CS014 is a novel HDAC inhibitor regulating the platelet activity, fibrinolysis and clot stability for prevention of thrombosis without increased risk of bleeding

Background

Cardiovascular disease is the leading cause of morbidity and mortality. A major challenge with current antithrombotic treatments is the increased risk of bleeding associated with effective inhibition of clot formation. We have developed a novel histone deacetylase inhibitor (HDACi) that effectively prevents occlusive thrombosis following vascular injury without increasing bleeding diathesis commonly associated with antithrombotic drugs.

Purpose

Develop an HDACi and antiplatelet drug, CS014, with an improved efficacy/safety profile and reduced bleeding risk compared with current anticoagulant and antiplatelet therapeutic approaches used to prevent thrombosis.

Methods

We assessed thrombosis and bleeding in mouse models by labelling platelets and fibrin and measuring accumulation at the site of injury using intravital microscopy. Drug was administered IP for 5 days prior to the experiments. Degree of clot formation in the vessel was assessed in the 1) laser-induced cremaster thrombosis assay, 2) carotid artery FeCl3 thrombosis assay, and 3) saphenous vein rebleeding laser-induced puncture wound assay. Bleeding was assessed in the tail vein bleeding assay. Potential off-target effects were studied using thromboelastography (TEG).

Results

CS014 treatment significantly reduced clot formation and fibrin formation at the site of injury in the laser-induced cremaster arteriole thrombosis assay (Fig. 1). FeCl3-induced injury of the carotid artery resulted in full occlusion of the carotid artery within 12–15 minutes. Treatment with CS014 was able to prevent full occlusion of the carotid artery, supporting its benefit in arterial injury conditions. In the saphenous vein rebleeding assay, fibrin and platelet accumulation at the site of injury wound was significantly inhibited, suggesting that CS014 functions in both arterial and venous systems to attenuate clot and thrombosis. The tail vein bleeding assay confirmed that while the thrombus formation and stability was decreased based on the cremaster and carotid artery assays, no significant change was observed in bleeding time under these conditions. Finally, TEG experiments in mouse blood treated with or without CS014 demonstrated no delay or decrease in clot strength confirming the prevention of a bleeding diathesis observed in the tail vein bleeding assay experiments.

Conclusions

We have shown for the first time that the HDACi CS014 results in inhibition of mouse thrombosis and decreased time to clot resolution without an increased risk of bleeding. This discovery represents a new class of inhibitors for prevention of platelet activation and thrombosis with the potential to protect from myocardial infarction and stroke while increasing fibrinolytic ability in the blood to limit the risk of thromboembolism on the venous side, with no signs of increased bleeding risk.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Cereno Scientific

Lemzoparlimab (lemzo) with venetoclax (ven) and/or azacitidine (aza) in patients (pts) with acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS): A phase 1b dose escalation study

TPS7067

Background: Despite treatment advances, pts with AML or higher-risk MDS who are ineligible for standard intensive treatments still have poor survival, highlighting the need for novel therapies. Overexpression of CD47 is common in leukemic stem cells and AML blasts and correlates with poor clinical outcomes. Lemzo is an anti-CD47 antibody with red blood cell–sparing properties. Treatment with ven plus aza has shown favorable safety and efficacy in older/unfit pts with AML and higher-risk MDS. Blocking CD47 is hypothesized to hypersensitize AML cells to the antitumor activity of ven and aza. This study will evaluate the safety and dose-limiting toxicities (DLTs) of lemzo with ven + aza for pts with treatment-naïve AML, as well as lemzo with aza ± ven for treatment-naïve higher-risk MDS. Methods: This phase 1b, open-label, dose-escalation study (NCT04912063) is enrolling adults with: (1) treatment-naïve AML with adverse cytogenetic/molecular risk not suitable for induction therapy, with an Eastern Cooperative Oncology Group Performance Status (ECOG-PS) 0–2 (aged ≥75 years) or 0–3 (aged ≥18–74 years) excluding acute promyelocytic leukemia; or (2) treatment-naïve higher-risk MDS (Revised International Prognostic Scoring Score > 3) with < 20% bone marrow blasts, ECOG-PS 0–2, and no immediately planned stem cell transplant. For each 28-day cycle, aza is administered subcutaneously or intravenously (IV) daily for 7 days within the first 9 days (7-0-0 or 5-2-2 schedule); ven is administered orally daily on days 1–28 (AML, following dose ramp-up) or days 1–14 (ven-containing MDS cohorts). Lemzo is administered IV at a schedule that is to be determined in this study. Dose escalation has Bayesian optimal interval design and may be expanded to investigate alternate dosing for lemzo. Dose expansion will initiate at recommended phase 2 dose. Treatment discontinuation criteria are unacceptable toxicity, progressive disease, lack of partial/complete remission or clinical benefit within 6 cycles, or at physician’s discretion. Pts who discontinue study treatment without progression will continue with posttreatment follow-up; pts who progress will enter survival follow-up. The primary endpoints are DLTs of lemzo. Secondary endpoints for both cohorts include best overall responses of complete remission, duration of response, event-free survival, and overall survival. Exploratory biomarker endpoints are included. Safety assessments include adverse event (AE, graded per National Cancer Institute Common Terminology Criteria for AEs v5.0) monitoring, physical examinations, vital signs, electrocardiograms, and laboratory tests. Response rates will be analyzed with estimates and 95% confidence intervals based on exact binomial distribution. Time-to-event endpoints will be analyzed using Kaplan–Meier methodology. Clinical trial information: NCT04912063.

