Antibacterial activity of Arthrobacter strains isolated from Great Gobi A Strictly Protected Area, Mongolia

Desert soil hosts many microorganisms, whose activities are essential from an ecological viewpoint. Moreover, they are of great anthropic interest. The knowledge of extreme environments microbiomes may be beneficial for agriculture, technology, and human health. In this study, 11 Arthrobacter strains from topsoil samples collected from the Great Gobi A Strictly Protected Area in the Gobi Desert, were characterized by a combination of different techniques. The phylogenetic analysis, performed using their 16S rDNA sequences and the most similar Arthrobacter sequences found in databases, revealed that most of them were close to A. crystallopoietes, while others joined a sister group to the clade formed by A. humicola, A. pascens, and A. oryzae. The resistance of each strain to different antibiotics, heavy-metals, and NaCl was also tested as well as the inhibitory potential against human pathogens (i.e., Burkholderia ssp., Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus ssp.) via cross-streaking, to check the production of metabolites with antimicrobial activity. Data obtained revealed that all strains were resistant to heavy metals and were able to strongly interfere with the growth of many of the human pathogens tested. The volatile organic compounds (VOCs) profile of the 11 Arthrobacter strains was also analyzed. A total of 16 different metabolites were found, some of which were already known for having an inhibitory action against different Gram-positive and Gram-negative bacteria. Isolate MS-3A13, producing the highest quantity of VOCs, is the most efficient against Burkholderia cepacia complex (Bcc), K. pneumoniae, and coagulase-negative Staphylococci (CoNS) strains. This work highlights the importance of understanding microbial populations' phenotypical characteristics and dynamics in extreme environments to uncover the antimicrobial potential of new species and strains.

The Great Gobi A Strictly Protected Area: Characterization of Soil Bacterial Communities from Four Oases

Understanding how microbial communities survive in extreme environmental pressure is critical for interpreting ecological patterns and microbial diversity. Great Gobi A Strictly Protected Area represents an intriguing model for studying the bacterial community since it is a protected and intact wild area of the Mongolian desert. In this work, the composition of a bacterial community of the soil from four oases was characterized by extracting total DNA and sequencing through the Illumina NovaSeq platform. In addition, the soil's chemical and physical properties were determined, and their influence on shaping the microbial communities was evaluated. The results showed a high variability of bacterial composition among oases. Moreover, combining specific chemical and physical parameters significantly shapes the bacterial community among oases. Data obtained suggested that the oases were highly variable in physiochemical parameters and bacterial communities despite the similar extreme climate conditions. Moreover, core functional microbiome were constituted by aerobic chemoheterotrophy and chemoheterotrophy, mainly contributed by the most abundant bacteria, such as Actinobacteriota, Pseudomonadota, and Firmicutes. This result supposes a metabolic flexibility for sustaining life in deserts. Furthermore, as the inhabitants of the extreme regions are likely to produce new chemical compounds, isolation of key taxa is thus encouraged.

Endophytic Bacteria Associated with Origanum heracleoticum L. (Lamiaceae) Seeds

Seed-associated microbiota are believed to play a crucial role in seed germination, seedling establishment, and plant growth and fitness stimulation, due to the vertical transmission of a core microbiota from seeds to the next generations. It might be hypothesized that medicinal and aromatic plants could use the seeds as vectors to vertically transfer beneficial endophytes, providing plants with metabolic pathways that could influence phytochemicals production. Here, we investigated the localization, the structure and the composition of the bacterial endophytic population that resides in Origanum heracleoticum L. seeds. Endocellular bacteria, surrounded by a wall, were localized close to the aleurone layer when using light and transmission electron microscopy. From surface-sterilized seeds, cultivable endophytes were isolated and characterized through RAPD analysis and 16S RNA gene sequencing, which revealed the existence of a high degree of biodiversity at the strain level and the predominance of the genus Pseudomonas. Most of the isolates grew in the presence of six selected antibiotics and were able to inhibit the growth of clinical and environmental strains that belong to the Burkholderia cepacia complex. The endophytes production of antimicrobial compounds could suggest their involvement in plant secondary metabolites production and might pave the way to endophytes exploitation in the pharmaceutical field.

