The Peptide Antibiotic Corramycin Adopts a β-Hairpin-like Structure and Is Inactivated by the Kinase ComG

The rapid development of antibiotic resistance, especially among difficult-to-treat Gram-negative bacteria, is recognized as a serious and urgent threat to public health. The detection and characterization of novel resistance mechanisms are essential to better predict the spread and evolution of antibiotic resistance. Corramycin is a novel and modified peptidic antibiotic with activity against several Gram-negative pathogens. We demonstrate that the kinase ComG, part of the corramycin biosynthetic gene cluster, phosphorylates and thereby inactivates corramycin, leading to the resistance of the host. Remarkably, we found that the closest structural homologues of ComG are aminoglycoside phosphotransferases; however, ComG shows no activity toward this class of antibiotics. The crystal structure of ComG in complex with corramycin reveals that corramycin adopts a β-hairpin-like structure and allowed us to define the changes leading to a switch in substrate from sugar to peptide. Bioinformatic analyses suggest a limited occurrence of ComG-like proteins, which along with the absence of cross-resistance to clinically used drugs positions corramycin as an attractive antibiotic for further development.

1-deoxy-D-xylulose-5-phosphate synthase from Pseudomonas aeruginosa and Klebsiella pneumoniae reveals conformational changes upon cofactor binding

The ESKAPE bacteria are the six highly virulent and antibiotic-resistant pathogens that require the most urgent attention for the development of novel antibiotics. Detailed knowledge of target proteins specific to bacteria is essential to develop novel treatment options. The methylerythritol-phosphate (MEP) pathway, which is absent in humans, represents a potentially valuable target for the development of novel antibiotics. Within the MEP pathway, the enzyme 1-deoxy-D-xylulose-5-phosphate synthase (DXPS) catalyzes a crucial, rate-limiting first step and a branch point in the biosynthesis of the vitamins B1 and B6. We report the high-resolution crystal structures of DXPS from the important ESKAPE pathogens Pseudomonas aeruginosa and Klebsiella pneumoniae in both the co-factor-bound and the apo forms. We demonstrate that the absence of the cofactor thiamine diphosphate results in conformational changes that lead to disordered loops close to the active site that might be important for the design of potent DXPS inhibitors. Collectively, our results provide important structural details that aid in the assessment of DXPS as a potential target in the ongoing efforts to combat antibiotic resistance.

Unusual peptide-binding proteins guide pyrroloindoline alkaloid formation in crocagin biosynthesis

Ribosomally synthesized and post-translationally modified peptide natural products have provided many highly unusual scaffolds. This includes the intriguing alkaloids crocagins, which possess a tetracyclic core structure and whose biosynthesis has remained enigmatic. Here we use in vitro experiments to demonstrate that three proteins, CgnB, CgnC and CgnE, are sufficient for the production of the hallmark tetracyclic crocagin core from the precursor peptide CgnA. The crystal structures of the homologues CgnB and CgnE reveal them to be the founding members of a peptide-binding protein family and allow us to rationalize their distinct functions. We further show that the hydrolase CgnD liberates the crocagin core scaffold, which is subsequently N-methylated by CgnL. These insights allow us to propose a biosynthetic scheme for crocagins. Bioinformatic analyses based on these data led to the discovery of related biosynthetic pathways that may provide access to a structurally diverse family of peptide-derived pyrroloindoline alkaloids.

Pineapple Lectin AcmJRL Binds SARS-CoV-2 Spike Protein in a Carbohydrate-Dependent Fashion

The highly glycosylated spike protein of SARS-CoV-2 is essential for infection and constitutes a prime target for antiviral agents and vaccines. The pineapple-derived jacalin-related lectin AcmJRL is present in the medication bromelain in significant quantities and has previously been described to bind mannosides. Here, we performed a large ligand screening of AcmJRL by glycan array analysis, quantified the interaction with carbohydrates and validated high-mannose glycans as preferred ligands. Because the SARS-CoV-2 spike protein was previously reported to carry a high proportion of high-mannose N-glycans, we tested the binding of AcmJRL to the recombinantly produced extraviral domain of spike protein. We could demonstrate that AcmJRL binds the spike protein with a low-micromolar K_D in a carbohydrate-dependent fashion.

A review on the potential of empty fruit bunch (EFB) compost as growing medium for oil palm seedling production

The oil palm industry is among the important sectors in Malaysia. The productions of palm oil keep increasing year by year due to high demand from other countries, generating an abundance of wastes from the field and the mill. These wastes may significantly affect the environment. Composting is one of the methods to reduce the volume of waste. The compost material is widely used especially in agriculture activities due to its properties which have been enhanced during the composting process. Empty fruit bunch (EFB) compost mostly returns to the soil as mulch to conserve soil moisture and acts as organic fertilizer since it contains high nutrients needed by the plant. Currently, the depletion of fertile soil leads to less availability of growing medium, especially in the nursery. The properties of the growing medium are important to ensure better root development of seedlings and subsequently affect the overall plant growth. Therefore, numerous studies have been conducted to identify the suitable growing medium as a substitute for topsoil which is currently limited to raising seedlings in the nursery. This review examines the current methods of composting EFB and provides summarized research information on the effect of EFB compost on oil palm seedling growth. The oil palm wastes that are properly managed could produce value-added by-products and promotes sustainable agriculture practices.