Psychological impairment and extreme weather event (EWE) exposure, 1980-2020: A global pooled analysis integrating mental health and well-being metrics

Extreme Weather Events (EWEs) impose a substantial health and socio-economic burden on exposed populations. Projected impacts on public health, based on increasing EWE frequencies since the 1950s, alongside evidence of human-mediated climatic change represents a growing concern. To date, the impacts of EWEs on mental health remain ambiguous, largely due to the inherent complexities in linking extreme weather phenomena with psychological status. This exploratory investigation provides a new empirical and global perspective on the psychological toll of EWEs by exclusively focusing on psychological morbidity among individuals exposed to such events. Morbidity data collated from a range of existing psychological and well-being measures have been integrated to develop a single ("holistic") metric, namely, psychological impairment. Morbidity, and impairment, were subsequently pooled for key disorders-, specifically PTSD, anxiety and depression. A "composite" (any impairment) post-exposure pooled-prevalence rate of 23% was estimated, with values of 24% calculated for depression and ⁓17% for both PTSD and anxiety. Notably, calculated pooled odds ratios (pOR = 1.9) indicate a high likelihood of any negative psychological outcome (+90%) following EWE exposure. Pooled analyses of reported risk factors (p < 0.05) highlight the pronounced impacts of EWEs among individuals with higher levels of event exposure or experienced stressors (14.5%) and socio-demographic traits traditionally linked to vulnerable sub-populations, including female gender (10%), previous history (i.e., pre-event) of psychological impairment (5.5%), lower socio-economic status (5.5%), and a lower education level (5.2%). Inherent limitations associated with collating mental health data from populations exposed to EWEs, and key knowledge gaps in the field are highlighted. Study findings provide a robust evidence base for developing and implementing public health intervention strategies aimed at ameliorating the psychological impacts of extreme weather among exposed populations.

Abstract CT207: Phase 1 first-in-human study of ABBV-151 as monotherapy or in combination with budigalimab in patients with locally advanced or metastatic solid tumors

Background Glycoprotein-A repetitions predominant (GARP) regulates membrane-bound transforming growth factor β1 (TGFβ1), an immunosuppressive cytokine. ABBV-151 is a first-in-class monoclonal antibody (mAb) that binds to the GARP-TGFβ1 complex and blocks TGFβ1 release. Preclinical data demonstrated that targeting both GARP-TGFβ1 and programmed cell death protein 1 (PD-1) improved antitumor effects compared with anti-PD-1 alone. Combining ABBV-151 with the anti-PD-1 mAb budigalimab (ABBV-181) may enable a more effective antitumor immune response by reducing the immunosuppressive effect of TGFβ1. Trial design This is a multicenter phase 1, dose escalation and dose expansion study (NCT03821935) in patients (pts; ≥18 yr, Eastern Cooperative Oncology Group performance status 0-1) with locally advanced or metastatic solid tumors. The primary objective of dose escalation is to determine the recommended phase 2 dose (RP2D) of ABBV-151 as monotherapy or with budigalimab; dose expansion will assess the objective response rate of ABBV-151 ± budigalimab. Secondary/exploratory objectives include assessing preliminary efficacy, safety, tolerability, pharmacokinetics (PK), and evaluating potential pharmacodynamic and predictive biomarkers. Dose escalation of ABBV-151, guided by a Bayesian optimal interval design, will assess dose-limiting toxicities during the first 28-day cycle and will be utilized until the RP2D is defined. ABBV-151 + budigalimab (fixed dose) will start ≥2 dose levels below that proven safe for ABBV-151. Adverse events will be evaluated per National Cancer Institute Common Terminology Criteria v5.0. Response will be assessed using Response Evaluation Criteria In Solid Tumors (RECIST) v1.1 and iRECIST every 8 weeks. PK of ABBV-151 will be characterized. Saturation of GARP-TGFβ1 on platelets and PD-1 on CD4 T cells will be determined. Modulation of cytokines, chemokines, lymphocyte activity, and gene expression will be assessed in blood, while gene signatures and protein markers will be explored in tumor tissues. Baseline tumor characteristics will be retrospectively related to response. Enrollment initiated Mar 2019, with 37 pts enrolled as of May 2020.

Citation Format: John Powderly, Toshio Shimizu, Patricia LoRusso, Albiruni Razak, Kathy Miller, Arjun Balar, Jordi Bruix, Loren Michel, Martha Blaney, Xiaowen Guan, Susan Lacy, Satwant Lally, Stacie Lambert, Rachel Leibman, Gregory Vosganian, Talia Golan, Anthony Tolcher. Phase 1 first-in-human study of ABBV-151 as monotherapy or in combination with budigalimab in patients with locally advanced or metastatic solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT207.

Abstract 153: Development of a workflow to handle the quality control and analysis of Olink protein biomarker data in early phase oncology clinical trials

INTRODUCTION: Olink is a high-throughput targeted biomarker platform based on Proximity Extension Assay (PEA) technology using oligonucleotide-labeled antibody pairs. At AbbVie RWC, we have primarily utilized the 96-plex Immune-Oncology (IO) panel measuring 92 proteins to support our early-phase oncology clinical trials. As we analyzed batches of specimens from ongoing trials, we set out to develop a workflow to control data quality and streamline analysis.

METHODS: Prior to sample shipment to Olink, we randomize sample position onto plates to ensure key factors such as dose and cohort are balanced within and across plates. This prevents plate or location effects from becoming a confounder. If the study specimens are analyzed in more than one batch, subsequent batches require bridging samples from the first batch to allow us to detect and remove batch effects if necessary. Our workflow thus identifies bridging samples and recommends the optimal number. Upon receiving the data, we evaluate its quality by calculating inter- and intra-plate coefficients of variation (CVs) and visualizing it in multiple ways. The next step in our workflow is analysis, including pharmacodynamic (PD) analysis and association with clinical response. In the PD analysis, we identify biomarkers that significantly change across time and/or exhibit a dose effect. To help interpret the results, enrichment analysis is performed to identify biological processes enriched in the significantly modulated biomarkers. Heatmaps and volcano plots are also generated. For analysis of association with clinical response, we examine how each biomarkers' baseline value and modulation over time associates with progression free survival (PFS) and best overall response (BOR).