Genomic Analysis of Endophytic Bacillus-Related Strains Isolated from the Medicinal Plant Origanum vulgare L. Revealed the Presence of Metabolic Pathways Involved in the Biosynthesis of Bioactive Compounds

Multidrug-resistant pathogens represent a serious threat to human health. The inefficacy of traditional antibiotic drugs could be surmounted through the exploitation of natural bioactive compounds of which medicinal plants are a great reservoir. The finding that bacteria living inside plant tissues, (i.e., the endophytic bacterial microbiome) can influence the synthesis of the aforementioned compounds leads to the necessity of unraveling the mechanisms involved in the determination of this symbiotic relationship. Here, we report the genome sequence of four endophytic bacterial strains isolated from the medicinal plant Origanum vulgare L. and able to antagonize the growth of opportunistic pathogens of cystic fibrosis patients. The in silico analysis revealed the presence of gene clusters involved in the production of antimicrobial compounds, such as paeninodin, paenilarvins, polymyxin, and paenicidin A. Endophytes’ adaptation to the plant microenvironment was evaluated through the analysis of the presence of antibiotic resistance genes in the four genomes. The diesel fuel degrading potential was also tested. Strains grew in minimum media supplemented with diesel fuel, but no n-alkanes degradation genes were found in their genomes, suggesting that diesel fuel degradation might occur through other steps involving enzymes catalyzing the oxidation of aromatic compounds.

Predictors of in-hospital mortality of COVID-19 patients and the role of telemetry in an internal medicine ward during the third phase of the pandemic

OBJECTIVE

The first pandemic phase of COVID-19 in Italy was characterized by high in-hospital mortality ranging from 23% to 38%. During the third pandemic phase there has been an improvement in the management and treatment of COVID-19, so mortality and predictors may have changed. A prospective study was planned to identify predictors of mortality during the third pandemic phase.

PATIENTS AND METHODS

From 15 December 2020 to 15 May 2021, 208 patients were hospitalized (median age: 64 years; males: 58.6%); 83% had a median of 2 (IQR,1-4) comorbidities; pneumonia was present in 89.8%. Patients were monitored remotely for respiratory function and ECG trace for 24 hours/day. Management and treatment were done following the timing and dosage recommended by international guidelines.

RESULTS

79.2% of patients necessitated O2-therapy. ARDS was present in 46.1% of patients and 45.4% received non-invasive ventilation and 11.1% required ICU treatment. 38% developed arrhythmias which were identified early by telemetry and promptly treated. The in-hospital mortality rate was 10%. At multivariate analysis independent predictors of mortality were: older age (R-R for≥70 years: 5.44), number of comorbidities ≥3 (R-R 2.72), eGFR ≤60 ml/min (RR 2.91), high d-Dimer (R-R for≥1,000 ng/ml:7.53), and low PaO2/FiO2 (R-R for <200: 3.21).

CONCLUSIONS

Management and treatment adherence to recommendations, use of telemetry, and no overcrowding appear to reduce mortality. Advanced age, number of comorbidities, severe renal failure, high d-Dimer and low P/F remain predictors of poor outcome. The data help to identify current high-risk COVID-19 patients in whom management has yet to be optimized, who require the greatest therapeutic effort, and subjects in whom vaccination is mandatory.

Clinical application of lung ultrasound score on COVID-19 setting: a regional experience in Southern Italy

OBJECTIVE

We aimed to assess the correlation between LUS Soldati proposed score and clinical presentation, course of disease and the possible need of ventilation support/intensive care.

PATIENTS AND METHODS

All consecutive patients with laboratory confirmed SARS-CoV-2 infection and hospitalized in two COVID Centers were enrolled. All patients performed blood gas analysis and lung ultrasound (LUS) at admission. The LUS acquisition was based on standard sequence of 14 peculiar anatomic landmarks with a score between 0-3 based on impairment of LUS picture. Total score was computed with their sum with a total score ranging 0 to 42, according to Soldati LUS score. We evaluated the course of hospitalization until either discharge or death, the ventilatory support and the transition in intensive care if needed.

