Sex differences in the impact of coronary artery disease on long-term survival after transcatheter aortic valve implantation

Background

It has been suggested that the complexity of coronary artery disease (CAD) is a determinant of worse outcomes after transcatheter aortic valve implantation (TAVI). However, no data is available showing this applies equally to both sexes.

Purpose

Males are usually overrepresented in studies regarding CAD and care should be used when translating these results to the female population. The purpose of this analysis was to compare sex specific clinical outcomes in patients undergoing TAVI with and without coexisting CAD.

Methods

All patients undergoing TAVI at a tertiary referral centre between 2008 and 2020 were included and outcomes up to five years after TAVI were prospectively recorded. Baseline and residual (after revascularization) SYNTAX-scores (SS) were retrospectively calculated to make groups of different CAD complexity.

Results

A total of 605 patients, of whome 284 (46.9%) female patients, underwent TAVI. Five years after TAVI, females and males had similar overall survival (62 vs 59%, p=0.320) and cardiovascular mortality (22% vs 20%, p=0.540), respectively. Females were older (82.7y vs 80.8y, p<0.001), had a higher left ventricular ejection fraction (53.7% vs 49.4%, p<0.001) and higher aortic valve mean gradient (45.7 vs 41.6 mmHg, p=0.002). EuroScore II was comparable between both groups (26.8 vs 27.5, p=0.330). Females had less obstructive CAD (49% vs 64%, p<0.001) and less complex CAD (mean SS: 8.3 vs 12.6, p<0.001), despite reporting similar rates of angina (10% vs 11%, p=0.492). While in males CAD complexity was not predictive of survival (fig 1A) or cardiovascular mortality (fig 2A), females showed worse survival (fig 1B) and cardiovascular mortality (fig 2B) with increasing CAD complexity. This difference seems not to be driven by a lower rate of revascularization since women with CAD received significantly more percutaneous coronary interventions (PCI) (41% vs 24%, p=0.001) and trended towards more complete revascularization (residual SS <8 70% in females vs 52% in males, p=0.054). Background medical therapy with aspirin (70% vs 72%, p=0.710), other antiplatelet agents (61% vs 57%, p=0.390) and statins (71% vs 81%, p=0.065) was not different between both groups. A possible explanation for the similar rates of angina despite less complex CAD in females might be a higher prevalence of underlying microvascular dysfunction, which is also known to be related with an increased rate of cardiovascular events.

Conclusion

We show that in females outcomes after TAVI are significantly influenced by co-existing CAD and its complexity, while in males this is less pronounced. We identified a subgroup of females with a SS >22 that are at particular high risk for fatal cardiovascular events after TAVI. Therefore, awareness for CAD and close follow-up in combination with guideline-directed treatment of complex CAD in females undergoing TAVI is crucial.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders

Effects of a telemedically supported home-based lifestyle intervention in patients with chronic ischaemic heart disease and type 2 diabetes mellitus

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Federal Joint Committee Germany

Background

Ischaemic heart disease is the leading cause of global mortality and when accompanied by type 2 diabetes mellitus (T2DM), prognosis is even worse. Lifestyle (LS) interventions are recommended, however, evidence in patients with both chronic ischaemic heart disease (CIHD) and T2DM is scarce. Furthermore, LS interventions were generally performed in a resource intensive supervised setting. Therefore, this study examined whether an individualised telemedically supported home-based LS intervention has a different effect on changes in glycosylated haemoglobin (HbA1c) compared to usual care (UC) in patients with CIHD and T2DM.

Methods

Eligible patients (ICD-10: I20-25; HbA1c≥6.5% or anti-diabetic drugs) were randomly assigned (1:1) to LS or UC at 11 sites. LS intervention consisted of home-based exercise training (ET) and nutritional recommendations following 7-day nutrition diaries. ET was based on the results of a cardiopulmonary exercise test (CPET), i.e. ventilatory thresholds and peak oxygen consumption, and was provided and recorded by a smartphone application. Intensities varied and volume was gradually increased to reach at least 150 min/week. Every 2-4 weeks, patients were contacted by telephone to receive feedback and adjust the training (if necessary). CPETs and nutrition diaries were analysed by a core laboratory, which also provided the feedback to the patients. Primary endpoint was the change in HbA1c after 6 months. Secondary endpoints included change in weight, waist circumference, HDL, LDL, triglycerides and quality of life (QoL). The main analysis included all patients with baseline and follow-up (FU) measures (full analysis). In a per-protocol analysis (PPA), patients randomised to LS who performed less than 2/3 of the scheduled exercise time or filled less than 2 out of 3 nutrition diaries were excluded.

Results

Among 499 enrolled patients (mean age, 68 years; 16% female; mean HbA1c, 6.9%), 402 (81%) completed the 6-month FU. From 201 patients who completed FU in the LS group, 76 (38%) were included in the PPA [81 (40%) adhered to ET, 144 (72%) filled at least 2 nutrition diaries]. In the full analysis, mean change in HbA1c was significantly different between LS and UC (-0.1% [95% CI, -0.2 to 0.0], p=0.04). Furthermore, significant differences were found for changes in weight (p<0.001) and the QoL mental component score (MCS) of the Short-Form-36 questionnaire (p=0.006, Table 1). In the PPA, mean changes in HbA1c (p=0.002), weight (p<0.001), waist circumference (p<0.001), triglycerides (p=0.03) and the QoL MCS (p=0.004) were significantly different between groups (Table 1).

Conclusion

In patients with CIHD and T2DM, a telemedically supported home-based LS intervention significantly reduced HbA1c as compared to UC. However, only in the per-protocol analysis, change in HbA1c met a clinically meaningful difference of 0.3% between groups. Therefore, future studies should aim at increasing adherence to such interventions.

