Multiple brown tumors: a bone complication due to long-term untreated pseudohypoparathyroidism

Bone lytic lesions are a possible complication of pseudohypoparathyroidism type 1B, in undertreated adult patients. Whole body [18F] F-fluorocholine PET/CT is a useful imaging tool to assess brown tumor progression in this context. We describe the case of a 33-year-old woman, referred for the diagnostic evaluation of lytic bone lesions of the lower limbs, in the context of asymptomatic pseudohypoparathyroidism. She had been treated with alfacalcidol and calcium during her childhood. Treatment was discontinued at the age of 18 years old because of the lack of symptoms. A femur biopsy revealed a lesion rich in giant cells, without malignancy, consistent with a brown tumor. Laboratory tests showed a parathyroid level at 1387 pg/ml (14-50). Whole-body Fluorocholine PET/CT revealed hypermetabolism of bone lesions. The final diagnosis was brown tumors related to hyperparathyroidism complicating an untreated pseudohypoparathyroidism. Genetic testing confirmed PHP type 1B. Pseudohypoparathyroidism with radiographic evidence of hyperparathyroid bone disease, is a very rare condition due to parathyroid hormone resistance in target organs, i.e., kidney resistance, but with conserved bone cell sensitivity. It has been reported in only a few cases of pseudohypoparathyroidism type Ib. Long-term vitamin D treatment was required to correct bone hyperparathyroidism. With this rationale, the patient was treated with calcium, alfacalcidol, and cholecalciferol. One-year follow-up showed complete resolution of pain, improvement in serum calcium, and regression of bone lesions on [18F]F-fluorocholine PET/CT. This case illustrates the usefulness of [18F]F-fluorocholine PET/CT for the imaging of brown tumors in pseudohypoparathyroidism type 1B, and emphasizes the importance of calcium and vitamin D treatment in adult patients, to avoid the deleterious effects of high parathyroid hormone on skeletal integrity.

Impact of low- or moderate-risk gonadotoxic chemotherapy prior to testicular tissue freezing on spermatogonia quantity in human (pre)pubertal testicular tissue

STUDY QUESTION

What is the impact of low- or moderate-risk gonadotoxic chemotherapy received prior to testicular tissue freezing (TTF), and of the cancer itself, on spermatogonia quantity in testicular tissue from (pre)pubertal boys?

SUMMARY ANSWER

Vincristine, when associated with alkylating agents, has an additional adverse effect on spermatogonia quantity, while carboplatin has no individual contribution to spermatogonia quantity, in testicular tissue of (pre)pubertal boys, when compared to patients who have received non-alkylating chemotherapy.

WHAT IS KNOWN ALREADY

The improved survival rates after cancer treatment necessitate the inclusion of fertility preservation procedures as part of the comprehensive care for patients, taking into consideration their age. Sperm cryopreservation is an established procedure in post-pubertal males while the TTF proposed for (pre)pubertal boys remains experimental. Several studies exploring testicular tissue of (pre)pubertal boys after TTF have examined the tubular fertility index (TFI, percentage of seminiferous tubule cross-sections containing spermatogonia) and the number of spermatogonia per seminiferous tubule cross-section (S/T). All studies have demonstrated that TFI and S/T always decrease after the introduction of chemotherapeutic agents, especially those which carry high gonadotoxic risks such as alkylating agents.

STUDY DESIGN, SIZE, DURATION

Testicular tissue samples from 79 (pre)pubertal boys diagnosed with cancer (from 6 months to 16 years of age) were cryopreserved between May 2009 and June 2014. Their medical diagnoses and previous chemotherapy exposures were recorded. We examined histological sections of (pre)pubertal testicular tissue to elucidate whether the chemotherapy or the primary diagnosis affects mainly TFI and S/T.

PARTICIPANTS/MATERIALS, SETTING, METHODS

(Pre)pubertal boys with cancer diagnosis who had been offered TTF prior to conditioning treatment for hematopoietic stem cell transplantation were included in the study. All the patients had previously received chemotherapy with low- or moderate-risk for future fertility. We have selected patients for whom the information on the chemotherapy received was complete. The quantity of spermatogonia and quality of testicular tissue were assessed by both morphological and immunohistochemical analyses.

MAIN RESULTS AND THE ROLE OF CHANCE

A significant reduction in the number of spermatogonia was observed in boys treated with alkylating agents. The mean S/T values in boys exposed to alkylating agents were significantly lower compared to boys exposed to non-alkylating agents (P = 0.018). In contrast, no difference was observed for patients treated with carboplatin as the sole administered alkylating agent compared to the group of patients exposed to non-alkylating agents. We observed an increase of S/T with age in the group of patients who did not receive any alkylating agent and a decrease of S/T with age when patients received alkylating agents included in the cyclophosphamide equivalent dose (CED) formula (r = 0.6166, P = 0.0434; r = -0.3759, P = 0.0036, respectively). The TFI and S/T decreased further in the group of patients who received vincristine in combination with alkylating agents (decrease of 22.4%, P = 0.0049 and P < 0.0001, respectively), but in this group the CED was also increased significantly (P < 0.0001). Multivariate analysis, after CED adjustment, showed the persistence of a decrease in TFI correlated with vincristine administration (P = 0.02).

LIMITATIONS, REASONS FOR CAUTION

This is a descriptive study of testicular tissues obtained from (pre)pubertal boys who were at risk of infertility. The study population is quite heterogeneous, with a small number of patients in each sub-group. Our results are based on comparisons between patients receiving alkylating agents compared to patients receiving non-alkylating agents rather than chemotherapy-naive patients. The French national guidelines for fertility preservation in cancer patients recommend TTF before highly gonadotoxic treatment. Therefore, all the patients had received low- or moderate-risk gonadotoxic chemotherapy before TTF. Access to testicular tissue samples from chemotherapy-naive patients with comparable histological types of cancer was not possible. The functionality of spermatogonia and somatic cells could not be tested by transplantation or in vitro maturation due to limited sample sizes.

WIDER IMPLICATIONS OF THE FINDINGS

This study summarizes the spermatogonial quantity of (pre)pubertal boys prior to TTF. We confirmed a negative correlation between the cumulative exposure to alkylating agents and spermatogonial quantity. In addition, the synergistic use of vincristine in combination with alkylating agents showed a cumulative deleterious effect on the TFI. For patients for whom fertility preservation is indicated, TTF should be proposed for chemotherapy with a predicted CED above 4000 mg/m2. However, the data obtained from vincristine and carboplatin use should be confirmed in a subsequent study including more patients.

STUDY FUNDING/COMPETING INTEREST(S)

This study had financial support from a French national research grant PHRC No. 2008/071/HP obtained by the French Institute of Cancer and the French Healthcare Organization. The sponsors played no role in the study. The authors declare no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Chimeras in Merlot grapevine revealed by phased assembly

Chimerism is the phenomenon when several genotypes coexist in a single individual. Used to understand plant ontogenesis they also have been valorised through new cultivar breeding. Viticulture has been taking economic advantage out of chimeras when the variant induced an important modification of wine type such as berry skin colour. Crucial agronomic characters may also be impacted by chimeras that aren't identified yet. Periclinal chimera where the variant has entirely colonised a cell layer is the most stable and can be propagated through cuttings. In grapevine, leaves are derived from both meristem layers, L1 and L2. However, lateral roots are formed from the L2 cell layer only. Thus, comparing DNA sequences of roots and leaves allows chimera detection. In this study we used new generation Hifi long reads sequencing, recent bioinformatics tools and trio-binning with parental sequences to detect periclinal chimeras on 'Merlot' grapevine cultivar. Sequencing of cv. 'Magdeleine Noire des Charentes' and 'Cabernet Franc', the parents of cv. 'Merlot', allowed haplotype resolved assembly. Pseudomolecules were built with a total of 33 to 47 contigs and in few occasions a unique contig for one chromosome. This high resolution allowed haplotype comparison. Annotation was transferred from PN40024 VCost.v3 to all pseudomolecules. After strong selection of variants, 51 and 53 'Merlot' specific periclinal chimeras were found on the Merlot-haplotype-CF and Merlot-haplotype-MG respectively, 9 and 7 been located in a coding region. A subset of positions was analysed using Molecular Inversion Probes (MIPseq) and 69% were unambiguously validated, 25% are doubtful because of technological noise or weak depth and 6% invalidated. These results open new perspectives on chimera detection as an important resource to improve cultivars through clonal selection or breeding.

Grafting of proteins onto polymeric surfaces: A synthesis and characterization challenge

This review aims at answering the following question: how can a researcher be sure to succeed in grafting a protein onto a polymer surface? Even if protein immobilization on solid supports has been used industrially for a long time, hence enabling natural enzymes to serve as a powerful tool, emergence of new supports such as polymeric surfaces for the development of so-called intelligent materials requires new approaches. In this review, we introduce the challenges in grafting protein on synthetic polymers, mainly because compared to hard surfaces, polymers may be sensitive to various aqueous media, depending on the pH or reductive molecules, or may exhibit state transitions with temperature. Then, the specificity of grafting on synthetic polymers due to difference of chemical functions availability or difference of physical properties are summarized. We present next the various available routes to covalently bond the protein onto the polymeric substrates considering the functional groups coming from the monomers used during polymerization reaction or post-modification of the surfaces. We also focus our review on a major concern of grafting protein, which is avoiding the potential loss of function of the immobilized protein. Meanwhile, this review considers the different methods of characterization used to determine the grafting efficiency but also the behavior of enzymes once grafted. We finally dedicate the last part of this review to industrial application and future prospective, considering the sustainable processes based on green chemistry.