RESULTS

One hundred and fifty-six patients were included in the final analysis. Most of patients presented moderate-to-severe respiratory failure (FiO2 <20%, PaO2 <60 mmHg) and consequent recommendation to invasive mechanic ventilation (CPAP/NIV/OTI). The median ultrasound thoracic score was 28 (IQR 18-36) and most of patients could be ascertained either in a score 2 (40%) or score 3 pictures (24.4%). The bivariate correlation analysis displayed statistically significant and high positive correlations between the LUS score and the following parameters: ventilation (rho=0.481, p<0.001), lactates (rho=0.464, p<0.001), dyspnea (rho=0.398, p=0.001) mortality (rho=0.410, p=0.001). Conversely, P/F (rho= -0.663, p<0.001), pH (rho = -0.363, p=0.003) and pO2 (rho = -0.400 p=0.001) displayed significant negative correlations.

CONCLUSIONS

LUS score improve the workflow and provide an optimal management both in early diagnosis and prognosis of COVID-19 related lung pathology.

Exploring the Gut Microbiome Alteration of the European Hare (Lepus europaeus) after Short-Term Diet Modifications

Simple Summary

The composition of gut microbial communities can be altered by host diet shift. In this study, we investigated the microbiome composition of European hares and the potential changes in their gut communities after 4 days from the introduction in the diet of new nourishment. The control group was fed with standard fodder; the diet of the experimental group was integrated with apples and carrots. DNA was extracted from fresh faecal pellets and the V3-V4 hypervariable regions were amplified and sequenced using the Illumina MiSeq^® platform. The amplicon sequence variants were classified into 735 bacterial genera belonging to 285 families and 36 phyla; the most abundant phyla represented by Bacteroidetes and Firmicutes. Experimental and control hares did not show statistically significant differences in their microbial communities suggesting the exposition time to a new diet should be extended to define the time frame necessary to affect microbiome composition.

Abstract

This study aimed to characterise the gut microbiome composition of European hares (Lepus europaeus) and its potential changes after a short-term diet modification. The high sensitivity of European hare to habitat changes makes this species a good model to analyse possible alterations in gut microbiome after the introduction of additional nourishment into the diet. In total, 20 pairs were chosen for the experiments; 10 pairs formed the control group and were fed with standard fodder. The other 10 pairs represented the experimental group, whose diet was integrated with apples and carrots. The DNA from fresh faecal pellets collected after 4 days from the start of the experiment was extracted and the V3-V4 hypervariable regions were amplified and sequenced using the Illumina MiSeq^® platform. The obtained amplicon sequence variants were classified into 735 bacterial genera belonging to 285 families and 36 phyla. The control and the experimental groups appeared to have a homogenous dispersion for the two taxonomic levels analysed with the most abundant phyla represented by Bacteroidetes and Firmicutes. No difference between control and experimental samples was detected, suggesting that the short-term variation in food availability did not alter the hares’ gut microbiome. Further research is needed to estimate significant time threshold.

Community and hospital pharmacists in Europe: encroaching on medicine?

Pharmacy has been historically regarded as a discipline between health and chemistry devoted to drug development, production, and compounding. These tasks have been almost lost with the industrial manufacturing, and dispensing remains the main activity of pharmacists. Hospital pharmacists are usually employees in their workplace, while the professional framework of community pharmacists is very different, being pharmacies predominantly private shops in almost all European countries. In the last years pharmacists have strongly advocated that the focus of their services should switch from 'product' to 'patient'. Clinical pharmacy and pharmaceutical care are the two most cited concepts to support this shift. Clinical pharmacy was originally defined as the area of pharmacy concerned with the science and practice of rational medication use, pharmaceutical care as the responsible provision of drug therapies to achieve definite outcomes. The practice of clinical pharmacy should embrace the philosophy of pharmaceutical care. The new wave of pharmacists' patient-centered care in Europe still seems to be a reaction against the loss of their traditional professional role after the drug manufacturing revolution. To depict a realistic scenario for progress, it is worth differentiating between hospital and community. Hospital pharmacists should strengthen their pivotal role of medication gatekeepers to improve among clinicians the appropriateness of drug prescriptions and generate savings in expenditures. Any proposal for clinical services provided by community pharmacists is inevitably affected by the issue of their potential remuneration, especially in countries where the remuneration for reimbursable drugs is still a proportion of the retail price.