IMR or CFR - Which parameter is better suited to determine microvascular disease in patients with severe aortic stenosis?

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders

Background

Chest pain in patients with severe aortic stenosis (AS) may result from the valve stenosis itself, a coronary atherosclerotic lesion or even microvascular dysfunction (MVD). MVD in severe AS may be purely functional or the consequence of structural left ventricular (LV) remodelling. Unfortunately, there is no data available about invasive quantification of MVD using the index of microvascular resistance (IMR) in this patient group.

Purpose

To study the microcirculation in patients with severe AS by means of IMR and coronary flow reserve (CFR) and to determine the relation between these indices and standard echocardiographic parameters.

Methods

Forty-five patients with severe AS (according to the focused 2017 EACVI/ASE update) were prospectively included and underwent invasive intracoronary hemodynamic assessment and dedicated transthoracic echocardiography (TTE). On TTE we measured LV ejection fraction (EF), diastolic function parameters (E/A, e’ septal and lateral, E/e’, TR velocity), left atrial volume (index) (LAV(I)), aortic valve (AV) pressure gradients, the aortic valve area (index) (AVA(I)) and LV mass (index). The invasive measurements compromised the calculation of the CFR and IMR via thermodilution with the use of an intracoronary guidewire with a dual pressure and temperature sensor and administration of IV adenosine.

Results

Mean IMR and CFR were 22.9 ± 14.2 and 2.5 ± 1.5, respectively (Fig. 1). When using the commonly used cut-offs (increased IMR ≥ 25; impaired CFR < 2.0), 29% of patients had high IMR and 33% had low CFR. Patients with normal and high IMR had similar LV EF (p = 0.54), grade of diastolic dysfunction (DD)(p = 0.18), AV peak (p = 0.80) and mean pressure gradient (p = 0.86), AVA (p= 0.80), AVAI (p = 0.92), E/e’ (p = 0.97), LAVI (p = 0.75), LV mass (p = 0.34) and LV mass index (p = 0.59). In contrast, patients with impaired CFR had significantly lower AVA (0.63 vs 0.80 cm2, p = 0.033) and AVAI (0.32 vs 0.43 cm2/m2, p = 0.035) (Fig. 2A). Moreover there was a significant negative correlation between CFR and LAV (r= -0.354, p= 0.019) as well as LAVI (r= -0.428, p= 0.004)(Fig. 2C). Similarly, patients with different DD grades had no significantly different IMR values (p= 0.71), while there was a significant difference with their CFR values (Grade I: 2.9 ± 1.6; Grade II: 3.1 ± 1.7; Grade III: 1.8 ± 0.6, undetermined DD (due to Atrial Fibrillation): 1.6 ± 0.7, ANOVA p= 0.033) (Fig. 2B).

Conclusion

Approximately 30% of patients with severe AS exhibit MVD as assessed by IMR and CFR. In contrast to CFR, IMR values were not related to the severity of valve disease or systolic and diastolic function of the LV. Interestingly, the IMR was also not related to LV hypertrophy. IMR may therefore be the more objective and independent marker of microvascular disease, better suited to evaluate MVD in severe AS patients with chest pain. Abstract Figure 1  Abstract Figure 2

Moderate differences in plasma leptin in mares have no effect on either the amino acid or the fatty acid composition of the uterine fluid

Female mammalian reproductive functions are closely linked to body condition and metabolic status. Energy homeostasis is regulated by endocrine hormones such as insulin, IGF-I, leptin and adiponectin via the hypothalamic-pituitary-adrenal axis. These metabolic hormones and their receptors are also expressed in reproductive tissues and the embryo. We investigated the relationship between circulating leptin and the fatty acid (FA) and amino acid (AA) composition of the equine uterine fluid (UF) and peripheral blood plasma (BP) by using a mass spectrometry-based approach. UF and BP were collected from ten broodmares on days 6 and 7 post ovulation, respectively. The mares were retrospectively assigned to two groups according to their BP leptin concentrations (high leptin (> 1.6 ng/ml) versus low leptin (<0.8 ng/ml)). Specific AA and FA compositions for BP and UF were found with different levels of respective metabolite abundances. The main FAs in BP were stearic, palmitic and linoleic acid. In UF, the three most abundant FAs were eicosapentaenoic, arachidonic and stearic acid. The AA profile of BP was dominated by glycine, glutamine, serine and alanine, which were likewise among the highly abundant AAs in UF. In UF, glutamic acid had by far the highest concentration. Therefore, BP leptin concentration within a physiological range do not seem to affect the specific FA nor the AA composition of the UF. The composition of the UF may therefore be mediated by local rather than by peripheral metabolic hormones.

Role of Orai3 in the Pathophysiology of Cancer

The mammalian exclusive Orai3 channel participates in the generation and/or modulation of two independent Ca²⁺ currents, the store-operated current, I_crac, involving functional interactions between the stromal interaction molecules (STIM), STIM1/STIM2, and Orai1/Orai2/Orai3, as well as the store-independent arachidonic acid (AA) (or leukotriene C4)-regulated current I_arc, which involves Orai1, Orai3 and STIM1. Overexpression of functional Orai3 has been described in different neoplastic cells and cancer tissue samples as compared to non-tumor cells or normal adjacent tissue. In these cells, Orai3 exhibits a cell-specific relevance in Ca²⁺ influx. In estrogen receptor-positive breast cancer cells and non-small cell lung cancer (NSCLC) cells store-operated Ca²⁺ entry (SOCE) is strongly dependent on Orai3 expression while in colorectal cancer and pancreatic adenocarcinoma cells Orai3 predominantly modulates SOCE. On the other hand, in prostate cancer cells Orai3 expression has been associated with the formation of Orai1/Orai3 heteromeric channels regulated by AA and reduction in SOCE, thus leading to enhanced proliferation. Orai3 overexpression is associated with supporting several cancer hallmarks, including cell cycle progression, proliferation, migration, and apoptosis resistance. This review summarizes the current knowledge concerning the functional role of Orai3 in the pathogenesis of cancer.

