Genomic analyses elucidate S-locus evolution in response to intra-specific losses of distyly in Primula vulgaris

Distyly, a floral dimorphism that promotes outcrossing, is controlled by a hemizygous genomic region known as the S-locus. Disruptions of genes within the S-locus are responsible for the loss of distyly and the emergence of homostyly, a floral monomorphism that favors selfing. Using whole-genome resequencing data of distylous and homostylous individuals from populations of Primula vulgaris and leveraging high-quality reference genomes of Primula we tested, for the first time, predictions about the evolutionary consequences of transitions to selfing on S-genes. Our results reveal a previously undetected structural rearrangement in CYPᵀ associated with the shift to homostyly and confirm previously reported, homostyle-specific, loss-of-function mutations in the exons of the S-gene CYPᵀ. We also discovered that the promoter and intronic regions of CYPᵀ in distylous and homostylous individuals are conserved, suggesting that down-regulation of CYPᵀ via mutations in its promoter and intronic regions is not a cause of the shift to homostyly. Furthermore, we found that hemizygosity is associated with reduced genetic diversity in S-genes compared with their paralogs outside the S-locus. Additionally, the shift to homostyly lowers genetic diversity in both the S-genes and their paralogs, as expected in primarily selfing plants. Finally, we tested, for the first time, long-standing theoretical models of changes in S-locus genotypes during early stages of the transition to homostyly, supporting the assumption that two copies of the S-locus might reduce homostyle fitness.

Improvements in quality of life over 2 years with cladribine tablets in people with relapsing multiple sclerosis: The CLARIFY-MS study

BACKGROUND

Multiple sclerosis (MS) negatively affects health-related quality of life (HRQoL).

OBJECTIVE

To evaluate HRQoL in people with highly active relapsing MS treated with cladribine tablets (CladT; 3.5 mg/kg cumulative dose over 2 years) in CLARIFY-MS.

METHODS

Changes in the MS quality of life (MSQoL)-54 scores were analysed using a repeated mixed-effects linear model. Subgroup analyses were performed for participants who were pretreatment-naïve and those pretreated with disease-modifying therapies (DMTs) before initiating CladT. Safety and tolerability of CladT were also assessed.

RESULTS

MSQoL-54 physical (mean change = 4.86; 95% confidence interval (CI) = 3.18, 6.53) and mental health (4.80; 95% CI = 3.13, 6.46) composite scores (primary endpoints) showed significant improvement at Month 24 versus Baseline (p < 0.0001). Changes in the MSQoL-54 scores were consistent across the pretreatment-naïve and DMT-pretreated subgroups. No new severe or opportunistic infections occurred. Most post-baseline lymphopenia events were Grade 1-2 in severity. Transient Grade-3 lymphopenia was observed in 19.7% (95/482) of participants. Grade-4 lymphopenia was not observed.

CONCLUSIONS

CladT treatment significantly improved the mean MSQoL-54 physical and mental health composite scores over 2 years. CladT efficacy in HRQoL, relapse rates and Expanded Disability Status Scale scores demonstrates its multidimensional effects in MS treatment.

Skewed morph ratios lead to lower genetic diversity of the heterostylous Primula veris in fragmented grasslands

Populations of heterostylous plant species are ideally composed of equal frequencies of two (distylous) or three (tristylous) morphologically different floral morphs. Intra-morph incompatibility helps to avoid inbreeding and to maintain genetic diversity, supporting plant fitness and long-term viability. Habitat fragmentation can lead to skewed morph ratios and thereby reduce the abundance of compatible mates. This, in turn, can result in a loss of genetic diversity. We tested whether the genetic diversity of heterostylous plants is affected by morph ratio bias using populations of the distylous grassland plant Primula veris in recently fragmented grasslands. We recorded morph frequencies and population sizes in 30 study populations of P. veris on two Estonian islands characterised by different degrees of habitat fragmentation. Examining variation of thousands of single nucleotide polymorphisms (SNPs) and heterostyly-specific genetic markers, we quantified overall and morph-specific genetic diversity and differentiation in these populations. Morph frequencies deviated more in smaller populations. Skewed morph ratios had a negative effect on the genetic diversity of P. veris in more fragmented grasslands. In the populations of better-connected grassland system, genetic differentiation among S-morphs was higher than among L-morphs. Our study shows that deviations from morph balance are stronger in small populations and have a negative impact on the genetic diversity of the distylous plant P. veris. Together with the direct negative effects of habitat loss and decreased population size on the genetic diversity of plants, morph ratio bias may intensify the process of genetic erosion, thus exacerbating the local extinction of heterostylous species.

Early Reduction of MRI Activity During 6 Months of Treatment With Cladribine Tablets for Highly Active Relapsing Multiple Sclerosis: MAGNIFY-MS

Background and Objectives

The onset of action for high-efficacy immunotherapies in multiple sclerosis (MS) is an important parameter. This study (MAGNIFY-MS) evaluates the onset of action of cladribine tablets by observing changes in combined unique active (CUA) MRI lesion counts during the first 6 months of treatment in patients with highly active relapsing MS.

Methods

MRI was performed at screening, baseline, and at months 1, 2, 3, and 6 after initiating treatment with cladribine tablets 3.5 mg/kg. CUA lesion counts, defined as the sum of T1 gadolinium-enhancing (Gd+) lesions and new or enlarging active T2 lesions (without T1 Gd+), were compared between postbaseline and the baseline period and standardized to the period length and the number of MRIs performed.

