Neuroprotective Effect of Curcumin-Loaded RGD Peptide-PEGylated Nanoliposomes

Curcumin is known for its anti-inflammatory, neuroprotective, and antioxidant properties, but its use in biological applications is hindered by its sensitivity to light, oxygen, and temperature. Furthermore, due to its low water solubility, curcumin has a poor pharmacokinetic profile and bioavailability. In this study, we evaluated the potential application of curcumin as a neuroprotective agent encapsulated in RGD peptide-PEGylated nanoliposomes developed from salmon-derived lecithin. Salmon lecithin, rich in polyunsaturated fatty acids, was used to formulate empty or curcumin-loaded nanoliposomes. Transmission electron microscopy, dynamic light scattering, and nanoparticle tracking analysis characterizations indicated that the marine-derived peptide-PEGylated nanoliposomes were spherical in shape, nanometric in size, and with an overall negative charge. Cytotoxicity tests of curcumin-loaded nanoliposomes revealed an improved tolerance of neurons to curcumin as compared to free curcumin. Wild-type SH-SY5Y were treated for 24 h with curcumin-loaded nanoliposomes, followed by 24 h incubation with conditioned media of SH-SY5Y expressing the Swedish mutation of APP containing a high ratio of Aβ40/42 peptides. Our results revealed significantly lower Aβ-induced cell toxicity in cells pre-treated with RGD peptide-PEGylated curcumin-loaded nanoliposomes, as compared to controls. Thus, our data highlight the potential use of salmon lecithin-derived RGD peptide PEGylated nanoliposomes for the efficient drug delivery of curcumin as a neuroprotective agent.

Impact of a Starch Hydrolysate on the Production of Exopolysaccharides in a Fermented Plant-Based Dessert Formulation

Plant-based desserts are becoming increasingly popular with and appreciated by consumers. However, they are limited by the choice of ingredients, which are often expensive and unstable with a random texture. Therefore, the aim of the research is to propose a new product that offers an advantageous texture and flavour in a fermented dessert based on a flour mix supplemented with an enzymatic hydrolysate. This study involved the development of two processes: (i) an enzymatic hydrolysis of oat flour and (ii) a fermentation of a flour mixture (oat, chickpea, and coconut) by lactic acid bacteria (Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus). The result of the oat flour hydrolysate shows a significant decrease in starch after 60 min of reaction, followed by an increase in sugar content. During 23 days of storage at 4 °C, the formulations used showed post-acidification, water retention capacity decrease, and hardness increase related to the hydrolysate rate (p < 0.05). All formulations allowed the viability of lactic bacteria (over 5 log10 CFU/mL) and verified their ability to produce exopolysaccharides (0.23-0.73 g/100 g). The prototyping of such a product represents a key step in meeting the growing demand for plant-based alternatives, with qualitative sensory characteristics without additives.

Gelatin Methacryloyl (GelMA) Hydrogel Scaffolds: Predicting Physical Properties Using an Experimental Design Approach

There is a growing interest for complex in vitro environments that closely mimic the extracellular matrix and allow cells to grow in microenvironments that are closer to the one in vivo. Protein-based matrices and especially hydrogels can answer this need, thanks to their similarity with the cell microenvironment and their ease of customization. In this study, an experimental design was conducted to study the influence of synthesis parameters on the physical properties of gelatin methacryloyl (GelMA). Temperature, ratio of methacrylic anhydride over gelatin, rate of addition, and stirring speed of the reaction were studied using a Doehlert matrix. Their impact on the following parameters was analyzed: degree of substitution, mass swelling ratio, storage modulus (log(G')), and compression modulus. This study highlights that the most impactful parameter was the ratio of methacrylic anhydride over gelatin. Although, temperature affected the degree of substitution, and methacrylic anhydride addition flow rate impacted the gel's physical properties, namely, its storage modulus and compression modulus. Moreover, this experimental design proposed a theoretical model that described the variation of GelMA's physical characteristics as a function of synthesis conditions.

Efficient TGF-β1 Delivery to Articular Chondrocytes In Vitro Using Agro-Based Liposomes

The low efficiency in transfecting rat- and human-derived chondrocytes have been hampering developments in the field of cartilage biology. Transforming growth factor (TGF)-β1 has shown positive effects on chondrocytes, but its applications remain limited due to its short half-life, low stability and poor penetration into cartilage. Naturally derived liposomes have been shown to be promising delivery nanosystems due to their similarities with biological membranes. Here, we used agro-based rapeseed liposomes, which contains a high level of mono- and poly-unsaturated fatty acids, to efficiently deliver encapsulated TGF-β1 to rat chondrocytes. Results showed that TGF-β1 encapsulated in nano-sized rapeseed liposomes were safe for chondrocytes and did not induce any alterations of their phenotype. Furthermore, the controlled release of TGF-β1 from liposomes produced an improved response in chondrocytes, even at low doses. Altogether, these outcomes demonstrate that agro-based nanoliposomes are promising drug carriers.

