Sensitization to genuine markers of timothy grass pollen (Phleum pratense) in the North-Central region of Portugal

Summary

Background. Pollen is the main cause of respiratory allergy and its prevalence is increasing. Timothy grass (Phleum pratense) is one of the most common pollen sources, and one of the best characterized allergenic grasses. The major allergens Phl p1, Phl p2, Phl p5 and Phl p6 are considered markers of genuine grass pollen sensitization. Methods. Retrospective study. IgE levels of Phl p1 and Phl p5 in patients living in the North-Central region of Portugal were analyzed, considering age and area of residence (inland or costal). Results. Among the 188 patients with IgE results for Phl p1 and Phl p5, sensitization to Phl p1 and Phl p5b was observed in 97.87% and 63.83%, respectively. The majority demonstrated co-sensitization to both Phl p1 and Phl p5b, while 68 patients were monosensitized to Phl p1 and 4 patients were monosensitized to Phl p5b. Either patients living in costal or inland areas showed IgE levels of Phl p1 higher than Phl p5b. Conclusions. Regarding genuine grass pollen sensitization, Phl p1 sensitization is more prevalent than Phl p5b in the North-Central region of Portugal.

Molecular profiling in bee venom allergy: clinical and therapeutic characterization in a Portuguese cohort

Summary

Background. Bee venom allergy (BVA) can trigger local and systemic allergic reactions, including anaphylaxis. Recently, the molecular sensitization profile has gained importance in the reaction's stratification and venom immunotherapy (VIT). Methods. Retrospective analysis of patients with hypersensitivity to BVA, confirmed by specific sIgE to Apis mellifera ≥0.35 kU/L and/or positive skin tests to bee venom commercial extract, evaluated in specialized consultation. Demographic, clinical, and laboratory data (including molecular Api m 1, 4, and 10) were analyzed, looking for risk factors associated with the severity of the index reaction and reactions during VIT. Results. 93 patients were included (55.9% male; median age of 46 years), 57.3% with atopic comorbidities, and 23.4% with cardiovascular comorbidities. The median specific IgE to Apis mellifera was 6.7 kU/L (IQR 1.0-20.3) kU/L. Regarding the molecular profile, the median IgE to Api m 1 was 0.5 kU/L (57.5% positive out of all measurements); Api m 4 - 0.01 kU/L (11.9% positive), and Api m 10 - 0.3 kU/L (50.0% positive). No patient was monosensitized to Api m 4. The median age of the most severe sting reaction was 36 (IQR 26-48) years, with a median severity (Müeller scale) of 3 (IQR 2-3). Forty-seven patients (50.5%) underwent VIT, with 35.6% of reactions recorded. Allergic reactions during VIT were recorded in 35.6% of cases. The severity of the index reaction correlated positively with older ages (p=0.040; r=0.249), in contrast to monosensitization to Api m 1, which was an independent predictor of milder reactions (p=0.015). Sensitization to Api m 10 was associated with a higher likelihood of reactions during VIT (p=0.038) but potentially less systemic reactions at re-stings (p=0.097). Conclusions. Molecular sensitization profile appears to be relevant not only to the severity of index reactions but also during VIT. Studies of a large cohort of patients with molecular profiles are essential to validate these results and improve the clinical and therapeutic approach to BVA.

MO653: High-Flux Haemodialysis and Haemodiafiltration: A Comparative Study Based on 1-H NMR Serum Metabolic Profile

BACKGROUND AND AIMS

Patients with chronic kidney disease (CKD) accumulate uraemic toxins (UTs). When compared to other conventional dialysis modalities, high volume haemodiafiltration (HDF) improves the removal of medium and low molecular weight UTs. The present study is a post-hoc analysis comparing the metabolomic profile in serum from patients under high flux HD (hf-HD) and HDF in HDFIT, a multicentric randomized controlled trial (RCT).

METHOD

Random (pre- and post-dialysis) samples from nine patients in a study arm were selected at baseline and at the end of the follow-up. To compare the samples, 26 possibly matching metabolites were identified by a t-test among the four groups using 1-H nuclear magnetic resonance (NMR).