[Implementation, of multidisciplinary consultations for patients with inflammatory arthritis and treated with subcutaneous biologic DMARDs: Assessment at one year and outlook]

INTRODUCTION

Biologics (bDMARDs) have revolutionized the prognosis of patients with inflammatory arthritis, but are not without serious side effects. The patient must be able to identify them, acquire self-care abilities or skills and adhere to their treatment. Multidisciplinary consultations, including a pharmaceutical consultation could improve the care of these patients. The pharmaceutical presence make it easier to switch to a biosimilar with etended patient support thanks to the community-hospital network. The return on investment is possible thanks to the more frequent use of biosimilars and the pricing of this type of consultation by the "Forfait de Prestation Intermédiaire".

METHODOLOGY

Eligible patients are patients with rheumatoid arthritis or spondyloarthritis, treated with subcutaneous bDMARDs. The criteria assessed were patient's knowledge of their biotherapy using the Biosecure score, their medication adherence using the CQR-5, the total of switch to biosimilars perform and the financial statement of the consultations. An assessment of the actions deployed for the community-hospital network.

RESULTS

Two hundred and ninety-five patients (47.4%) benefited multidisciplinary consultation. The mean score of the Biosecure score was 69.6/100 (moderate knowledge) and 261 patients (88.5%) were highly adherent. 57 patients (73%) accepted the switch to biosimilar. 197 pharmacy were contacted, all of witch for patients who receive the switch. Overall patient's satisfaction was 26.9/28.

CONCLUSION

Multidisciplinary consultations with involvement of the pharmacist should optimized patient care and the management of outpatients treated with bDMARDs. Patients have already expressed their satisfaction with this course of care and the return on investment is positive.

Profiling oocytes with neural networks from images and mechanical data

The success rate of assisted reproductive technologies could be greatly improved by selectively choosing egg cells (oocytes) with the greatest chance of fertilization. The goal of mechanical profiling is, thus, to improve predictive oocyte selection by isolating the mechanical properties of oocytes and correlating them to their reproductive potential. The restrictions on experimental platforms, however - including minimal invasiveness and practicality in laboratory implementation - greatly limits the data that can be acquired from a single oocyte. In this study, we perform indentation studies on human oocytes and characterize the mechanical properties of the zona pellucida, the outer layer of the oocyte. We obtain excellent fitting with our physical model when indenting with a flat surface and clearly illustrate localized shear-thinning behavior of the zona pellucida, which has not been previously reported. We conclude by outlining a promising methodology for isolating the mechanical properties of the cytoplasm using neural networks and optical images taken during indentation.

[Embryo stage impact on the risk of ectopic pregnancy after In Vitro Fecondation]

OBJECTIVES

Ectopic pregnancies are still the first mortality cause of the first semestre of pregnancy. They are much more frequent in IVF (2-5%) than in the standard population (1-2%). The aim of this study was to compare the rate of ectopic pregnancies following a fresh embryo transfer done whether at an clived embryo stage (day 2 or 3 of the embryo development) or at a blastocyst stage (day 5 or 6 of the embryo development).

METHODS

This is a monocentric retrospective study including all 18 to 43 year-old patients getting pregnant (ßHCG>100 UI/L) after a fresh embryo transfer from In Vitro Fecondation with or without Intra-Cytoplasmic Sperm Injection, between January 1st 2014 and December 30th 2020 in the Hospital of Besançon (France). This population has been divided into 2 groups according to the embryo stage on the day of transfer.

RESULTS

Nine hundred and twenty two patients have been included. There were statistically more ectopic pregnancies after a blastocyst transfer (n=4; 5.4%) than after a clived embryo transfer (n=14; 1.7%). (P=0.049) CONCLUSION: In our population, there were more ectopic pregnancies from blastocyst(s) transfers than from clived embryo(es).

Is it justified to search for cancer in patients with peripheral arterial disease?

BACKGROUND

Cancer is the leading cause of death in European countries, ahead of cardiovascular diseases. Cancer is also the most common co-morbidity among patients hospitalized for the management of cardiovascular diseases. Through an overview, we searched for the frequency and types of cancer associated with peripheral arterial disease (PAD) in order to address the relevance of cancer screening in patients with PAD.

METHODS

We searched in PubMed database from 1996 to 2020 for retrospective and prospective cohort or cross-sectional or randomized studies evaluating the frequency of all types of cancer in patients with PAD excluding patients with aneurysmal disease. The keywords used were: peripheral arterial disease, arterial thrombosis, acute leg ischemia, critical leg ischemia, chronic leg ischemia, intermittent claudication, malignant tumor, cancer.

RESULTS

Based on published studies, the frequency of cancer in patients with PAD varied widely from 3.8 to 30.4% depending on study design, population, method used to screen for cancer and study period. In medical records database and registers,cancer prevalence varied from 3,8% to 22,4% in 4 retrospective studies of patients with acute limb ischemia and from 10.5 to 30.4% in 3 prospective studies of patients with acute limb ischemia, critical ischemia or intermittent claudication. In 3 retrospective analyses from 2 population-based cohorts and health insurance claims data, incidence of cancer in patients with intermittent claudication, acute limb ischemia or peripheral arterial disease varied from 8% to 11.7%. The frequency of cancer in PAD patients appeared higher than in the general population. Tobacco-dependent cancers seemed to be the most common cancers in PAD. Cancers were also more frequent in case of anemia, amputation and iterative bypass thrombosis in few studies.

CONCLUSION

Although there is no recommendation for cancer screening in patients with PAD, the high prevalence of cancer raises the question of screening patients at high risk such as those with acute or critical limb ischemia and especially in case of severe tobacco use, anemia, amputation and iterative bypass thrombosis. These results call for further studies with larger sample size and long term follow-up.

O-262 Impact of the cancer treatment received on the quality of the human (pre)pubertal testicular tissue prior to testicular tissue freezing (TTF)

Study question

What is the impact of the cancer treatment received prior to TTF and the disease on spermatogonia quantity in testicular tissue from (pre)pubertal boys?

Summary answer

A decrease in spermatogonia number was observed in testicular tissue after cancer treatment when cyclophosphamide equivalente dose (CED) is above 4000 mg/m2.

What is known already

The improved survival rates associated with the development of sperm and testicular tissue freezing (TTF) renders difficult not to offer fertility preservation to children or adolescents before cancer. Several studies exploring cancer patients have examined the number of spermatogonia per seminiferous tubular cross-section (S/T) or tubular fertility index (TFI, percentage of tubular cross-sections containing spermatogonia) in testicular biopsies. All studies, demonstrated that the S/T and TFI always decreased after the introduction of chemotherapy and more specifically in case of highly gonadotoxic risk such as alkylating agents.

Study design, size, duration

Testicular tissue samples from 79 (pre)pubertal boys diagnosed with cancer (ranging from 6 month to 16 years of age) were cryopreserved between May 2009 and June 2014. Medical diagnosis and previous chemotherapy exposure were recorded. We examined histological sections of (pre)pubertal testicular tissue to elucidate whether chemotherapy, doses or primary diagnosis affects the quality of testicular tissue.

Participants/materials, setting, methods

(Pre)pubertal boys with cancer diagnosis who benefitted from TTF prior to conditioning treatment for hematopoietic stem cell transplantation. All the patients included had previously received chemotherapy with moderate risk for future fertility. We have selected patients for whom data on chemotherapy received were complete. The quantity of spermatogonia and quality of testicular tissue were assessed by both morphological and immunohistochemical analysis.

Main results and the role of chance

The main finding was a significant reduction in spermatogonial cell counts in boys treated with alkylating agents. The mean S/T values in boys exposed to alkylating agents was significantly lower than in a group exposed to non-alkylating agents (p = 0.018). In contrast, no difference was observed for patients treated with carboplatin as the only alkylating agent compared to the group of patients exposed to non-alkylating agents. We observed an increase of S/T with age in the group of patients who did not receive alkylating agents and a decrease of S/T with age when patients received alkylating agents included in the CED formula (r = 0.6166, p = 0.0434; r= -0.3759, p = 0.0036, respectively). The TFI and S/T were decreased in the group of patients who received vincristine (p = 0.0049; p &lt; 0.0001, respectively), but the CED was also significantly increased (p &lt; 0.0001). Multivariate analysis, adjusted for CED, showed the persistence of a decrease in TFI correlated with vincristine administration (-0.5 [-0.96; 0.09], p = 0.02).