Use of Active Salmon-Lecithin Nanoliposomes to Increase Polyunsaturated Fatty Acid Bioavailability in Cortical Neurons and Mice

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) play an important role in the development, maintenance, and function of the brain. Dietary supplementation of n-3 PUFAs in neurological diseases has been a subject of particular interest in preventing cognitive deficits, and particularly in age-related neurodegeneration. Developing strategies for the efficient delivery of these lipids to the brain has presented a challenge in recent years. We recently reported the preparation of n-3 PUFA-rich nanoliposomes (NLs) from salmon lecithin, and demonstrated their neurotrophic effects in rat embryo cortical neurons. The objective of this study was to assess the ability of these NLs to deliver PUFAs in cellulo and in vivo (in mice). NLs were prepared using salmon lecithin rich in n-3 PUFAs (29.13%), and characterized with an average size of 107.90 ± 0.35 nm, a polydispersity index of 0.25 ± 0.01, and a negative particle-surface electrical charge (-50.4 ± 0.2 mV). Incubation of rat embryo cortical neurons with NLs led to a significant increase in docosahexaenoic acid (DHA) (51.5%, p < 0.01), as well as palmitic acid, and a small decrease in oleic acid after 72 h (12.2%, p < 0.05). Twenty mice on a standard diet received oral administration of NLs (12 mg/mouse/day; 5 days per week) for 8 weeks. Fatty acid profiles obtained via gas chromatography revealed significant increases in cortical levels of saturated, monounsaturated, and n-3 (docosahexaenoic acid,) and n-6 (docosapentaenoic acid and arachidonic acid) PUFAs. This was not the case for the hippocampus or in the liver. There were no effects on plasma lipid levels, and daily monitoring confirmed NL biocompatibility. These results demonstrate that NLs can be used for delivery of PUFAs to the brain. This study opens new research possibilities in the development of preventive as well as therapeutic strategies for age-related neurodegeneration.

Diagnostic value and prognostic impact of various invasively derived hemodynamic parameters in patients with severe aortic stenosis undergoing TAVI

Background

Ejection time (ET) and Acceleration time (AT) have been described as echocardiographic markers for aortic stenosis (AS).1 Moreover, in a recent study time between invasively measured left ventricular and aortic systolic pressure peaks (T-LVAo) was associated with anatomic AS severity.2 However, the diagnostic value of these parameters has not been validated in a larger patient cohort and their prognostic impact in AS patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown.

Purpose

We aimed to assess the diagnostic value and prognostic impact of ET, AT, and T-LVAo as assessed by invasive measurements in patients undergoing TAVI for severe AS.

Methods

This retrospective single-centre analysis studied 1478 patients undergoing TAVI from 2014 to 2019 for severe AS. All patients received echocardiographic, multislice computed tomography (MSCT) and invasive hemodynamic evaluation with simultaneous pressure measurements in left ventricle and aorta prior to TAVI. Anatomic AS severity was assessed according to MSCT-derived aortic valve calcification density (AVCd) defined as calcium volume per annulus area. All hemodynamic parameters were calculated offline using a dedicated software.

Results

Median patients' age was 81.2 (76.8–84.7) years and 807 (54.6%) were women. Predicted operative risk for mortality was 3.8 (2.6–5.7)% according to STS Score. Medians of invasively derived parameters were 70.0 ms (46.0–98.0) for T-LVAo, 308.0 ms (276.0–336.0) for ET, 180.0 ms (146.0–206.0) for AT. In spline analysis correlation of T-LVAo (Spearman: r=0.35; p&lt;0.001) and ET (Spearman: r=0.18; p&lt;0.001) with AVCd was significant but weak. AT showed negligible correlation with ACVd (Spearman: r=−0.05; p=0.089). The optimal cutoff for death (CD) according to C-statistic was 274 ms for ET and 158 ms for AT. Patients with ET or AT ≥ CD showed lower short and mid-term mortality rates compared to patients with ET or AT &lt; CD (ET ≥ vs. &lt; CD: mortality at 1-year: 14.5 vs. 31.9%, 3-years: 28.3 vs. 53.5%, all p&lt;0.001; AT ≥ vs &lt; CD: mortality at 1-year: 15.5 vs. 25.9%, p&lt;0.001, 3-years: 34.0 vs. 41.0%, p=0.0032). Moreover, multivariate analysis for mortality identified ET (HR 0.58 [95% CI 0.43–0.77; p&lt;0.001]) and AT (HR 0.65 [95% CI 0.49–0.86; p=0.0027]) to be associated with beneficial outcome after TAVI, independent from clinical risk factors and echocardiography-derived parameters like LVEF, mean gradient or stroke volume index. In contrast, T-LVAo showed no prognostic impact according to uni- or multivariate analyses.

Conclusion

T-LVAo provides the highest diagnostic value among the investigational hemodynamic parameters, however correlation with AVCd was weak. ET and AT are strong independent outcome predictors beyond clinical risk factors and standard echocardiographic parameters in AS patients following TAVI. Accordingly, use of ET and AT might improve risk assessment in patients scheduled for TAVI.