Semi-automated left ventricular endocardial detection versus hand-tracing in the measurement of left ventricular volumes and ejection fraction in daily clinical practice

Background

The common method of assessing left ventricle (LV) volumes and ejection fraction (EF) is hand-tracing Biplane Simpson method. Alternatively, ultrasound vendors offer different semi-automated LV endocardial border detection software with anatomical intelligence to assess LV volumes and EF. By using speckle-tracking technique, this software tracks the LV endocardium throughout the cardiac cycle and computes the LV volumes in every image frame using the disk summation method from which a volume-curve is generated, and the EF is calculated using the maximum and minimum volumes obtained. Data on the performance of this method in comparison with the hand-tracing Biplane Simpson method in daily clinical practice is scarce.

Purpose

To determine the accuracy of LV volumes and EF using semi-automated LV endocardial detection tracing, and to compare the reproducibility of this method with the hand-tracing Biplane Simpson method, among operators with varying level of experience in echocardiography.

Methods

This was a single center retrospective observational study, conducted in year 2020. 127 patients, aged >18 years, who underwent clinically indicated transthoracic echocardiography were recruited. The echocardiographic images were analyzed independently in a blinded fashion by 3 operators – a sonographer, a fellow-in-training and a cardiologist specialized in echocardiography. The LV volumes and EF were first measured using hand-tracing Biplane Simpson method, then repeated using semi-automated tracing at a different time and the operator were blinded to the initial hand-tracing measurements.

Results

The mean age of patients was 50±16 years, 35.4% were male, mean body surface area was 1.62±0.18m2, 92.1% were in sinus rhythm, and 61.4% had good acoustic window. Table 1 shows the LV end-diastolic volume (EDV), end-systolic volume (ESV) and EF, measured using different method, by the 3 operators. There were excellent correlation and agreement between semi-automated tracing measurements and hand-tracing measurements of LV EDV (r=0.985, LOA [mean ± 1.96 SD] 16.9 ml, ICC 0.991), ESV (r=0.990, LOA 12.7 ml, ICC 0.994) and EF (r=0.962, LOA 7.43%, ICC 0.967) by experienced cardiologist. The limit of agreement (LOA) between cardiologist and sonographer for semi-automated tracing measurement of LV EDV, ESV and EF were 29.13 ml, 19.74 ml and 9.25% respectively, which was comparable with that of hand-tracing measurement. The agreement between cardiologist and fellow-in-training for semi-automated tracing measurement of LV volumes and EF was slightly better than hand-tracing method, with a LOA of 25.60 ml, 17.48 ml and 7.08%, for EDV, ESV and EF respectively (Table 2).

Conclusion

In daily clinical practice, measurement of LV volumes and EF using semi-automated LV endocardial tracing method is accurate and demonstrates comparable reproducibility with hand-tracing Biplane Simpson method among operators with different level of experience in echocardiography.

Funding Acknowledgement

Type of funding sources: None.

Structure-Activity Relationship and Mode-Of-Action Studies Highlight 1-(4-Biphenylylmethyl)-1H-imidazole-Derived Small Molecules as Potent CYP121 Inhibitors

CYP121 of Mycobacterium tuberculosis (Mtb) is an essential target for the development of novel potent drugs against tuberculosis (TB). Besides known antifungal azoles, further compounds of the azole class were recently identified as CYP121 inhibitors with antimycobacterial activity. Herein, we report the screening of a similarity-oriented library based on the former hit compound, the evaluation of affinity toward CYP121, and activity against M. bovis BCG. The results enabled a comprehensive SAR study, which was extended through the synthesis of promising compounds and led to the identification of favorable features for affinity and/or activity and hit compounds with 2.7-fold improved potency. Mode of action studies show that the hit compounds inhibit substrate conversion and highlighted CYP121 as the main antimycobacterial target of our compounds. Exemplified complex crystal structures of CYP121 with three inhibitors reveal a common binding site. Engaging in both hydrophobic interactions as well as hydrogen bonding to the sixth iron ligand, our compounds block a solvent channel leading to the active site heme. Additionally, we report the first CYP inhibitors that are able to reduce the intracellular replication of M. bovis BCG in macrophages, emphasizing their potential as future drug candidates against TB.