Limitations, reasons for caution

This is a descriptive study of testicular tissues obtained from patients who were at risk of infertility. Spermatognia functionanlity could not be tested by transplantation due limited sample size.

Wider implications of the findings

This study summarizes spermatogonia quantity and quality of testicular tissue of (pre)pubertal boys after potentially sterilizing treatments. We confirmed a negative correlation between the cumulative exposure to alkylating agents and the spermatogonial quantity. For patients in whom fertility preservation is indicated, TTF should be performed before initiation of alkylating agents.

Trial registration number

N/A

POS0196 NINE PERCENT OF PATIENTS PRESENT WITH MUSCULOSKELETAL SYMPTOMS AFTER A SEVERE SARS-CoV2 INFECTION: A DESCRIPTIVE ANALYSIS OF THE ASSISTANCE PUBLIQUE - HÔPITAUX DE PARIS CLINICAL DATA WAREHOUSE

Background

the main and most severe manifestation of the SARS-CoV2 infection is pneumonia, but other organ-specific symptoms have been described (myocarditis, encephalitis,..), and some sparse cases have reported musculoskeletal (MSK) symptoms following such an infection.

Objectives

to determine the prevalence of MSK symptoms appearing after a SARS-CoV2 infection.

Methods

this was an observational cohort based on data available at the Assistance Publique-Hôpitaux de Paris (APHP) Clinical Data Warehouse (which includes data from patients admitted in the 39 APHP hospitals). Data collected included both ICD-10 codes in discharge summaries, and ‘key-words’ search on electronic medical records (EMR). To be included in the analysis, patients had to have a positive RT-PCR for SARS-CoV2 performed in APHP and be admitted in any APHP department between 1st March 2020 until 31st December 2020. Patients with past history of any MSK condition were excluded. MSK conditions were considered only if coded or reported in an EMR up to 90 days after the positive RT-PCR. Demographics and disease characteristics including treatment were compared in both groups (MSK yes/no) by T-test or ChiSquare test, accordingly.

Results

Among the 55872 patients with a positive SARS-CoV2 RT-PCR performed in APHP, 17771 were admitted in APHP hospitals. Among them, 2170 had a previous history of MSK condition and were therefore excluded from this analysis. Among the remaining 15601 patients, 1370 (8.8%) presented with MSK symptoms. The most prevalent MSK symptoms were low back pain (32.9%), followed by joint pain (29.9%), radicular pain (20.2%) and joint effusion/arthritis (22.8%). Patients with MSK symptoms were older (67y vs. 64y, p<0.01), more frequently obese (29% vs. 25%, p=0.03), hypertensive (34% vs. 30%, p<0.01) and with diabetes (21% vs. 18%, p<0.01). There were no differences on gender nor on the ICU admission rate between groups (31% vs. 29%, NS); 30-days mortality was significantly lower in the MSK+ group probably due to selection bias (i.e. only patients who survived could present with MSK symptoms up to 90 days later) (7.8% vs. 16.9%, p<0.01). Treatment for SARS-CoV2 was slightly different in both groups, with higher corticosteroids (40.7% vs. 29.0%, p<0.01), antivirals (21.5% vs. 15.3%, p<0.01) and immunosuppressive drugs (8.5% vs. 4.5%, p<0.01) prescription rates in the MSK+ group.

Conclusion

MSK symptoms occurred in almost 9% of patients admitted to the hospital after a SARS-CoV2 infection, particularly in older and more comorbid patients. Further analysis evaluating the persistence of these symptoms are needed.

Acknowledgements

We would like to acknowledge all departments of Rheumatology of APHP

Disclosure of Interests

Anna Moltó Consultant of: abbvie, MSD, BMS, Pfizer, Lilly, UCB, GIlead, Jansenn, NOvartis, Grant/research support from: UCB, Pierre Pinson: None declared, Nathanael Beeker: None declared, Christian Roux: None declared

POS0953 IMPACT OF A WEARABLE ACTIVITY TRACKER ON DISEASE ACTIVITY IN SPONDYLOARTHRITIS: A RANDOMIZED CONTROLLED TRIAL

Background

Other studies have shown the ability of a wearable activity tracker (TAP) to improve physical activity (PA) in different rheumatic diseases. Given the importance of PA in spondyloarthritis, our hypothesis is that the use of a TAP could improve physical activity and thus disease activity.

Objectives

The purpose of this study is to evaluate the impact of a TAP used to encourage PA on disease activity in patients with spondyloarthritis.

Methods

In this randomized controlled trial consisting of three 12-week stages (Figure 1). Patients with spondyloarthritis were randomized to a group with TAP (GT), or a group without TAP (GST). For the first stage, both groups received physical activity counseling. In the second 12-week stage, no patients received TAP. In the third 12-week stage, all patients received supervised PA combined with TAP for GT only. Disease activity, performance (assessed by the TM6 6-minute walk test), and quality of life (assessed by the Short Form 36 Health Survey Questionnaire [SF-36]) were assessed at 12, 24, and 36 weeks. The primary endpoint was the progression of relapses between baseline and 12 weeks.

Figure 1.

Results

A total of 108 patients were included in the study. At 12 weeks, both groups showed a non-significant improvement in the number of relapses: mean change (Δ), -0.32 [95% CI-0.68;60.09] in GT and Δ, -0.38 [95% CI-0.68;60.09] in GST. But, differences in outcome between groups were not significant (p=0.87). The TM6 was improved in the GT and GST groups at 12, 24, and 36 weeks (p < 0.01, and p < 0.001, respectively). We observed improvement in different dimensions of the SF36, mainly in physical function, emotional role, general health, and physical pain at 12 weeks (p < 0.01).

Multivariate analysis showed improvement over time in performance (p < 0.01) and moderate flare-ups (p < 0.01) without the influence of a PAR (p = 0.29, and p = 0.66, respectively).

Conclusion

To our knowledge, our study is the first to explore the impact of TAP use on disease activity in spondyloarthritis.

We observed an improvement in disease activity, physical performance and quality of life without significant difference between the two groups. The lack of difference could be explained by the encouragement of physical activity to both groups. But also by the fact that our patients presented a significant number of severe relapses. Indeed, authors have shown the limits of the use of TAP in severe diseases, particularly in pulmonary pathologies [1].

Our study did not show any effect of the use of a connected object on disease activity. However, this study confirmed the benefits of physical activity on disease activity, quality of life and physical performance in patients with spondyloarthritis.

References

[1]Bentley CL, Powell L, Potter S, et al. The use of a smartphone app and an activity tracker to promote physical activity in the management of chronic obstructive pulmonary disease: randomized controlled feasibility study. J.M.I.R. MHealth UHealth 2020;8:e16203. https://doi.org/10.2196/16203.

Disclosure of Interests

Guillaume Labat: None declared, Meggy Hayotte: None declared, Olilvier Brocq: None declared, laurent bailly: None declared, Roxane fabre: None declared, manuella Fournier: None declared, Véronique Breuil: None declared, fabienne d’arripe longueville: None declared, Christian Roux Speakers bureau: Pfizer, BMS, Novartis, Lilly, Grant/research support from: Novartis and Lilly

OP0240 ZOLEDRONATE-RELATED OSTEONECROSIS OF THE JAW IN OSTEOPOROSIS: INCIDENCE, RISK FACTORS AND COMPARISON TO ORAL BISPHOSPHONATES

Background

Mediatization of bisphosphonate(BP)-related osteonecrosis of the jaw (ONJ) has hampered the treatment of osteoporosis (OP). The risk of ONJ associated with oral BP in OP and zoledronate (ZOL) in oncology has previously been reported. However, the risk of ZOL-related ONJ in OP has only been reported in Randomized clinical trials.

Objectives

Therefore, we aimed to characterize ZOL-related ONJ in OP and compare it’s incidence with oral BP in real life setting.

Methods

All reports of adverse events (AEs) of BP (ZOL, alendronate (ALN), risedronate (RIS)) were extracted from the French pharmacovigilance database (FPD) since its origin till 2020. For ZOL, cases were separated by indication, rheumatological (ZOL-R) or oncological (ZOL-K). The risk factors analyzed for ONJ were age, sex, active smoking, alcoholism, diabetes, corticotherapy, neoplasia, previous treatment by chemo or immunotherapy, recent dental care and time of exposure to BP. The association between the occurrence of ONJ and the associated BP was assessed by calculating the reporting odds ratio (ROR) in a case/non-case study. Stratification on assumed risk factors was performed to assess their impact on the risk of ONJ.

The incidence of ONJ under BP between 2011 and 2020 was estimated by relating the number of ONJ cases under BP reported to the FPD to the estimated number of patients treated with ZOL, ALN and RIS over the same period according to health insurance reimbursement data of Medic AM database. Incidence rate calculation, confidence interval calculation, and comparison of incidence rates (Fischer exact test) were performed.