To evaluate the comparison between the modalities in a single treatment session, the clearance rates (CRs) of each metabolite were calculated based on pre- and post-dialysis samples. In addition, to evaluate the effect of UTs removal during the trial follow-up period, the pre-dialysis metabolite concentrations both at the baseline and 6 months were compared with the two arms of the study.

RESULTS

Evaluating the concentrations of the metabolites during the follow-up period for each study arm, it was possible to assess the effects of UTs removal during the study for each modality. The comparison of the intensity of the peaks identified 26 possible metabolites that differentiated hf-HD and HDF in this timeframe. The correlation (see Figure 1a) then suggested that the peak integrals of 16 of these metabolites increased from baseline to 6 months in the hf-HD, but not in the HDF arm. Amongst the metabolites, several are involved in important metabolic pathways, such as the metabolisms of phenylalanine and the biosynthesis of phenylalanine, tyrosine and tryptophan, which both relate to UTs and the development of cardiovascular diseases. The peak integration relative to glycolic acid was significantly higher (P<.05) at 6 months than at baseline (see Figure 1b) in the hf-HD than in the HDF arm, which has been related to an increased number of renal failure and of renal insufficiency cases [1,2], as well as it related to liver damage [3].

CONCLUSION

The concentrations of metabolites related both to CKD and associated pathologies were stable in the HDF arm only during the follow-up period, suggesting enhancement of the long-term stability by this method. In the hf-HD long-term follow-up, the relative increase in the glycolic acid peak integration area, which is related to the metabolite concentration, has also previously been linked to an increased number of renal failures and renal insufficiency cases and to liver damages.

Comparative metabolomic study of high-flux hemodialysis and high volume online hemodiafiltration in the removal of uremic toxins using 1H NMR spectroscopy

Uremic toxins (UTs) accumulate in the circulation of patients with chronic kidney disease (CKD). High volume hemodiafiltration (HDF) improves clearance of low and medium molecular weight UTs compared to HD. The present study is a post-hoc analysis comparing the metabolomic profile in serum from patients under high flux HD (hf-HD) and HDF in HDFIT, a multicentric randomized controlled trial (RCTs). Per protocol, serum samples were collected pre- and post- dialysis treatments at randomization (baseline) and at the end of the follow up (6 months) and stored in a biorepository. Random (pre- and post-dialysis) samples from nine patients in study arm were selected at baseline and at the end of the follow up. To compare the samples, 26 possibly matching metabolites were identified by a t-test among the four groups using ¹H nuclear magnetic resonance (NMR). To evaluate the comparison between the modalities is a single treatment session, the clearance rates (CRs) of each metabolite were calculated based on pre-dialysis and post-dialysis samples. In addition, to evaluate to effect of UT removal during the trial follow up period, the pre-dialysis metabolite concentrations at the baseline and at 6 months were compared among the two arms of the study. There was no significant difference between in the single session CRs of metabolites when hf-HD and HDF were compared. On the other hand, the comparison between baseline and 6-month (long-term evolution) led to the identification of 16 metabolites that differentiated the hf-HD and the HDF evolutions. Most of these 16 metabolites are involved in several important metabolic pathways, such as metabolism of phenylalanine and biosynthesis of phenylalanine, tyrosine, and tryptophan, which are related to UTs and cardiovascular disease development. Although no difference was observed between hf-HD and HDF samples before and after a single session, concentrations of CKD-relevant metabolites and associated pathologies were stable in the HDF samples, but not in the hf-HD samples, over the six-month period, suggesting that HDF enhances long-term stability.

Occupational management of healthcare workers exposed to COVID-19

BACKGROUND

The year 2020 was marked by the new coronavirus pandemic, resulting in millions of cases and deaths, placing healthcare workers at high risk of infection.

AIMS

The aim of this study was to describe the role of an occupational health service during coronavirus disease 2019 pandemic in an oncologic hospital and characterize the most likely sources of viral infection.

METHODS

The information of all healthcare workers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from 11 March to 15 December 2020 was collected through an epidemiological survey conducted during contact tracing. The data extracted included gender, age, comorbidities, occupational group, source of infection, clinical presentation, duration of the disease, need for hospitalization and persistent or late symptoms after disease or upon returning to work.