Clinical and haemodynamic effects of percutaneous edge-to-edge mitral valve repair in atrial versus ventricular functional mitral regurgitation

Background

Atrial functional mitral regurgitation (A-FMR) is a novel entity characterized by a MR due to atrial remodeling but with preserved left ventricular (LV) systolic function.

Purpose

To assess the clinical and haemodynamic impact of percutaneous edge-to-edge mitral valve repair with MitraClip in patients with A-FMR as compared to ventricular (V)-FMR.

Methods

MR grade, functional status (NYHA class), and major adverse cardiac events (MACE= all-cause mortality or hospitalization for heart failure (HF)) were evaluated in 52 A-FMR patients (pts.) and in 307 V-FMR pts. who underwent MitraClip implantation in 7 Belgian centers. In a subgroup of 56 pts (10 A-FMR and 46 V-FMR) haemodynamic assessment during a symptom-limited exercise echocardiography was performed before and 6-month after intervention.

Results

MitraClip implantation resulted in similar MR reductions in A-FMR and V-FMR (MR grade ≤2 at 6-month in 94% versus 82%, respectively (p=0.08)) and was associated with improvement of functional status in both groups (NYHA class ≤2 at 6 months in 90% versus 80%, respectively (p=0.2)). Serial haemodynamic assessment revealed that the cardiac output at 6-month was significantly higher in A-FMR pts. both at rest (5.1±1.5 L/min versus 3.8±1.5 L/min, p=0.002) and during peak exercise (7.9±2.4 L/min versus 6.1±2.1 L/min, p=0.02). Also the reduction in systolic pulmonary artery pressure (sPAP) was more pronounced in A-FMR: Δ sPAP at rest – 13.1±15.1 mmHg versus – 2.2±13.3 mmHg (p=0.03). During a follow-up period of 1.3±1.2 years MACE rate was significantly lower in A-FMR versus V-FMR with an adjusted OR of 0.46 (95% CI 0.24–0.88, see figure), which was mainly driven by a reduction in HF hospitalization.

Conclusion

Percutaneous edge-to-edge mitral valve repair with MitraClip is at least as effective in A-FMR as in V-FMR in reducing MR. But, the haemodynamic and clinical impact is stronger in A-FMR pts.

Funding Acknowledgement

Type of funding sources: None. MACE in A-FMR versus V-FMR pts

Protocols for endothelial cell isolation from mouse tissues: brain, choroid, lung, and muscle

Endothelial cells (ECs) harbor distinct phenotypical and functional characteristics depending on their tissue localization and contribute to brain, eye, lung, and muscle diseases such as dementia, macular degeneration, pulmonary hypertension, and sarcopenia. To study their function, isolation of pure ECs in high quantities is crucial. Here, we describe protocols for rapid and reproducible blood vessel EC purification established for scRNA sequencing from murine tissues using mechanical and enzymatic digestion followed by magnetic and fluorescence-activated cell sorting. For complete details on the use and execution of these protocol, please refer to Kalucka et al. (2020), Rohlenova et al. (2020), and Goveia et al. (2020).

Protocols for endothelial cell isolation from mouse tissues: kidney, spleen, and testis

Endothelial cells (ECs) exhibit phenotypic and functional tissue specificities, critical for studies in the vascular field and beyond. Thus, tissue-specific methods for isolation of highly purified ECs are necessary. Kidney, spleen, and testis ECs are relevant players in health and diseases such as chronic kidney disease, acute kidney injury, myelofibrosis, and cancer. Here, we provide tailored protocols for rapid and reproducible EC purification established for scRNA sequencing from these adult murine tissues using the combination of magnetic- and fluorescence-activated cell sorting. For complete details on the use and execution of these protocols, please refer to Kalucka et al. (2020) and Dumas et al. (2020).

Protocols for endothelial cell isolation from mouse tissues: small intestine, colon, heart, and liver

Endothelial cells (ECs) from the small intestine, colon, liver, and heart have distinct phenotypes and functional adaptations that are dependent on their physiological environment. Gut ECs adapt to low oxygen, heart ECs to contractile forces, and liver ECs to low flow rates. Isolating high-purity ECs in sufficient quantities is crucial to study their functions. Here, we describe protocols combining magnetic and fluorescent activated cell sorting for rapid and reproducible EC purification from four adult murine tissues. For complete details on the use and execution of these protocols, please refer to Kalucka et al. (2020).

ORAI3 silencing alters cell proliferation and promotes mitotic catastrophe and apoptosis in pancreatic adenocarcinoma

Changes in cytosolic free Ca2+ concentration play a central role in many fundamental cellular processes including muscle contraction, neurotransmission, cell proliferation, differentiation, gene transcription and cell death. Many of these processes are known to be regulated by store-operated calcium channels (SOCs), among which ORAI1 is the most studied in cancer cells, leaving the role of other ORAI channels yet inadequately addressed. Here we demonstrate that ORAI3 channels are expressed in both normal (HPDE) and pancreatic ductal adenocarcinoma (PDAC) cell lines, where they form functional channels, their knockdown affecting store operated calcium entry (SOCE). More specifically, ORAI3 silencing increased SOCE in PDAC cell lines, while decreasing SOCE in normal pancreatic cell line. We also show the role of ORAI3 in proliferation, cell cycle, viability, mitotic catastrophe and cell death. Finally, we demonstrate that ORAI3 silencing impairs pancreatic tumor growth and induces cell death in vivo, suggesting that ORAI3 could represent a potential therapeutic target in PDAC treatment.