Results

For ZOL 2254 AEs were reported: 568 ONJ/1103 AES with ZOL-K and 70 ONJ/1151 AEs with ZOL-R. For ZOL-R-related ONJ, 30/70 cases had recent dental care and 48.7 months of mean time of exposure to BP. Risk factors for ONJ were smoking, history of neoplasia and chemotherapy. For ALN, 1,010 AEs were reported, including 188 ONJ. 91/188 ONJ had recent dental care and 70.9 months of mean time of exposure to BP. Risk factors for ONJ were age ≥65 years, diabetes, corticotherapy, and history of neoplasia. For RIS, 771 AEs were reported including 68 cases of ONJ. 28/68 ONJ had recent dental care and 53.6 months the average time of exposure to BP. The risk factors were age ≥ 65 years, smoking, corticotherapy, history of neoplasia and chemotherapy. ROR calculation shows that corticotherapy was associated more frequently with RIS (2.10 [1.64-2.69]) and ALN (1.33 [1.04-1.70]) as compared with ZOL-R, with no other significant difference.

The incidence of ONJ was significantly higher with ZOL-R than with RIS (p<0.001) and ALN (p<0.001). Indeed, between 2011 and 2020, 614 932 patients were treated with ZOL-R and 59 cases of ONJ reported yielding an incidence of 9.6/100,000 person-years; 2 233 536 patients were treated with RIS and 44 cases of ONJ reported yielding an incidence of 2.0/100 000 person-years; 2 432 373 patients were treated with ALN and 125 cases of ONJ reported yielding an incidence of 5.1/100 000 person-years.

Conclusion

Our data confirm in real-life settings and a large population, that BP-related ONJ is a rare event associated with OP. The risk of BP-related ONJ appears related to the potency of bone resorption inhibition, as RIS has the lowest and ZOL-R the highest risk. Smoking appears a consistent risk factor of ONJ, as is recent dental care. However, we must stress out the usual limitations of pharmacovigilance studies, their retrospective nature, common under-reporting of adverse-events, and the fact that the Medic AM database only refers to city reimbursements.

To our knowledge, this is the first study reporting the risk of ONJ under ZOL from the national pharmacovigilance database. Our study confirms the rarity, in OP, of BP-related ONJ. The risk of incidence of ONJ on ZOL-R is higher than on RIS and ALN, suggesting a risk associated with the inhibitory power of bone resorption.

Acknowledgements

Acknowledgements to the French Network of Pharmacovigilance Centers

Disclosure of Interests

Claire Amigues: None declared, Audrey Fresse: None declared, Christian Roux: None declared, Sophie Gauthier: None declared, Marie-Hélène Vieillard: None declared, Milou-Daniel Drici: None declared, Véronique Breuil Speakers bureau: AMGEN MSD UCB THERAMEX LILLY, Consultant of: AMGEN MSD UCB THERAMEX LILLY, Grant/research support from: AMGEN LILLY

Patient preferences for lifestyle behaviours in osteoporotic fracture prevention: a cross-European discrete choice experiment

Using a discrete choice experiment, we aimed to assess patients' preferences with regard to adopting lifestyle behaviours to prevent osteoporotic fractures. Overall, the 1042 patients recruited from seven European countries were favourable to some lifestyle behaviours (i.e., engaging in moderate physical activity, taking calcium and vitamin D supplements, reducing their alcohol consumption and ensuring a normal body weight).

INTRODUCTION

Alongside medical therapy, healthy lifestyle habits are recommended for preventing osteoporotic fractures. In this study, we aimed to assess patients' preferences with regard to adopting lifestyle changes to prevent osteoporotic fractures.

METHODS

A discrete choice experiment was conducted in seven European countries. Patients with or at risk of osteoporosis were asked to indicate to what extent they would be motivated to adhere to 16 lifestyle packages that differed in various levels of 6 attributes. The attributes and levels proposed were physical activity (levels: not included, moderate or high), calcium and vitamin D status (levels: not included, taking supplements, improving nutrition and assuring a minimal exposure to sunlight daily), smoking (levels: not included, quit smoking), alcohol (levels: not included, moderate consumption), weight reduction (levels: not included, ensure a healthy body weight) and fall prevention (levels: not included, receiving general advice or following a 1-day fall prevention program). A conditional logit model was used to estimate a patient's relative preferences for the various attributes across all participants and per country.

RESULTS

In total, 1042 patients completed the questionnaire. Overall, patients were favourable to lifestyle behaviours for preventing osteoporotic fractures. However, among the lifestyle behaviours proposed, patients were consensually not prone to engage in a high level of physical activity. In addition, in Ireland, Belgium, the Netherlands and Switzerland, patients were also not inclined to participate in a 1-day fall prevention program and Belgian, Swiss and Dutch patients were not prone to adhere to a well-balanced nutritional program. Nevertheless, we observed globally that patients felt positively about reducing their alcohol consumption, engaging in moderate physical activity, taking calcium and vitamin D supplements and ensuring a normal body weight, all measures aimed at preventing fractures.

CONCLUSIONS

In a patient-centred approach, fracture prevention should take these considerations and preferences into account.

Minimal residual disease detection by multicolor flow cytometry in cryopreserved ovarian tissue from leukemia patients

Background

Cryopreservation of ovarian tissue is a fertility-preservation option for women before gonadotoxic treatments. However, cryopreserved ovarian tissue transplantation must be performed with caution in women with malignancies that may metastasize to the ovaries. For this purpose, detecting minimal residual disease (MRD) in the ovarian cortex using sensitive methods is a crucial step. We developed an automated ovarian tissue dissociation method to obtain ovarian cell suspensions.

Results

We assessed MRD by multicolor flow cytometry (MFC) in cryopreserved ovarian cortex of 15 leukemia patients: 6 with B-cell acute lymphoblastic leukemia (B-ALL), 2 with T-cell acute lymphoblastic leukemia (T-ALL) and 7 with acute myeloid leukemia (AML). Ovarian MRD was positive in 5 of the 15 leukemia patients (one T-ALL and 4 AML). No B-ALL patient was positive by MFC. Quantitative reverse-transcribed polymerase chain reaction was performed when a molecular marker was available, and confirmed the MFC results for 3 patients tested. Xenografts into immunodeficient mice were also performed with ovarian cortical tissue from 10 leukemia patients, with no evidence of leukemic cells after the 6-month grafting period.

Conclusions

In conclusion, this is the first study using MFC to detect MRD in ovarian cortical tissue from acute leukemia patients. MFC has been accepted in clinical practice for its ease of use, the large number of parameters available simultaneously, and high throughput analysis. We demonstrate here that MFC is a reliable method to detect MRD in cryopreserved ovarian tissue, with a view to controlling the oncological risk before ovarian tissue transplantation in leukemia patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13048-021-00936-4.

Assessment of the architecture and integrity of frozen-thawed testicular tissue from (pre)pubertal boys with cancer

BACKGROUND

Testicular tissue freezing is proposed for fertility preservation to (pre)pubertal boys with cancer before highly gonadotoxic treatment. Studies accurately comparing human (pre)pubertal testicular tissue quality before freezing and after thawing are exceptional. No study has reported this approach in a systematic manner and routine care.

OBJECTIVES

To assess the impact of a control slow freezing protocol on testicular tissue architecture and integrity of (pre)pubertal boys after thawing.

MATERIALS AND METHODS

(Pre)pubertal boys (n = 87) with cancer from 8 Reproductive Biology Laboratories of the French CECOS network benefited from testicular tissue freezing before hematopoietic stem cell transplantation. Seminiferous tubule cryodamage was determined histologically by scoring morphological alterations and by quantifying intratubular spermatogonia and the expression of DNA replication and repair marker in frozen-thawed testicular fragments.

RESULTS

A significant increase in nuclear and epithelial score alterations was observed after thawing (p < 0.0001). The global lesional score remained lower than 1.5 and comparable to fresh testicular tissue. The number of intratubular spermatogonia and the expression of DNA replication and repair marker in spermatogonia and Sertoli cells did not vary significantly after thawing. These data showed the good preservation of the seminiferous tubule integrity and architecture after thawing, as previously reported in our studies performed in prepubertal mice and rats.

DISCUSSION

The current study reports, for the first time, the development of a semi-quantitative analysis of cryodamage in human (pre)pubertal testicular tissue, using a rapid and useful tool that can be proposed in routine care to develop an internal and external quality control for testicular tissue freezing. This tool can also be used when changing one or several parameters of the freezing-thawing procedure.

CONCLUSION

Control slow freezing protocol without seeding maintains the seminiferous tubule architecture and integrity, the concentration of spermatogonia and the expression of DNA replication and repair marker in spermatogonia and Sertoli cells after thawing.

The French multicentre elevated bone mass study: prevalence and causes

The purpose of this multicentric study was to evaluate the prevalence and causes of Elevated Bone Mass (EBM) in patients who underwent DXA scanning over a 10-year period. The prevalence of EBM was 1 in 100. The main causes of EBM were degenerative spine disorders and renal osteodystrophy.

INTRODUCTION

Reports of elevated bone mass (EBM) on routine dual energy X-Ray absorptiometry (DXA) scanning are not infrequent. However, epidemiological studies of EBM are few and definition thresholds are variable. The purpose of this French multicentric study was to evaluate the prevalence and causes of EBM in adult patients who underwent DXA scanning over a 10-year period.