RESULTS: We successfully created a workflow that handles quality control and analysis of Olink protein biomarker data. The workflow starts from experimental design quality control. Upon receiving the data, we conduct data quality assessment and examination and removal of potential batch effects. Finally, we perform analysis of the data to identify potential biomarkers of interest. We used elements of this workflow on data from M15-891 (ABBV-181) and have now applied the full workflow to multiple batches of data from three early-phase oncology trials (M15-862 (ABBV-927), M16-074 (ABBV-368) and M19-345 (ABBV-151)), with plans to incorporate this methodology into several additional upcoming trials.

CONCLUSIONS: We have developed a comprehensive workflow that manages Olink quality control and analysis and can potentially be implemented to all early-phase oncology clinical trials using Olink. It allows us to standardize and streamline Olink data handling and provide robust and efficient analyses that enable rapid biomarker data interpretation, hypothesis generation, and decision making for our trials.

Citation Format: Claire J. Guo, Mary Saltarelli, Stacie Lambert, Hua Fang, Chun Zhang. Development of a workflow to handle the quality control and analysis of Olink protein biomarker data in early phase oncology clinical trials [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 153.

Evaluation of cognitive impairment in a French sample of patients with restrictive anorexia nervosa: two distinct profiles emerged with differences in impaired functions and psychopathological symptoms

PURPOSE

The cognitive profiles of patients suffering from anorexia nervosa (AN) are currently explored as potential facilitating and/or maintenance factors. Specific data in restrictive AN (AN-R) remain contradictory. This study focused on women with AN-R to evaluate their cognitive functions to develop a more specific cognitive remediation program.

METHODS

Female patients older than 15 years who were suffering from AN-R were recruited in a specialized unit for eating disorder management. Female healthy control (HC) participants were recruited who were matched with AN patients on age. All participants completed a cognitive evaluation (premorbid intelligence quotient (IQ), planning, information processing speed, cognitive flexibility) and a clinical evaluation (impulsivity, anxiety, depression).

RESULTS

A total of 122 participants were included. Patients suffering from AN-R had significant impairment in information processing speed and planning. Patients exhibited significantly better cognitive flexibility than did the HC group when adjustments were made for other cognitive functions and impulsivity. Two distinct subgroups of patients were identified. The first subgroup had more marked cognitive impairment and fewer psychopathological symptoms than did the second subgroup of patients and the HC group.

CONCLUSION

Our results highlight cognitive impairment in patients with AN who had normal premorbid IQ. Two distinct profiles emerge. In clinical practice, these results open up perspectives for the development of more specific cognitive remediation programs (one specific program for cold cognitions and another specific program targeting emotions and hot cognitions). These results warrant confirmation by larger studies with a more specific evaluation of the impact of emotional status. Trial registration NTC02381639, Date of registration. March 6, 2015.

Safety, pharmacokinetics, and efficacy of budigalimab with rovalpituzumab tesirine in patients with small cell lung cancer

BACKGROUND

Agents targeting programmed cell death protein 1 (PD-1) have been approved as monotherapy for patients with small cell lung cancer (SCLC). In preclinical models, the combined targeting of PD-1 and delta-like protein 3 resulted in enhanced antitumor activity. Herein, we report results from the expansion arm of study NCT03000257 evaluating the combination of the anti-PD-1 antibody budigalimab and the targeted antibody-drug conjugate rovalpituzumab tesirine (Rova-T) in patients with previously treated SCLC.

MATERIALS AND METHODS

This expansion arm of a multicenter, open-label, multi-arm, first-in-human phase 1 clinical trial enrolled adult patients with progressive SCLC. The primary objective was to assess safety and tolerability. Patients received budigalimab 375 mg via intravenous infusion every 3 weeks, and Rova-T was administered as a dose of 0.3 mg/kg intravenously, on day 1 of the first and third 3-week cycle.

RESULTS

As of October 2019, 31 patients with SCLC were enrolled and treated with budigalimab plus Rova-T. The combination was tolerated, with the most common treatment-emergent adverse events (in >30%) being pleural effusion, fatigue, and cough. The overall response rate was 24.1%, with one confirmed complete response and six confirmed partial responses. The overall response rate in patients with high delta-like protein 3 expression was similar (21.1%). The median progression-free survival was 3.48 months.

CONCLUSION

Combination therapy with budigalimab and Rova-T had promising efficacy and appeared to be tolerated in patients with SCLC. Although Rova-T development has been discontinued, development of budigalimab combined with other anticancer agents is ongoing.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03000257 Statement on originality of the work The manuscript represents original work and has not been submitted for publication elsewhere nor previously published. Statement of prior presentation Data from this study were previously presented at the European Society for Medical Oncology (ESMO) Congress 2019.