Decrease in sulfate aerosol light backscattering by reactive uptake of isoprene epoxydiols

Sulfate aerosol is responsible for a net cooling of the Earth's atmosphere due to its ability to backscatter light. Through atmospheric multiphase chemistry, it reacts with isoprene epoxydiols leading to the formation of aerosol and organic compounds, including organosulfates and high-molecular weight compounds. In this study, we evaluate how sulfate aerosol light backscattering is modified in the presence of such organic compounds. Our laboratory experiments show that reactive uptake of isoprene epoxydiols on sulfate aerosol is responsible for a decrease in light backscattering compared to pure inorganic sulfate particles of up to - 12% at 355 nm wavelength and - 21% at 532 nm wavelength. Moreover, while such chemistry is known to yield a core-shell structure, the observed reduction in the backscattered light intensity is discussed with Mie core-shell light backscattering numerical simulations. We showed that the observed decrease can only be explained by considering effects from the complex optical refractive index. Since isoprene is the most abundant hydrocarbon emitted into the atmosphere, and isoprene epoxydiols are the most important isoprene secondary organic aerosol precursors, our laboratory findings can aid in quantifying the direct radiative forcing of sulfates in the presence of organic compounds, thus more clearly resolving the impact of such aerosol particles on the Earth's climate.

Episodic Future Thinking in Autism Spectrum Disorder and 22q11.2 Deletion Syndrome: Association with Anticipatory Pleasure and Social Functioning

Episodic future thinking (EFT) has been suggested to underlie anticipatory pleasure (AP), itself known to play a crucial role in social functioning (SF). Both AP and SF are impaired in various clinical populations, including autism spectrum disorders (ASD) and 22q11.2 deletion syndrome (22q11DS). Therefore, the relationship between EFT, AP and SF was investigated, as well as the potential role of projecting oneself in a social vs. non-social context. Seventy-seven participants [24 with 22q11DS, 20 with ASD, 33 typically developing controls (TDs)] (aged 12–25) were included. They were assessed with a future thinking task in which they were asked to recall a memory and produce a likely event. Narratives were rated based of specificity, richness and imaginability. Participants completed questionnaires assessing AP and SF. Narratives from ASD and 22q11DS participants were rated as less vivid compared to TDs. However, the characteristics of the narratives differed between ASD and 22q11DS participants in terms of specificity and level of details, as well as in reaction to social condition. Moreover, correlations were found between AP and EFT in both ASD and 22q11DS participants, and between SF and EFT in ASD participants. These results point towards impairments in EFT in both ASD and 22q11DS participants but with a specific profile in each condition. The observed associations between EFT and AP suggest that decreased autonoetic consciousness might underlie AP impairments. In ASD individuals, the association between SF and EFT highlights the need to better characterize EFT since EFT could be another mechanism contributing to social difficulties.

Left heart Impella-device to bridge acute mitral regurgitation to MitraClip-procedure: a novel implementation of percutaneous mechanical circulatory support

Background

Acute mitral regurgitation (MR) is an emergency, often requiring urgent surgery. Severe acute MR presenting with hemodynamic collapse is usually caused by papillary muscle rupture or dysfunction after acute myocardial infarction (AMI) or chordal rupture, resulting in flail mitral leaflet(s). Preoperative stabilization is complex due to concomitant hemodynamic collapse and hypoxic respiratory failure. Finding the right balance between both preload and inotropic support is challenging. When patients are too sick for immediate surgical intervention, mechanical circulatory support can be considered because of its ability to both unload and reduce of cardiac work while increasing coronary perfusion and cardiac output. Nevertheless, even after initial stabilization, surgical risk remains high in critically ill acute severe MR patients and transcatheter treatments such as MitraClip are increasingly being explored.

Methods

Between August 2017 and September 2019, patients presenting with acute severe mitral regurgitation and considered too ill for immediate surgical intervention (EURO-II score &gt;11.2% plus pulmonary oedema necessitating mechanical ventilation and/or hemodynamic instability), were selected for an Impella-assisted LV unloading technique as bridge to MitraClip-procedure. Five patients were selected for the combined left Impella/MitraClip-procedure in two tertiary cardiac ICUs.

Results

The mean age was 72 years. The cause of MR was ischemic in 20% and all patients presented in cardiogenic shock state, necessitating mechanical ventilation. The overall cardiac operative risk assessment (Euro-II) score predicted a 35% chance of in-hospital mortality. Cardiac output was severely impaired (mean LVOT VTI 8.2 cm). All patients were on inotropic support and supported by an Impella-CP pVAD (mean flow 2.5 Liter per minute; mean 6.3 days of support). In all cases, we managed to reduce the LVEDP below 15 mmHg using the combination of medical therapy (afterload reduction, inotropes), mechanical ventilation and pVAD-therapy. The MR was significantly reduced by a MitraClip-procedure in each Impella supported patient. The overall survival at discharge was 80%. One patient with late referral and multiple organ failure at presentation deceased due to refractory cardiogenic shock. Overall, severe MR was reduced to grade 1+ and all four patients survived 6 months after discharge with only one readmission for decompensated heart failure.

Conclusions

A combined strategy of Impella and MitraClip appears to be a novel, feasible alternative for patients presenting with acute, severe MR unable to proceed to a corrective surgical procedure at presentation due to severe left ventricular forward flow failure. In these cases, the early initiation of pVAD-support may reduce the risk of development of irreversible end- organ damage and dysfunction. Exploration in a larger, randomised population is warranted to investigate this strategy further.