Results

Included in this analysis were 270 patients who received ≥1 dose of cladribine tablets. After treatment initiation, significant reductions in mean CUA lesion counts were observed from month 1 onward compared with the baseline period (−1.193 between month 1 and month 6, −1.500 between month 2 and month 6, and −1.692 between month 3 and month 6; all p < 0.0001). Mean T1 Gd+ lesion counts were decreased from month 2 onward compared with baseline (−0.857 at month 2, −1.355 at month 3, and −1.449 at month 6; all p < 0.0001), whereas the proportion of patients without any CUA lesions increased from 52.0% between month 1 and month 6 to 80.5% between month 3 and month 6.

Discussion

Findings suggest an early onset of action for cladribine tablets, with an increasing reduction in active MRI lesions over time.

Trial Registration Information

NCT03364036; Date registered: December 06, 2017.

Classification of Evidence

Using frequent MRI assessments of the brain over the first 6 months of the MAGNIFY-MS study (NCT03364036), we aimed to determine the onset of action of cladribine tablets 3.5 mg/kg in adult patients with highly active relapsing MS. This study provides Class IV evidence that, in such patients, treatment with cladribine tablets is associated with an early onset of action with reductions in active MRI lesion counts from month 2 (day 60) onward, with an increasing reduction in such lesions over time.

015 Reduced risk of secondary progressive multiple sclerosis by treatment with clad- ribine tablets: CLARITY study analysis

Background

Cladribine tablets 10mg, cumulative dose 3.5mg/kg (CT3.5) over 2 years, showed efficacy vs placebo in patients with relapsing multiple sclerosis. This post-hoc analysis explored the relationship between baseline Expanded Disability Status Scale (EDSS) and risk of progression to secondary progres- sive (SPMS, EDSS ≥6.0) in CLARITY.

Methods

This analysis used a proxy composite definition of SPMS. Patients progressing to EDSS ≥6.0 were defined as ≥1 post-baseline EDSS ≥6.0 with 3- or 6-month confirmed disability progression (CDP).

Results

Proxy SPMS progression was lower for CT3.5 vs placebo: overall (6.7% vs 13.5% [OR 0.46; 95%CI: 0.28–0.76]; P=0.0024); baseline EDSS ≤3.0 subgroup (3.5% vs 7.7% [OR 0.44; 95%CI: 0.19–0.99]; P=0.047]); baseline EDSS ≥3.5 subgroup (12.2% vs 22.4% [OR 0.48; 95%CI: 0.26–0.9]; P=0.0212). Patients with 3-month CDP with EDSS ≥6.0: 3.5% vs 8.0% (OR 0.42 [95%CI: 0.22–0.82]; P=0.0114); 6-month CDP with EDSS ≥6.0: 2.8% vs 5.8% (OR 0.48 [95%CI: 0.22–1.02]; P=0.0566).

Conclusions

Risk of progressing to proxy SPMS within 2 years of treatment or experiencing EDSS ≥6.0 was sig- nificantly reduced with CT3.5 compared to placebo, regardless of baseline EDSS. CLARITY:NCT00213135

g.giovannoni@qmul.ac.uk

016 Long-term disease stability in patients treated with cladribine tablets in CLARITY and CLARITY extension

Background

This post-hoc analysis evaluated long-term disease stability of relapsing-remitting multiple sclerosis (RRMS) patients, according to Expanded Disability Status Scale (EDSS), after treatment with clad- ribine tablets 10mg (cumulative dose 3.5mg/kg [CT3.5] over 2 years) in CLARITY and CLARITY Extension.

Methods

Patients randomised to CT3.5 in CLARITY then placebo in CLARITY Extension, with ≥1 post- baseline EDSS measurement, were included (CP3.5, n=98). EDSS score over time (CLARITY randomisation to end of follow-up in CLARITY Extension, including the bridging interval between studies) was assessed at 6-month intervals, and separately at time to 3- and 6-month confirmed EDSS score progression from CLARITY baseline.

Results

Five years after CLARITY baseline, median EDSS remained stable compared with baseline. Median EDSS score (95%CI) for CP3.5 was 2.5(2.0–3.5) vs 3.0(2.5–3.5) at baseline. In each 12-month period, EDSS score was stable in >50% of patients, 21–30% improved and 0–25% worsened. During Year 5, EDSS was stable in 53.9% of patients, 21.3% improved and 24.7% worsened; <30% of patients reached 3- or 6-month confirmed EDSS progression.

Conclusions

EDSS score was stable up to 5 years post-CLARITY baseline for CP3.5 patients. Between 20–30% of patients demonstrated improvement in EDSS score vs baseline each year. CLARITY:NCT00213135.

CLARITY Extension

NCT00641537

g.giovannoni@qmul.ac.uk

Treatment satisfaction, safety, and tolerability of cladribine tablets in patients with highly active relapsing multiple sclerosis: CLARIFY-MS study 6-month interim analysis