Funding Acknowledgement

Type of funding sources: None.

Polymer functionalization through an enzymatic process: Intermediate products characterization and their grafting onto gum Arabic

The modification of gum Arabic with ferulic acid oxidation products was performed in aqueous medium, at 30 °C and pH 7.5, in the presence of Myceliophthora thermophila laccase as biocatalyst. First, this study aimed to investigate the structures of the oxidation products of ferulic acid that could possibly be covalently grafted onto gum Arabic. HPLC analyses revealed that this reaction produced several oxidation products, whose structures were investigated using LC-MS/MS analyses (liquid chromatography-mass spectrometry with mass fragmentation analyses) and NMR experiments. The chemical structure of one intermediate reaction product was fully elucidated as the 2-(4-hydroxy-3-methoxyphenyl)-4-[(4-hydroxy-3-methoxyphenyl) methylidene] cyclobutane-1, 3-dione, called by the authors cyclobutadiferulone. Secondly, this study aimed to locate the grafting of the oxidation products onto gum Arabic by performing several NMR experiments. This study did not determine how much and specifically which oxidation products were grafted but some of them were undeniably present onto modified gum Arabic, close to the glucuronic acid C5 carbon or close to the galactose C6 carbon.

Prevalence and prognostic impact of left ventricular outflow tract calcification in patients with severe aortic stenosis undergoing transfemoral TAVI using second-generation devices

Introduction

Left ventricular outflow tract (LVOT) calcification is known to be associated with adverse outcomes after TAVI in patients receiving first-generation transcatheter heart valves (THV). Second-generation THV have been shown to improve outcomes of TAVI patients. Thus, aim of this study is to assess the prevalence of LVOT calcification as well as its impact on procedural and clinical outcomes in patients with severe aortic stenosis undergoing transfemoral TAVI with second-generation THV in a real-world patient cohort.

Methods

In this retrospective single-center analysis patients receiving transfemoral TAVI with second-generation THV for the treatment of aortic stenosis (AS) between 05/2012 and 06/2018 and with adequate CT data were included (n=836). Amount of LVOT calcification was measured quantitatively from contrast-enhanced multislice CT using a dedicated software. Baseline characteristics and outcomes were compared according to presence of significant LVOT calcification (none/≤10 mm3 vs. &gt;10 mm3). Procedural and clinical outcome were assessed in accordance with VARC-2 criteria. All-cause mortality was assessed by Kaplan-Meier method, median follow-up was 1.4 years.

Results

Significant LVOT calcification was present in 37.0% of patients. Patients with LVOT calcification were older (all results as follows without (w/o) vs. with (w) LVOT calcification: 81.4 (77.1, 84.8) vs. 82.3 (78.0, 86.3) years, p=0.006), but presented similar STS scores compared to those without LVOT calcification (5.4±4.7 vs. 5.4±3.5%, p=0.94). Moreover, patients with LVOT calcification had higher mean transvalvular gradients at baseline (30.0 (21.0, 41.0) vs. 37.0 (25.7, 47.0) mmHg, p&lt;0.001) and higher aortic valve calcium volume (380.7 (226.8, 632.1) vs. 663.6 (364.5, 1070.3) mm3, p&lt;0.001). There were no significant differences in rate of device success (97.0 vs. 94.2%, p=0.11), renal failure (2.6 vs. 2.3%, p=1.00), myocardial infarction (0.9 vs. 1.2%, p=1.00) or rate of permanent pacemaker implantation at 30 days after TAVI (16.6 vs. 17.2%, p=0.91). However, rate of TIA/stroke was significantly higher in patients with LVOT calcification (2.1 vs. 6.2%, p=0.0098). Furthermore, patients with LVOT calcification had a higher rate of more than mild paravalvular leakage at discharge (3.8 vs. 7.6%, p=0.033). Rate of 1 year all-cause mortality (17.8 vs. 21.2%, p=0.23) was not significantly different between both groups.

Conclusions

Significant LVOT calcification is present in a substantial proportion of patients receiving TAVI. In such patients, higher rates of cerebrovascular events and more than mild PVL occurred compared to those without significant LVOT calcification even with currently available second-generation THV. Although these findings did not translate into higher mortality rates in the present study, they underline the need for further optimization of THV technology in order to improve outcomes among all TAVI patients.