RESULTS

Out of a total of 2300 workers, 157 were infected, consisting of nurses (36%), nurse assistants (33%) and diagnostic and therapeutic professionals (10%). Physicians and administrative staff accounted for 8% each. The most frequently reported source of infection was occupational (43%), owing to worker-to-worker transmission (45%) and patient-to-worker transmission (36%). The most frequent moments of infection perceived corresponded to the removal of protective equipment during meals and moments of rest in the staff and changing rooms.

CONCLUSIONS

The study revealed that occupational transmission from patients and colleagues might be an important source of SARS-CoV-2 infection in healthcare workers. Spread between colleagues accounted for 45% of the occupational source infections reported. Implementing physical distancing measures and limiting the number of people in changing and rest rooms could significantly reduce infection and related absenteeism.

MO017THERAPEUTICAL POTENTIAL OF ENZYME REPLACEMENT: NEW INSIGHTS AND PERSPECTIVES IN HUMAN ENDOTHELIAL CELLS TREATED WITH CHLOROQUINE

Background and Aims

COVID-19 is a pandemic with no end in sight. There is only one approved antiviral agent but global stocks are deemed insufficient. Despite in vitro antiviral activity, clinical trials of chloroquine and hydroxychloroquine were disappointing, and they may even impair outcomes. Chloroquine causes zebroid deposits reminiscent of Fabry disease (α-galactosidase A deficiency) and endothelial cells are key targets of COVID-19. The study aims to investigate in vitro the effect of enzyme replacement therapy (ERT) in chloroquine-induced endothelial dysfunction.

Method

We have explored the effect of chloroquine on cultured endothelial cells and its modulation by recombinant α-galactosidase A (agalsidase-β). Following dose-response studies, 0.5 μg/mL chloroquine was added to cultured human endothelial cells. Neutral red and Lysotracker were used to assess lysosomes. Cytotoxicity was evaluated by the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide) - MTT assay and cell stress by assessing reactive oxygen species (ROS) and nitric oxide (NO). In endothelial cells, chloroquine induced dose-dependent cytotoxicity at in vitro test concentrations for COVID-19 therapy.

Results

Chloroquine significantly induced the accumulation of acid organelles (P<0.05), increased ROS levels, and decreased NO production (P<0.05), in vitro. These adverse effects of chloroquine on endothelial cell biology were decreased by agalsidase-β (P<0.05).

Conclusion

Chloroquine-induced endothelial cell cytotoxicity and stress is attenuated by agalsidase-β treatment. This suggests that endothelial cell injury may contribute to the failure of chloroquine as therapy for COVID-19 and may be at least in part related to causing dysfunction of the lysosomal enzyme α-galactosidase A.

Chest CT imaging features of COVID-19 pneumonia: First radiological insights from Porto, Portugal

INTRODUCTION

The outbreak of a highly infectious respiratory disease - COVID-19 - has spread globally and a novel type of coronavirus (SARS-CoV-2) was identified as its cause. Chest CT findings have been described as an aid for COVID-19 diagnosis and management. We aimed to describe the CT imaging characteristics in a group of COVID-19 patients while we also intended to assess if any of these radiological features were associated with short-term prognosis.

MATERIALS AND METHODS

CT examinations from 164 consecutive patients with at least one positive RT-PCR nucleic acid assay for SARS-CoV-2 were retrospectively analyzed. Numerous CT imaging features were recorded independently by two radiologists. Patients were grouped according to their status 14 days after the initial CT scan in either discharged/hospitalized in a non-ICU ward (favorable prognosis group) versus deceased/admitted to an intensive care unit (unfavorable prognosis group).

RESULTS

Ground-glass opacities (89.0 %) and consolidations (73.2 %) with multilobar involvement were the predominant imaging findings, while a nodular pattern (3.7 %) and cavitation (1.2 %) were uncommon. Mean age was higher in the mortality/ICU group. Ground-glass opacities and consolidations were dominant in both groups, but distribution pattern of abnormalities was different, being more often diffuse in the mortality/ICU group. Linear opacities and opacities that were rounded in shape were more frequently observed in the favorable prognosis group. CT severity index was significantly higher in the mortality/ICU group. For assessing unfavorable prognosis, the best cut-off for CT severity index was 24 (sensitivity 78 %; specificity 59 %). Interobserver agreement for all CT findings was excellent.