Abstract 4464: Pharmacodynamic and predictive biomarkers of clinical responses to PD-1 inhibitor budigalimab from the first-in-human clinical trial

Background: Programmed cell death 1 (PD-1) is a receptor upregulated on activated lymphocytes that mediates a dominant-negative checkpoint signal limiting antigen receptor-driven cellular activation. PD-1 immune checkpoint inhibitors have shown durable clinical responses in patients with non-small cell lung cancer (NSCLC) and head and neck squamous cell carcinoma (HNSCC). Budigalimab (formerly ABBV-181) is a blocking humanized recombinant anti-PD-1 monoclonal antibody, currently under evaluation in multiple studies such as phase 1 clinical trial (NCT03000257) in patients with solid tumors including HNSCC and NSCLC. Multiple clinical biomarker assessments have been incorporated into this study to accommodate pharmacodynamic (PD) and predictive analyses. Methods: Patients with previously treated, advanced HNSCC (n=41) or NSCLC (n=40) that were PD-1 inhibitor naïve received budigalimab IV at 250 mg every two weeks or 500 mg every four weeks to progression, with responses assessed every 8 weeks. Archival tumor FFPE specimens from patients with HNSCC (n=37) and NSCLC (N=33) were evaluated for CD8 infiltration and tumor PD-L1 expression by Dako 28-8 IHC assay, with remaining samples processed for RNA sequencing and whole-exome sequencing. Serum (for soluble biomarkers) and whole blood (for flow cytometric analysis of T cell biomarkers) were taken at baseline and selected on-treatment time points. Univariate analysis of biomarkers associated with the best overall response (BOR) and progression-free survival was conducted. Results: As of July 2019, responses per response evaluation criteria in solid tumors (RECIST) v1.1 or iRECIST were observed at the expected rates for a PD-1 inhibitor (BOR of partial or complete response of 15% in HNSCC and 19% in NSCLC), with responses in PD-L1+ and PD-L1- tumors in both groups. Budigalimab dosing was associated with rapid complete PD-1 receptor saturation, transient decreases in circulating lymphocytes, upregulation of proliferation (Ki67) biomarkers in T cells, and upregulation of multiple soluble biomarkers, including IFNγ-induced chemokines. Differential neoantigen burden and lymphocyte-associated gene expression in tumors were observed in responders versus non-responders. Preliminary univariate analysis of biomarkers found that baseline tumor size, serum IL-6, and T cell counts were significantly associated with outcomes. Conclusions: Our biomarker analysis of budigalimab-treated HNSCC and NSCLC patients has identified early PD biomarkers consistent with PD-1 inhibitor activity as well as pre-treatment tumor and peripheral biomarkers associated with observed clinical responses. These findings confirm that budigalimab is a biologically active PD-1 inhibitor.

Citation Format: Stacie Lambert, Chun Zhang, Stefan Englert, Claire Guo, Tolga Turan, Catherine Tribouley, David Masica, Robert T. McLaughlin, Gregory S. Vosganian, Daniel E. Afar. Pharmacodynamic and predictive biomarkers of clinical responses to PD-1 inhibitor budigalimab from the first-in-human clinical trial [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4464.

A cognitive style dataset including functional near-infrared spectroscopy, eye-tracking, psychometric and behavioral measures

The dataset includes data from the triangulated investigation reported in our paper: 'Psychophysiological indices of cognitive style: A triangulated study incorporating neuroimaging, eye-tracking, psychometric and behavioral measures' [1,2]. The data was collected at the Directorate of Psychology & Public Health laboratories at the University of Salford, UK, in 2015 among an English-speaking sample. The dataset includes measures described in the paper including information-processing/cognitive style recorded as Cognitive Style Index [CSI; 3] scores, comparative visual search (CVS) task behavioral measures (reaction time and accuracy), eye-movement data (fixation duration, number of saccades, number of comparative saccades and distance moved) and prefrontal cortex (PFC) oxygenated hemoglobin (oxy-Hb) recorded using functional near-infrared spectroscopy (fNIRS).

The Dietary Behaviours of Cancer Caregivers: Preliminary Findings on How Becoming a Cancer Caregiver Might Influence Food Choices and Dietary Behaviours in the Carer Compared With Pre-Caring

Background: Cancer is often called a “we-disease” as the effects of the diagnosis can go beyond the patient to others, including the caregiver. In Australia, it is estimated that approximately 138,000 new cancer diagnoses will be made in 2018, with the 5 year survival rate currently at 68%. This has shifted the way that cancer care is delivered, with many patients now being cared for at home by a loved one. As a result, cancer caregivers report higher levels of fatigue, stress, mood disturbances and mental illness (depression and anxiety), insomnia and digestive complaints than noncaring counterparts. While it is known that these characteristics can influence diet, very little has been published with relation to cancer caregivers as a stand-alone population. Aim: To explore how being a cancer caregiver might influence dietary behaviors, food choices and eating patterns in the caregiver to see if these have changed/not changed from precaring. Methods: Participants were recruited from a number of avenues, including not-for-profit cancer support services and support groups. Our study is a descriptive qualitative study where participants complete an online questionnaire to determine their Burden of Care score (through Given and Given's Caregiver Reaction Assessment) and current dietary patterns and behaviors. Some of these participants were further interviewed using a semistructured interview to explore their role as a carer, dietary patterns and food choices and this interview data were thematically analyzed. Results: Preliminary results (as part of an ongoing study) from six completed semistructured interviews with cancer caregivers from New South Wales, Australia suggests that the food intake and dietary behaviors of cancer caregivers were influenced by five main aspects: food access and availability, caregiver health, food preferences, the impact of cancer or the patient and caregivers needing more support. This study is ongoing, with an additional 6-8 interviews proposed (or until data saturation is achieved). In the case of some caregivers their dietary behaviors and food choices improved when they became a caregiver (e.g., eating more fruit and vegetables, reducing sugar consumption and an increase in their perception of the importance of healthy eating). Others reported a decline (e.g., increased “grazing” on “junk food”, losing motivation for healthy eating and preparing healthy food and skipping meals). Conclusion: This preliminary data clearly suggests that dietary behaviors and food choices of cancer caregivers do change from precaring. There is however, still a gap in our understanding as to why some carers report improvements and others report a decline. This is an ongoing area of research and is an important aspect of public health given the role cancer caregivers play in Australia.