Identification of N,N-arylalkyl-picolinamide derivatives targeting the RNA-binding protein HuR, by combining biophysical fragment-screening and molecular hybridization

Hu proteins are members of the RNA-binding protein (RBP) family and play a pivotal role in the regulation of post-transcriptional processes. Through interaction with selected mRNAs, RBPs regulate their function and stability; as a consequence, RBP dysregulation can cause abnormal translation of key proteins involved in several pathologies. In the past few years, this observation has sparked interest to develop new treatments against these pathologies by using small molecules able to modulate RBP activity. Among the four Hu proteins, we have directed our efforts towards the isoform HuR, which is mainly involved in cancer, inflammation and retinopathy. Aimed at developing compounds able to modulate the stability of HuR-mRNA complexes, in the present work, we applied a biophysical fragment screening by assessing a library of halogen-enriched heterocyclic fragments (HEFLibs) via Surface Plasmon Resonance (SPR) and Saturation Transfer Difference (STD) NMR to select promising fragments able to interact with HuR. One selected fragment and a few commercially available congeners were exploited to design and synthesize focused analogues of compound N-(3-chlorobenzyl)-N-(3,5-dihydroxyphenethyl)-4-hydroxybenzamide (1), our previously reported hit. STDNMR spectroscopy, molecular modeling, and SPR offered further insight into the HuR-small molecule interaction and showed that fragment-based approaches represent a promising and yet underexplored strategy to tackle such unusual targets. Lastly, fluorescence polarization (FP) studies revealed the capability of the new compounds to interfere with the formation of the HuR-mRNA complex. This is, to our knowledge, the first fragment-based campaign performed on the Hu protein class, and one of the few examples in the larger RBP field and constitutes an important step in the quest for the rational modulation of RBPs and related RNA functions by small molecules.

The human sialic acid-binding immunoglobulin-like lectin Siglec-9 and its murine homolog Siglec-E control osteoclast activity and bone resorption

Regulation of osteoclast differentiation and function is a central element in bone homeostasis. While the role of soluble factors, such as cytokines, hormones and growth factors, in controlling osteoclast differentiation has been intensively characterized, the function of surface receptors is less well understood. Sialic acid-binding immunoglobulin-like lectin (Siglec)-9 and its murine homolog Siglec-E are sialic acid-recognizing inhibitory receptors from the CD33-related Siglec-family and mainly expressed on myeloid cells. We found Siglec-9 and Siglec-E to be expressed at all stages of human and murine osteoclastogenesis, respectively. Siglec-E knockout mice displayed lower bone mass despite unchanged osteoclast numbers and an increased bone formation rate. Ex vivo osteoclast assays using Siglec-E knockout cells or a blocking antibody against human Siglec-9 confirmed the suppressive effect of Siglec-9/Siglec-E on osteoclast function. Although osteoclast numbers were unchanged or even slightly decreased, the blockade/absence of Siglec-9/Siglec-E resulted in an augmented resorption activity of mature osteoclasts. This increased resorption activity was associated with enlarged actin rings. Together, our results suggest Siglec-9/Siglec-E to inhibit osteoclast activation independently from osteoclast differentiation and thereby propose a new mechanism for the control of local bone resorption.

La présence simulée comme outil de gestion des troubles du comportement pour les résidents atteints de démence en institution : recommandations

En milieu institutionnel, les troubles du comportement des résidents atteints de démence restent essentiellement abordés via des approches pharmacologiques alors que de nombreuses solutions non médicamenteuses existent. Parmi celles-ci, la présence simulée consiste en un enregistrement sonore ou vidéo réalisé par des proches dans le but d’apaiser un résident présentant un trouble du comportement. La présence simulée est encore peu reconnue du fait, notamment, d’un manque d’information théorique et pratique. Le but de cet article est de proposer des recommandations pratiques et méthodologiques quant à la mise en place et à l’utilisation de la présence simulée. Ces recommandations se basent, d’une part, sur la littérature scientifique et, d’autre part, sur notre propre expérience clinique d’application de cet outil en institution pour résidents atteints de démence.

Making tiestalls more comfortable: III. Providing additional lateral space to improve the resting capacity and comfort of dairy cows

Dairy cows housed in tiestalls are restricted to one space; therefore, this space should be designed to accommodate all the activities cows need to perform. Lying is a very important behavior for dairy cows as well as a critical measure in the assessment of stall designs, to ensure that the cows' needs for resting space are met. The objective of this study was to determine if increasing tiestall width alters the lying behavior of lactating dairy cows. Two treatments were compared: the current recommendation (139 cm) and a double stall (284 cm). Sixteen cows were blocked by parity and lactation stage, then randomly allocated to a treatment and a stall within 1 of 2 rows in the research barn, for 6 wk. The average stall length was 188 cm. Leg-mounted accelerometers were used to record lying behaviors. Cows were video-recorded 24 h/wk using surveillance cameras positioned above the stalls. Video data from wk 1, 3, and 6 were extracted at a rate of 1 image/min and analyzed by a trained observer to assess the position and the location of the cow's body, head, and limbs during the lying hours. Lying behaviors and frequency of each position and location were analyzed in SAS (SAS Institute Inc., Cary, NC) using a mixed model in which treatment, block, and week were included as fixed factors, and cow and row as random factors. Multiple comparisons were adjusted using the Scheffé method. Results indicate that cows in double stalls fully extended their hindlimbs more often than single stall cows (21.7 vs. 7.6% of lying time). Cows in double stalls also intruded in the neighboring stalls with their hindlimbs less often (1.3 vs. 14.7% of lying time), instead positioning them inside their own stall more often (92.7 vs. 84.6% of lying time). Use of the second stall in the double stall group totaled 11.6, 5.1, 33.8, and 18.0% of lying time, respectively, for the head, front legs, hind legs, and body. Total lying time was not statistically different between double (716 min/d) and single stall (671 min/d) groups. Contacts with stall hardware during lying-down movements were also less frequent in double stalls (43.1 vs. 77.1% of lying events) compared with single stalls. These results suggest that dairy cows housed in double stalls modified their resting habits and used the extra space made available to them. Increasing stall width beyond the current recommendation is likely to benefit the cows by improving their ability to rest.