METHODS

This multicentric, retrospective study was conducted in six French regional bone centres. DXA databases were initially searched for individuals with a bone mineral density (BMD) Z-score ≥ +4 at any site in the lumbar spine or hip from April 1st, 2008 to April 30st, 2018.

RESULTS

In all, 72,225 patients with at least one DXA scan were identified. Of these, 909 (322 men and 587 women) had a Z-score ≥ + 4, i.e. a prevalence of 1.26% [1.18-1.34%]. The DXA scan reports and imagery and medical records of the 909 EBM patients were reviewed and 936 causes were found. In 42 patients (4%), no cause could be determined due to unavailability of data. Artefactual causes of EBM were found in 752 patients (80%), in whom the predominant cause was degenerative disease of the spine (613 patients, 65%). Acquired causes of focal EBM-including Paget's disease (n = 7)-were found in 12 patients (1%), and acquired causes of generalized EBM-including renal osteodystrophy (n = 32), haematological disorders (n = 20) and hypoparathyroidism (n = 15)-in 84 patients (9%). Other causes were rare hereditary diseases and unknown EBM in 19 (2%) and 27 (3%) cases respectively.

CONCLUSIONS

The prevalence of EBM was approximately 1 in 100. These findings suggest that degenerative disease of the spine is the main cause of EBM, but that acquired or hereditary diseases are also causal factors.

P–436 Identification of ovarian cell subpopulations by multicolor flow cytometry and its potential impact on ovarian reconstruction programs

Study question

How could multicolor flow cytometry (MFC) help to identify ovarian subpopulations that could be used for ovarian reconstruction with isolated follicles?

Summary answer

MFC is useful to identify ovarian cell subpopulations in the ovarian cortex.

What is known already

Ovarian tissue cryopreservation is a fertility preservation option for women before gonadotoxic chemo- and/or radiotherapy. However, graft of cryopreserved ovarian tissue must be performed with caution in women suffering from malignancies that may metastasize to the ovaries. For this purpose, functional ovarian tissue qualification is essential to identify ovarian cell subpopulations that could be used for ovary reconstruction in combination with isolated follicles. Furthermore, ischemic tissue damage occurring after the graft is currently another important issue to be resolved for successful ovarian reuse.

Study design, size, duration

We developed an automated ovarian tissue dissociation method to obtain ovarian cell suspensions. Then, we used MFC for the identification of different cell subpopulations in the cell suspension thus obtained.

Participants/materials, setting, methods

Human ovarian tissues from patients undergoing surgery for polycystic ovary syndrome were used in this study. Biopsies of ovarian cortex (fresh or frozen-thawed) were dissociated using an automated dissociation method.

We used FVS780 and SYTO13 markers to gate viable ovarian cells by MFC. Variable markers were chosen to differentiate and identify cell subpopulations among the viable ovarian cells.

Main results and the role of chance

The dissociation yield was on average 1.59 ± 1.58 x 106 and 0.78 ± 0.72 x 106 viable ovarian cells per 100 mg of fresh (n = 17) and frozen-thawed (n = 43) ovarian cortical tissue, respectively. On average, 35.4 ± 13.1% of viable ovarian cells were CD34 + (n = 61, stromal phenotype). Concerning endothelial phenotype, 7.8 ± 5.5% of CD31+ cells (n = 51) and 5.3 ± 3.6% of CD144+ cells (n = 29) were identified among viable ovarian cells. Vimentin marker is found in 25.6 ± 10.8% of viable ovarian cells (n = 23) and CD326 (EpCAM expression) in 0.6 ± 0.8% (n = 16). Finally, pericyte phenotype (CD34-/Vimentin-/CD31-/CD146+/ CD140b+) was identified in 4.6 ± 4.3% of viable ovarian cells (n = 7).

Limitations, reasons for caution

We do not know how these ovarian cell subpopulations could be a factor associated or not with time for ovarian function recovery in vivo after ovarian tissue graft and the impact of these ovarian cells on the ovarian microenvironment of an artificial ovary.

Wider implications of the findings: Functional qualification of ovarian tissue can be performed by MFC. MFC is a promising tool for ovarian cortex qualification before reuse of cryopreserved ovarian tissue. Cell sorting could be used to separate and isolate cell subpopulations and add these cells with isolated follicles in an ovarian reconstruction program.

Trial registration number

Not applicable

Regulation of mating genes during arbuscular mycorrhizal isolate co-existence-where is the evidence?

A recent study published by Mateus et al. [1] claimed that 18 "mating-related" genes are differentially expressed in the model arbuscular mycorrhizal fungus (AMF) Rhizophagus irregularis when genetically distinct fungal strains co-colonize a host plant. To clarify the level of evidence for this interesting conclusion, we first aimed to validate the functional annotation of these 18 R. irregularis genes using orthology predictions. These analyses revealed that, although sequence relationship exists, only 2 of the claimed 18 R. irregularis mating genes are potential orthologues to validated fungal mating genes. We also investigated the RNA-seq data from Mateus et al. [1] using classical RNA-seq methods and statistics. This analysis found that the over-expression during strain co-existence was not significant at the typical cut-off of the R. irregularis strains DAOM197198 and B1 in plants. Overall, we do not find convincing evidence that the genes involved have functions in mating, or that they are reproducibly up or down regulated during co-existence in plants.

Absence of relationships between depression and anxiety and bone mineral density in patients hospitalized for severe anorexia nervosa

INTRODUCTION

Low BMD is frequent in anorexia nervosa (AN), depression, and during SSRI treatment but relation between these elements in AN is not established. The aims of this study were to assess the relationships between depression and anxiety, SSRI prescription, and (1) low BMD during inpatient treatment and (2) BMD change 1 year after hospital discharge.

METHODS

From 2009 to 2011, 212 women with severe AN have been included in the EVHAN study (EValuation of Hospitalisation for AN). Depression, anxiety and obsessive-compulsive symptoms and comorbidity were evaluated using psychometric scales and CIDI-SF. BMD was measured by dual-energy X-ray absorptiometry.

RESULTS

According to the CIDI-SF, 56% of participants (n = 70) had a lifetime major depressive disorder, 27.2% (n = 34) had a lifetime obsessive-compulsive disorder, 32.8% (n = 41) had a lifetime generalized anxiety disorder and 25.6% (n = 32) had a lifetime social phobia disorder. Half of the sample (50.7%; n = 72) had a low BMD (Z score ≤ - 2). In multivariate analysis, lifetime lowest BMI was the only determinant significantly associated with low BMD (OR = 0.56, p = 0.0008) during hospitalization. A long duration of AN (OR = 1.40 (0.003-3.92), p = 0.03), the AN-R subtype (OR = 4.95 (1.11-26.82), p = 0.04), an increase of BMI between the admission and 1 year (OR = 1.69 (1.21-2.60), p = 0.005) and a gain of BMD 1 year after the discharge explained BMD change.

CONCLUSION

We did not find any association between depression and anxiety or SSRI treatment and a low BMD or variation of BMD.

LEVEL OF EVIDENCE

Level III, cohort study.

[Overweight or obesity: impact on the results of the first IVF/ICSI attempt]

OBJECTIVES

To evaluate the influence of overweight and obesity on the results of the first in vitro fertilization attempt, without or with intracytoplasmic microinjection (IVF/ICSI), in terms of live births.

METHODS

Retrospective observational study concerning the first IVF/ICSI attempts from 01/01/2006 to 31/12/2017 carried out at the Assisted Reproductive Technology of the CHU of Besançon, studying the delivery rate (excluding frozen embryos transfers), and the data of Assisted Reproductive Technology attempts, in overweight (BMI 25 to 29.9kg/m²) and obese women (BMI≥30kg/m²), compared to women with a standard BMI (18 to 24.9kg/m²).

RESULTS

A total of 3192 patients were included. At the end of their first IVF/ICSI attempt, the delivery rate of women with standard BMI was 34.7%. The delivery rate was significantly lower in overweight women (29.5%, p=0.011) and comparable in obese women (32.4%, p=0.476). The birth rate of women with a BMI≥25 kg/m² was also significantly lower than that of women with a standard BMI (30.4% versus 34.7%, p=0.019). After multivariate analysis, the delivery rate in overweight patients remained significantly lower compared to the population with standard BMI (OR=0.707; 95% CI 0.561-0.890), and comparable in obese patients (OR=0.796; 95% CI 0.585-1.084).

CONCLUSION

The delivery rate was lower in overweight women, whereas it was not significantly different in obese women.

[Radiotherapy for oligometastatic non-small cell lung cancer patients]

The oligometastatic disease concept suggests that patients with a limited number of metastases have a favorable prognosis. Radical local treatment of oligometastatic patients has then increased given developments in imaging (mainly positron emission tomography and brain magnetic resonance imaging) and access to effective and better tolerated treatments. Stereotactic radiotherapy has the advantage of being noninvasive, allowing a good rate of local control and a limited number of side effects. A better definition of oligometastatic disease, particularly for non-small cell lung cancer (NSCLC), has recently been published. For patients with NSCLC, two randomized phase II trials also suggested that the addition of a radical local treatment results in encouraging survival data, with a good safety profile. A single-arm phase II finally showed a benefit when combining a radical local treatment with an anti-PD1 immunotherapy. This review describes the definitions of oligometastatic disease, the main prospective findings including radiation therapy, and prospects for oligometastatic NSCLC patients.