CONCLUSION

COVID-19 pneumonia in Porto, Portugal, manifests as multilobar ground-glass opacities and consolidations. Older age, diffuse distribution and increasing CT severity index are associated with worse short-term prognosis while linear opacities resembling organizing pneumonia and rounded opacities herald a more favorable prognosis.

SAT0593 ANA TESTING IN THE (VERY) ELDERLY: EXPECTATION VERSUS REALITY

Background:

Antinuclear antibodies (ANA) are frequently used as a screening tool for systemic autoimmune rheumatic diseases (SARD), although they are also present in 10-15% of the adult healthy population. SARD have their peak incidence in the young/ middle-aged adult. As age progresses, the incidence of SARD decreases while the prevalence of ANA tends to increase, with some series reporting up to 30% prevalence in older ages1.

Objectives:

To determine the clinical significance and utility of ANA testing in a population over 85 years of age.

Methods:

We conducted a retrospective study of patients over the age of 85 who underwent ANA testing due to a SARD suspicion at our hospital autoimmunity laboratory, from 2011 to 2018. Justification for ANA request was collected from patient’s clinical records. Patients with pre-established diagnosis of SARD and patients with no justification given for ANA request were excluded from the analysis. ANA titer (positive ≥ 1:160) and cellular staining patterns were assessed by indirect immunofluorescence (Hep-2 cells).

Results:

Ages ranged from 85 to 98 years, with 58.8% being females. The prevalence of ANA in this population was 61.5%, mostly in lower titers (1:160 in 45.0%, 1:320 in 31.9%, 1:640 in 20.3% and 1:1280 in 2.7%). Dense fine speckled pattern was by far the most common cellular staining pattern (79.1%). A suspicion of SARD was the reported reason for ANA testing in 34,5% (n=296) of the 854 patients submitted to this test. The main clinical clues justifying SARD suspicion were: arthralgia/arthritis (11.9%), thrombocytopenia (10.0%), pancytopenia (10.0%), spotless fever (8.2%), interstitial lung disease (4.8%), pleural (6.1%) and pericardial (4.1%) effusion. Over a median follow-up of 1.0 year, 10 patients (3.4%) were diagnosed with a SARD, only one being an ANA-related disease: 5 cases of polymyalgia rheumatica, 2 cases of rheumatoid arthritis, 1 case of giant cell arteritis, 1 case of Sjogren syndrome and 1 case of sarcoidosis. In 60% of patients with a confirmed SARD, the main reason for suspicion was the presence of arthralgia/ arthritis. Positive ANA testing showed a 90.0% sensitivity and a 39.6% specificity for SARD. This translates into a positive predictive value of 5.0%.

Conclusion:

ANA are highly prevalent in elderly patients under SARD suspicion, while the incidence of SARD is very low, which explains the low positive predictive value of ANA testing. Interestingly, only one among the ten cases of SARD confirmed was indeed an ANA-related disease (Sjogren syndrome).

References:

[1]Selmi C, Ceribelli A, Generali E, et al. Serum antinuclear and extractable nuclear antigen antibody prevalence and associated morbidity and mortality in the general population over 15 years.Autoimmun Rev. 2016;15(2):162–166. doi:10.1016/j.autrev.2015.10.007

Disclosure of Interests:

Mariana Luis: None declared, Anália Carmo: None declared, Rosário Cunha: None declared, José Antonio P. da Silva Grant/research support from: Pfizer, Abbvie, Consultant of: Pfizer, AbbVie, Roche, Lilly, Novartis, Tânia Santiago: None declared

P1057UNTARGETED 1H NMR-BASED SERUM METABOLIC PROFILE ANALYSIS OF PATIENTS TREATED WITH HIGH VOLUME HEMODIAFILTRATION (HDF)

Background and Aims

Uremic toxins (UTs) accumulate in the circulation of patients with chronic kidney disease (CKD), contributing to poor outcomes. One of the main objectives of renal replacement therapies is the removal of UTs, and while HD is restricted to the clearance of low molecular weight UTs, hemodiafiltration (HDF) adds efficiency to the removal of medium molecular weight UTs through the association of diffusion and convection methods. Metabolomic analysis from nuclear magnetic resonance (NMR) spectra offers efficient data about metabolites profile, indicating the main features of HDF, and possibly highlighting the positive effects of this modality. Thus, the aim of the present study is to evaluate the profile of metabolites in the circulation of a cohort of patients undergoing HDF.