Making tiestalls more comfortable: II. Increasing chain length to improve the ease of movement of dairy cows

Although most farms in Canada still use tiestall housing for dairy cows, little information is available pertaining to cow comfort and behavior in such systems. Tiestalls are often criticized as they offer a reduced dynamic space to cows, thereby restricting their ability to move. The object of this study was to see if increasing the length of the tie chain provides cows with improved movement opportunities and to measure its effect on cows' rising and lying movements and behaviors. Two treatments were tested: the current recommendation of 1.00 m (recommended) and a longer chain of 1.40 m (long). Twenty-four cows (12/treatment) were blocked by parity number and lactation stage, then randomly allocated to a treatment and a stall within one of 2 rows in the research barn for 10 wk. Leg-mounted accelerometers were used to record lying behaviors and moments of transition between lying and standing positions for all cows. Cows were video-recorded for 24 h/wk using cameras positioned above the stall. The videos were used to evaluate the cows' rising and lying-down movements on wk 1, 2, 3, 6, 8, and 10. Six rising and 6 lying-down motions per cow per week were assessed by a trained observer to detect the presence of abnormal behaviors. Differences between and within treatments over time were analyzed in SAS (SAS Institute Inc., Cary, NC) using a mixed model with treatment, week, and block as fixed effects and with row and cow as random effects. Data from wk 1-3 were grouped together as the short-term effects, and those from wk 8-10 as the long-term effects. Week 6 was used as the mid-term assessment for analysis. Multiple comparisons between terms were accounted for using a Scheffé adjustment. Results indicate that duration of intention movements (exploratory head movements made by cows before lying down) is shorter in cows with longer chains (13.6 ± 1.03 s vs. 16.8 ± 1.01 s). It was also significantly shorter in the long term compared with the short term for both treatments (13.3 ± 0.92 s vs. 16.9 ± 0.81 s). These results suggest that increasing the chain length improves the cows' ease of movement and transitions, although all cows became more at ease in their surroundings with time. It may provide evidence of a potential way to improve the dynamic space provided to cows in tiestall systems, using a simple, affordable modification.

Making tiestalls more comfortable: I. Adjusting tie-rail height and forward position to improve dairy cows' ability to rise and lie down

The overall goal of the study was to develop new recommendations for tie-rail placement combining both vertical and horizontal positions to improve dairy cow welfare. Four treatments were tested: 2 new tie-rail positions that followed the natural neckline of cows when feeding and rising [neckline 1 (NL1), neckline 2 (NL2)], current recommendation (CR), and the average tie-rail position currently found on Quebec farms (current average on farm; CF). All other stall dimensions followed CR based on average cow size. Forty-eight cows blocked by parity and stage of lactation were randomly allocated to a treatment for 10 wk. Live scoring was performed weekly to evaluate injury, cow and stall cleanliness, and bedding quantity. Daily lying time, lying bout frequency, and lying bout duration were continuously recorded using leg-mounted accelerometers. Cows were recorded 1 d/wk by overhead cameras to evaluate lying down and rising events. Tie-rail placement did not affect cow and stall cleanliness, bedding quantity, and lying time. All tie-rail placements tested resulted in neck injuries with the position of neck injuries shifting based on the change in tie-rail placement: CR increased in proximal neck injuries (mean ± standard deviation, difference in injury score from baseline: +0.89 ± 0.153) compared with NL2 (+0.06 ± 0.153), but decreased in medial neck injuries (-0.11 ± 0.166) compared with NL2 (+0.78 ± 0.166) and NL1 (+0.53 ± 0.166). All treatments showed a decrease over time in average lying intention time (mean, difference between overall short- and long-term: -5.8 s/event), lying-down time (-1.1 s/event), contact with stall during lying (-32.5%), slipping during lying (-9.1%), backward movement on knees during rising (-10.9%), contact with tie-rail during rising (-14.3%), and overall abnormal rising (-15.6%) over time. Although lying and rising ability improved over time, abnormal lying and rising behaviors were still highly prevalent in the long term. Overall, our results show that dairy cows are limited in their ability to move within their environment without coming in contact with the stall confines (tie-rail and divider bars), warranting further research to determine alternatives to metal tie-rail bars, such as a flexible bar or chain, or provide fewer obstacles through the elimination of some stall hardware.