Funding Acknowledgement

Type of funding source: None

Selatogrel, the reversible and specific P2Y12 receptor antagonist, does not interfere with haemostasis

Background

Combination of a P2Y12 receptor (P2Y12R) antagonist (clopidogrel, prasugrel, ticagrelor) with aspirin is the recommended standard of care for patients with acute coronary syndrome. Selatogrel is a reversible and potent antagonist of P2Y12R. Interestingly, in an experimental thrombosis model in rat, at equivalent antithrombotic effect, blood loss was lower in the presence of selatogrel, compared with clopidogrel or ticagrelor.

Purpose

To characterise the lower risk of bleeding previously observed with selatogrel

Methods

Mechanistic studies were performed to profile laser-induced thrombosis in wild-type and P2Y12 deficient mice with real-time intravital microscopy. Ticagrelor and clopidogrel were used as selatogrel comparators.

Results

Selatogrel, ticagrelor and clopidogrel dose-dependently inhibited laser-induced platelet thrombus formation. At maximal antithrombotic effect, only small mural platelets aggregates, corresponding to the haemostatic seals, were present. The phenotype of these haemostatic seals depended on the P2Y12R antagonist used. In the presence of clopidogrel or ticagrelor, the stability of haemostatic seals was reduced. In contrast, in the presence of selatogrel, the apparent stability was not disturbed. Moreover, equivalent antithrombotic dosing regimens of ticagrelor and clopidogrel interfered with laser-induced calcium mobilisation in the endothelium, restricted subsequent neutrophil adhesion and thus reduced fibrin-mediated stabilisation of the haemostatic seals in wild type mice. The effects of ticagrelor were also observed in P2Y12R-deficient mice, indicating that the effects are P2Y12R independent and off-target. In contrast, an equivalent antithrombotic dosing regimen of selatogrel did not interfere with the process of haemostasis in wild-type or P2Y12R-deficient mice. The degree of interference with the stability of the haemostatic seals correlated with the blood loss profile. The dosing regimens of clopidogrel and ticagrelor, corresponding to the equivalent antithrombotic effects, induced a more pronounced increase in blood loss than that observed with selatogrel.

Conclusion

Our data offer a novel mechanistic explanation for the differences in bleeding risk of clopidogrel, ticagrelor and selatogrel. Clopidogrel and ticagrelor were found to interfere with haemostasis due to off-target activities. In contrast, selatogrel did not interfere with haemostasis in wild-type and P2Y12-deficient mice, inferring that the process of haemostasis, as defined by formation of haemostatic seals, is independent of P2Y12R. In addition, our data emphasize that the absence of interference with haemostasis is paramount to preserve the advantage of P2Y12R antagonism.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Idorsia Pharmaceuticals Ltd. Allschwil, Switzerland

202 Proteomic, metabolomic and fatty acid composition in lactating and non-lactating mares&rsquo; uterine fluids

In the equine industry, horse breeders aim to produce one foal per mare per year. Thus, mares are bred while nursing. In high-yielding dairy cattle, concurrent lactation and conception may affect embryo quality, but effects on uterine fluid (UF) quality are unknown. No data are available in horses. The aim of our study was to analyse the effect of nursing on protein, metabolite and fatty acid (FA) compositions of UF at ~7.5 days post-ovulation. Anglo-Arab mares (multiparous (2.7±0.9 foals), 10.8±2.5 years old) that were either nursing (N; 105±12 days of lactation) or barren (B) were inseminated with the semen of the same stallion at induction of ovulation with human chorionic gonadotrophin. Ovulation was confirmed by ultrasound within 48h. At 7.4±0.7 days post-ovulation, UF was collected with a human tampon that was left for 10min in the uterus before embryo collection. Only mares for which no embryo was collected were selected (n=5 in both groups). Trypsin digestion followed by liquid chromatography-tandem mass spectrometry analysis was used for proteomic analysis, with subsequent characterisation with the PANTHER platform using an overrepresentation test (Fisher's exact type with false discovery rate correction) with the PANTHER pathway database. An untargeted approach based on liquid chromatography-tandem mass spectrometry was performed for metabolomics (normalisation to 50µg of protein), and data were analysed with the MS Peaks to Pathways tool of the MetaboAnalyst platform, using both the GSEA and mummichog algorithms (cut-off=0.05). Fatty acid composition (% of total FA) was analysed using gas chromatography. Differences between groups were analysed using a linear model with permutation using R software with the pgirmess package (P=0.05 for significance). Altogether, 2706 proteins with at least two peptides were identified in mares’ UF, with 164 being differentially expressed. Ubiquitin proteasome, involved in embryo-endometrium interactions, was the most enriched pathway in N mares (fold enrichment=15.12; P&lt;0.0001). For metabolomics, ubiquinone biosynthesis [MetaFishNet, P=0.02; NES (Enrichment Score for the variable)/(mean of all Enrichment Score in all permutations in the dataset)=1.84] was enriched in N mares. N-Glycans, mainly guanosine diphosphate mannose (Kyoto Encyclopedia of Genes and Genomes, P=0.04; NES=−1.33) and leukotriene biosynthesis (Biocyc; P=0.006; NES=−1.31), were enriched in B mares with differentially expressed leukotrienes C4/D4. The proportion of saturated FA was higher in N vs. B mares (38.4±3.6% vs. 33.2±3.6%; P=0.03), probably due to increased palmitic (P=0.08) and stearic (P=0.08) acid proportions. In conclusion, pathways involved in uterine receptivity and inflammation seem to be enriched in B mares. Fatty acids that are readily available in the diet were more present in N mares, possibly because more elaborate FA are exported to the mammary gland for milk production. Nursing could thus modify the inflammatory response in the uterine environment at ~7.5 days post-ovulation and could affect reproductive efficiency in horses.

Opticourses: promoting healthier food purchases at no additional cost in low-income households

Introduction

Healthy diets are generally more expensive than unhealthy diets, explaining why socially disadvantaged individuals perceive food prices as a barrier to improve their diets. It is thus crucial to develop strategies enabling the achievement of good nutritional quality with a low budget, taking into account actual beliefs and expectations of the target population. A co-construction approach is thus recommended, involving participants at each step of the intervention to maximize its impact.