Correction to: Defensive medicine in Europe: a 'full circle'?

The Editorial "Defensive medicine in Europe: a 'full circle'?"

AB0617 OPTICAL COHERENCE TOMOGRAPHY IN THE ASSESSMENT OF SKIN FIBROSIS IN SYSTEMIC SCLEROSIS: A CROSS-SECTIONAL STUDY

Background:

Previous studies have shown that Optical Coherence Tomography (OCT) is a reliable biomarker of skin fibrosis and significantly correlates with the severity of the skin involvement in Systemic Sclerosis (SSc)1,2.

Objectives:

Aim of this cross-sectional study was to evaluate the performance of skin OCT to discriminate between SSc and healthy controls (HC) and to compare results with the current gold standard, the modified Rodnan skin score (mRss), in a different SSc study cohort.

Methods:

Dorsal forearm skin of consecutive diffuse cutaneous SSc (dcSSc) patients and matched-HC was scanned by an investigator blinded to the clinical data using Vivosight scanner (Michelson Diagnostics, Kent, UK). Minimum Optical Density (MinOD), Maximum OD (MaxOD) and OD at 300 micron-depth (OD300) were measured. Clinical involvement was assessed by a blinded operator using the mRss and results were compared with imaging data. Statistical analysis was performed using GraphPad Prism software V.7.0.

Results:

A total of 88 OCT images were obtained from 22 dcSSc patients [20 Female, mean age 49 (±11) years, 12 with < 5 years disease duration) and 22 HC (20 Female, mean age 50.7 (±6.7) years]. All OCT measures (MinOD, MaxOD and OD300) were significantly lower in SSc patients than in HC (p=0.011, p<0.0001, p<0.0001 respectively). MaxOD and OD300 were significantly different between the four groups (0-3) of patients based on the mRss at the site of analysis (p=0.035, p=0.001 respectively). Skin OCT showed a good performance in discriminating SSc skin vs HC (overall AUC 0.72, 0.8 and 0.89 for MinOD, MaxOD and OD300 respectively).

Conclusion:

These results confirm in a cohort different from those of the previous studies that skin OCT is able to reflect the severity of skin involvement in SSc. Longitudinal studies are needed to validate its potential as surrogate outcome measure of skin fibrosis in SSc patients.

References:

[1]Abignano G et al. Ann Rheum Dis 2013; 2. Pires NSM et al. Ann Rheum Dis 2018.

Disclosure of Interests:

None declared

FRI0569 SERUM AMYLOID A: ASSESSMENT OF REFERENCE VALUE AND COMPARISON OF SERUM CONCENTRATION IN HEALTHY SUBJECTS AND PATIENTS WITH BEHÇET SYNDROME

Background:

Serum amyloid A (SAA) is a family of acute-phase reactants. The rise of SAA concentration in blood circulation is a clinical marker of active inflammation in several auto-inflammatory diseases, including Behçet syndrome (BS). Despite its practical and analytical advantages, SAA measurement by ELISA has been mainly used as a research tool rather than for the routine laboratory testing due to the lack of a robust reference data in the literature.

Objectives:

Using the recommended procedures of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), we aimed to develop the SAA reference interval for a well-defined Italian healthy population (HC). Secondly, we compared the SAA serum concentration between HC and patients with BS.

Methods:

Sera specimens were collected from adult healthy blood donors after rule out the exclusion criteria (inflammatory disorders, ongoing infections, pregnancy and breastfeeding, obesity, using oral contraceptives, use of any medication, or consumed of alcohol), and from unselected BS patients fulfilling the International Study Group (ISG) classification criteria. Serum SAA concentrations were detected and quantified with a commercial solid phase sandwich enzyme-linked immunosorbent assay (Human SAA ELISA kit, IBL International GmbH, Hamburg, Germany) used on automated analyzer (Immunomat, SERION Diagnostic, Alifax, Polverara (PD), Italy) according to the manufacturer’s protocol. Statistical analysis and data normalization of HC SAA values were carried out to determine the reference cut off. In the second step of the study, HC and BS patients were stratified in two groups according to the cut-off value.