Background Multiple sclerosis (MS) is a chronic disabling disease that is associated with negative effects on health-related quality of life (HRQoL) due to reduced physical and psychosocial functioning. Cladribine tablets 10 mg (3.5 mg/kg cumulative dose over 2 years) have been approved for the treatment of adult patients with highly active relapsing multiple sclerosis (RMS). The ongoing CLARIFY-MS study (NCT03369665; EudraCT number: 2017-002632-17) aims to assess the effect of cladribine tablets 3.5 mg/kg on HRQoL of patients with highly active RMS. Objective To report on the design of the CLARIFY-MS study, baseline patient characteristics, and results of a pre-planned interim analysis focusing on treatment satisfaction, safety, and tolerability that includes all data reported till 6 months after start of treatment. Methods The CLARIFY-MS study is a 2-year, open-label, single-arm, prospective, multicenter, phase IV study. Eligible patients with highly active RMS were assigned to receive cladribine tablets 3.5 mg/kg over 2 years. Treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM, v1.4; scale range from 0 to 100, higher values indicating higher satisfaction). Safety assessments, including occurrence of treatment-emergent adverse events (TEAEs; any adverse event reported after drug administration), serious adverse events (SAEs), and lymphocyte counts, were summarized descriptively. Results A total of 482 patients from 85 sites in Europe were treated with cladribine tablets. Mean patient age was 37.4 years, 338 (70.1%) were women, median EDSS was 2.5, and 345 (71.6%) were prior users of disease-modifying therapy (DMT). During the first 6 months after the start of treatment, and before reaching the full dose of cladribine tablets, mean TSQM global satisfaction score for the overall population was 70.4 (standard deviation, ± 18.48). The side effects score was 91.9 (± 17.68), convenience scored 86.6 (± 13.57), and effectiveness was 65.8 (± 21.14). A total of 275 patients (57.1%) reported at least one TEAE and 9 patients (1.9%) had a SAE. The majority of observed lymphopenia cases were of grade 1 or 2; 33 (6.8%) of the total study cohort had grade 3 lymphopenia, and no grade 4 lymphopenia was reported. Conclusion Patients reported high treatment satisfaction (TSQM) with cladribine tablets in this pre-planned interim analysis at 6 months. Few serious, and no unexpected, adverse events were reported, and there were no instances of grade 4 lymphopenia over the first 6 months. These preliminary data indicate good tolerability and convenience of administration of cladribine tablets in patients with highly active RMS.

The potential for aflatoxin predictive risk modelling in sub-Saharan Africa: a review

This review presents the current state of aflatoxin risk prediction models and their potential for value actors throughout the food chain in sub-Saharan Africa, with a specific focus on improving smallholder farmer management practices. Several empirical and mechanistic models have been developed either in academic research or by private sector aggregators and processors in high-income countries including Australia, the USA, and Southern Europe, but these models have been only minimally applied in sub-Saharan Africa, where there is significant potential and increasing need due to climate variability. Predictions can be made based on historic occurrence data using either a mechanistic microbiological framework for aflatoxin accumulation or an empirical model based on statistical correlations with climate conditions and local agronomic factors. Model results can then be distributed to smallholders through private, public, or mobile extension services, used by policymakers for strategy or policy, or utilised by private sector institutions for management decisions. Specific agricultural advice can be given during the three most critical points in the phenological cycle: preseason insight including sowing timing and crop varieties, preharvest advice about management and harvest timing, and postharvest optimal practices including storage, drying, and market information. Model development for sub-Saharan Africa is limited by a dearth of georeferenced aflatoxin occurrence data and real-time high resolution climate data; the wide diversity of farm typologies each with significant information and technology gaps; a prevalence of informal market structures and lack of economic incentives systems; and general lack of awareness around aflatoxins and best management practices to mitigate risk. Given advancements towards solving these challenges, predictive aflatoxin models can be integrated into decision support platforms to focus on optimisation of value for smallholders by minimising yield and nutritional losses, which can propagate value throughout the production and postharvest phases.

Analysis of frequency and severity of relapses in multiple sclerosis patients treated with cladribine tablets or placebo: The CLARITY and CLARITY Extension studies

Background:

In the CLARITY (CLAdRIbine Tablets treating multiple sclerosis orallY) study of patients with relapsing-remitting multiple sclerosis, treatment with cladribine tablets 3.5 mg/kg (CladT) significantly reduced the annualised relapse rate (ARR) versus placebo; this effect was sustained in CLARITY Extension, without further treatment.

Objective:

To assess the frequency and severity of relapses in patients treated with CladT versus placebo in CLARITY over 2 years and evaluate the durability of effect in patients who received no further treatment for 2 years in CLARITY Extension.

Methods:

In this post hoc analysis, ARRs were calculated for qualifying and all relapses, and qualifying and all severe relapses (i.e. requiring steroid treatment or leading to hospitalisation) in patients treated with CladT (n = 433) and placebo (n = 437) in CLARITY, and those from the CladT group who received placebo in CLARITY Extension (n = 98).

Results:

At Month 6, Year 1 and Year 2, patients receiving CladT had a significantly lower risk of qualifying or all relapses (all p < 0.0001), and qualifying or all severe relapses (all p < 0.005), compared with placebo. This effect was sustained in CLARITY Extension without further treatment.

Conclusion:

The results show durable efficacy of cladribine tablets 3.5 mg/kg for reducing frequency and severity of relapses in patients with relapsing-remitting multiple sclerosis.

CLARITY: NCT00213135; CLARITY Extension: NCT00641537

Yeasts in Liquid Swine Diets: Identification Methods, Growth Temperatures and Gas-Formation Potential

Liquid feed is susceptible to microbiological growth. Yeasts are said to cause sudden death in swine due to intestinal gas formation. As not all animals given high yeast content feed fall ill, growth and gas formation potential at body temperature were investigated as possible causally required properties. The best identification method for these environmental yeasts should be tested beforehand. Yeasts derived from liquid diets without (LD - S) and liquid diets with maize silage (LD + S) were examined biochemically (ID32C-test) and with MALDI-TOF with direct smear (DS) and an extraction method (EX). Growth temperature and gas-forming potential were measured. With MALDI-EX, most yeast isolates were identified: Candida krusei most often in LD - S, and C. lambica most often in LD + S, significantly more than in LD - S. Larger colonies, 58.75% of all yeast isolates, were formed at 25 °C rather than at 37 °C; 17.5% of all isolates did not grow at 37 °C at all. Most C. krusei isolates formed high gas amounts within 24 h, whereas none of the C. lambica, C. holmii and most other isolates did. The gas pressure formed by yeast isolates varied more than tenfold. Only a minority of the yeasts were able to produce gas at temperatures common in the pig gut.