Contingency Training Alters Neurobiological Components of Emotional Resilience in Male and Female Rats

Prior research with a rat model of behavioral therapy [i.e., effort-based reward (EBR) contingency training] suggests that strengthened associations between physical effort and desired outcomes enhance neurobiological indices of resilience. In the current study, male and female Long-Evans rats were exposed to either six weeks of EBR training or noncontingent training prior to 10 days of exposure to chronic unpredictable stress (CUS). Subsequently, all animals were exposed to a problem-solving task and then trained in a spatial learning/foraging task, the Dry Land Maze (DLM). Following habituation training and test trials, rats were assessed in a probe trial that generated a prediction error (cognitive uncertainty). Results indicated that, during CUS exposure, contingency-training enhanced dehydroepiandrosterone/corticosterone ratios (consistent with healthier stress responses), especially in male rats. Additionally, contingency training increased exploratory behaviors in the probe trial as well as differentially influenced on-task problem-solving performance in males and females. Following the probe trial, brains were exposed to histological analyses to determine the effects of sex and contingency training on various neurobiological markers. Contingency training decreased BDNF-immunoreactivity (ir) in the hippocampus CA1 and lateral habenula, implicating differential neuroplasticity responses in the training groups. Further, coordinated fos-ir activation in areas associated with emotional resilience (i.e., motivation-regulation) was observed in contingent-trained animals. In sum, the current findings confirm that behavioral training is associated with neurobiological markers of emotional resilience; however, further assessments are necessary to more accurately determine the therapeutic potential for the EBR contingency training model.

The psoriasis-protective TYK2 I684S variant impairs IL-12 stimulated pSTAT4 response in skin-homing CD4+ and CD8+ memory T-cells

Tyrosine kinase 2 (TYK2) belongs to the Janus kinase (JAK) family of tyrosine kinases, which transmit signals from activated cytokine receptors. GWAS have consistently implicated TYK2 in psoriasis susceptibility. We performed an in-depth association analysis of TYK2 using GWAS and resequencing data. Strong genetic association of three nonsynonymous variants in the exonic regions of the TYK2 gene (rs34536443, rs12720356, and rs2304256) were found. rs12720356 encoding I684S is predicted to be deleterious based on its location in the pseudokinase domain. We analyzed PBMCs from 29 individuals representing the haplotypes containing each of the significantly associated signals. STAT4 phosphorylation was evaluated by phospho-flow cytometry after CD3/CD28 activation of cells followed by IL-12 stimulation. Individuals carrying the protective I684S variant manifested significantly reduced p-STAT4 levels in CD4 + CD25 + CD45RO+ (mean Stimulation Index (S.I.) 48.08, n = 10) and CD8 + CD25 + CD45RO + cells (S.I. 55.71, n = 10), compared to controls homozygous for the ancestral haplotype (S.I. 68.19, n = 10 (p = 0.002) and 76.76 n = 10 (p = 0.0008) respectively). Reduced p-STAT4 levels were also observed in skin-homing, cutaneous lymphocyte associated antigen (CLA)-positive CD4 and CD8 cells from I684S carriers. No significant changes in p-STAT4 for the psoriasis-associated variant rs34536443 was found. These data establish the functional significance of the TYK2 I684S variant in psoriasis susceptibility.

Disordered eating in French high-level athletes: association with type of sport, doping behavior, and psychological features

PURPOSE

Over the last few years, disordered eating in athletes has received increasing attention. According to several studies, athletes could be more vulnerable to disordered eating and some characteristics specific to the athletic community could be in favour of an increased risk of poor body image and disturbed eating habits in athletes. However, the literature is sparse and some methodological issues in studies have been pointed out. In this context, we aimed at determining the prevalence of disordered eating in French high-level athletes using clinical interviews of three different clinicians and identifying what are the factors associated with disordered eating in athletes.

METHODS

In France, all athletes registered on the French high-level list have to undergo a yearly evaluation. Data collected during the somatic assessment, the dietary consultation, and the psychological of the yearly evaluation were used. Multivariate analysis was performed for identification of factors associated with disordered eating.

RESULTS

Out of the 340 athletes included, 32.9% have been detected with a disordered eating. They were difficult to detect by clinicians, as usual criteria did not seem to be reliable for athletes. Competing in sports emphasizing leanness or low body weight was associated with disordered eating; however, gender was not.

CONCLUSION

These results highlight the need for the development of specific screening tools for high-level athletes. Furthermore, the identification of factors associated with disordered eating could improve early detection and prevention program effectiveness.

Predictive factors of dropout from inpatient treatment for anorexia nervosa

BACKGROUND

Patients with severe Anorexia Nervosa (AN) whose condition is life-threatening or who are not receiving adequate ambulatory care are hospitalized. However, 40 % of these patients leave the hospital prematurely, without reaching the target weight set in the treatment plan, and this can compromise outcome. This study set out to explore factors predictive of dropout from hospital treatment among patients with AN, in the hope of identifying relevant therapeutic targets.

METHODS

From 2009 to 2011, 180 women hospitalized for AN (DSM-IV diagnosis) in 10 centres across France were divided into two groups: those under 18 years (when the decision to discharge belongs to the parents) and those aged 18 years and over (when the patient can legally decide to leave the hospital). Both groups underwent clinical assessment using the Morgan & Russell Global Outcome State questionnaire and the Eating Disorders Examination Questionnaire (EDE-Q) for assessment of eating disorder symptoms and outcome. Psychological aspects were assessed via the evaluation of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Socio-demographic data were also collected. A number of factors identified in previous research as predictive of dropout from hospital treatment were tested using stepwise descending Cox regressions.