Characterization of the Stereoselective P450 Enzyme BotCYP Enables the In Vitro Biosynthesis of the Bottromycin Core Scaffold

Bottromycins are ribosomally synthesized and post-translationally modified peptide natural product antibiotics that are effective against high-priority human pathogens such as methicillin-resistant Staphylococcus aureus. The total synthesis of bottromycins involves at least 17 steps, with a poor overall yield. Here, we report the characterization of the cytochrome P450 enzyme BotCYP from a bottromycin biosynthetic gene cluster. We determined the structure of a close BotCYP homolog and used our data to conduct the first large-scale survey of P450 enzymes associated with RiPP biosynthetic gene clusters. We demonstrate that BotCYP converts a C-terminal thiazoline to a thiazole via an oxidative decarboxylation reaction and provides stereochemical resolution for the pathway. Our data enable the two-pot in vitro production of the bottromycin core scaffold and may allow the rapid generation of bottromycin analogues for compound development.

Enhancing glycan stability via site-selective fluorination: modulating substrate orientation by molecular design

Single site OH → F substitution at the termini of maltotetraose leads to significantly improved hydrolytic stability towards α-amylase and α-glucosidase relative to the natural compound. To explore the effect of molecular editing, selectively modified oligosaccharides were prepared via a convergent α-selective strategy. Incubation experiments in purified α-amylase and α-glucosidase, and in human and murine blood serum, provide insight into the influence of fluorine on the hydrolytic stability of these clinically important scaffolds. Enhancements of ca. 1 order of magnitude result from these subtle single point mutations. Modification at the monosaccharide furthest from the probable enzymatic cleavage termini leads to the greatest improvement in stability. In the case of α-amylase, docking studies revealed that retentive C2-fluorination at the reducing end inverts the orientation in which the substrate is bound. A co-crystal structure of human α-amylase revealed maltose units bound at the active-site. In view of the evolving popularity of C(sp³)–F bioisosteres in medicinal chemistry, and the importance of maltodextrins in bacterial imaging, this discovery begins to reconcile the information-rich nature of carbohydrates with their intrinsic hydrolytic vulnerabilities.

Single site OH → F substitution at the termini of maltotetraose leads to significantly improved hydrolytic stability towards α-amylase and α-glucosidase relative to the natural compound.

Biosynthesis of Cittilins, Unusual Ribosomally Synthesized and Post-translationally Modified Peptides from Myxococcus xanthus

Cittilins are secondary metabolites from myxobacteria comprised of three l-tyrosines and one l-isoleucine forming a bicyclic tetrapeptide scaffold with biaryl and aryl-oxygen-aryl ether bonds. Here we reveal that cittilins belong to the ribosomally synthesized and post-translationally modified peptide (RiPP) family of natural products, for which only the crocagins have been reported from myxobacteria. A 27 amino acid precursor peptide harbors a C-terminal four amino acid core peptide, which is enzymatically modified and finally exported to yield cittilins. The small biosynthetic gene cluster responsible for cittilin biosynthesis also encodes a cytochrome P450 enzyme and a methyltransferase, whereas a gene encoding a prolyl endopeptidase for the cleavage of the precursor peptide is located outside of the cittilin biosynthetic gene cluster. We confirm the roles of the biosynthetic genes responsible for the formation of cittilins using targeted gene inactivation and heterologous expression in Streptomyces ssp. We also report first steps toward the biochemical characterization of the proposed biosynthetic pathway in vitro. An investigation of the cellular uptake properties of cittilin A connected it to a potential biological function as an inhibitor of the prokaryotic carbon storage regulator A (CsrA).

The prevention of female genital mutilation in England: what can be done?

BACKGROUND

Female genital mutilation (FGM) is a global public health issue. Women in the UK are at risk of FGM and its adverse health consequences but little is known about its practice. Since 1985 it has been a criminal offence to perform FGM in the UK and further legislation has tightened the law but FGM continues.

METHODS

Four community researchers from the Kenyan, Nigerian, Somalian and Sudanese communities in Oxford conducted focus groups and interviews with 53 people to understand the communities' beliefs about how best to prevent FGM.

RESULTS

Participants believed that the current UK legislation alone was not sufficient to tackle FGM and might in fact be counterproductive by alienating communities through its perceived imposition. They felt that there had been insufficient consultation with affected communities, awareness raising and education about the legislation. Community-led solutions were the most effective way to tackle FGM.

CONCLUSIONS

FGM adversely affects communities globally. In the UK, researchers from affected communities gathered data demonstrating the feasibility and importance of involving communities in FGM prevention work. Further research is needed to understand how best to prevent FGM in affected communities and, very importantly, to examine the impact of the UK legislation relating to FGM.

AB0330 HIGH REMISSION RATES IN RA – REAL LIFE DATA FROM BARITICINIB

Background:

Recent developments of targeted treatments such as targeted synthetic DMARDs (tsDMARDs) increase the chances of a sustained low disease activity (LDA) or remission state for patients suffering rheumatoid arthritis (RA). tsDMARDs such as baricitinib, an oral inhibitor of the Janus Kinases (JAK1/JAK2) was recently approved for the treatment of RA with an inadequate response to conventional (cDMARD) and biological (bDMARD) therapy. (1, 2).

Objectives:

Aim of this study is to analyze the effect of baricitinb on disease activity (DAS28, LDA) in patients with RA in real life, to analyze drug persistance and associate these effects with various baseline characteristics.