Intestinal Microbiota of Fattening Pigs Offered Non-Fermented and Fermented Liquid Feed with and without the Supplementation of Non-Fermented Coarse Cereals

Introducing high numbers of lactic acid bacteria into the gastrointestinal tract of pigs via fermented liquid feed (FLF) could have an impact on intestinal bacterial ecosystems. Twenty piglets were allocated into four groups and fed a botanically identical liquid diet that was offered either non-fermented (twice), fully fermented or partially fermented but supplemented with 40% of non-fermented coarse cereals. Microbiota studies were performed on the small and large intestine digesta and faecal samples. A 16S rRNA gene amplification was performed within the hypervariable region V4 and sequenced with the Illumina MiSeq platform. R (version 3.5.2) was used for the statistical analyses. The digesta of the small intestines of pigs fed FLF were dominated by Lactobacillaceae (relative abundance up to 95%). In the colonic contents, the abundance of Lactobacillaceae was significantly higher only in the pigs fed the FLF supplemented with non-fermented coarse cereals. Additionally, the digesta of the small and large intestines as well as in the faeces of the pigs fed the FLF supplemented with non-fermented coarse cereals were significantly enriched for two operational taxonomic units (OTUs) belonging to the genus Lactobacillus and Bifidobacterium. The FLF supplemented with non-fermented coarse cereals had probiotic and prebiotic-like impacts on the intestinal and faecal bacterial composition of pigs.

From laboratory to the field: biological control of Fusarium graminearum on infected maize crop residues

Aim

To evaluate biological control agents (BCAs) against Fusarium graminearum on infected maize stalks as a means to reduce Fusarium head blight (FHB) in subsequently grown wheat.

Methods and Results

In the laboratory, BCAs were applied against F. graminearum on maize stalk pieces. Clonostachys rosea inhibited the perithecia development and ascospore discharge when applied before, simultaneously with and after the pathogen. In the field, we simulated a system with high disease pressure, that is, a maize‐wheat rotation under no‐tillage, by preparing maize stalks inoculated with F. graminearum. The infected stalks were treated with formulations of C. rosea selected in vitro or the commercial BCA strain Trichoderma atrobrunneum ITEM908 and exposed to field conditions over winter and spring between winter wheat rows. Monitoring with spore traps and of FHB symptoms, as well as quantification of F. graminearum incidence and DNA in harvested grain revealed significant reductions by C. rosea by up to 85, 91, 69 and 95% compared with an inoculated but untreated positive control, respectively. Deoxynivalenol (DON) and zearalenone (ZEN) contents were reduced by up to 93 and 98%, respectively. Treatments with T. atrobrunneum were inconsistent, with significant reductions of DON and ZEN under warm and wet climatic conditions only.

Conclusions

The findings support the application of C. rosea against F. graminearum on residues of maize to suppress the primary inoculum of FHB.

Significance and Impact of the Study

As sustainable agriculture requires solutions to control FHB, hence, the application of C. rosea during the mulching of maize crop residues should be evaluated in on‐farm experiments.

Changes in Pulmonary Function in Patients With Advanced Heart Failure Listed for Heart Transplantation

BACKGROUND

Pulmonary function tests (PFTs) are often impaired in patients with advanced heart failure. There is limited data about their impact on survival after heart transplantation (HT). We sought to assess the prevalence and type of PFT abnormalities in patients on HT waiting list and their impact on outcomes.

METHODS

We performed a retrospective analysis of a prospective registry of consecutive patients undergoing HT between 2012 and 2018. Patients were classified into 4 groups according to pre-HT PFT results: 1. normal pattern: forced vital capacity (FVC) ≥ 80% and forced expiratory volume in 1 second (FEV₁) to FVC ratio (FEV₁/FVC) ≥ 0.7; 2. obstructive: FEV₁/FVC < 0.7; 3. nonobstructive: FEV₁/FVC ≥ 0.7 and FVC < 80% when total lung capacity value was not available; and 4. restrictive: FEV₁/FVC ≥ 0.7 and total lung capacity < 80%. The prevalence of impaired carbon monoxide diffusing capacity corrected for hemoglobin < 80% and FEV₁ < 70% was also analyzed. High-urgency HT patients and those referred from other centers without quantitative pulmonary evaluation were excluded.

RESULTS

Among 123 patients who underwent HT, 83 patients with complete PFT were included. Median follow-up was 2.7 ± 1.9 years. Of these, 29 (34.9%) had an obstructive pattern, 20 (24.1%) a nonobstructive, 18 (21.7%) a restrictive, and 16 (19.3%) a normal pattern. Fifty-one (61.4%) patients had FEV₁ < 70% and 58 (69.9%) a carbon monoxide diffusing capacity corrected for hemoglobin < 80%. There was a tendency to lower survival in all altered PFT groups compared with normal (P = .054) but not within the other groups. Patients with an impaired FEV₁ had significantly higher mortality than patients with normal values (P = .008). Area under receiver operating characteristic curve for FEV₁ was 0.73 (95% confidence interval [0.60-0.86]). A cutoff value of FEV₁ (60.5) predicts mortality with 66% sensitivity and 64% specificity.

CONCLUSIONS

PFT alterations have a very high prevalence on HT waiting list patients. Patients with impaired FEV₁ had worse outcomes after heart transplantation.