RESULTS

We found that factors predictive of dropout varied according to age groups (being under 18 as opposed to 18 and over). For participants under 18, predictive factors were living in a single-parent family, severe intake restriction as measured on the "dietary restriction" subscale of the Morgan & Russell scale, and a low patient-reported score on the EDE-Q "restraint concerns" subscale. For those over 18, dropout was predicted from a low depression score on the HADS, low level of concern about weight on the EDE-Q subscale, and lower educational status.

CONCLUSION

To prevent dropout from hospitalization for AN, the appropriate therapeutic measures vary according to whether patients are under or over 18 years of age. Besides the therapeutic adjustments required in view of the factors identified, the high dropout rate raises the issue of resorting more frequently to compulsory care measures among adults.

Reactions to a Stranger as a Function of Style of Dress

A female E posed as a market research investigator, under two conditions of dress: smart and untidy. Ss, who were persons leaving an underground station, were more willing to answer the questions of a smartly dressed E. This difference was significant for older people. There was also a marked difference in the reactions of older and younger women to the untidy condition of dress.

Histological evaluation of two designs of shoulder surface replacement implants

AIMS

To assess the extent of osteointegration in two designs of shoulder resurfacing implants. Bony integration to the Copeland cylindrical central stem design and the Epoca RH conical-crown design were compared.

PATIENTS AND METHODS

Implants retrieved from six patients in each group were pair-matched. Mean time to revision surgery of Copeland implants was 37 months (standard deviation (sd) 23; 14 to 72) and Epoca RH 38 months (sd 28; 12 to 84). The mean age of patients investigated was 66 years (sd 4; 59 to 71) and 58 years (sd 17; 31 to 73) in the Copeland and Epoca RH groups respectively. None of these implants were revised for loosening.

RESULTS

Increased osteointegration was measured under the cup in the Copeland implant group with limited bone seen in direct contact with the central stem. Bone adjacent to the Epoca RH implants was more uniform.

CONCLUSION

This difference in the distribution of bone-implant contact and bone formation was attributed to the Epoca implant's conical crown, which is positioned in more dense peripheral bone. The use of a central stem may not be necessary provided there is adequate peripheral fixation within good quality humeral bone.

TAKE HOME MESSAGE

Poor osteointegration of cementless surface replacement shoulder prosthesis may be improved by implant design.

Structural requirements of steroidal agonists of transient receptor potential melastatin 3 (TRPM3) cation channels

Background and Purpose

Transient receptor potential melastatin 3 (TRPM3) proteins form non-selective but calcium-permeable membrane channels, rapidly activated by extracellular application of the steroid pregnenolone sulphate and the dihydropyridine nifedipine. Our aim was to characterize the steroid binding site by analysing the structural chemical requirements for TRPM3 activation.

Experimental Approach

Whole-cell patch-clamp recordings and measurements of intracellular calcium concentrations were performed on HEK293 cells transfected with TRPM3 (or untransfected controls) during superfusion with pharmacological substances.

Key Results

Pregnenolone sulphate and nifedipine activated TRPM3 channels supra-additively over a wide concentration range. Other dihydropyridines inhibited TRPM3 channels. The natural enantiomer of pregnenolone sulphate was more efficient in activating TRPM3 channels than its synthetic mirror image. However, both enantiomers exerted very similar inhibitory effects on proton-activated outwardly rectifying anion channels. Epiallopregnanolone sulphate activated TRPM3 almost equally as well as pregnenolone sulphate. Exchanging the sulphate for other chemical moieties showed that a negative charge at this position is required for activating TRPM3 channels.

Conclusions and Implications

Our data demonstrate that nifedipine and pregnenolone sulphate act at different binding sites when activating TRPM3. The latter activates TRPM3 by binding to a chiral and thus proteinaceous binding site, as inferred from the differential effects of the enantiomers. The double bond between position C5 and C6 of pregnenolone sulphate is not strictly necessary for the activation of TRPM3 channels, but a negative charge at position C3 of the steroid is highly important. These results provide a solid basis for understanding mechanistically the rapid chemical activation of TRPM3 channels.

[Endometriosis: increasing concentrations of serum interleukin-1β and interleukin-1sRII is associated with the deep form of this pathology]

OBJECTIVES

To assess interleukin-1β (IL-1β) and its inhibitory soluble interleukin-1 receptor type II (IL-1sRII) levels into the serum of patients with various forms of endometriosis and normal women, and investigate the correlation with disease activity.

PATIENTS AND METHODS

In this prospective laboratory study (2005-2010), 510 women with histologically proven endometriosis and 93 endometriosis-free controls have been enrolled. Laparoscopic complete exploration of the abdominopelvic cavity and blood samples have been performed in each patient. For each serum, IL-1β and IL-1sRII have been evaluated using Elisa.

RESULTS

IL-1β and IL-1sRII have been respectively detectable in 64% and 54.6% of serum samples from all 603 women studied. IL-1β was higher in women with deep infiltrating endometriosis (DIE) (mean 10.0pg/mL [0.005-416.2]) than in endometriosis-free women (mean 0.5pg/mL [0.01-1.7], P<0.01) or in women with superficial endometriosis (SUP) (mean 0.6pg/mL [0.1-2.9], P<0.01). Also, IL-1sRII was higher in DIE (mean 236.7pg/mL [0.9-6975]) than in the witness group (mean 85.0pg/mL [1-235.2], P<0.05) or in SUP (mean 85.1pg/mL [0.6-302], P<0.01).