Methods:

All RA patients were seen in our outpatient clinic. If a patient was switched to a baricitinib due to medical reasons, these patients were included in our prospective, observational study which started in April 2017. Clinical scores (SJC/TJC 76/78), composite scores (DAS28), PROs (HAQ-DI; RAID; FACIT), safety parameters (not reported in this abstract) as well as laboratory biomarkers were collected at each visit every three months. Linear mixed effects models for repeated measurements were used to analyze the time course of disease activity, patient reported outcomes and laboratory results. We estimated the probabilities of continued baricitinib treatment and the probabilities of LDA and remission by DAS-28 as well as Boolean remission up to one year using survival analysis and explored their association with disease characteristics using multivariable Cox regression. All patients gave informed consent. The study is approved by the local ethics.

Results:

95 patients were included and 85 analyzed with available follow-up data until November 2019. Demographics are shown in table 1. Mean follow-up duration after starting baricitinib was 49.3 (28.9) weeks. 51 patients (60%) were on monotherapy. Baricitinib survival (95%CI) was 82% (73% to 91%) at one year. Cumulative number (%probability, 95%CI) of patients that attained DAS-28 LDA at least once up to one year was 67 (92%, 80% to 97%) and the number of patients attaining DAS-28 and Boolean remission were 31 (50%, 34% to 61%) and 12(20%, 9% to 30%) respectively. Median time to DAS-28 LDA was 16 weeks (Figure 1). Cox regression analyses did not show any sufficiently precise association of remission or LDA with age, gender, seropositivity, disease duration, concomitant DMARD use and number of previous bDMARDs. Increasing number of previous bDMARDs was associated with poor baricitinib survival (HR=1.5, 95%CI 1.1 to 2.2) while this association was not robust to adjustment for baseline disease activity. Favorable changes were observed in tender and swollen joint counts, pain-VAS, patient and physician disease assessment scores, RAID, FACIT and the acute phase response.

Conclusion:

In this prospective observational study, we observed high rates of LDA and DAS-28 remission and significant improvements in disease activity and patient reported outcome measurements over time.

References:

[1]Keystone EC, Taylor PC, Drescher E, Schlichting DE, Beattie SD, Berclaz PY, et al. Safety and efficacy of baricitinib at 24 weeks in patients with rheumatoid arthritis who have had an inadequate response to methotrexate. Annals of the rheumatic diseases. 2015 Feb;74(2):333-40.

[2]Genovese MC, Kremer J, Zamani O, Ludivico C, Krogulec M, Xie L, et al. Baricitinib in Patients with Refractory Rheumatoid Arthritis. The New England journal of medicine. 2016 Mar 31;374(13):1243-52.

Figure 1.

Cumulative probability of low disease activity or remission under treatment with baricitinib.

Disclosure of Interests:

Sara Bayat Speakers bureau: Novartis, Koray Tascilar: None declared, Veronica Kaufmann: None declared, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Johannes Knitza Grant/research support from: Research Grant: Novartis, Fabian Hartmann: None declared, Susanne Adam: None declared, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, EIT Health, EU-IMI, DFG, Universität Erlangen (EFI), Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB

More Than Meets the Eye? The Role of Annual Ornamental Flowers in Supporting Pollinators

Ornamental flowers are commonly planted in urban and suburban areas to provide foraging resources for pollinator populations. However, their role in supporting broad pollinator biodiversity is not well established as previous studies have been conducted in urban landscapes with pollinator communities that are distinct from those in natural systems. We observed pollinator visitation patterns to five ornamental annual plant genera and their cultivars over multiple years at two semi-natural sites in Pennsylvania to understand their potential for supporting diverse pollinator communities. There was significant variation in visitor abundance and diversity by season and year for many annual ornamental cultivars. Within some genera, cultivars had similar visitor abundance, diversity, and main visitor taxa, while cultivars in other genera varied greatly in these measures. We observed only polylectic (pollen generalist) bee species visiting annual ornamentals, despite the presence of oligolectic (pollen specialist) bee species in the background population. We conclude that the attractiveness of annual ornamental plants likely depends on both cultivar characteristics and environmental context. While their role in supporting complex pollinator populations is limited both based on the number of and dietary breadth of the species they support, ornamental plants may nonetheless provide long-lasting supplemental foraging resources for the generalist pollinator communities characteristic of urban and suburban environments.

Response to Comment on "The role of electron-electron interactions in two-dimensional Dirac fermions"

Hesselmann et al question one of our conclusions: the suppression of Fermi velocity at the Gross-Neveu critical point for the specific case of vanishing long-range interactions and at zero energy. The possibility they raise could occur in any finite-size extrapolation of numerical data. Although we cannot definitively rule out this possibility, we provide mathematical bounds on its likelihood.