Results:

We recruited 141 HC (84 M and 57 F; mean age, 44.5±13.2 years) and 63 BS patients (39 M and 24 F mean age, 45.3±13.2 years) assayed for SAA. The reference cut-off was calculated as 225 ng/ml. No statistically significant differences were found between males and females when SAA means were compared, suggesting that not gender-partitioned reference range is recommended for this analyte. After the stratification according to the cut-off value (group 1: < 225 ng/ml and group 2: > 225 ng/ml), we found 53/63 (84.1%) BS patients and 133/141 (94.3%) HC with concentration less than cut-off value, respectively. We identified 10/63 (15.9%) BS patients and 8/141 (5.7%) HC within the second group. The difference was statistically significant (p=0.0177; OR: 3.14, 95% CI: 1.17-3.38).

Conclusion:

This study allowed to define a widely accepted reference cut-off for the SAA detected by ELISA, responding to an unmet need of laboratory medicine. We found a statistically significant higher frequency of BS patients compared with HC when SAA values is higher than cut-off (225 ng/ml). This preliminary data could add significant information for better clarify the role of SAA as biomarker of inflammation and in guidance of clinical practice. Further studies will be required to stratify SAA values in relation to disease activity of BS.

Disclosure of Interests:

Teresa Carbone: None declared, Maria Carmela Padula: None declared, Vito Pafundi: None declared, Carlo Schievano: None declared, Nancy Lascaro: None declared, Angela Padula: None declared, Pietro Leccese: None declared, Salvatore D’Angelo Consultant of: AbbVie, Biogen, BMS, Celgene, Eli Lilly, MSD, Novartis, and UCB, Speakers bureau: AbbVie, BMS, Celgene, Eli Lilly, Novartis, Pfizer, and Sanofi

FRI0226 OPTICAL COHERENCE TOMOGRAPHY OF THE SKIN DETECTS SCLERODERMA CHANGES IN CLINICALLY UNAFFECTED SKIN: AN OPPORTUNITY FOR EARLY DETECTION OF SYSTEMIC SCLEROSIS

Background:

The Very Early Diagnosis Of Systemic Sclerosis (VEDOSS) study has shown that 82% of patients with Raynaud’s Phenomenon, specific ANA positivity and scleroderma pattern at nail fold videocapillaroscopy will fulfil classification criteria within 5 years. This is suggesting that there is a subclinical window of opportunity to diagnose systemic sclerosis (SSc) before clinical manifestations occur. In this scenario, a non-invasive tool to diagnose SSc in clinically unaffected skin might improve the early detection of disease in at risk-patients. Optical coherence tomography (OCT) of the skin has been shown to be a sensitive and accurate biomarker of skin fibrosis in SSc.

Objectives:

Here we aimed to assess the ability of skin OCT to “detect” SSc in clinically unaffected skin from a multicentre cohort.

Methods:

Dorsal forearm skin of SSc patients and matched-healthy controls (HC) was evaluated using VivoSight scanner (Michelson Diagnostics). Mean A-scans (mean OCT signal plotted against depth-in-tissue) were derived as previously described. Minimum Optical Density (MinOD), Maximum OD (MaxOD) and OD at 300 micron-depth (OD300) were calculated. Clinical involvement was assessed by an operator blinded to OCT findings using the mRSS. Receiver-operating characteristic (ROC) curve analysis was carried out for MinOD, MaxOD, and OD300 to evaluate their ability to discriminate between SSc and HC. Statistical analysis was performed using GraphPad Prism software V.7.0.