Figure 1. 1-year mortality

Funding Acknowledgement

Type of funding source: None

Lipid Composition of Liposomal Membrane Largely Affects Its Transport and Uptake through Small Intestinal Epithelial Cell Models

Lipid composition of liposomal bilayer should alter the cell response for permeability, transport, and uptake in small intestine. This work was done to investigate the transport and uptake of liposomes composed of docosahexaenoic acid-enriched phosphatidylcholine (PtdCho), phosphatidylserine (PtdSer), and sulfoquinovosyl diacylglycerol (SQDG) derived from marine products on multilamellar vesicles (MLV) in small intestinal epithelial cell models. The results showed that addition of PtdSer and SQDG as liposomal bilayer could improve the efficiency entrapment of liposomes. The liposomes containing PtdSer showed higher transport and uptake through both Caco-2 cell and M cell monolayers as compared to PtdCho-MLV. SQDG-containing liposomes exhibited only higher transport through M cell monolayer, while its uptake effect was higher both in Caco-2 cell and M cell monolayers. The results of experiments done with endocytosis inhibitors indicated that PtdCho-MLV must be transported via macropinocytosis and uptaken by phagocytosis in M cell monolayer model. PtdCho/PtdSer-MLV and PtdCho/SQDG-MLV might be transported and uptaken through M cell monolayer by phagocytosis. The result also indicated that PtdCho/SQDG-MLV could open the tight junction of small intestinal epithelial cell monolayers. Furthermore, our findings demonstrated that the surface status of cholesterol-containing liposomes were smooth, but they did not affect their transport and uptake through Caco-2 cell and M cell monolayers.

The adverse impact of HFpEF in patients with aortic stenosis: evaluation of the H2FPEF score for risk assessment among patients with preserved ejection fraction undergoing TAVI

Background

The H2FPEF score enables identification of patients with high probability of prevalent heart failure with preserved ejection fraction (HFpEF). High H2FPEF scores have proven to be associated with adverse outcome in patients with known HFpEF.

Objective

The aim of this study was to assess the prognostic impact of the H2FPEF score in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) for severe aortic stenosis (AS) and preserved left ventricular ejection fraction (EF).

Methods

In this multi-centre study a total of 832 patients from two German high-volume centres, who received TAVI for severe AS and preserved EF (≥50%), were identified for calculation of the H2FPEF score. Score variables included BMI &gt;30 kg/m2, arterial hypertension, atrial fibrillation, systolic pulmonary artery pressure &gt;31 mmHg, age &gt;60 years, and invasively assessed elevated LV filling pressure. Patients were dichotomized according to low (1–5 points; n=570) and high H2FPEF scores (6–9 points; n=262). Kaplan-Meier and Cox regression analyses were applied to assess the prognostic impact of the H2FPEF score. Median follow-up time was 1.08 years.

Results

Patients presenting with high H2FPEF scores had higher prevalence of moderate to severe mitral and tricuspid regurgitation compared to those with low H2FPEF scores. Stroke volume index (SVI) (Figure 1A) and mean transvalvular gradient (Pmean) consistently decreased with increasing H2FPEF score. All-cause mortality 30 days after TAVI was significantly higher in patients with high H2FPEF scores (p&lt;0.0001). This finding was consistent both after 1 year (p&lt;0.0001) and 3 years (p&lt;0.0001) (Figure 1B). Multivariate analysis revealed a high H2FPEF score to be independently predictive for all-cause mortality (HR 1.62, 95% CI: 1.11–2.38, p=0.013). Among the single H2FPEF score parameters atrial fibrillation was the strongest independent predictor of adverse outcome.

Conclusion

An elevated H2FPEF score of ≥6 is independently predictive for mortality in patients with preserved EF undergoing TAVI for severe AS, which might be due to a higher proportion of paradoxical low flow low gradient AS in these patients. Our findings provide evidence that the H2FPEF score may help identify AS patients with preserved ejection fraction that are at higher risk for adverse outcome after TAVI.

Spline/SVI (A) and 3y-mortality KM (B)

Funding Acknowledgement

Type of funding source: None

Curcumin Loaded Nanoliposomes Localization by Nanoscale Characterization

Curcumin is a hydrophobic drug gaining growing attention because of its high availability, its innocuity, and its anticancer, antitumoral, and antioxidative activity. However, its poor ‎‎bioavailability in the human body, caused by its low aqueous solubility and fast degradation, ‎‎presents a big hurdle for its oral administration. Here, we used nano-vesicles made of ‎‎phospholipids to carry and protect curcumin in its membrane. Various curcumin amounts were ‎‎encapsulated in the produced phospholipid system to form drug-loaded liposomes. ‎Curcumin's ‎concentration was evaluated using UV-visible measurements. The maximal ‎amount of curcumin ‎that could be added to liposomes was assessed. Nuclear magnetic ‎resonance (NMR) analyses ‎were used to determine curcumin's interactions and localization ‎within the phospholipid ‎membrane of the liposomes. X-ray scattering (SAXS) and atomic ‎force microscopy (AFM) ‎experiments were performed to characterize the membrane structure ‎and organization, as well as its ‎mechanical properties at the nanoscale. Conservation of the membrane's properties is found with ‎the addition of curcumin in various ‎amounts before saturation, allowing the preparation of a ‎defined nanocarrier with desired ‎amounts of the drug.