CONCLUSION

This study highlights both a marked significant increase in serum IL-1β and IL-1sRII levels in DIE compared to SUP and normal women and suggests that a defect in the control of IL-1 can impact the pathophysiology of endometriosis.

A reverse shoulder arthroplasty with increased offset for the treatment of cuff-deficient shoulders with glenohumeral arthritis

Inherent disadvantages of reverse shoulder arthroplasty designs based on the Grammont concept have raised a renewed interest in less-medialised designs and techniques. The aim of this study was to evaluate the outcome of reverse shoulder arthroplasty (RSA) with the fully-constrained, less-medialised, Bayley–Walker prosthesis performed for the treatment of rotator-cuff-deficient shoulders with glenohumeral arthritis. A total of 97 arthroplasties in 92 patients (53 women and 44 men, mean age 67 years (standard deviation (sd) 10, (49 to 85)) were retrospectively reviewed at a mean follow-up of 50 months ((sd 25) (24 to 96)). The mean Oxford shoulder score and subjective shoulder value improved from 47 (sd 9) and 24 points (sd 18) respectively before surgery to 28 (sd 11) and 61 (sd 24) points after surgery (p <  0.001). The mean pain at rest decreased from 5.3 (sd 2.8) to 1.5 (sd 2.3) (p < 0.001). The mean active forward elevation and external rotation increased from 42°(sd 30) and 9° (sd 15) respectively pre-operatively to 78° (sd 39) and 24° (sd 17) post-operatively (p < 0.001). A total of 20 patients required further surgery for complications; 13 required revision of components. No patient developed scapular notching.

The Bayley–Walker prosthesis provides reliable pain relief and reasonable functional improvement for patients with symptomatic cuff-deficient shoulders. Compared with other designs of RSA, it offers a modest improvement in forward elevation, but restores external rotation to some extent and prevents scapular notching. A longer follow-up is required to assess the survival of the prosthesis and the clinical performance over time.

Cite this article: Bone Joint J 2014;96-B:936–42.

Influence of domestication process on immune response to repeated emersion stressors in Eurasian perch (Perca fluviatilis, L.)

Domestication might be a possible way to reduce the physiological response to long-term stressors and deleterious effects on immunity. The present study aimed to evaluate the chronic immune response induced by repeated emersions and the possible impact of domestication by comparing farmed Eurasian perch with short (F1) and long (F4) captive-life history. In the first experiment, fish were exposed to a single emersion and physiological stress response was measured in the short term to characterize fish sensitivity to the tested stressor. Serum cortisol and glucose elevated within 6h post-stress and splenosomatic index (SSI) decreased within 48h, indicating that the species was affected by emersion stressor. In the second experiment, F1 and F4 generations were submitted to repeated water emersions (3 times/week during 44days). On day 9, 18 and 44, samplings were performed 48h post-stressor to highlight any sustained disruption of immune system. Serum cortisol, glucose, SSI and lysozyme activity were evaluated and serum proteome was analyzed using 2D-DIGE. Any of the tested variables were affected by repeated emersions and proteomic analysis only revealed that alpha-2 macroglobulins (a2Ms) were up-regulated in the serum of stressed individuals. Domestication also resulted in the up-regulation of five a2M isoforms and down-regulation of complement C3 and Ig light chain proteins, independently of any stressor exposure. In conclusion, the results suggested that repeated emersions are not severe stressors for Eurasian perch, probably explaining why domestication had no influence on fish responses. Changes associated with domestication are highly complex and certainly need further investigations.

Systematic molecular and cytogenetic screening of 100 patients with marfanoid syndromes and intellectual disability

The association of marfanoid habitus (MH) and intellectual disability (ID) has been reported in the literature, with overlapping presentations and genetic heterogeneity. A hundred patients (71 males and 29 females) with a MH and ID were recruited. Custom-designed 244K array-CGH (Agilent®; Agilent Technologies Inc., Santa Clara, CA) and MED12, ZDHHC9, UPF3B, FBN1, TGFBR1 and TGFBR2 sequencing analyses were performed. Eighty patients could be classified as isolated MH and ID: 12 chromosomal imbalances, 1 FBN1 mutation and 1 possibly pathogenic MED12 mutation were found (17%). Twenty patients could be classified as ID with other extra-skeletal features of the Marfan syndrome (MFS) spectrum: 4 pathogenic FBN1 mutations and 4 chromosomal imbalances were found (2 patients with both FBN1 mutation and chromosomal rearrangement) (29%). These results suggest either that there are more loci with genes yet to be discovered or that MH can also be a relatively non-specific feature of patients with ID. The search for aortic complications is mandatory even if MH is associated with ID since FBN1 mutations or rearrangements were found in some patients. The excess of males is in favour of the involvement of other X-linked genes. Although it was impossible to make a diagnosis in 80% of patients, these results will improve genetic counselling in families.

An adjuvanted respiratory syncytial virus fusion protein induces protection in aged BALB/c mice

Background

Respiratory Syncytial Virus (RSV) causes significant disease in the elderly, in part, because immunosenescence impairs protective immune responses to infection in this population. Despite previous and current efforts, there is no RSV vaccine currently licensed in infants or elderly adults. Adjuvanted RSV subunit vaccines have the potential to boost waning immune responses and reduce the burden of RSV disease in the elderly population.