Resistance Reservoirs and Multi-Drug Resistance of Commensal Escherichia coli From Excreta and Manure Isolated in Broiler Houses With Different Flooring Designs

Carriage of resistant bacteria and spread of antimicrobial resistance (AMR) in the environment through animal manure pose a potential risk for transferring AMR from poultry and poultry products to the human population. Managing this risk is becoming one of the most important challenges in livestock farming. This study focused on monitoring the prevalence of multi-drug resistance (MDR) bacteria and development of AMR depending on flooring. In two experiments (2 × 15,000 birds), broilers were always divided in two different stables. In the control group, the entire floor pen was covered with litter material and in the experimental group, the flooring system was partly modified by installing elevated slat platforms equipped with water lines and feed pans. Over the whole fattening period, excreta and manure samples were taken (days 2, 22, and 32). In total, 828 commensal E. coli isolates were collected. The development and prevalence of resistance against four different antibiotic classes (quinolones, β-lactams, tetracyclines, and sulfonamides) were examined by using broth microdilution. At the end of the trials, the amount of manure per square metre was twice as high below the elevated platforms compared to the control group. Approximately 58% of E. coli isolates from excreta showed resistance against at least one antibacterial agent at day 2. During and at the end of the fattening period, resistant E. coli isolates at least against one of the four antibacterial agents were observed in excreta (46 and 46%, respectively), and manure samples (14 and 42%, respectively), despite the absence of antibacterial agent usage. In spite of less contact to manure in the experimental group, the prevalence of resistant E. coli isolates was significantly higher. Birds preferred the elevated areas which inevitably led to a local high population density. Animal-to-animal contact seems to be more important for spreading antimicrobial resistant bacteria than contact to the litter-excreta mixture. Therefore, attractive areas in poultry housing inducing crowding of animals might foster transmission of AMR. In poultry farming, enrichment is one of the most important aims for future systems. Consequently, there is a need for keeping birds not carrying resistant bacteria at the start of life.

Caecal Microbiota of Experimentally Campylobacter jejuni-Infected Chickens at Different Ages

Campylobacter jejuni is the most common bacterial cause of foodborne zoonosis in the European Union. Infections are often linked to the consumption and handling of poultry meat. The aim of the present study was to investigate the caecal microbiota of birds infected with C. jejuni at different ages. Therefore, a total of 180 birds of the laying hybrid Lohmann Brown-Classic were housed in 12 subgroups of 15 animals each in three performed repetitions. Three birds per subgroup were experimentally infected with C. jejuni at an age of about 21 days and about 78 days (4.46 ± 0.35 log10 CFU/bird). Twenty-one days after experimental infection, microbiome studies were performed on 72 caecal samples of dissected birds (three primary infected and three further birds/subgroup). Amplification within the hypervariable region V 4 of the 16S rRNA gene was performed and sequenced with the Illumina MiSeq platform. Statistical analyses were performed using SAS® Enterprise Guide® (version 7.1) and R (version 3.5.2). Both factors, the experimental replication (p < 0.001) and the chickens' age at infection (p < 0.001) contributed significantly to the differences in microbial composition of the caecal samples. The factor experimental replication explained 24% of the sample's variability, whereas the factor age at infection explained 14% thereof. Twelve of 32 families showed a significantly different count profile between the two age groups, whereby strongest differences were seen for seven families, among them the family Campylobacteraceae (adjusted p = 0.003). The strongest difference between age groups was seen for a bacterial species that is assigned to the genus Turicibacter which in turn belongs to the family Erysipelotrichaceae (adjusted p < 0.0001). Correlation analyses revealed a common relationship in both chicken ages at infection between the absolute abundance of Campylobacteraceae and Alcaligenaceae, which consists of the genus Parasutterella. In general, concentrations of particular volatile fatty acids (VFA) demonstrated a negative correlation to absolute abundance of Campylobacteraceae, whereby the strongest link was seen for n-butyrate (-0.51141; p < 0.0001). Despite performing consecutive repetitions, the factor experimental replication contributed more to the differences of microbial composition in comparison to the factor age at infection.

P5407Body-composition analysis of patients with acute heart failure - preliminary results from the SCALE HF trial

Background

Guidance for intensified diuretic therapy in acute heart failure (AHF) is mainly based on body weight measurement, frequently leading to a short episode of dehydration with kidney failure after recompensation. In addition, patients often present immobilized due to severe health issues making weight measurement stressful.

Purpose

Bioelectrical impedance analysis (BIA) may be a more direct approach to guide intensified diuretic therapy analysing patient's body composition. We hypothesized that patient's weight loss during therapy correlates with loss of body water measured by BIA. Therefore, we tested if this method could be an alternative to daily weight measurement.

Methods

We conducted an observational, single-centre study to evaluate and monitor body composition of patients hospitalised with AHF, adjudicated according to current ESC/HFA guidelines by a cardiologist. We used an eight-electrode, segmental, multi-frequency body composition analyser, previously validated against air displacement plethysmography, whole body MRI, deuterium and sodium bromide dilution. We investigated patients until hospital discharge or latest one day after ending intensified diuretic therapy. Disease specific properties, BIA and weight measurement were assessed daily. Furthermore, we investigated BIA raw data.

Results

390 BIA were applied on 76 patients (47 men; 29 women; mean age 76±11 years; mean weight 75.6±15.7 kg). 34 patients presented with global, 27 with left-heart, 8 with right-heart and 7 with not specified AHF. 44 patients presented with pleural effusion. Pearson correlations showed that total body water (r=0.737, p≤0.001) and extracellular water (r=0.69, p≤0.001) correlated each with total body weight. Changes in total body water accurately (within a range of ± 1kg) reflected changes in total body weight in 40.28% of the patients and changes in extracellular water showed a similarly accurate reflection of total body weight change in 68.06% of the patients. BIA raw-data analysis showed significant changes using Wilcoxon test between measurements at the beginning of intensified diuretic therapy and at its end. We found a significant increase of resistance (mean from 334.6±67.5 to 362.8±69.5 Ohm/m; p=0.021) and reactance (mean from 21.3±7.1 to 24.1±6.2 Ohm/m; p=0.009) standardized to patients height and a non-significant increase of phase angle (mean from 3.6±0.9 to 3.8±0.8 °; p=0.149) during hospitalisation.