The structure of CgnJ, a domain of unknown function protein from the crocagin gene cluster

Natural products often contain interesting new chemical entities that are introduced into the structure of a compound by the enzymatic machinery of the producing organism. The recently described crocagins are novel polycyclic peptides which belong to the class of ribosomally synthesized and post-translationally modified peptide natural products. They have been shown to bind to the conserved prokaryotic carbon-storage regulator A in vitro. In efforts to understand crocagin biosynthesis, the putative biosynthetic genes were expressed and purified. Here, the first crystal structure of a protein from the crocagin-biosynthetic gene cluster, CgnJ, a domain of unknown function protein, is reported. Possible functions of this protein were explored by structural and sequence homology analyses. Even though the sequence homology to proteins in the Protein Data Bank is low, the protein shows significant structural homology to a protein with known function within the competency system of Bacillus subtilis, ComJ, leading to the hypothesis of a similar role of the protein within the producing organism.

Own attitude toward aging among nursing home residents: results of the SENIOR cohort

BACKGROUND

Stereotypes associated with aging are of great concern as extensive literature emphasizes its deleterious effects on physical and mental health of the elderly.

AIM

To assess the relationship between the attitude toward aging and the frailty status of nursing homes residents.

METHODS

A cross-sectional analysis of the data collected at baseline in the SENIOR cohort was conducted. All subjects received a diagnosis of frailty based on the Fried's criteria. They also responded to the Attitude to Aging Questionnaire (AAQ) and other questions assessing their subjective age, the age at which someone stops being considered young or is considered old and the open-ended Image-of-Aging question to evaluate the relationship between their perception of aging and their frailty status.

RESULTS

272 nursing home residents (83.9 ± 8.19 years; 75% women) participated in this study. Out of them, 54 (19.9%) were frail, 182 (66.9%) were pre-frail, and 36 (13.2%) were robust. According to the AAQ questionnaire, frail subjects have a more negative perception of aging (score of 80.3 ± 10.2 points) than pre-frail subjects (83.6 ± 10.8) and robust subjects (86.5 ± 10.5) (p = 0.02). However, the three groups did not differ in the age that would mark, to their opinion, the end of youth (p = 0.93) or the beginning of old age (p = 0.98). The subjective age, rapported by nursing home residents, was not significantly different according to their frailty status. At least, based on the Open-Ended Image of Aging question, the residents' vision of aging was not different according to the frailty status (p = 0.52).

CONCLUSION

Based on the AAQ, frail subjects have more negative attitude to ageing compared to non-frail ones.

Assessing Shared Decision-Making Clinical Behaviors Among Genetic Counsellors

Shared decision-making (SDM) is a collaborative approach in which clinicians educate, support, and guide patients as they make informed, value-congruent decisions. SDM improves patients' health-related outcomes through increasing knowledge, reducing decisional conflict, and enhancing experience of care. We measured SDM in genetic counselling appointments with 27 pregnant women who were at increased risk to have a baby with a genetic abnormality. The eight experienced genetic counsellors who participated had no specific SDM training and were unaware that SDM was being assessed. Audio transcripts of appointments were scored using 'Observing Patient Involvement in Decision Making' (OPTION12). Patients' anxiety and decisional conflict were also assessed. The genetic counsellors' mean OPTION12 score was 42.4% (SD 9.0%; possible range 0-100%). Specific SDM behaviours that scored highest included introducing the concept of equipoise and listing all options with their pros and cons. Behaviours that scored lowest included eliciting patients' preferred approach to receiving information and desired degree of involvement in decision-making. Patients' levels of anxiety and decisional conflict were unassociated with genetic counsellors' OPTION12 scores. Some SDM behaviours were better demonstrated in this prenatal genetic counselling study than others. Formal training of genetic counsellors in SDM may enhance use of this approach in their professional practice.

Thioholgamides: Thioamide-Containing Cytotoxic RiPP Natural Products

Thioviridamide is a structurally unique ribosomally synthesized and post-translationally modified peptide that contains several thioamide bonds and is active against a number of cancer cell lines. In the search for naturally occurring thioviridamide analogs, we employed genome mining that led to the identification of several related gene clusters. Chemical screening followed by cultivation and isolation yielded thioholgamides A and B, two new additions to the thioviridamide family with several amino acid substitutions, a different N-capping moiety, and with one less thioamide bond. Thioholgamides display improved cytotoxicity in the submicromolar range against a range of cell lines and an IC₅₀ of 30 nM for thioholgamide A against HCT-116 cells. Herein, we report the isolation and structural elucidation of thioholgamides A and B, a proposed biosynthetic cluster for their production, and their bioactivities against a larger panel of microorganisms and cancer cell lines.

Communication of healthcare professionals: Is there ageism?

Elderspeak is often used when talking to older individuals and is characterised by a slower and/or louder speech, a patronising tone, etc. A part of the reason of such communication can be found in the actual context of negative view of ageing. However, the link between view of ageing and elderspeak has never been objectively studied in oncology. Therefore, 40 healthcare professionals (physicians and medical students) record a podcast where they have to explain an endocrine therapy to two fictional patients (40- vs. 70-year old). Results show that when participants explained the treatment to the older patient, they used shorter utterances and made more repetitions. They also evoked fewer side effects such as sexual issues. Moreover, reduction in length of utterances and of word-per-minute rate was observed for older patient when participants have a positive view of ageing but for both patients when they have a negative view of ageing. In conclusion, physicians and medical students used elderspeak when they explained a treatment to older patients. Participants with a more negative view of ageing also unconsciously talked slower and made shorter utterances to a 40 -year-old patient.