Method

From 97 individuals participating in the HDF arm of a randomized control trial (ClinicalTrials.gov Identifier: NCT02787161), we randomly (using Python language; NumPy library) selected 6 patients (mean age 49, 6 males, 44% diabetics, average duration of 245 minutes, blood flow of 400 mL/min, target convective volume of 22 L per treatment). Patient’s serum samples were collected in the beginning of the study (baseline) and 6 months. The samples were prepared with deuterium oxide, sodium trimethylsilylpropanesulfonate as internal standard (ð=0.0 ppm), and further submitted to 1H NMR spectra recorded with Bruker 600 MHz AVANCE III spectrometer in order to identify the patient’s metabolomic profile. Data was evaluated with t-test and results were then compared with the Human Metabolome Database (HMDB) for descending order of the Jaccard similarity score.

Results

A total of 50 metabolites were investigated. Interestingly, 2 metabolites were significantly (P&lt;0.05) reduced in the serum after 6 months compared to baseline, acetate (3.3 ± 0.1) % and dimethylglyoxal (7.6 ± 0.1) % (Figure 1). In order to confirm the presence of these metabolites in human serum, further studies will be conducted with 2D 1H-13C-HSQCed NMR.

Conclusion

We observed a reduction of acetate and dimethylglyoxal levels after six months of HDF treatment, in comparison to baseline, most likely as a consequence of the increase in clearance of these molecules. Hypothetically these changes in solute removal could explain the positive effects of HDF on clinical outcomes, and further studies should address this potential benefit of the modality.

Heterozygous TERT gene mutation associated with familial idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease of unknown cause that occurs sporadically, but it can also occur in families and so named as Familial Pulmonary Fibrosis (FPF). Some forms of FPF overlaps IPF features, namely the radiological and histological pattern of usual interstitial pneumonia (UIP). Genetic and environmental factors commonly play an important role in the pathogenesis of FPF and the most commonly identified mutations involve the telomerase complex. Here, we report a rare case of FPF in a male at the age of 44, in whom genetic testing showed heterozygous variants for the telomerase reverse transcriptase gene (TERT). Our report highlights the importance of compiling a thorough family history in younger patients identified with UIP serving as a resource for identifying the current and future genetic links to disease. Families with UIP hold a great promise in defining UIP pathogenesis, potentially suggesting targets for the development of future therapies.

Organizing pneumonia revisited: insights and uncertainties from a series of 67 patients

Background: Organizing pneumonia (OP) is classified as an acute/subacute pneumonia according to the American Thoracic Society/European Respiratory Society statement (2013 update). Although its clinical presentation, radiologic and histologic features are well established, data on the relevance of potential causes, corticosteroid doses and length, or management of relapses are based on heterogeneous series of patients. Objectives: The aims of this study were to describe clinical presentation, diagnosis and treatment of OP, explore potential causes, discuss strategies for managing relapses, and analyze prognostic factors. We also discuss our findings in relation to relevant data in the literature. Methods: We performed a cross-sectional study of all patients diagnosed with OP at a tertiary referral center in northern Portugal between 2008 and 2015. Results: Sixty-seven patients were diagnosed with OP over the 7-year study period. Dyspnea and cough were the most common presenting symptoms and approximately 30% of patients were hospitalized at the time of diagnosis. Approximately half of the patients were receiving drugs described as potential causes of OP. Microorganisms were isolated in approximately one-third of patients. Other potential causes identified were hematologic disorders, neoplasms, connective tissue diseases, myelodysplastic syndromes, immunodeficiencies, radiotherapy, and bird exposure. Cryptogenic OP was diagnosed in just 16 patients (23.8%). Corticosteroids were the most common treatment and 11 patients (16.4%) experienced relapse. Conclusions: The findings for this series of patients confirm the extreme variability of the contexts in which OP can occur and suggest that rather than a distinct, homogeneous clinicopathologic entity, OP is a non-specific reaction whose outcomes are dependent on the cause. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 129-138).