POS0818 TREATMENT OF POLYMYALGIA RHEUMATICA WITH TOCILIZUMAB: RESULTS OF AN OBSERVATIONAL RETROSPECTIVE MULTICENTER STUDY

Background:

In 2017, TOCILIZUMAB (TCZ) obtained marketing authorization for treatment of giant cell arteritis (GCA); however, this doesn’t extend to polymyalgia rheumatica (PMR) therapy. Based on efficacy data for TCZ in GCA, TCZ is sometimes used as a glucocorticoid (GC) sparing agent when PMR is GC dependent or when a rapid steroid withdraw is needed. Currently, there are no available recommendations on the use of this therapeutic class in for this particular indication.

Objectives:

Here, we present the results of an observational French multicentric study of patients with PMR treated with TCZ.

Methods:

Thirteen medical centers were included in this study. The data was collected retrospectively between 2015 and 2020. The minimum duration of treatment was 3 months. Patients were included when receiving TCZ for isolated PMR or associated with a non-active GCA (asymptomatic, no vascular fixation on PET scanner).

Results:

Overall, 34 patients were included (24 women; mean age 70.1 years (+/-10.3)). At TCZ introduction, patients had been treated with GC for a mean duration of 27,9 months (+/-25.9) and the mean GC dose was 16,8mg/d (+/-10). Fifteen patients (44%) had one or more complications from GC therapy. Another immunosuppressant was added before TCZ treatment for 25 (74%); mostly METHOTREXATE (24/25).

TCZ was initiated intravenously at 8mg/kg every 4 weeks for 27 patients (79%) and subcutaneously at 162mg/week for 7 patients (21%).

The reasons for TCZ introduction included GC dependence (n=30, 88%), and necessity of quick GC sparing (n=4 patients,12%).

Of all patients, 76% (26 patients) had stopped GC treatment definitively, with a mean time of 9,4 (0-32) months.

The mean TCZ treatment period was 19,2 months (3-66). Fifteen patients (44%) permanently stopped TCZ at the end of the observation period (8 prolonged remissions;1 myocardial infarction; 1 cutaneous lymphoma; 1 primary failure, 3 lost to follow up).

Eighteen patients (60%) benefited from an attempted tapering of TCZ (infusion spacing or dose reduction), 6 attempts (1/3) led to a relapse. 1/2 patients had side effects mostly benign (cytopenia n=6, infections n=5).

Conclusion:

This is the largest cohort presenting results of the use of TCZ in PMR. Despite the small number of participants, our study suggests TCZ is effective as a GC sparing agent in PMR. As there are no official recommendations of use, indications for TCZ use within this population are no defined. Randomized Controlled Trial would be beneficial to validate these first results.

References:

[1]Toussirot, « Biothérapies, pseudo- polyarthrite rhizomélique et artérite à cellules géantes État des lieux en 2018 ».

[2]Devauchelle-Pensec et al., « Efficacy of First-Line Tocilizumab Therapy in Early Polymyalgia Rheumatica ».

[3]Genovese et al., « Longterm Safety and Efficacy of Tocilizumab in Patients with Rheumatoid Arthritis ».

[4]Stone et al., « Trial of Tocilizumab in Giant-Cell Arteritis ».

Disclosure of Interests:

None declared

POS0284 CLINICAL AND MRI COMPARISON OF ECCENTRIC VERSUS CONCENTRIC REHABILITATION IN SYMPTOMATIC KNEE OSTEOARTHRITIS: A PROSPECTIVE RANDOMIZED STUDY

Background:

Rehabilitation is at the center of the non-medical management of knee osteoarthritis. Concentric muscle strengthening is often preferred, while eccentric contractions play an important role in controlling knee flexion and knee stability and allow the development of a high level of strength with a low energy cost. But few studies have focused on these two technique

Objectives:

To explore the effect of a 6-week-exercise program on function, pain and performance level in symptomatic knee osteoarthritis patients

Methods:

An analysis was performed of the data from 60 individuals with symptomatic knee osteoarthritis who were included in the EXART study. The EXART study was a prospective, randomized controlled trial which included patients aged 40 to 85 with KL 2 or 3 responding to the American College of Rheumatology criteria. The first group benefitted from a 6 week eccentric rehabilitation program and the second group from a standard 6 week concentric rehabilitation program. The endpoints were the changes from baseline to week 6 in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain, and performance measured with quadriceps power (PMax) and contraction strength (MMax). MRI muscle analysis was performed before and after physical activity.

Results:

Among 80 patients screened, 60 were included in the study and randomized. 25/30 subjects finished the program in the concentric group and 28/30 in the eccentric group. The mean population age was 74 (+/-8), mean IMC 27.2 (+/-4). The baseline total WOMAC mean was 49.2 (+/-19), VAS pain 5.3 (+/-2). At 6 weeks, both groups showed a significant improvement compared to baseline for the WOMAC without any difference between the two groups (mean difference evolution concentric = 7.5 ± 11.9 (p= p<0.0001); mean difference evolution eccentric = 4.5 ± 1.9 (p<0.0001); intergroup analysis p=0.7). Similar significant results were found in the WOMAC function subscale. No difference between the groups appeared in VAS pain evolution (p= 0.7). The eccentric group showed a significant improvement in PMax and high speed MMax evolution (p=0.001 and p=0.002). This improvement was not found for the concentric group (p= 0.52 and p=0.27). MRI showed a vastus medialis hypertrophy only in the eccentric group (p=0.002). We did not observe any change in the fatty infiltration of the quadriceps on MRI.

Conclusion:

Rehabilitation, whether eccentric or concentric, has a beneficial action on function and pain in symptomatic knee osteoarthritis whatever the methods. A gain in muscle performance and vastus medialis volume was found only with the eccentric rehabilitation. This study confirms the importance of any type of rehabilitation in knee osteoarthritis and raises the question of the relation between muscle gain/performance and function or pain

Acknowledgements:

We would like to thank all the patients who took part in the study as well as all the members of the Fragile Platform of the Nice University Hospital.

Disclosure of Interests:

None declared

POS0273-HPR PHARMACIST’S IMPACT ON SELF-MANAGEMENT FOR PATIENTS WITH CHRONIC INFLAMMATORY ARTHRITIS TREATED WITH BIOLOGICAL DMARDS

Background:

Knowledge about chronic inflammatory rheumatisc diseases and skills to administer and manage subcutaneous (subcut) biological DMARDs (bDMARDs) are key aspects to optimize patient’s self-management. Intervention of several successive health professionals (e.g comprehensive multidisciplinary team) has proven to be an effective method to improve patient’s self-management of their disease and treatment.

Objectives:

To assess the pharmacist’s impact on patient’s knowledge and skills during a multidisciplinary annual review. The secondary objectives were to assess this impact on therapeutic adherence and patient’s satisfaction as well as to determine the factors associated with the level of knowledge at baseline.

Methods:

Study type: prospective, monocentric, 6 months-follow-up, non-controlled study approved by Local Ethical Committee. Inclusion criteria: patient with either rheumatoid arthritis (RA) or spondyloarthritis (SpA), and treated with subcut bDMARDs. Intervention: The visit with a pharmacist evaluating and discussing patient’s knowledge and treatment adherence. At baseline (M0): date of the visit and, 3 (M3) and 6 months (M6) later, knowledge and adherence were assessed using self-administered questionnaires: Biosecure and CQR-5 respectively. A questionnaire was sent at M3 in order to evaluate the patient satisfaction. Endpoints: Primary: Changes in Biosecure score Secondary: Percentage of patients with high level of knowledge (score > 84) and percentage of patients with high adherence at M3 and M6; patient’s satisfaction; identification of patient’s factors (socio-demographics, rheumatisc disease treatments) associated with different levels of knowledge at baseline.

Statistical analysis: repeated measures ANOVA, Bonferroni and Generalized Estimating Equation, univariate and multivariate linear regression.

Results:

The study was conducted from October 2019 to July 2020; 79 patients were included (age (years) = 50±15; sex ratio = 1.1; RA=25, SpA=54). The Biosecure scores changed from 71±18 to 82±15 (M3) and to 84±14 (M6) (p<0.001). At M0, M3 and M6, the rate of patients with a high level of knowledge was 24.1%, 59.5% and 63.3% respectively (p<0.001). No difference was observed for the change in the 92% of patients considered as high adherent (92% versus 95% at M0 and M6 respectively; p=0.077). Patient’s satisfaction regarding the pharmaceutical intervention was 25±3 (max = 28).