Improving vasomotor symptoms; psychological symptoms; and health-related quality of life in peri- or post-menopausal women through yoga: An umbrella systematic review and meta-analysis

OBJECTIVES

Vasomotor symptoms (VMS), commonly reported during menopausal transition, negatively affect psychological health and health-related quality of life (HRQoL). While hormone therapy is an effective treatment, its use is limited by concerns about possible harms. Thus, many women with VMS seek nonhormonal, nonpharmacologic treatment options. However, evidence to guide clinical recommendations is inconclusive. This study reviewed the effectiveness of yoga, tai chi and qigong on vasomotor, psychological symptoms, and HRQoL in peri- or post-menopausal women.

DESIGN

MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, CINAHL and the Allied and Complementary Medicine Database were searched. Researchers identified systematic reviews (SR) or RCTs that evaluated yoga, tai chi, or qigong for vasomotor, psychological symptoms, and health-related quality of life (HRQoL) in peri- or post-menopausal women. Data were abstracted on study design, participants, interventions and outcomes. Risk of bias (ROB) was assessed and updated meta-analyses were performed.

RESULTS

We identified one high-quality SR (5 RCTs, 582 participants) and 3 new RCTs (345 participants) published after the SR evaluating yoga for vasomotor, psychological symptoms, and HRQoL; no studies evaluated tai chi or qigong. Updated meta-analyses indicate that, compared to controls, yoga reduced VMS (5 trials, standardized mean difference (SMD) -0.27, 95% CI -0.49 to -0.05) and psychological symptoms (6 trials, SDM -0.32; 95% CI -0.47 to -0.17). Effects on quality of life were reported infrequently. Key limitations are that adverse effects were rarely reported and outcome measures lacked standardization.

CONCLUSIONS

Results from this meta-analysis suggest that yoga may be a useful therapy to manage bothersome vasomotor and psychological symptoms.

Improvised Vacuum-Assisted Closure for severe neck infection in poorly equipped conditions

INTRODUCTION

Dental infections are common and are mainly due to dental caries. When left untreated, these infections can lead to severe life-threatening sepsis.

CASE REPORT

The authors reported a case of a severe odontogenic deep neck space infection in a 54-year-old male. The patient was a heavy smoker with incidentally discovered diabetes. He was successfully treated by surgical drainage combined with an improvised Vacuum-Assisted Closure (VAC) system. The results of surgical drainage followed by insertion of an improvised VAC system were spectacular. The abscess resolved in response to dual-agent antibiotic therapy on day 17 and blood glucose control was achieved with insulin. Full-thickness skin graft was performed to repair the necrotic zone of the neck.

DISCUSSION

The use of VAC can be a valuable alternative to conventional dressings and hyperbaric oxygen therapy in poorly equipped conditions. Public awareness campaigns remain the most effective form of prevention against these odontogenic infections.

Use of uterine artery embolization to prevent peripartum hemorrhage of placental abruption with fetal demise & severe DIC

Uterine artery embolization (UAE) is typically not indicated in the pre-operative management of pregnancies with a live fetus, because risk of fetal death from reduced uteroplacental blood flow. However, pre-operative UAE in pregnancies with a fetal demise poses no fetal risk, and may offer maternal benefits. Patients with placental abruption resulting in fetal demise are at high-risk for developing disseminated intravascular coagulation (DIC), which could have devastating complications such as peri-operative hemorrhage and death. This case report describes the first successful execution of a pre-operative UAE that effectively prevented antepartum and postpartum hemorrhage in a patient with DIC secondary to a placental abruption and recent fetal demise.

SOS—A Sample Ordering System for Delivering “Assay-Ready” Compound Plates for Drug Screening

Many bottlenecks in drug discovery have been addressed with the advent of new assay and instrument technologies. However, storing and processing chemical compounds for screening remains a challenge for many drug discovery laboratories. Although automated storage and retrieval systems are commercially available for medium to large collections of chemical samples, these samples are usually stored at a central site and are not readily accessible to satellite research labs.

Drug discovery relies on the rapid testing of new chemical compounds in relevant biological assays. Therefore, newly synthesized compounds must be readily available in various formats to biologists performing screening assays. Until recently, our compounds were distributed in screw cap vials to assayists who would then manually transfer and dilute each sample in an “assay-ready” compound plate for screening. The vials would then be managed by the individuals in an ad hoc manner.

To relieve the assayist from searching for compounds and preparing their own assay-ready compound plates, a newly customized compound storage system with an ordering software application was implemented at our research facility that eliminates these bottlenecks. The system stores and retrieves compounds in 1 mL-mini-tubes or microtiter plates, facilitates compound searching by identifier or structure, orders compounds at varying concentrations in specified wells on 96- or 384-well plates, requests the addition of controls (vehicle or reference compounds), etc. The orders are automatically processed and delivered to the assayist the following day for screening. An overview of our system will demonstrate that we minimize compound waste and ensure compound integrity and availability. (JALA 2004;9:123-7)