Analysis of sarcoidosis in the Oporto region (Portugal)

BACKGROUND

Sarcoidosis is a systemic granulomatous disease of unknown etiology. Epidemiological studies of different populations are essential because clinical presentation, organ involvement, disease severity, and prognosis vary significantly according to region and population. The aim of this study was to assess epidemiological and clinical characteristics, staging factors, and clinical course in patients with sarcoidosis from a tertiary hospital in Oporto, Portugal.

METHODS

A retrospective analysis of patients with sarcoidosis and at least 2 years of follow-up evaluated at the Centro Hospitalar de São João between 2000 and 2014.

RESULTS

We identified 409 patients with sarcoidosis (females, 58.9%; mean age at diagnosis, 38.9±13.4 years; smokers, 14.4%]. All the patients were diagnosed according to the ERS/ATS/WASOG consensus statement and 64.1% had evidence of noncaseating epithelioid cell granulomas in biopsy specimens. Bronchoalveolar lavage was performed as part of the diagnostic work-up in 289 patients and 90.2% had lymphocytosis (CD4/CD8 ratio ≥3.5 in 60.9% of cases). Exertion dyspnea, cough, and constitutional symptoms were the most common presenting symptoms; 10.1% of patients were asymptomatic, 22.8% had Löfgren syndrome, and 50.5% had extrathoracic involvement. Radiographic stages of disease according to the Scadding criteria were as follows: stage 0 (5.2%), stage I (33.7%), stage II (47.0%), stage III (8.4%), and stage IV (5.7%). Impaired respiratory function was observed in 45.6% patients and was mostly mild. Systemic treatment was administered in 58.6% of cases. Overall, 45.3% of patients experienced disease resolution.

CONCLUSION

The epidemiological and clinical characteristics of this cohort of patients with sarcoidosis from the Oporto region in northern Portugal revealed epidemiological and clinical characteristics that were generally similar to those described in other Western Europe populations and in the US ACCESS study. However, we found a higher proportion of patients who progressed to chronic forms.

Survival of people living with HIV who defaulted from tuberculosis treatment in a cohort, Recife, Brazil

Background

Tuberculosis is a serious public health problem worldwide. It is the leading cause of death amongst people living with HIV, and default from tuberculosis (TB) treatment in people living with HIV increases the probability of death. The aim of this study was to estimate the survival probability of people living with HIV who default treatment for TB compared to those who complete the treatment.

Methods

This was a longitudinal cohort study of people living with HIV, from June 2007 to December 2013 with two components: a retrospective (for those who started tuberculosis treatment before 2013 for whom failure (death) or censoring occurred before 2013), and prospective (those who started tuberculosis treatment at any time between 2007 and June 2013 and for whom death or censoring occurred after the beginning of 2013), at two referral hospitals for people living with HIV (Correia Picanço Hospital - HCP and at Hospital Universitário Oswaldo Cruz – HUOC), in Recife/PE. A total of 317 patients who initiated TB treatment were studied. Default from TB treatment was defined as any patient who failed to attend their pre-booked return appointment at the health center for more than 30 consecutive days, in accordance with Brazilian Ministry of Health recommendations.

Results

From a cohort of 2372 people living with HIV we analyzed 317 patients who had initiated TB treatment. The incidence of death was 5.6 deaths per 100 persons per year (CI 95% 4.5 to 7.08). Independent factors associated with death: default from TB treatment 3.65 HR (95% CI 2.28 to 5.83); CD4 < 200 cells/mm³ 2.39 HR (95% CI 1.44 to 3.96); extrapulmonary tuberculosis 1.56 HR (95% CI 0.93 to 2.63); smoking 2.28 HR (95% CI 1.33 to 3.89); alcohol light 0.13 HR (95% CI 0.03 to 0.56).