Factors associated with a better Biosecure score in the multivariate analysis were the following, lifestyle as a couple (p<0.001), information given by a nurse (p=0.033), information searched for on patient associations (p=0.013) and a low Charlson score (p=0.001)

Conclusion:

Pharmacist’s intervention in the comprehensive multidisciplinary annual review resulted in a beneficial impact on patients’ knowledge and skills to manage their bDMARDs with a high level of satisfaction from a patient perspective.

Disclosure of Interests:

None declared

POS0188 DISEASE ACTIVITY OUTCOME MEASURES ARE ONLY AVAILABLE IN HALF OF THE ELECTRONIC MEDICAL FILES OF PATIENTS WITH AXIAL SPONDYLOARTHRITIS FOLLOWED IN AN OUTPATIENT CLINIC: THE RESULTS OF AN AUDIT OF A TERTIARY-CARE RHEUMATOLOGY DEPARTMENT

Background:

Current recommendations for management of patients with axial Spondylarthritis (axSpA) include regular collection of validated disease activity outcomes.

Objectives:

This study aimed at evaluating the proportion of patients for whom the elements allowing the calculation of the validated outcome measures were available on the visits reported on the electronic medical records (EMR) and the factors associated with the presence of such information on the EMR.

Methods:

This was a cross-sectional and monocentric observational study conducted in a tertiary-care rheumatology department, EULAR center of excellence and ASAS center. We performed a systematic electronic search among all patients with a SpA diagnosis code who attended an outpatient visit between February 1st, 2018 and February 28th, 2019. Thereafter, a manual search was performed in order to check whether disease activity outcome measures (or the elements allowing its calculation): BASDAI individual questions, Disease activity Global, CRP, BASDAI and ASDAS) were reported on EMR. Patient’s and physician’s demographics disease characteristics (including treatment) and whether the patient had participated in a systematic review were also collected. A descriptive analysis of the percentage of EMR with available outcomes was performed, and the characteristics of patients in whom these measures were available/were not available evaluated by univariable and multivariable analysis (including only variables with p < 0,10 on the univariate)

Results:

320 EMR of axSpA patients seen in the outpatient clinic were screened and selected. Among them, 178 (55.6%) had at least one disease activity outcome measure reported, while 144(45%) and 123 (38.4%) had a BASDAI and an ASDAS reported, respectively. The most frequently reported disease activity items were duration of morning stiffness (n=230, 72%) and CRP (n=224, 70%).

Only previous participation on an educational program for self-assessment was found to be independently associated with a reported disease activity outcome: among the patients participating in such program, 93.1% (n=27/29) had a disease activity measure available, compared to 51.9% (n=151/291) in those who did not participate in such program (p<0.001) (Table 1)

Conclusion:

Implementation of recommendations with regard to regularly collecting disease activity outcome measures is not optimal. The participation in educational programs including self-assessment educational programs might be one of the keys to improve such implementation.

References:

[1]Smolen JS, Braun J, Dougados M, Emery P, Fitzgerald O, Helliwell P, et al. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force. Ann Rheum Dis 2014;73:6–16. https://doi.org/10.1136/annrheumdis-2013-203419.

[2]van der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017;76:978–91. https://doi.org/10.1136/annrheumdis-2016-210770.

Figure 1.

Frequency of disease activity measures reporting in the Electronic Medical Record of patients with axial Spondyloarthritis, followed in a tertiary care rheumatology department outpatient clinic

Table 1.

Factors associated with the presence of a reported disease activity measures on the electronic medical file of patients with axial SpA

Disclosure of Interests:

Elodie Portier: None declared, Maxime Dougados: None declared, Christian Roux: None declared, Anna Moltó Consultant of: Abbvie, BMS, MSD, Pfizer, Lilly, UCB Novartis, Grant/research support from: Pfizer

Lineage-Specific Genes and Cryptic Sex: Parallels and Differences between Arbuscular Mycorrhizal Fungi and Fungal Pathogens

Arbuscular mycorrhizal fungi (AMF) live as obligate root symbionts on almost all land plants. They have long been regarded as ancient asexuals that have propagated clonally for millions of years. However, genomic studies in Rhizophagus irregularis and other AMF revealed many features indicative of sex. Surprisingly, comparative genomics of conspecific isolates of R. irregularis revealed an unexpected interstrain diversity, suggesting that AMF carry a high number of lineage-specific (LS) genes. Intriguingly, cryptic sex and LS genomic regions have previously been reported in a number of fungal pathogens of plants and humans. Here, we discuss these genomic similarities and highlight their potential relevance for AMF adaptation to the environment and for symbiotic functioning.

Radiofrequency ablation versus surgical resection for the treatment of oligometastatic lung disease

PURPOSE

The purpose of this study was to compare efficacy and tolerance between radiofrequency ablation (RFA) and surgery for the treatment of oligometastatic lung disease.

MATERIALS AND METHODS

This retrospective study reviewed patients treated in two institutions for up to 5 pulmonary metastases with a maximal diameter of 4cm and without associated pleural involvement or thoracic lymphadenopathy. Patient demographics, tumor characteristics, treatment outcome, and length of hospital stay were compared between the two groups. Efficacy endpoints were overall survival (OS), progression-free survival (PFS) and pulmonary or local tumor progression rates.

RESULTS

Among 204 patients identified, 78 patients (42 men, 36 women; mean age, 53.3±14.9 [SD]; age range: 15-81 years) were treated surgically, while 126 patients (59 men, 67 women; mean age, 62.2±10.8 [SD]; age range: 33-80 years) were treated by RFA. In the RFA cohort, patients were significantly older (P<0.0001), with more extra-thoracic localisation (P=0.015) and bilateral tumour burden (P=0.0014). In comparison between surgery and RFA cohorts, respectively, the 1- and 3-year OS were 94.8 and 67.2% vs. 94 and 72.1% (P=0.46), the 1- and 3-year PFS were 49.4% and 26.1% vs. 38.9% and 14.8% (P=0.12), the pulmonary progression rates were 39.1% and 56% vs. 41.2% and 65.3% (P>0.99), and the local tumour progression rates were 5.4% and 10.6% vs. 4.8% and 18.6% (P=0.07). Tumour size>2cm was associated with a significantly higher local tumor progression in the RFA group (P=0.010). Hospitalisation stay was significantly shorter in the RFA group (median of 3 days; IQR=2 days; range: 2-12 days) than in the surgery group (median of 9 days; IQR=2 days; range: 6-21 days) (P<0.01).

CONCLUSION

RFA should be considered a minimally-invasive alternative with similar OS and PFS to surgery in the treatment of solitary or multiple lung metastases measuring less than 4cm in diameter without associated pleural involvement or thoracic lymphadenopathy.

Hypophosphatasia in adolescents and adults: overview of diagnosis and treatment

This article provides an overview of the current knowledge on hypophosphatasia-a rare genetic disease of very variable presentation and severity-with a special focus on adolescents and adults. It summarizes the available information on the many known mutations of tissue-nonspecific alkaline phosphatase (TNSALP), the epidemiology and clinical presentation of the disease in adolescents and adults, and the essential diagnostic clues. The last section reviews the therapeutic approaches, including recent reports on enzyme replacement therapy (EnzRT).

AB1125 PERFORMANCE OF ULTRASOUNDS TO ASSESS EROSION PROGRESSION IN RHEUMATOID ARTHRITIS

Background:

Ultrasonography (US) can detect more erosions than radiography (RX) at the joint level in rheumatoid arthritis (RA), especially at an early stage of the disease.

Objectives:

The aim of the study is to determine the ability of ultrasonography to detect erosion progression by the US Score for erosions (USSe), in early (less than 2 years disease duration (DD)) and late stage (more than 2 years DD) RA over two years of follow-up.

Methods:

Patients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA were prospectively included. Clinical and demographic informations were recorded at baseline and hands and feet RX were scored according to the Sharp erosion score (SHSe). Erosive RA on RX was defined by the presence of at least three eroded joints (1). US examinations were performed at baseline and during the two years of follow-up. Erosions were scored by US on six bilateral joints (MCP 2, 3, 5 and MTP 2, 3, 5) with a four grade-scale to calculate total USSe. Erosive RA on US was defined by presence of one erosion ≥ 2mm (2). Inter-examiner reproducibility was performed on 14 patients in order to calculate the smallest detectable change (SDC), which was 2.3. Ultrasonographic progression was defined as a change in USSe > 2 (erosion change > SDC).

Results:

A total of 71 patients were included, 22 patients (31.0%) had early RA and 49 (69.0%) patients had late RA diseases. On RX, 30 (42.3%) patients were erosive at baseline with a mean SHSe at 29.4 (SD at 24.7). On US, 63 patients (88.7%) were classified as eroded. On US, erosions prevailed at baseline in MTP5 joints, then MCP2 and MCP5 joints on their lateral facets. During follow-up, 28 patients (39.4%) were classified as US progressors, 30 (42.3%) were stable and 13 (18.3%) considered as regressors (figure 1). In early RA disease, three of the four non eroded patients became eroded. USSe progressed in 11 patients (50%) while regression was observed in only one patient. In late RA disease, 17 patients (34.7%) progressed and 12 patients (24.5%) decreased significantly their USSe. Erosion progression prevailed on MTP 5 joints followed by MCP2 and finally MCP5 joints (figure 2).

