.0% of pSS patients; 29.5% had non-specific abnormalities, and 11.5% presented a SD-like pattern. Patients presented a higher deletion score than controls (p < 0.001). Other capillaroscopic parameters (number of dilated, bizarre, and meandering capillaries; capillary hemorrhages; venous plexus visibility) did not differ significantly between patients and controls. Among patients, the deletion score was higher in those with systemic manifestations (p = 0.022) and Raynaud's phenomenon (p = 0.050). No association between the presence of antinuclear antibodies, rheumatoid factor, anti-SSA/Ro and anti-SSB/La with qualitative or quantitative NCM findings was found. Among the 7 patients with SD-like pattern on NCM, 6 had Raynaud's phenomenon, but only 2 presented autoantibodies related to systemic sclerosis (1 with anticentromere and 1 with low titer antitopoisomerase I). None of these patients met the ACR criteria for SSc.

CONCLUSIONS

SD-like pattern on NCM is observed in a small but significant proportion of pSS patients. The association of systemic involvement with a higher deletion score may be related to the hypothesis that these manifestations represent clinical expressions of systemic vasculitis.

A study of the association between epistaxis and the severity of hypertension

Hypertension (HTN) has frequently been cited as a general risk factor for epistaxis. However, studies dealing with this association have yielded equivocal results. In this study, a sample of 121 hypertensives (blood pressure > or = 140/90 mmHg) was selected to evaluate the association between the severity of HTN and a previous history of epistaxis. Patients with an average blood pressure > or = 160/100 mmHg were classified as suffering from a more severe form of HTN and were compared with those with a less severe form of the disease (160/100 mm Hg < or = blood pressure > or = 140/90 mm Hg). The frequency of epistaxis did not differ among patients categorized by the severity of HTN. Users of aspirin were found to be twice as likely to have a history of epistaxis. In addition, there was a statistical tendency for an association between a history of epistaxis and the duration of hypertension. We conclude that the severity of HTN and a history of epistaxis were not associated in a cohort of hypertensive patients. The identification of other risk factors for epistaxis, including the duration of HTN, deserves further study.

Alcohol intake and blood pressure: the importance of time elapsed since last drink

BACKGROUND

A positive association of chronic exposure to alcoholic beverages with blood pressure and the prevalence of hypertension has been described in epidemiological surveys, but the influence of time elapsed since last ingestion in this setting was not demonstrated.

DESIGN

A cross-sectional, population-based survey.

METHODS

In total 1089 adults from Porto Alegre, randomly selected from a population-based, multi-stage probability sample, were interviewed at home. The average daily alcohol intake of each subject was calculated taking into account the concentration of ethanol in the beverages (distilled or fermented beverages), and the time elapsed between the last ingestion of ethanol and the moment of blood pressure determination. Standardized sitting blood pressure and anthropometric parameters were collected. The magnitude and shape of the associations were analyzed considering blood pressure as a continuous variable and the prevalence of arbitrarily defined hypertension. Simple and multiple linear regression models, including models to identify nonlinear associations, with quadratic and cubic terms of the amount of alcohol consumed, were employed. Blood pressure means were compared by analysis of variance and analysis of covariance. The association between hypertension and exposure to ethanol was analyzed through logistic regression models, controlling for various potential confounders.

RESULTS

Positive nonlinear associations of the amount of alcohol consumed with blood pressure and the prevalence of hypertension (> or = 160/95 mmHg) were found, independent of age, years of education, smoking, and use of oral contraceptive and antihypertensive drugs. The consumption of 30 g/day ethanol was associated with increases of 1.5 and 2.3 mmHg in diastolic and systolic blood pressures, respectively, for men, and 2.1 and 3.2 mmHg, respectively, for women. The prevalence of hypertension was higher among those ingesting more than 30 g/day (odds ratio = 2.9, P < 0.01). The time elapsed between the last ingestion and blood pressure measurement was independently associated with the prevalence of hypertension. Men with last consumption of alcohol 13-23 h prior to measurement had odds of being hypertensive 2.6 (confidence interval 1.3-5.0) greater than did subjects who had consumed alcoholic beverages 24 h and more before the blood pressure determination. For men, systolic and diastolic blood pressures were lower during the first 3 h after ingestion and increased afterward. Frequency of consumption and type of beverage consumed were not independently associated with level of blood pressure.

CONCLUSION

A time-dependent association between alcohol consumption and effects on blood pressure, demonstrated in experimental studies, was found for free-living individuals selected at random.

Alcoholic beverage consumption and associated factors in Porto Alegre, a southern Brazilian city: a population-based survey

OBJECTIVE

To describe the pattern of alcoholic beverage consumption and the prevalence of at risk drinking behaviors, as well as their association with demographic and socioeconomic factors in the adult population of Porto Alegre, a southern Brazilian city.