Conclusion

BIA is able to estimate changes in total body weight by analysing changes in extracellular body water in patients under intensified diuretic therapy and raw data analysis seems even more accurate and promising. This data derive from a heterogeneous AHF patient group, needing further investigation. Once validated, wearable BIA connected to an automated device monitoring system would enable an easy to use diuretic therapy monitoring for impaired patients or outpatients and could help reducing care efforts.

Performance, Fermentation Characteristics and Composition of the Microbiome in the Digest of Piglets Kept on a Feed With Humic Acid-Rich Peat

The transition from breast milk to solid feed is a dramatic change in the nutrition of piglets, frequently necessitating antibiotic treatment. In efforts to reduce the use of antibiotics, dietetic concepts based on natural feed additives are becoming more and more important. In the present study, experiments were carried out with 15 rearing piglets (days 28–56) divided into three groups that were offered different diets (Ctr [0% peat]; H1.5 [1.5% peat]; and H3.0 [3.0% peat] based on a commercial weaner recipe; all ~178 g CP, 13.7 MJ ME, 13.3 g Lys, as-fed). The contents of cecal and colon digesta were removed at necropsy. The gas formation (4 h) in colon digesta was measured using in vitro batch fermenters. For microbiome studies, 16S rRNA amplification was performed within the hypervariable region V 4 and sequenced with Illumina MiSeq platform. DNA read mapping and statistical analysis were performed using QIIME (version 1.8.0), MicrobiomeAnalyst, RStudio, and SAS Enterprise Guide. The mean body weight of the animals at the end of the trial did not show statistical differences (in kg: Ctr: 26.1 ± 4.85, H1.5: 28.5 ± 3.41, H3.0: 26.2 ± 4.92). The daily weight gains were high for this age (in g/day; Ctr: 607 ± 157; H1.5: 692 ± 101; H3.0: 615 ± 113) and the feed to gain ratio low (in kg/kg; Ctr: 1.538; H1.5: 1.462; H3.0: 1.462). Concentrations of short-chain fatty acids in the cecal content were significantly lower when peat was used (mmol/kg wet weight; Ctr: 173 ± 30.0; H1.5:134 ± 15.0; H3.0:133 ± 17.3). Numerical differences were found in the gas formation (in mL gas per 10 mL batch in 4 h; Ctr: 7.9 ± 2.2; H1.5: 7.4 ± 2.4; H3.0: 6.6 ± 1.1). The microbiome analyses in the cecal content showed significantly higher values for alpha diversity Chao 1 index for samples from the control group. Significant differences were found for bacterial relative abundance for Tenericutes at phylum level and Mollicutes at class level (p < 0.05) in cecal microbiota. Therefore, there was initial evidence that peat influences intestinal microflora causing a shift in the overall concentration of fermentation products in both, the cecal and the colon content.

Convergent evolution of a metabolic switch between aphid and caterpillar resistance in cereals

Tailoring defense responses to different attackers is important for plant performance. Plants can use secondary metabolites with dual functions in resistance and defense signaling to mount herbivore-specific responses. To date, the specificity and evolution of this mechanism are unclear. Here, we studied the functional architecture, specificity, and genetic basis of defense regulation by benzoxazinoids in cereals. We document that DIMBOA-Glc induces callose as an aphid resistance factor in wheat. O-methylation of DIMBOA-Glc to HDMBOA-Glc increases plant resistance to caterpillars but reduces callose inducibility and resistance to aphids. DIMBOA-Glc induces callose in wheat and maize, but not in Arabidopsis, while the glucosinolate 4MO-I3M does the opposite. We identify a wheat O-methyltransferase (TaBX10) that is induced by caterpillar feeding and converts DIMBOA-Glc to HDMBOA-Glc in vitro. While the core pathway of benzoxazinoid biosynthesis is conserved between wheat and maize, the wheat genome does not contain close homologs of the maize DIMBOA-Glc O-methyltransferase genes, and TaBx10 is only distantly related. Thus, the functional architecture of herbivore-specific defense regulation is similar in maize and wheat, but the regulating biosynthetic genes likely evolved separately. This study shows how two different cereal species independently achieved herbivore-specific defense activation by regulating secondary metabolite production.

THUR 174 The magnify-ms study: mavenclad® tablets in active rms

Authors Disclaimer: http://medpub-poster.merckgroup.com/ABN2018DISC_MAGNIFY.pdf

Background

Cladribine tablets (CT) improve clinical and MRI outcomes in patients with active RMS, with significant differences versus placebo after 24 weeks.

Objective

Describe the design of a study to assess the onset of CT’s clinical and MRI effects in patients with active RMS.

Methods

MAGNIFY-MS is a 2 year prospective Phase IV trial (including approximately 100 centres in Europe). Eligible patients will receive two years treatment with CT 3.5 mg/kg cumulative dose. Frequent MRI assessments (including lesion count, lesion volume, brain volume and MTR) will be performed at screening, baseline and 1, 2, 3, 6, 12, 15, 18 and 24 months. Various T- and B-cell subtype counts and functional profiling (eg cytokine production) will be assessed. Clinical outcomes will include changes in cognition (SDMT), disability (EDSS/KFS, 9HPT, T25FW), relapses, NEDA, NEDAP and safety at timepoints up to 24 months.

Results

Aim recruit 300 patients. Primary endpoint: change in the count of combined unique active lesions at end of 6 months versus baseline. Final outcomes expected in 2021.

Conclusions

MAGNIFY-MS will provide important information on the effects of CT, including early MRI changes, insights into effects on a range of disability and cognition markers, and detailed characterization of immune cell reconstitution.