Methods

The “Opticourses” program was launched in 2010 with a feasibility study, followed by an intervention research in 2012-2014, in order to develop and evaluate a prevention program aiming at improving the nutritional quality of food purchases at no additional cost in a socioeconomically disadvantaged population. In order to implement activities tailored to the target population, participants were involved in the development of the protocol and the tools of the intervention and evaluation processes.

Results

Opticourses’s workshops (8 to 12 participants) include different activities displayed in four 2h sessions around real food purchases of participants, and games and exchanges aimed at promoting food and food choices of good nutritional quality for their price. The intervention research showed improvements in food purchasing behaviors of Opticourses participants. A transferability phase was conducted in 2015-2017. Since 2017, Opticourses is spreading in several regions of France, through training of professionals, in particular the courses organized by the Health Education Regional Committee (CRES) in the South of France.

Discussion

Bringing an original, concrete, co-constructed and scientifically based response to an everyday life problem is the main strength of the program. One important risk of failure for such prevention program is the underestimation of the requirements of the intervention research, in terms of time and human and budgetary resources.

Key messages

From a research point of view, getting access to new food purchasing data will allow a continuous refinement and innovation in the improvement of the diet for people with budgetary constraints. By focusing on food purchasing, a familiar activity that most adults feel able to handle, the Opticourses program is engaging and pragmatic, in accordance with health promotion principles.

Improving participation of hard-to-reach older people in diet interventions: the INVITE strategy

Background

A lot of behavioural interventions promoting healthy eating and physical activity are focusing older people, but, among them, individuals from low socioeconomic status and/or experiencing social isolation participate less. The aim of the present study was to design, pilot and perform a formative evaluation of an active recruitment strategy called ’INVITE’. This strategy aimed to improve participation of hard-to-reach older people in existing collective workshops combining diet and physical activities dedicated to older people.

Methods

We co-constructed this strategy, based on results from a literature review, qualitative interviews with older people and professionals using the Behaviour Change Wheel framework as a guide. INVITE includes 5 steps: i) identification of socially deprived/isolated people aged 60-85 years in retirement fund databases; ii) postal invitation letter; iii) phone call; iv) home visit by a social worker. The formative evaluation used questionnaires (closed and open-ended questions) completed by 2 social workers in April 2019.

Results

Among the 54 older people selected in the databases, 29 could be reached by phone. Among these 29 persons, 25 reported being interested by the collective workshops; 17 refused the home visit (main reasons: not available during the workshops period, current health problems); 12 accepted the home visit, but only 10 could be visited at home (one was ill; one cancelled the visit). Nine out of these 10 persons accepted to participate to the workshops. The main motivating factors were that workshops were: free; perceived as friendly; and as an opportunity to “go out” and to receive diet counselling to improve diet quality with no additional cost.

Conclusions

The INVITE strategy was perceived positively but adjustments are needed to improve home visits acceptation rate (e.g., by revising the criteria used to identify people in the databases). We will now evaluate the attendance rate to the collective workshop.

Key messages

The INVITE strategy was designed to improve participation of hard-to-reach older people in combined diet and physical activity collective workshops. This strategy was perceived positively by most older people contacted and both social workers.

Blood CD9+ B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation

Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24^hi CD38^hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24^hi CD38^hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9⁺ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24^hi CD38^hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.

A Pilot Study of Side Effects of Cancer Therapies and their Impact on Satisfaction with Life

This survey aimed at getting a first insight into diverse side effects and their association with satisfaction with life as well as the use of complementary and alternative medicine (CAM) in cancer patients. A total of 100 patients in a German University Hospital were included. General side effects like fatigue, fever, headache, limb pain and sleep disorders had a significant influence on the patients' satisfaction with life (p = .034 and p = .032, respectively). Concerning CAM, we could not detect any association between the frequency of side effects and the use of CAM. Improving the treatment of side effects may have a strong impact on patients' satisfaction with life.

Quiescent Endothelial Cells Upregulate Fatty Acid β-Oxidation for Vasculoprotection via Redox Homeostasis

Little is known about the metabolism of quiescent endothelial cells (QECs). Nonetheless, when dysfunctional, QECs contribute to multiple diseases. Previously, we demonstrated that proliferating endothelial cells (PECs) use fatty acid β-oxidation (FAO) for de novo dNTP synthesis. We report now that QECs are not hypometabolic, but upregulate FAO >3-fold higher than PECs, not to support biomass or energy production but to sustain the tricarboxylic acid cycle for redox homeostasis through NADPH regeneration. Hence, endothelial loss of FAO-controlling CPT1A in CPT1A^ΔEC mice promotes EC dysfunction (leukocyte infiltration, barrier disruption) by increasing endothelial oxidative stress, rendering CPT1A^ΔEC mice more susceptible to LPS and inflammatory bowel disease. Mechanistically, Notch1 orchestrates the use of FAO for redox balance in QECs. Supplementation of acetate (metabolized to acetyl-coenzyme A) restores endothelial quiescence and counters oxidative stress-mediated EC dysfunction in CPT1A^ΔEC mice, offering therapeutic opportunities. Thus, QECs use FAO for vasculoprotection against oxidative stress-prone exposure.