Results:

One hundred seventy four OCT images were collected from 87 subjects [43 SSc (39 Female, mean age 49.7±9.1 years) and 44 gender/age-matched healthy controls (HC) (36 Female, mean age 50.2±8.3 years)] in two different SSc centres. All patients fulfilled classification criteria for SSc. OCT measures demonstrated discriminative ability in SSc skin detection with any clinical skin involvement (0-3 at site of analysis) with an AUC of 0.73 (MinOD, 95%CI 0.64-0.81), 0.77 (MaxOD, 95%CI 0.7-0.85) and 0.82 (OD300, 95%CI 0.76-0.89); p<0.0001 for all as previously indicated. Most importantly, all three measures showed comparable performance in detecting scleroderma also in clinically unaffected skin (mRss=0 at site of analysis), with an AUC of 0.7 (95%CI 0.6-0.81, p=0.001), 0.72 (95%CI 0.61-0.83, p=0.0003) and 0.72 (95%CI 0.61-0.83, p=0.0003) for MinOD, MaxOD and OD300 respectively.

Conclusion:

Virtual biopsy by OCT recognises clinically unaffected skin of SSc patients from the HC skin. This is consistent with gene array data showing that scleroderma specific signatures are consistent in affected and clinically unaffected skin. These results inform future studies on at risk patients with clinically unaffected skin which may define a role for OCT in detecting subclinical SSc.

Disclosure of Interests:

Giuseppina Abignano: None declared, Duygu Temiz Karadağ: None declared, Ozcan Gundogdu: None declared, Giovanni Lettieri: None declared, Maria Carmela Padula: None declared, Angela Padula: None declared, Paul Emery Grant/research support from: AbbVie, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, Roche (all paid to employer), Consultant of: AbbVie (consultant, clinical trials, advisor), Bristol-Myers Squibb (consultant, clinical trials, advisor), Lilly (clinical trials, advisor), Merck Sharp & Dohme (consultant, clinical trials, advisor), Novartis (consultant, clinical trials, advisor), Pfizer (consultant, clinical trials, advisor), Roche (consultant, clinical trials, advisor), Samsung (clinical trials, advisor), Sandoz (clinical trials, advisor), UCB (consultant, clinical trials, advisor), Salvatore D’Angelo: None declared, Francesco Del Galdo: None declared

AB0018 TNFΑ RS1800629 POLYMORPHISM: WHAT ABOUT ITS ASSOCIATION WITH CLINICAL MANIFESTATIONS AND ANTI-TNFΑ THERAPY? DATA FROM A SERIES OF ITALIAN PATIENTS WITH BEHÇET SYNDROME

Background:

Tumor Necrosis Factor-alpha (TNF-α) is a pleiotropic cytokine with a critical role in the pathogenesis of Behçet syndrome (BS). Anti-TNF-α therapy is useful for patients with refractory, severe BS, in particular for ocular, central nervous system, and gastrointestinal manifestations. However, although biological treatment with anti-TNF-α agents are effective in BS, not all patients are definite responders. Non-responders patterns could be due to: alternative non-TNFα related pathway of inflammation; anti-drug antibodies presence or development; polymorphic alleles ofTNFαgene.TNFαrs1800629 (-308G>A) is a drug-response single nucleotide polymorphism (SNP) located within the gene promoter. Poor and conflicting data are currently available about the association of this polymorphism and clinical manifestations of BS, as well as about the responsivness to the TNFα blockers in BS patients [1-3].

Objectives:

Aims of this study were to investigate in a cohort of Italian patients with BS the frequency of rs1800629 genotypes and its association with clinical features and anti-TNFα therapy response.

Methods:

Consecutive patients with BS were recruited. Patients demographic and clinical data were collected by medical records and analyzed. Home-made specific primer pairs were used for rs1800629 coverage. gDNA was isolated and amplified using PCR. Good-quality amplicons were sequenced (Sanger method).In silicoanalysis was downstream performed using specific software for query-subject similarity analysis.

Results:

130 BS patients (64M:66F; mean age: 45.8±12.3 years) were included in the study. Patients predominant lesions were oral aphtosis (100%), eye involvement (86.2%), skin lesions (72.3%) and genital ulcers (57.7%).TNFαrs1800629 wild-type GG genotype was found in 106/130 BS patients (81.5%); the heterozygous genotype (GA) was identified in 24/130 patients (18.5%). No statistically significant differences were found in genotypes frequencies when the patients were stratified for presence and absence of each clinical manifestation (p>0.05), while statistical significant differences were found when the patients were compared for therapy (anti-TNFα drugs) response. In detail, 73/130 patients (56.2%) were treated with anti-TNFα agents. We found 16/73 (21.9%) non-responders patients (NRP). In NRP group, we identified 9/16 patients (56.3%) with GG genotype and 7/16 (43.7%) with GA genotype, while 8/57 (14.0%) responder patients showed GA genotype and 49/57 responder patients (86.0%) showed GG genotype (p=0.0093; OR: 0.21, CI: 0.06-0.729).