Results

We used an aged BALB/c mouse model to evaluate immune responses to RSV Fusion (F) protein in the absence and presence of an alum adjuvant. We demonstrate that aged BALB/c mice immunized with alum-adjuvanted RSV F protein had significantly reduced lung viral titers at day 4 following challenge with wild-type (wt) RSV. Serum neutralizing antibody titers measured on day 27 correlated with protection in both young and aged vaccinated mice, although the magnitude of antibody titers was lower in aged mice. Unlike young mice, in aged mice, alum-adjuvanted RSV F did not induce lung T_H2-type cytokines or eosinophil infiltration compared to non-adjuvanted F protein following wt RSV challenge.

Conclusion

Our studies demonstrate that neutralizing anti-RSV antibody titers correlate with protection in both young and aged BALB/c mice vaccinated with RSV F protein vaccines. The F + alum formulation mediated greater protection compared to the non-adjuvanted F protein in both young and aged mice. However, while alum can boost F-specific antibody responses in aged mice, it does not completely overcome the reduced ability of a senescent immune system to respond to the RSV F antigen. Thus, our data suggest that a stronger adjuvant may be required for the prevention of RSV disease in immunosenescent populations, to achieve the appropriate balance of protective neutralizing antibodies and effective T_H1-type cytokine response along with minimal lung immunopathology.

Comment on: Hip fractures: public perceptions--are we jumping the gun?

McBride TJ, Panrucker S, Clothier JC Hip fractures: public perceptions. Ann R Coll Surg Engl 2011; 93: 67–70 doi: 10.1308/003588411X12851639107034

Rehabilitation for shoulder instability

Both structural and non-structural components can contribute to shoulder instability. Classification and therefore management must recognise these factors to achieve functional stability. This paper discusses a classification system proposing three types of shoulder instability recognising the structural and non-structural components and that a continuum exists between pathologies. Structural causes can be addressed with surgical intervention, but non-structural causes such as altered neuromuscular control within the rotator cuff should be addressed conservatively. The purpose of this article is to describe the types of instability and guide appropriate management, helping to avoid surgery in inappropriate cases and ensure that effective rehabilitation has been achieved.

Latent membrane protein 1 of Epstein Barr Virus alters cellular microRNAs in B cell lymphomas (169.37)

Epstein-Barr Virus (EBV) infection is usually benign but immunodeficiency can lead to B cell lymphomas such as Post-Transplant Lymphoproliferative Disease (PTLD). PTLD is associated the expression of the EBV oncogene latent membrane protein 1 (LMP1). MicroRNAs (miRs) are small, non-coding RNAs that regulate gene expression. We hypothesized that LMP1 signaling in EBV+ B cell lymphomas can modulate cellular miRNA expression as a mechanism to promote viral persistence and/or host cell survival. Using an inducible, chimeric LMP1 signaling system we analyzed miR expression in a B cell lymphoma cell line after activation of LMP1 variants isolated from PTLD patients and from the B95.8 form obtained from a mononucleosis patient. The expression of 747 miRs was assayed by qPCR array and 323 miRs were detected. B95.8 LMP1 activation modulated 50 total miRs including miR503, linked to inhibition of proliferation in epithelial cells. The PTLD-derived LMP1 variants modulated 59 distinct miRs. These included pro-apoptotic miR29b which was down-regulated by PTLD-derived LMP1 variants but not by B95.8 LMP1. These data indicate that PTLD-derived forms of LMP1 uniquely alter cellular miR as compared to B95.8 LMP1. Thus, study of the functional properties of LMP1 variants may provide insight into mechanisms of lymphomagenesis.

Syk survival signals in Epstein-Barr virus + B cell lymphomas (165.27)

EBV latent membrane protein 2a (LMP2a) is a B cell receptor mimic that provides a constitutive survival signal to virally-infected cells through Syk; however, the precise downstream mechanisms executing this survival signal have yet to be elucidated. Previously, we have shown that Syk inhibition induces apoptosis and reduces PI3K/Akt and Erk downstream signals in our EBV+ B cell lymphoma lines. Small molecule inhibitors for the Syk, PI3K/Akt and Erk pathway, or a DMSO vehicle control, were used to interrogate the function of each pathway. Survival of EBV+ B cell lymphoma lines was dependent on PI3K/Akt, but not Erk, as assayed by Annexin-V staining. Akt signaling can promote survival by directly phosphorylating molecules that inhibit apoptosis, including FOXO, Bad, and XIAP. XIAP is degraded after Syk and PI3K/Akt, but not Erk, inhibition, as assayed by Western blot. Treatment of EBV+ B cell lymphoma lines with an inhibitor of the XIAP protease Omi/HtrA2 rescued XIAP degradation and apoptosis induced by Syk inhibition. Our data supports a model in which Syk signaling in EBV+ B cell lymphomas activates Akt, which subsequently stabilizes XIAP and prevents its degradation. Small molecule, peptidic, substrate mimetic inhibition strategies for XIAP, Akt, and Syk are currently in clinical development and present potential new treatment strategies for EBV+ B cell lymphomas that target these EBV-driven survival signals.

[Risk factors for dryness or irritation of staff hands in nine healthcare institutions]

OBJECTIVE

We performed a prospective multicenter study to assess dryness and irritation of hands of staff in care facilities, and to show that disinfection with alcohol-based hand rub is better tolerated than classic hand washing with mild soap.

METHOD

Dryness and irritation were self-evaluated by volunteers and hetero-evaluated by a team of investigators. The study took into account most of the individual and environmental risk factors of dryness and irritation (season, age, gender, use of protective agent, constitutional, personal and external factors, institution, function, number of consecutive working days).

RESULTS

The results from the 1932 assessments collected showed that traditional hand washing was a risk factor for dryness or irritation, while alcohol-based hand rubs caused no skin deterioration and had a protective effect even when used intensively.

COMMENT

These results should help to fight non-adherence to the use of alcohol-based hand rubs.