Disclosure statement

This study was sponsored by EMD Serono, Inc., a business of Merck KGaA, Darmstadt, Germany (in the USA), and Merck Serono SA – Geneva, an affiliate of Merck KGaA Darmstadt, Germany (ROW).

THUR 172 Phase iv study of cladribine tablets and quality of life: clarify-ms

Authors Disclaimer: http://medpub-poster.merckgroup.com/ABN2018DISC_CLARIFY.pdf

Background

Relapsing multiple sclerosis (RMS) negatively affects health-related quality of life (HRQoL).

Objective

An open-label, single-arm, exploratory Phase IV study in centres in Europe and Australia will assess HRQoL in RMS patients receiving CT 3.5 mg/kg (CT3.5).

Methods

Eligible patients will receive CT 3.5 (cumulative) over 2 years. HRQoL (Multiple Sclerosis Quality of Life-54 [MSQoL-54]) and other patient-reported outcomes (Fatigue Severity Scale; Hospital Anxiety and Depression Scale; Treatment Satisfaction Questionnaire for Medication v1.4) will be assessed at baseline, and at 6, 12, 24 months.

Other outcomes include AEs, MRI measures (T1 Gd+ lesions, T2 lesions, brain atrophy), number of relapses, and disability/functioning measures (EDSS; 9-Hole Peg Test; Timed 25-Foot Walk and Brief International Cognitive Assessment for Multiple Sclerosis). The sample size estimation is based on the power to detect a mean difference of 5 points in MSQoL-54 composite score at 24 months vs baseline.

Results

The study aims to recruit 356 adults with RMS by 2019. Final data are anticipated in 2022.

Conclusions

This study will explore the effects of CT on HRQoL outcomes, and describe the effects of CT on treatment satisfaction and disability/functioning.

Disclosure statement

The trial is sponsored by Merck KGaA, Darmstadt, Germany.

Resistance of Escherichia coli in Turkeys after Therapeutic or Environmental Exposition with Enrofloxacin Depending on Flooring

Gaining knowledge about the spread of resistance against antibacterial agents is a primary challenge in livestock farming. The purpose of this study was to test the effect of double antibiotic treatment (at days 10⁻14 and days 26⁻30) with enrofloxacin or solely environmental exposition (identical times, directly into the litter) on resistance against antibacterial agents in commensal Escherichia coli in comparison with the control (without treatment), depending on different flooring. A total of 720 Big 6 turkeys participated in three trials. Four different flooring designs were examined: An entire floor pen covered with litter, a floor pen with heating, a partially slatted flooring including 50% littered area, and a fully slatted flooring with a sand bath. A total of 864 Escherichia coli isolates were obtained from cloacal swabs and poultry manure samples at days 2, 9, 15, 21, and 35. The broth microdilution method (MIC) was used to determine the resistance of isolates to enrofloxacin and ampicillin. A double antibiotic treatment with enrofloxacin reduced the proportion of susceptible Escherichia coli isolates significantly in all flooring designs. Simulation of water losses had no significant effect, nor did the flooring design. Ampicillin-resistant isolates were observed, despite not using ampicillin.

Effectiveness of opicapone and switching from entacapone in fluctuating Parkinson disease

OBJECTIVE

To evaluate the effectiveness of opicapone as add-on to levodopa and the effects of switching from entacapone over 1 year of treatment in patients with fluctuating Parkinson disease.

METHODS

After completion of a placebo- and entacapone-controlled double-blind study of opicapone (5, 25, or 50 mg), 495 patients continued to a 1-year extension phase in which patients were treated with opicapone. Patients began with once-daily opicapone 25 mg for 1 week, followed by individually tailored levodopa and/or opicapone dose adjustments. The primary efficacy variable was the change from baseline in absolute "off" time based on patient diaries. Other outcomes included proportion of responders, scale-based assessments, and standard safety assessments.

RESULTS

One year of treatment with opicapone reduced "off" time by a half-hour (33.8 minutes) vs the open-label baseline and >2 hours (126.9 minutes) vs the double-blind baseline. Whereas patients who were originally treated with opicapone 50 mg in the double-blind phase maintained their efficacy, switching treatments led to further decreases in "off" time (-64.9, -39.3, -27.5, and -23.0 minutes for switching from placebo, entacapone, and opicapone 5 and 25 mg, respectively). Dyskinesia was the most frequently reported adverse event (14.5%) and was managed by adjustment of dopaminergic therapy. No new safety concerns were observed with long-term opicapone administration.

CONCLUSION

Long-term use of opicapone provided sustained efficacy over 1 year. Switching from entacapone to opicapone led to enhanced efficacy under the conditions of the study.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that for patients with Parkinson disease and end-of-dose motor fluctuations, long-term use (52 weeks) of opicapone is well tolerated and reduces "off" time.

„Mein Haus, mein Auto, mein Boot“. Zufriedenheit mit dem Lebensstandard als geschlechtsspezifischer Mortalitätsprädiktor

Hintergrund: Männer haben ein höheres Mortalitätsrisiko als Frauen und reagieren wesentlich sensibler auf statusbezogene Stressbelastungen. Mögliche Erklärungen für die stärker ausgeprägte männliche Empfindlichkeit liefert der über die HPA-Achse vermittelte Zusammenhang zwischen hierarchischem Rang und Gesundheit. Viel Aufmerksamkeit hat in diesem Zusammenhang das Konstrukt des Statusunbehagens erfahren, wonach soziale Vergleichsprozesse das generelle Wohlbefinden senken und als wesentliche Risikofaktoren für verschiedene Erkrankungen angesehen werden.