Conclusion:

Here we described a low frequency ofTNFαrs1800629 SNP-containing allele and the lack of association between SNP and BS clinical hallmark, as previously reported in literature [1-4]. We also found higher percentage of GG genotype in case of therapy response than GA genotype. The SNP is a promoter polymorphism that could affect the auto-inflammatory response and the therapy responsivness, as suggested by our preliminary data of pharmacogenomics. Analyses of a larger cohort of patients are need to confirm the study findings and to explain the SNP role as outcome predictor.

References:

[1]Touma Z et al. (2010). Arch Med Res 41(2):142-6;

[2]Vallet H et al. (2015). J Autoimmun 62:67-74.

[3]Zhang M et al. (2013). Mol Vis 19:1913-24.

[4]Ateş A et al. (2006). Rheumatol Int 26(4):348-53.

Disclosure of Interests:

Maria Carmela Padula: None declared, Pietro Leccese: None declared, Nancy Lascaro: None declared, Giusi Gaia Sorrento: None declared, Rosa Paola Radice: None declared, Antonina Rita Limongi: None declared, Teresa Carbone: None declared, Angela Padula: None declared, Giuseppe Martelli: None declared, Salvatore D’Angelo Consultant of: AbbVie, Biogen, BMS, Celgene, Eli Lilly, MSD, Novartis, and UCB, Speakers bureau: AbbVie, BMS, Celgene, Eli Lilly, Novartis, Pfizer, and Sanofi

SAT0305 PERFORMANCE OF HIGH FREQUENCY ULTRASOUND IN THE ASSESSMENT OF SKIN INVOLVEMENT IN SYSTEMIC SCLEROSIS

Background:

The modified Rodnan skin score (mRSS) is the current gold standard for skin assessment in systemic sclerosis (SSc) both in clinical trials and practice. High frequency ultrasound (HFUS) has been suggested to offer a quantitative assessment of skin thickness in SSc by several studies, however results are inhomogeneous with regards to the machine used, number of imaged sites, as well as the various stages of skin involvement.

Objectives:

Aim of this cross-sectional study was to compare performance of HFUS in the assessment of skin involvement in diffuse cutaneous SSc (dcSSc) patients, at different disease stages, as compared with healthy controls (HC).

Methods:

Dorsal finger, hand, forearm and upper arm skin of consecutive dcSSc patients, at different disease stages, and of matched-HC were scanned bilaterally using HFUS. Two investigators, expert in MSK ultrasound, blinded to the clinical details, measured skin thickness using Esaote MyLab70 equipped with a 22 MHZ probe. Clinical involvement was assessed by a blinded operator using the mRSS and results were compared with imaging data. Statistical analysis was performed using GraphPad Prism software V.7.0.

Results:

A total of 704 HFUS images were obtained from 22 dcSSc patients [20 Female, mean age 49 (±11) years, 12 with ≤ 5 years disease duration] and 22 HC [20 Female, mean age 50.7 (±6.7) years]. Skin thickness was significantly higher in SSc patients than in HC at fingers (p<0.0001) and hands (p<0.0001), while no significant difference was found at the forearms and upper arms (p>0.05). HFUS showed a good discriminative ability between SSc and HC skin at fingers and hands (AUC 0.91, 0.81, 0.6 and 0.65 for fingers, hands, forearms and upper arms respectively). When analysing the subgroup of SSc patients with ≤5 years disease duration, HFUS showed a slightly lower performance in discriminating between SSc without clinical skin involvement (site mRSS=0) and HC (AUC 0.68, 0.57, 0.68 for hands, forearms and upper arms respectively). Mean HFUS skin thickness significantly correlated with mRSS at site of analysis (hand: r=0.78, p=<0.0001; forearm: r=0.47, p=0.0013; upper arm: r=0.52, p=0.0003) and total mRSS (hand: r=0.53, p=0.0002; forearm: r=0.63, p<0.0001; upper arm: r=0.63, p<0.0001). No significant correlation was found between finger skin thickness and mRSS (both local and total, p>0.05). Interobserver reliability for skin thickness was good to excellent at all sites with intraclass correlation coefficient ranging between 0.79 and 0.94.