Physicochemical Properties and Liposomal Formulations of Hydrolysate Fractions of Four Sea Cucumbers (Holothuroidea: Echinodermata) from the Northwestern Algerian Coast

To promote the nutritional and pharmacological values of four sea cucumber species (Holothuria poli, H. tubulosa, H. arguinensis, and H. sanctori), harvested from the Algerian coast, we aimed to study their proximate composition, fatty acid profile and angiotensin-converting enzyme (ACE) inhibitory activity. Their phospholipids were also used to elaborate nanoliposomes and to encapsulate peptides obtained from the same source. After the physico-chemical characterization of nanoliposomes and peptides, in vitro analyses were realized. The four holothurian species showed a high amount of protein (49.26-69.34%), and an impressive lipid profile of 27 fatty acids, mainly composed of polar fatty acids (91.16-93.85%), with a high polyunsaturated fatty acids (PUFA) content (50.90-71.80%), particularly eicosapentaenoic acid (EPA) (5.07-8.76%) and docosahexaenoic acid (DHA) (4.86-7.25%). A high phospholipids amount was also found (55.20-69.85%), mainly composed of phosphatidylcholine (PC) (51.48-58.56%). Their peptide fractions exhibited a high ACE inhibitory activity (IC50 0.30 to 0.51 mg/mL). The results also showed that the nanoliposomes do not induce cytotoxicity and cell death in human MSCs and no perturbation of proliferation for all the times and the tested concentrations, as well as the combined nanoliposomes and hydrolysates (HTS) at a concentration of 0.1 mg/mL. All four sea cucumbers show potential as a new source for omega-3, omega-6, and bioactive peptides.

Nanoliposomes from Agro-Resources as Promising Delivery Systems for Chondrocytes

Investigations in cartilage biology have been hampered by the limited capacity of chondrocytes, especially in rats and humans, to be efficiently transfected. Liposomes are a promising delivery system due to their lipid bilayer structure similar to a biological membrane. Here we used natural rapeseed lecithin, which contains a high level of mono- and poly-unsaturated fatty acids, to evaluate the cytocompatibility of these phospholipids as future potential carriers of biomolecules in joint regenerative medicine. Results show that appropriate concentrations of nanoliposome rapeseed lecithin under 500 µg/mL were safe for chondrocytes and did not induce any alterations of their phenotype. Altogether, these results sustain that they could represent a novel natural carrier to deliver active substances into cartilage cells.

Growth-Inhibitory Effect of Chitosan-Coated Liposomes Encapsulating Curcumin on MCF-7 Breast Cancer Cells

Current anticancer drugs exhibit limited efficacy and initiate severe side effects. As such, identifying bioactive anticancer agents that can surpass these limitations is a necessity. One such agent, curcumin, is a polyphenolic compound derived from turmeric, and has been widely investigated for its potential anti-inflammatory and anticancer effects over the last 40 years. However, the poor bioavailability of curcumin, caused by its low absorption, limits its clinical use. In order to solve this issue, in this study, curcumin was encapsulated in chitosan-coated nanoliposomes derived from three natural lecithin sources. Liposomal formulations were all in the nanometric scale (around 120 nm) and negatively charged (around -40 mV). Among the three lecithins, salmon lecithin presented the highest growth-inhibitory effect on MCF-7 cells (two times lower growth than the control group for 12 µM of curcumin and four times lower for 20 µM of curcumin). The soya and rapeseed lecithins showed a similar growth-inhibitory effect on the tumor cells. Moreover, coating nanoliposomes with chitosan enabled a higher loading efficiency of curcumin (88% for coated liposomes compared to 65% for the non-coated liposomes) and a stronger growth-inhibitory effect on MCF-7 breast cancer cells.

Effects of ‎Bioactive ‎Marine-Derived ‎Liposomes on ‎Two ‎Human ‎Breast Cancer ‎‎Cell Lines

Breast cancer is the leading cause of death from cancer among women. Higher consumption of dietary marine n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) is associated with a lower risk of breast cancer. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are two n-3 LC-PUFAs found in fish and exert anticancer effects. In this study, natural marine-derived lecithin that is rich in various polyunsaturated fatty acids (PUFAs) was extracted from salmon heads and transformed into nanoliposomes. These nanoliposomes were characterized and cultured with two breast cancer lines (MCF-7 and MDA-MB-231). The nanoliposomes decreased the proliferation and the stiffness of both cancer cell types. These results suggest that marine-derived lecithin possesses anticancer properties, which may have an impact on developing new liposomal delivery strategies for breast cancer treatment.

Role of active nanoliposomes in the surface and bulk mechanical properties of hybrid hydrogels

Nanoliposomes are widely used as delivery vehicles for active compounds. Nanoliposomes from rapeseed phospholipids were incorporated into interpenetrating polymer network hydrogels of gelatin methacryloyl and alginate. The multiscale physicochemical properties of the hydrogels are studied both on the surface and through the thickness of the 3D network. The obtained composite hydrogels exhibited strong mechanical properties and a highly porous surface. The blend ratio, as well as the concentration of nanoliposomes, affects the properties of the hydrogels. Nanofunctionalized hydrogels induced keratinocyte ​growth. These advantageous characteristics may open up many applications of the developed hydrogels in drug delivery and tissue engineering.