Conclusion

The probability of death in people living with HIV who default TB treatment is approximately four times greater when compared to those who do not default from treatment.

In vitro expansion of human cardiac progenitor cells: exploring 'omics tools for characterization of cell-based allogeneic products

Human cardiac stem/progenitor cells (hCPCs) have been shown to be capable to regenerate contractile myocardium. However, because of their relative low abundance in the heart, in vitro expansion of hCPC is mandatory to achieve necessary quantities for allogeneic or autologous cardiac regeneration therapy applications (10(6)-10(9) cells/patient). Up to now, cell number requirements of ongoing phase I/IIa trials have been fulfilled with production in static monolayer cultures. However, this manufacturing process poses critical limitations when moving to the following clinical phases where hundreds of patients will be enrolled. For this, increased process yield is required, while guaranteeing the quality of the cell-based products. In this work, we developed and validated a robust, scalable, and good manufacturing practice (GMP)-compatible bioprocess for the expansion of high-quality hCPC. We applied platforms extensively used by the biopharmaceutical industry, such as microcarrier technology and stirred systems, and assessed culture conditions' impact on hCPC's quality and potency, as required by regulatory agencies. Complementary analytical assays including gene expression microarrays and mass spectrometry-based approaches were explored to compare transcriptome, proteome, surface markers, and secretion profiles of hCPC cultured in static monolayers and in stirred microcarrier-based systems. Our results show that stirred microcarrier-based culture systems enabled achieving more than 3-fold increase in hCPC expansion, when compared with traditional static monolayers, while retaining cell's phenotype and similar "omics" profiles. These findings demonstrate that this change in the production process does not affect cell's identity and quality, with potential to be translated into a transversal production platform for clinical development of stem-cell therapies.

Beyond central adiposity: liver fat and visceral fat area are associated with metabolic syndrome in morbidly obese patients

BACKGROUND

Despite its widespread clinical use, both body mass index (BMI) and waist circumference have been reported as inaccurate methods to measure abdominal obesity. The main objective of this study was to determine the relation between visceral fat area and fatty liver infiltration with the expression of metabolic syndrome (MS) in morbidly obese patients.

METHODS

We recruited a random selection of 100 morbidly obese patients on pre-operative evaluation for bariatric surgery. A pre-operative CT slice at L4-L5 level, was performed to measure visceral fat and at T12 level to measure hepatic attenuation.

RESULTS

Patients with MS had lower hepatic attenuation values (median 49.9 vs 55.5HU; p = .018) and had more VAT (242 vs 172 cm(2);p = .001). Conventional measures (BMI: p = .729 and waist circumference: p = .356), were not useful in discriminating morbidly obese patients with MS. By multivariable logistic regression, fatty liver infiltration (OR = 5.3; p = .03) and age (OR = 1.08; p = .04) were the only factors independently related to the presence of MS. MS prevalence was 100%, 71% and 55%, respectively for patients with both fatty liver and visceral adiposity; one; or none of this findings (AUC - .715; p = .016).

CONCLUSION

CT scan seems to measure 2 important markers of MS: visceral adiposity and hepatic fatty infiltration. In morbidly obese patients, both visceral adiposity and hepatic fatty infiltration increase the risk for the presence of MS.

Inhibition of norovirus replication by the nucleoside analogue 2'-C-methylcytidine

We here report on the activity of 2'-C-methylcytidine (2CMC) [a nucleoside polymerase inhibitor of the hepatitis C virus (HCV)] on the in vitro replication of (murine) norovirus (MNV). 2CMC inhibits (i) virus-induced CPE formation, (ii) viral RNA synthesis and (iii) infectious progeny formation with EC(50) values of ∼2μM. 2CMC acts at a time-point that coincides with the onset of viral RNA synthesis. Even following 30 passages of selective pressure no MNV-resistant virus was selected, which is in line with the high barrier to resistance of the nucleoside analogue for HCV. When combined with the broad-spectrum RNA virus inhibitor ribavirin, a marked antagonistic activity was observed indicating that these molecules should not be combined for the treatment of norovirus infections. Our results suggest that 2'-C-methyl nucleoside analogues should be further explored for the treatment and prophylaxis of norovirus infections.