Impairment of Angiogenesis by Fatty Acid Synthase Inhibition Involves mTOR Malonylation

The role of fatty acid synthesis in endothelial cells (ECs) remains incompletely characterized. We report that fatty acid synthase knockdown (FASN^KD) in ECs impedes vessel sprouting by reducing proliferation. Endothelial loss of FASN impaired angiogenesis in vivo, while FASN blockade reduced pathological ocular neovascularization, at >10-fold lower doses than used for anti-cancer treatment. Impaired angiogenesis was not due to energy stress, redox imbalance, or palmitate depletion. Rather, FASN^KD elevated malonyl-CoA levels, causing malonylation (a post-translational modification) of mTOR at lysine 1218 (K1218). mTOR K-1218 malonylation impaired mTOR complex 1 (mTORC1) kinase activity, thereby reducing phosphorylation of downstream targets (p70S6K/4EBP1). Silencing acetyl-CoA carboxylase 1 (an enzyme producing malonyl-CoA) normalized malonyl-CoA levels and reactivated mTOR in FASN^KD ECs. Mutagenesis unveiled the importance of mTOR K1218 malonylation for angiogenesis. This study unveils a novel role of FASN in metabolite signaling that contributes to explaining the anti-angiogenic effect of FASN blockade.

Serine Synthesis via PHGDH Is Essential for Heme Production in Endothelial Cells

The role of phosphoglycerate dehydrogenase (PHGDH), a key enzyme of the serine synthesis pathway (SSP), in endothelial cells (ECs) remains poorly characterized. We report that mouse neonates with EC-specific PHGDH deficiency suffer lethal vascular defects within days of gene inactivation, due to reduced EC proliferation and survival. In addition to nucleotide synthesis impairment, PHGDH knockdown (PHGDH^KD) caused oxidative stress, due not only to decreased glutathione and NADPH synthesis but also to mitochondrial dysfunction. Electron transport chain (ETC) enzyme activities were compromised upon PHGDH^KD because of insufficient heme production due to cellular serine depletion, not observed in other cell types. As a result of heme depletion, elevated reactive oxygen species levels caused EC demise. Supplementation of hemin in PHGDH^KD ECs restored ETC function and rescued the apoptosis and angiogenesis defects. These data argue that ECs die upon PHGDH inhibition, even without external serine deprivation, illustrating an unusual importance of serine synthesis for ECs.

Maternal obesity increases insulin resistance, low-grade inflammation and osteochondrosis lesions in foals and yearlings until 18 months of age

INTRODUCTION

Obesity is a growing concern in horses. The effects of maternal obesity on maternal metabolism and low-grade inflammation during pregnancy, as well as offspring growth, metabolism, low-grade inflammation, testicular maturation and osteochondrotic lesions until 18 months of age were investigated.

MATERIAL AND METHODS

Twenty-four mares were used and separated into two groups at insemination according to body condition score (BCS): Normal (N, n = 10, BCS ≤4) and Obese (O, n = 14, BCS ≥4.25). BCS and plasma glucose, insulin, triglyceride, urea, non-esterified fatty acid, serum amyloid A (SAA), leptin and adiponectin concentrations were monitored throughout gestation. At 300 days of gestation, a Frequently Sampled Intravenous Glucose Tolerance Test (FSIGT) was performed. After parturition, foals' weight and size were monitored until 18 months of age with plasma SAA, leptin, adiponectin, triiodothyronine (T3), thyroxine (T4) and cortisol concentrations measured at regular intervals. At 6, 12 and 18 months of age, FSIGT and osteoarticular examinations were performed. Males were gelded at one year and expression of genes involved in testicular maturation analysed by RT-qPCR.

RESULTS

Throughout the experiment, maternal BCS was higher in O versus N mares. During gestation, plasma urea and adiponectin were decreased and SAA and leptin increased in O versus N mares. O mares were also more insulin resistant than N mares with a higher glucose effectiveness. Postnatally, there was no difference in offspring growth between groups. Nevertheless, plasma SAA concentrations were increased in O versus N foals until 6 months, with O foals being consistently more insulin resistant with a higher glucose effectiveness. At 12 months of age, O foals were significantly more affected by osteochondrosis than N foals. All other parameters were not different between groups.

CONCLUSION

In conclusion, maternal obesity altered metabolism and increased low-grade inflammation in both dams and foals. The risk of developing osteochondrosis at 12 months of age was also higher in foals born to obese dams.

65 Placental Function at Term is Altered in Broodmares Fed with Cereals from Mid Gestation

Recent data obtained in our laboratory suggest that feeding pregnant broodmares with cereal concentrates may affect both mare and foal metabolism in the short and long term. Here, we investigated feto-placental biometry and placental function at term in mares fed with cereals and forage or forage only. Twenty-two multiparous mares inseminated with the same stallion were allocated to 1 of 2 groups from 7 months of gestation: group F (n = 10) were fed forage only, whereas group B (n = 12) received forage and cracked barley until foaling. At 3 and 9 months of gestation, a glucose tolerance test (IVGTT) was performed to evaluate the insulin resistance of pregnant mares. At birth, placentas and foals were weighed and measured. Placental samples were collected above the umbilical cord insertion and snap frozen. An RNA sequencing (RNAseq) analysis was performed on 9 placentas of each group. After normalization, gene levels were analysed using the DESEqn 2 package of R software (https://www.r-project.org/). Enrichment of gene sets was analysed using the Gene Set Enrichment Analysis (GSEA) software using the Kyoto Encyclopaedia of Genes and Genomes (KEGG) and Gene Ontology [GO, biological processes (bp), molecular function (mf) and cellular components (cc)] databases. Gene analysis statistical results were considered significant for P-values < 0.05 after false rate discovery (fdr) correction. The IVGTT results were analysed using a type 3 ANOVA on a mixed linear model with group as fixed effect and age of the mare as random effect. At 3 months of gestation, maternal glucose metabolism was not different between groups. At 9 months, B mares had a higher insulin area under the curve (AUC) after glucose injection than F mares (P < 0.01), without any difference in glucose AUC, suggesting that B mares were more insulin resistant than F mares. At birth, no difference was observed for feto-placental biometry between groups. Gene-level analysis could not discern differences in gene expression between groups after fdr correction. The GSEA analysis, however, showed that 8 gene sets were down-regulated in C placentas (2 KEGG, 2 GObp, 3 GOmf, 1 GOcc) and 193 gene sets were up-regulated (15 KEGG, 144 GObp, 12 GOmf, 22 GOcc) in B placentas. The down-regulated gene sets were involved in neutral amino acids and anion transport, fatty acid oxidation, acetyl coA synthesis, cholesterol and folate degradation, and the up-regulated gene sets were involved in RNA expression, inflammation (activation and recruitment of immune cells, MAPK signalling, complement and coagulation cascades, pro-inflammatory cytokine production and signalling) and in vascularisation (vasculogenesis, angiogenesis and smooth muscle cells development). The results are consistent with the altered function observed in term placentas of women who suffer from gestational diabetes. In conclusion, feeding pregnant mares with cereal from mid gestation alters the placental function at term. The authors thank the GeT platform (Toulouse, France) for the sequencing of the samples.