METHOD

In a cross-sectional, population-based, multistage random sampling study, 1,091 (600 female) individuals (92% of those eligible) were selected and interviewed at home. Exposure to alcohol was measured by the CAGE questionnaire and by inquiring about the type, quantity and frequency of alcoholic beverage consumption. An average consumption of 30 g per day or more, a level of exposure associated with health risks, was considered as heavy drinking. Two positive answers to the GAGE questionnaire represented the cutoff for indicating dependence.

RESULTS

The prevalences were: 9.3% (95% CI: 7.6 to 11.0) for dependence, 15.5% (13.4 to 17.7) for heavy drinking and 12.3% (10.4 to 14.2) for daily drinking; 24.1% (21.7 to 26.6) were abstinent. Women consumed alcoholic beverages in lower frequency and amounts than men. The most widely consumed beverages were beer, wine and "cachaça," a Brazilian sugarcane spirit. In a logistic regression model, increasing age, lower education and income, and nonwhite race were associated with heavy drinking and dependence. Households with 3-4 persons were associated with the lowest risk of heavy drinking, but the prevalence of dependence was higher in crowded households. The presence of another heavy drinker or dependent in the household was associated with heavy drinking but not with dependence.

CONCLUSIONS

The study characterized a detailed pattern of alcoholic beverage use and indicated that at risk drinking is an important public health problem in a developing country. The risk factors for heavy drinking and dependence were the same, with the exception of age at starting to drink, heavy drinking or dependence-positive household members.

Study of the usefulness of optic fundi examination of patients with hypertension in a clinical setting

The purpose of this study was to evaluate the usefulness of direct opthalmoscopy by non-opthalmologists in patients with hypertension. In a cross-sectional survey, we analysed the association between optic fundi abnormalities, individually and according to the criteria of Keith and Wagener (KW), with blood pressure and duration of known hypertension in 400 non-diabetic hypertensive patients. The optic fundi abnormalities were more frequent in patients with diastolic blood pressure (DBP) > 105 mm Hg (P = 0.002), SBP > 180 mm Hg (P < 0.0001) and with a duration of known hypertension > 3 years (P = 0.002). The severity of hypertension did not vary in parallel with the KW classes I and II: 34.5% of patients classified as KW I had a diastolic pressure of > 105 mm Hg compared with only 25.3% of those classified as KW II. Class III abnormalities were infrequent (2.5% of the whole cohort). In a logistic regression model, diffuse arteriolar narrowing was associated with DBP (P = 0.002) and age (P < 0.001). Abnormalities of the arteriovenous crossings were associated with SBP (P = 0.001) and duration of disease (P = 0.008). The positive predictive value of any fundoscopic abnormality to estimate the severity of hypertension was 59% and the negative value was 60%. The results of this study demonstrate that optic fundi examination by internists and cardiologists does not give an accurate assessment of the severity of hypertension in most patients, and that the Keith-Wagener classification of retinopathy has a limited applicability.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevalence of systemic arterial hypertension and associated risk factors in the Porto Alegre metropolitan area. Populational-based study]

PURPOSE

To evaluate the contemporaneous prevalence of hypertension in Porto Alegre, RS, and its association with biological, socioeconomic and environmental factors.

METHODS

It was done an observational and analytical study with a cross-sectional design, of a representative sample of the adults of the urban region. The study was planned with a power to describe the main estimates with 0.5% confidence limits of +/- 2%. One thousand and ninety one individuals, selected at random in conglomerates and in a multiple stage process, were interviewed. The data were obtained in the domiciles through standardized questionnaires and physical examination.

RESULTS

The prevalence of hypertension, defined by blood pressure (BP) > or = 160/95 mmHg, was 12.6% (CI = 10.6 to 14.6). Considering as hypertensives the individuals with BP < 160/95 mmHg under drug treatment, the prevalence increased to 19.2% (CI = 16.9 to 21.5). The corresponding figures for the 140/90 mmHg criteria were 25.8% (CI = 23.2 to 28.4) and 29.8% (CI = 27.1 to 32.5). Among those using anti-hypertensive drugs (11%), 58.9 had BP < 160/95 mmHg and 35.5% < 140/90 mmHg; 57.7% of the hypertensives (160/95 criteria) were aware of diagnosis; 28% had body mass index above 27kg/m2, 15.5% consumed more than 30g per day of ethanol, 35.1% were smokers, and 17.8% ex-smokers. The prevalence increased with age and was higher in individuals with obesity, strong family history of hypertension, low education and in those which abused from alcoholic beverages. In a logistic regression model, these putative risk factors showed to be independent of others.

CONCLUSION

The contemporaneous prevalence of hypertension in Porto Alegre demonstrates that the prevalence rates have not decreased in the last 15 years. It was also shown an inadequate BP control in almost 50% of those under drug treatment, and finally, the association of hypertension with well-known risk factors.