P3470Comparative effectiveness and safety of non-vitamin K oral anticoagulants and warfarin in non-valvular atrial fibrillation - a cohort study in 3 Nordic countries

Background

Non-vitamin K oral anticoagulants (NOACs) are an alternative to warfarin in the prevention of stroke in non-valvular atrial fibrillation (NVAF). Nordic countries have high quality of warfarin treatment, making them an especially suitable setting for assessing effectiveness and safety of NOACs against warfarin.

Purpose

The BEYOND Pooled (BEnefit of NOACs studY of nOn-valvular AF patieNts in NorDic countries) study compared risks of ischaemic or haemorrhagic stroke/systemic embolism (S/SE), and risk of bleeding with acute hospitalisation with an overnight stay (bleeding) in NVAF patients treated with apixaban, dabigatran or rivaroxaban, each compared with warfarin treatment.

Methods

A cohort study of treatment-naïve adult NVAF patients dispensed apixaban, dabigatran, rivaroxaban or warfarin was identified from 01 Jan 2013 to 31 Dec 2016. The population and study variables were identified from national registries in Denmark, Norway and Sweden. After 1:1 propensity score (PS) matching for each NOAC-warfarin comparison, individual-level data were pooled across the countries. Cox proportional-hazards regression was used to estimate adjusted hazard ratios (aHRs) of the endpoints.

Results

PS matched NOAC cohort sizes were: apixaban (55,696) dabigatran (28,526) and rivaroxaban (30,701), and the total follow-up in the PS-matched population was 291,171 years (mean 1.3 years). During the follow-up, 35,450 oral anticoagulation (OAC) patients had a S/SE and 38,620 OAC patients had bleeding. Adjusted HRs for the two endpoints are presented in the table. PH assumption has not been formally tested but cum incidence curves did not indicate substantial differences in the effects over time.

Table 1. Adjusted hazard ratios (aHR) of stroke/systemic embolism and bleeding for non-vitamin K oral anticoagulants versus warfarin Endpoint Apixaban vs Warfarin: aHR (95% CI) Dabigatran vs Warfarin: aHR (95% CI) Rivaroxaban vs Warfarin: aHR (95% CI) Stroke/SE 0.93 (0.85–1.03) 0.89 (0.80–1.00) 0.97 (0.88–1.08) Bleeding 0.72 (0.67–0.77) 0.87 (0.80–0.95) 1.12 (1.04–1.20)

Conclusions

Relative to warfarin, apixaban and dabigatran were associated with lower rates of bleeding whereas rivaroxaban was associated with a higher rate. The three NOACs had comparable rates of stroke and systemic embolism relative to warfarin.

Acknowledgement/Funding

This study was funded by the Pfizer/Bristol-Myers Squibb Alliance.

P3858High H2FPEF score is an independent predictor of adverse outcome in patients with severe aortic stenosis and preserved ejection fraction undergoing TAVR

Background

Recently, the H2FPEF score has been developed in an evidence-based approach relying on simple clinical and echocardiographic variables. It enables the identification of patients with high probability of prevalent heart failure with preserved ejection fraction (HFpEF) which is associated with a dismal prognosis. Left ventricular diastolic dysfunction, a key mechanism in HFpEF, is also a common finding in patients with severe aortic stenosis.

Objective

To assess the prognostic impact of the H2FPEF score in patients with preserved ejection fraction and severe aortic stenosis undergoing Transcatheter Aortic Valve Replacement (TAVR).

Methods

Among 1148 patients with preserved ejection fraction who received TAVR at our institution between 2013 and 2018, data for calculation of the H2FPEF score was available in 535 patients. Score variables include BMI >30 kg/m2, arterial hypertension, atrial fibrillation, pulmonary hypertension >35 mmHg, age >60 years, and elevated LV filling pressure. Patients were dichotomized according to “low” (1–5 points; n=377) and “high” H2FPEF scores (6–9; n=158). Kaplan-Meier survival curves and Cox regression analyses were used to assess the prognostic impact of H2FPEF scores. Median follow-up time was 0.3 years.

Results

TAVR patients presenting with high H2FPEF scores had higher prevalence of moderate to severe mitral regurgitation (19.4% vs. 33.6%, p<0.001) as well as tricuspid regurgitation (15.2% vs. 35.1%, p<0.001), and presented with lower stroke volume index (42.2 ml/m2 vs. 36.0 ml/m2, p<0.001) compared to those with low H2FPEF scores. All-cause mortality one year after TAVR was significantly higher in patients in the high H2FPEF score group (10.5% vs. 21.0%, p=0.0019, Figure 1). Multivariate analysis revealed a high H2FPEF score to be independently predictive for 1-year all-cause mortality (HR 2.66, 95% CI: 1.41–5.02, p=0.025). Among the single H2FPEF score variables, atrial fibrillation (HR 3.45, 95% CI: 1.86–6.40, p<0.001) and systolic pulmonary hypertension >55 mmHg (HR=2.68, 95% CI: 0.97–7.40, p=0.057) were strong independent predictors of adverse outcome.