Western Blotting and Co-immunoprecipitation of Endogenous STIM/ORAI and Protein Partners

The characterization of protein-protein interactions through methods such as co-immunoprecipitation, followed by Western blot analysis, is a crucial step in the understanding of protein functions and the biology of the cell. Since the discovery of ORAI and STIM proteins as component of store-operated channel (SOC), overexpressing systems have been used to demonstrate how ORAI and STIM can associate with physiological and pathological conditions. Here we describe a protocol allowing endogenous studies.

How Endothelial Cells Adapt Their Metabolism to Form Vessels in Tumors

Endothelial cells (ECs) line blood vessels, i.e., vital conduits for oxygen and nutrient delivery to distant tissues. While mostly present as quiescent "phalanx" cells throughout adult life, ECs can rapidly switch to a migratory "tip" cell and a proliferative "stalk" cell, and sprout into avascular tissue to form new blood vessels. The angiogenic switch has long been considered to be primarily orchestrated by the activity of angiogenic molecules. However, recent evidence illustrates an instrumental role of cellular metabolism in vessel sprouting, whereby ECs require specific metabolic adaptations to grow. Here, we overview the emerging picture that tip, stalk, and phalanx cells have distinct metabolic signatures and discuss how these signatures can become deregulated in pathological conditions, such as in cancer.

Effects of in situ exposure to tritiated natural environments: A multi-biomarker approach using the fathead minnow, Pimephales promelas

Aquatic ecosystems are chronically exposed to radionuclides as well as other pollutants. Increased concentrations of pollutants in aquatic environments can present a risk to exposed organisms, including fish. The goal of this study was to characterize the effects of tritium, in the context of natural environments, on the health of fathead minnow, Pimephales promelas. Fish were exposed to tritium (activity concentrations ranging from 2 to 23,000Bq/L) and also to various concentrations of several metals to replicate multiple-stressor environments. Fish were exposed for 60days, then transferred to the tritium background site where they stayed for another 60days. Tritium, in the forms of tritiated water (HTO) and organically bound tritium (OBT), and a series of fish health indicators were measured in fish tissues at seven time points throughout the 120days required to complete the exposure and the depuration phases. Results showed effects of environmental exposure following the increase of tritium activity and metals concentrations in water. The internal dose rates of tritium, estimated from tissue HTO and OBT activity concentrations, were consistently low (maximum of 0.2μGy/h) compared to levels at which population effects may be expected (>100μGy/h) and no effects were observed on survival, fish condition, gonado-somatic, hepato-somatic, spleno-somatic and metabolic indices (RNA/DNA, proteins/DNA and protein carbonylation (in gonads and kidneys)). Using multivariate analyses, we showed that several biomarkers (DNA damages, MN frequency, gamma-H2AX, SFA/MUFA ratios, lysosomal membrane integrity, AChE, SOD, phagocytosis and esterase activities) were exclusively correlated with fish tritium internal dose rate, showing that tritium induced genotoxicity, DNA repair activity, changes in fatty acid composition, and immune, neural and antioxidant responses. Some biomarkers were responding to the presence of metals, but overall, more biomarkers were linked to internalized tritium. The results are discussed in the context of multiple stressors involving metals and tritium.

Placental structure and function in different breeds in horses

Ponies and sometimes draft horses are often used as experimental models for horses although size and metabolic parameters are known to vary between horse breeds. So far, there is little information about differences of placental structure and no information about differences of placental function between breeds. The aim of this study was to investigate differences in placental size, structure and function at birth in relation to foal size and weight in ponies, Saddlebred and draft horses. Pony, Saddlebred and draft horse pregnancies were obtained by artificial insemination over 2 successive breeding seasons. Foals and total fetal membranes (TFM) were weighed and placentas measured for surface area at term. Placentas were sampled above the umbilical cord insertion. Surface density and volume fraction of the different cellular components of the placenta were measured on histological sections using stereology. The expression of genes involved in growth and development, nutrient transfer and vascularization was compared between groups. Foals and TFM were lighter at birth in ponies than Saddlebred horses, and both were lighter compared to draft horses. The surface density and volume fraction of microcotyledonary vessels was increased in pony compared to Saddlebred placentas. The relative expression of genes involved in growth and development was different between breeds and increased with maternal, fetal and placental weight. Primiparous dams produced lighter foals and smaller placentas, associated with a decreased volume fraction of microcotyledonary vessels and genes involved in growth and development and vascularization. Foal sex had little effect on placental structure and function as the expression of only one gene differed according to sex, with EGFR expression being decreased in placentas of females compared to males. In conclusion, foal and placental weight, as well as placental expression of genes involved in growth and development were correlated with maternal size. Placental structure also differed between breeds, with a stronger difference between ponies and both breeds of horses.