Conclusion:

HFUS of the skin is a reliable measure of skin involvement in SSc. Studies with higher number of patients with different clinical features are needed to explore the potential of HFUS to discriminate between healthy and SSc skin, including sites at a preclinical stage of involvement.

Disclosure of Interests:

None declared

Conflicts of interest in medicine: a never-ending story

Individuals may have conflicts of interest (CoI) when they choose between the duties of their jobs and their own private interests. In medicine, CoI are potentially ubiquitous and their disclosure has now become the most frequent strategy to address them in professional lives. In the medical literature, CoI are classified into two different types-financial and non-financial. Financial CoI are easy to identify and can bias any kind of results in research; so, their disclosure is very important. The unsolvable dilemma is where to set the lowest limit for sums received from industry. Non-financial CoI are a very large category intrinsically related to the individuals concerned, ranging from family relationships to religious beliefs, and the mere disclosure of many of them can raise privacy and ethical issues. Two opposite narratives characterize the debate on financial CoI caused by pharmaceutical industry. The critical side argues that, because the primary goal of pharmaceutical industry is inevitably to promote its products, the best strategy is to stay away from financial CoI. On the other hand, the defensive side claims that financial CoI are boosted by ideology but meaningless in real practice, since any kind of interest can raise a potential conflict. A missing point in the debate on financial CoI is that health care is a classical example of 'market failure' in the economic theory. Since health cannot be considered a 'consumer good', the economic paradigm of 'free market' does not fit for healthcare products. To conclude, even though transparency on financial CoI cannot itself deter the risk of bias, rejecting it would be an even bigger mistake. At variance, mandatory disclosure of non-financial CoI risks to be confusing and questionable in many cases, paradoxically distracting attention from the potential bias created by financial CoI.

Between pharmaceutical patents and European patients: is a compromise still possible?

INTRODUCTION

Pharmaceutical regulation has always attempted to balance the public health objective to make safe and effective drugs available for patients while providing commercial incentives through patents. Here we discuss whether it is still possible to find a balance between the incentives on the supply side and the regulatory framework on the demand side. Areas covered: The current regulatory framework on pharmaceutical exclusivity has been harshly criticized by many experts, arguing about whether it is still fit for public purposes and needs. Here we envisage a different scenario without 'revolutionizing' the whole present system. The main radical change should concern the present management of pharmaceutical patents by introducing a specific agency dedicated to them. Secondly, specific pharmaceutical patents could be restricted to compounds for one (or more) declared indication(s). Thirdly, pharmaceutical patents should be kept only for compounds that start a first clinical trial within five years from the granting date. Expert opinion: We think it is time to reconsider the regulation of pharmaceutical patents in the light of their relevance in terms of public health. New models of enhancing research investments are required for long-term sustainability of public pharmaceutical expenditure and the EU can still play a leading role.

Cholesterol-lowering drugs: science and marketing

Long-term use of statin therapy is essential to obtain clinical benefits, but adherence is often suboptimal and some patients are also reported to fail because of 'statin resistance'. The identification of PCSK9 as a key factor in the LDL clearance pathway has led to the development of new monoclonal antibodies. Here we critically review the economic evaluations published in Europe and focused on statins. We searched the PubMed database to select the studies published from July 2006 to June 2016 and finally selected 19 articles. Overall, the majority of studies were conducted from a third-party payer's viewpoint and recurred to modelling. Most studies were sponsored by industry and funding seemed to play a pivotal role in the study design. Patients resistant to LDL-C level reduction were considered only in a few studies. The place in therapy of the new class of biologic should be considered a kind of 'third line' for cholesterol-lowering, after patients have failed with restricted dietary regimens and then with current drug therapies. Otherwise they could result in hardly sustainable expenses even for developed countries.