Figure 1. All-cause mortality of patients undergoing TAVR after one year stratified by low (1–5 points) and high (6–9) H2FPEF score

Conclusion

An elevated H2FPEF score of >6 is independently predictive for mortality in patients with preserved ejection fraction undergoing TAVR for severe aortic stenosis. Our findings provide evidence that the H2FPEF score, which was meant for diagnostic use originally, is able to serve as a prognostic tool in patients with preserved ejection fraction undergoing TAVR, highlighting the adverse impact of diastolic dysfunction in patients with preserved ejection fraction and aortic stenosis.

P1848Prevalence and outcomes in patients with Heyde syndrome after transcatheter aortic valve implantation, a single centre experience

Introduction

Heyde syndrome is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. To date only few data exist regarding the prevalence of Heyde syndrome and results after transcatheter aortic valve implantation (TAVI) for the treatment of AS.

Purpose

We sought to evaluate the prevalence of Heyde syndrome in a routine clinical cohort of patients undergoing TAVI and analyze the effectiveness of treatment of AS regarding recurrent GIB in these patients.

Methods

We conducted a retrospective single-center analysis of 2545 consecutive patients who underwent TAVI for the treatment of AS in 2008–2017. Patients with a history of GIB were identified. The diagnosis of Heyde syndrome was defined as a clinical triad of presence of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia. GIB of unknown origin or related to other causes was defined as bleeding unrelated to angiodysplasia. Clinical outcomes of patients with Heyde syndrome were evaluated with emphasis on bleeding complications and recurrence of GIB.

Results

A history of GIB prior to TAVI was detected in 190 patients (7.5%) of the TAVI cohort. Among them, 143 patients had a GIB unrelated to angiodysplasia (5.6%) and 47 patients (1.8%) were diagnosed with Heyde syndrome. Median age and STS-PROM were 80.7 (75.3, 84.0) years and 4.7 (2.7, 9.0) respectively in Heyde patients. TAVI was successfully performed in all cases (66% endovascular access, 34% transapical access). The effective orifice areas increased from 0.8±0.1 cm2 to 2.1±0.5 cm2. Periprocedural major/life-threatening bleeding was found in 6 patients (12.8%), mainly access-related and none due to GIB. In 51% of Heyde-patients transfusion of 4.5±5.7 packed red blood cells was required during the index hospitalisation. During a mean follow-up of 12 months, recurrent GIB after TAVI was detected in 32% of patients with Heyde syndrome. In contrast only 18% of patients with GIB unrelated to angiodysplasia (Non-Heyde) had recurrent GIB after TAVI. In patients diagnosed with Heyde syndrome and recurrent GIB after TAVI the rate of residual mild or moderate paravalvular regurgitation was higher compared to those with an unremarkable course (73% vs. 37%, p=0.045).

Figure 1. 1-year Follow-Up

Conclusions

A relevant number of patients presenting for treatment of AS can be diagnosed with Heyde syndrome. In these patients TAVI can be successfully performed with moderate incidence of periprocedural bleeding complications but significant transfusion rates. Regardless of successful treatment of AS, recurrent GIB was detected in a significant number of Heyde patients during follow-up. The possible association with residual paravalvular regurgitation requires further investigation to improve treatment options in patients with Heyde syndrome.

Neurotrophic Effect of Fish-Lecithin Based Nanoliposomes on Cortical Neurons

Lipids play multiple roles in preserving neuronal function and synaptic plasticity, and polyunsaturated fatty acids (PUFAs) have been of particular interest in optimizing synaptic membrane organization and function. We developed a green-based methodology to prepare nanoliposomes (NL) from lecithin that was extracted from fish head by-products. These NL range between 100–120 nm in diameter, with an n-3/n-6 fatty acid ratio of 8.88. The high content of n-3 PUFA (46.3% of total fatty acid content) and docosahexanoic acid (26%) in these NL represented a means for enrichment of neuronal membranes that are potentially beneficial for neuronal growth and synaptogenesis. To test this, the primary cultures of rat embryo cortical neurons were incubated with NL on day 3 post-culture for 24 h, followed by immunoblots or immunofluorescence to evaluate the NL effects on synaptogenesis, axonal growth, and dendrite formation. The results revealed that NL-treated cells displayed a level of neurite outgrowth and arborization on day 4 that was similar to those of untreated cells on day 5 and 6, suggesting accelerated synapse formation and neuronal development in the presence of NL. We propose that fish-derived NL, by virtue of their n-3 PUFA profile and neurotrophic effects, represent a new innovative bioactive vector for developing preventive or curative treatments for neurodegenerative diseases.