Methodik: Mittels Sekundärdatenanalyse des sozio-ökonomischen Panels (SOEP) soll analysiert werden, inwiefern die subjektive Unzufriedenheit mit dem eigenen Lebensstandard mit einem erhöhten geschlechtsabhängigen Mortalitätsrisiko assoziiert werden kann. Zur statistischen Modellierung der Fragestellung werden geschlechtsdifferenzierte Cox-Regressionsmodelle berechnet. Die unbalancierte Teilstichprobe umfasst 6 963 Männer (764 Todesfälle) und 7 461 Frauen (663 Todesfälle).

Ergebnisse: Unzufriedenheit mit dem eigenen Lebensstandard hat einen signifikanten Einfluss auf das Mortalitätsrisiko von Männern nicht jedoch von Frauen. Unzufriedene Männer weisen ein nahezu doppelt so hohes Mortalitätsrisiko auf als die Referenzgruppe (HR=1,95, 95% KI 1,48–2,58), Männer mit mittlerer Zufriedenheit ein um 25% höheres Mortalitätsrisiko (HR=1,26, 95% KI 1,08–1,49). Außerdem zeigt der subjektive Statusindikator stärkere Dosis-Wirkungs-Beziehungen als die klassischen objektiven Statusparameter.

Schlussfolgerung: Unzufriedenheit mit dem eigenen Lebensstandard kann mit einem erhöhten geschlechtsabhängigen Mortalitätsrisiko in Verbindung gebracht werden und erweist sich als klarer Prädiktor insbesondere für die männliche Mortalität. Eine zentrale Ursache können über die HPA-Achse vermittelte Stressreaktionen aufgrund von herabsetzenden sozialen Vergleichsprozessen zu sein. Die Ergebnisse sprechen für eine standardisierte Einbeziehung subjektiver Statusindikatoren; der ausgeprägte Geschlechterunterschied legt darüber hinaus eine geschlechtergerechte epidemiologische Datenanalyse nahe.

Effects of different types of flooring design on the development of antimicrobial resistance in commensal Escherichia coli in fattening turkeys

The objective of this study was to evaluate the effects of different types of flooring designs on antimicrobial resistance in commensal Escherichia coli from turkeys treated with enrofloxacin. Two trials were performed with same feed, housing conditions and fattening duration, but with different flooring designs. Furthermore, the first trial was performed in an unchanged environment and the second trial in a changed environment. The flooring designs of the pens were assigned to four groups; G1 - entire floor pen covered with litter, G2 - floor pen with heating, G3 - partially slatted flooring including an area that was littered, G4 - fully slatted flooring with a sand bath. Enrofloxacin was given at days 10-14 via drinking water. The changed environment in the second trial was achieved by moving the animals to new pens with the respective same conditions as previously after antimicrobial administration at day 15. A total of 576 E. coli were isolated from cloacal swab and poultry manure samples. Sample collection was done before the treatment, after the treatment and at the end of the trials at day 35. The resistance of isolates to enrofloxacin and ampicillin was determined using broth microdilution A single treatment with enrofloxacin reduced the proportion of samples with susceptible E. coli isolates significantly in all flooring designs. Overall, frequencies of enrofloxacin resistance were significantly different between the unchanged and changed environment. At the same time, the proportion of ampicillin-resistant isolates increased in the first trial, although no ampicillin was applied in this study.

Neural correlates of proactive and reactive motor response inhibition of gambling stimuli in frequent gamblers

We used functional magnetic resonance imaging to examine whether motivational-salient cues could exert a differential impact on proactive (the restrain of actions in preparation for stopping) and reactive (outright stopping) inhibition. Fourteen high-frequency poker players, and 14 matched non-gambler controls, performed a modified version of the stop-signal paradigm, which required participants to inhibit categorization of poker or neutral pictures. The probability that a stop-signal occurs (0%, 17%, 25%, 33%) was manipulated across blocks of trials, as indicated by the color of the computer screen. Behavioral analyses revealed that poker players were faster than controls in categorizing pictures across all levels of proactive motor response inhibition (go trials). Brain imaging analyses highlighted higher dorsal anterior cingulate cortex activation in poker players, as compared to controls, during reactive inhibition. These findings suggest that, due to their faster rates of stimulus discrimination, poker players might have recruited more cognitive resources than controls when required to stop their response (reactive inhibition). Nevertheless, no main effect of stimulus type was found, on either proactive or reactive inhibition. Additional studies are, therefore, needed in order to confirm that investigating the dynamics between reactive and proactive inhibition offers a discriminative analysis of inhibitory control toward motivational-salient cues.

Cyanobacteria facilitate parasite epidemics in Daphnia

The seasonal dominance of cyanobacteria in the phytoplankton community of lake ecosystems can have severe implications for higher trophic levels. For herbivorous zooplankton such as Daphnia, cyanobacteria have poor nutritional value and some species can produce toxins affecting zooplankton survival and reproduction. Here we present another, hitherto largely unexplored aspect of cyanobacteria, namely that they can increase Daphnia susceptibility to parasites. In a 12-yr monthly time-series analysis of the Daphnia community in Greifensee (Switzerland), we observed that cyanobacteria density correlated significantly with the epidemics of a common gut parasite of Daphnia, Caullerya mesnili, regardless of what cyanobacteria species was present or whether it was colonial or filamentous. The temperature from the previous month also affected the occurrence of Caullerya epidemics, either directly or indirectly by the promotion of cyanobacterial growth. A laboratory experiment confirmed that cyanobacteria increase the susceptibility of Daphnia to Caullerya, and suggested a possible involvement of cyanotoxins or other chemical traits of cyanobacteria in this process. These findings expand our understanding of the consequences of toxic cyanobacterial blooms for lake ecosystems and might be relevant for epidemics experienced by other aquatic species.