Preparation, Characterization, and Release Kinetics of Chitosan-Coated Nanoliposomes Encapsulating Curcumin in Simulated Environments

Curcumin, a natural polyphenol, has many biological properties, such as anti-inflammatory, antioxidant, and anti-carcinogenic properties, yet, its sensitivity to light, oxygen, and heat, and its low solubility in water renders its preservation and bioavailability challenging. To increase its bioaccessibility, we fabricated nanoliposomes and chitosan-coated nanoliposomes encapsulating curcumin, and we evaluated the systems in terms of their physicochemical characteristics and release profiles in simulated gastrointestinal mediums. Chitosan-coating enhanced the stability of nanoliposomes and slowed the release of curcumin in the simulated gastrointestinal (GI) environment. This study demonstrates that nanoliposomes and chitosan-coated nanoliposomes are promising carriers for poorly soluble lipophilic compounds with low oral bioavailability, such as curcumin.

Virus Infection and Blood Coagulation

By means of a new model, the fowl plague of chickens, further evidence is given that viruses may trigger blood coagulation. Macroscopically, hemorrhages were observed, whereas microscopic studies revealed platelet and fibrin thrombi in the small vessels of various organs. Hematologic studies demonstrated an increase in the clotting time and a decrease in the activities of clotting factors I, II, VIII and X, and drop in platelet counts. Heparin could diminish the hemorrhages but did not influence the survival time of the animals.

Effect of Boiling and roasting on lipid quality, proximate composition, and mineral content of walnut seeds (Tetracarpidium conophorum) produced and commercialized in Kumba, South-West Region Cameroon

The effect of boiling and roasting on the lipid quality, proximate composition, and mineral content of African walnut seeds (Tetracarpidium conophorum) was assessed. Results indicated that the quality of walnut oil significantly (p < .05) reduces with the treatments. Oils extracted from DBWN 60 min (Dried and boiled walnuts 60 min) and FBWN 60 min (Boiled fresh walnuts 60 min) were the most altered. The proximate composition and mineral content of walnut seeds was also significantly affected (p < .05) by the treatments. This study reveals that, thermal processing has significant effects on the nutrients and quality of lipids of walnut oil. DTRWN 60 min (Dried and traditionally roasted walnuts 60 min), DORWN 60 min (Dried and oven roasted walnuts 60 min), and TRFWN 30 min (traditionally roasted fresh nuts 30 min) are the best methods for cooking walnut because they preserve the quality of its lipids and some of the nutrients.

The wearable cardioverter defibrillator as a bridge to reimplantation in patients with ICD or CRT-D-related infections

Background

The approach to treat device infection in patients with implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) is a challenging procedure. Optimal treatment is complete extraction of the infected device. To protect these patients from sudden cardiac arrest while waiting for reimplantation and to avoid recurrent infection, a wearable cardioverter defibrillator (WCD) seems to be a valuable solution.

Therefore, we investigated the management and outcome of patients with ICD or CRT-D infections using the WCD as a bridge to re-implantation after lead extraction procedures.

Methods

We conducted a retrospective study on consecutive patients who underwent ICD or CRT-D removal due to device-related local or systemic infections. All patients were prescribed a WCD at our center between 01/2012 and 10/2015. All patients returned to our outpatient clinic for regular ICD or CRT-D monitoring initially 1 and 3 months after reimplantation followed by 6-months intervals.

Results

Twenty-one patients (mean age 65.0 ± 8.0 years, male 76.2%) were included in the study. Complete lead extraction was achieved in all patients. While waiting for reimplantation one patient experienced a symptomatic episode of sustained ventricular tachycardia. This episode was converted successfully into sinus rhythm by a single 150 J shock.

Mean follow-up time 392 ± 206 days, showing survival rate of 100% and freedom from reinfection in all patients.

Conclusion

The WCD seems to be a valuable bridging option for patients with ICD or CRT-D infections, showing no recurrent device infection.

Effect of refrigeration time on the lipid oxidation and fatty acid profiles of catfish (

The effects of refrigeration at 4 °C during 9 days on the quality and stability of catfish oil were evaluated using a change in fatty acid composition by gas chromatography (GC), commonly used analytical indexes (acid and peroxide values), and analysis by Fourier transform infrared (FTIR) spectroscopy. The results revealed that lipid deterioration, hydrolysis and oxidation occurred throughout the cold storage (4 °C). Refrigeration induced the lipolysis of triglycerides by lipases and phospholipases. It also affected the fatty acids composition of the catfish. The progressive loss of unsaturation was monitored by the decrease in the absorbance band at 3012 cm-1 on FTIR spectra and the lowest value was observed in the catfish muscle at 9 days of refrigeration. Eicosapentaenoic C20:5ω3 (EPA) and docosahexaenoic C22:6ω3 (DHA) acids were the polyunsaturated fatty acids most affected during refrigeration. Refrigeration for less than 5 days was found to be the best conditions for the preservation of the catfish.