Figure 1.

USSe progression plots (n=71)

Figure 2.

Differences of USSe by joints during follow-up in early and late RA

Conclusion:

US structural examination is a highly reproducible method to assess erosion in RA disease. The USSe is able to detect structural changes (progression, stabilization and regression) in RA patients during a follow-up of two years especially in RA patients with short disease duration.

References:

[1]Van der Heijde D, van der Helm-van Mil AHM, Aletaha D, Bingham CO, Burmester GR, Dougados M, et al. EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria. Ann Rheum Dis. avr 2013;72(4):479‑81.

[2]Roux C, Gandjbakhch F, Pierreisnard A, Couderc M, Lukas C, Masri R, et al. Optimization of ultrasonographic examination for the diagnosis of erosive Rheumatoid Arthritis in comparison to erosive hand Osteoarthritis. Eur J Radiol. sept 2019;118:10‑8.

Disclosure of Interests:

None declared

FRI0449 MANAGEMENT AND OUTCOME OF SEPTIC ARTHRITIS OF NATIVE JOINT: A NATIONWIDE SURVEY

Background:

Objectives:

To describe current management and outcome of septic arthritis on native joint in French rheumatology departments.

Methods:

Retrospective, nation-wide multicentric study. 127 French rheumatology departments were contacted to report 10 successive cases of septic arthritis on native joint that occurred between the 01/01/16 to 31/12/17 (excluding mycobacteria). Characteristics, diagnosis procedure, therapeutic management and outcome were recorded.

Results:

52 centers included 363 patients (mean age 64± 18.7 years, mean Charlson comorbidity index 4±3). 28.3% patients had a preexisting arthropathy on affected joint. Monoarthritis was observed in 89.6% patients, knee was the most frequent site (38.9%). The most frequent pathogens wereStaphylococcus sp(50.7%) andStreptococcus sp.(23.3%). Bacteremia was found in 156 (45.1%) patients and endocarditis in only 12 (3.0%). Management was heterogeneous. All patients received antibiotics for a mean duration of 46.7±22 days (including intravenous route: 17.3±15.4 d). An initial monotherapy was administered in 42.3% of patients. Surgical procedure (mostly lavage 70.6%) was performed in 171 (48.3%), joint immobilization in 128 (35.3%) (median duration of 21.7±14.1 days). 94 (29.2%) patients have had serious complications including 29 (9.5%) death. Factors associated with death are reported in the table.

Conclusion:

This study shows that management of septic arthritis is very heterogenous with a still high rate of morbidity and mortality. We identified age, comorbidities, bacteremia and recent antibiotherapy were associated with mortality. Of note, duration of antibiotics was not. Thus, new guidelines are needed in order to facilitate septic arthritis management.

Table:FactorsSurvivor(N=276)Dead(N=29)Univariate analysispAdjusted Odds ratio (95%IC)Multivariate analysispAge65 (16-97)82 (32-98)<0,0011,07 (1,03-1,12)< 0.001Charlson’s index1 (0-12)2 (0-9)0,00011,3 (1,05-1,63)0,018Delay before antibiotic initiation8,5 (0-310)5 (0-75)0,04840,99 (0,96-1,02)0,562Corticosteroid in the previous 3 months13,9%33,3%0,01842,56 (0,75-8,74)0,133Bacteriemia42,4%71,4%0,00615,07 (1,4-18,370,013Antibiotics in the previous 3 months26,6%56,6%0,00566,7 (2,04-22,01)0,002

Disclosure of Interests:

Pauline Richebé: None declared, Sophie Godot: None declared, Guillaume Coiffier: None declared, Pascal GUGGENBUHL: None declared, Denis Mulleman: None declared, Marion Couderc: None declared, Emmanuelle Dernis Speakers bureau: Lilly, Novartis, Valentine Deprez: None declared, Carine Salliot: None declared, Saik Urien: None declared, Rachel Brault: None declared, Adeline Ruyssen-Witrand Grant/research support from: Abbvie, Pfizer, Consultant of: Abbvie, BMS, Lilly, Mylan, Novartis, Pfizer, Sandoz, Sanofi-Genzyme, Emmanuel Hoppe: None declared, Jacques-Eric Gottenberg Grant/research support from: BMS, Pfizer, Consultant of: BMS, Sanofi-Genzyme, UCB, Speakers bureau: Abbvie, Eli Lilly and Co., Roche, Sanofi-Genzyme, UCB, Christian Roux: None declared, Sebastien Ottaviani: None declared, Maxime Breban: None declared, Marie Beaufrere: None declared, Alexia Michaut: None declared, Loic Pauvele: None declared, Christelle Darrieutort: None declared, Daniel Wendling: None declared, Pascal COQUERELLE: None declared, Géraldine Bart: None declared, Elisabeth Gervais: None declared, Vincent Goeb: None declared, Marc Ardizzone: None declared, Edouard Pertuiset: None declared, Sophie Derolez: None declared, Jean Marc Ziza: None declared, René-Marc Flipo Consultant of: Johnson and Johnson, MSD France, Novartis, Sanofi, Speakers bureau: Johnson and Johnson, MSD France, Novartis, Sanofi, Raphaèle Seror Consultant of: BMS UCB Pfizer Roche

SAT0587 MACHINE-LEARNING DERIVED ALGORITHMS FOR OUTCOMES PREDICTION IN RHEUMATIC DISEASES: APPLICATION TO RADIOGRAPHIC PROGRESSION IN EARLY AXIAL SPONDYLOARTHRITIS

Background:

Axial spondyloarthritis (axSpA) is a chronic rheumatic disease that encompasses various clinical presentations: inflammatory chronic back pain, peripheral manifestations and extra-articular manifestations. The current nomenclature divides axSpA in radiographic (in the presence of radiographic sacroiliitis) and non-radiographic (in the absence of radiographic sacroiliitis, with or without MRI sacroiliitis. Given that the functional burden of the disease appears to be greater in patients with radiographic forms, it seems crucial to be able to predict which patients will be more likely to develop structural damage over time. Predictive factors for radiographic progression in axSpA have been identified through use of traditional statistical models like logistic regression. However, these models present some limitations. In order to overcome these limitations and to improve the predictive performance, machine learning (ML) methods have been developed.

Objectives:

To compare ML models to traditional models to predict radiographic progression in patients with early axSpA.

Methods:

Study design: prospective French multicentric cohort study (DESIR cohort) with 5years of follow-up. Patients: all patients included in the cohort, i.e. 708 patients with inflammatory back pain for >3 months but <3 years, highly suggestive of axSpA. Data on the first 5 years of follow-up was used. Statistical analyses: radiographic progression was defined as progression either at the spine (increase of at least 1 point per 2 years of mSASSS scores) or at the sacroiliac joint (worsening of at least one grade of the mNY score between 2 visits). Traditional modelling: we first performed a bivariate analysis between our outcome (radiographic progression) and explanatory variables at baseline to select the variables to be included in our models and then built a logistic regression model (M1). Variable selection for traditional models was performed with 2 different methods: stepwise selection based on Akaike Information Criterion (stepAIC) method (M2), and the Least Absolute Shrinkage and Selection Operator (LASSO) method (M3). We also performed sensitivity analysis on all patients with manual backward method (M4) after multiple imputation of missing data. Machine learning modelling: using the “SuperLearner” package on R, we modelled radiographic progression with stepAIC, LASSO, random forest, Discrete Bayesian Additive Regression Trees Samplers (DBARTS), Generalized Additive Models (GAM), multivariate adaptive polynomial spline regression (polymars), Recursive Partitioning And Regression Trees (RPART) and Super Learner. Finally, the accuracy of traditional and ML models was compared based on their 10-foldcross-validated AUC (cv-AUC).

Results:

10-fold cv-AUC for traditional models were 0.79 and 0.78 for M2 and M3, respectively. The 3 best models in the ML algorithm were the GAM, the DBARTS and the Super Learner models, with 10-fold cv-AUC of: 0.77, 0.76 and 0.74, respectively (Table 1).

Table 1.

Comparison of 10-fold cross-validated AUC between best traditional and machine learning models.

Best modelsCross-validated AUCTraditional models M2 (step AIC method)0.79 M3 (LASSO method)0.78Machine learning approach SL Discrete Bayesian Additive Regression Trees Samplers (DBARTS)0.76 SL Generalized Additive Models (GAM)0.77 Super Learner0.74

AUC: Area Under the Curve; AIC: Akaike Information Criterion; LASSO: Least Absolute Shrinkage and Selection Operator; SL: SuperLearner. N = 295.

Conclusion:

Traditional models predicted better radiographic progression than ML models in this early axSpA population. Further ML algorithms image-based or with other artificial intelligence methods (e.g. deep learning) might perform better than traditional models in this setting.

Acknowledgments:

Thanks to the French National Society of Rheumatology and the DESIR cohort.

Disclosure of Interests:

Romain Garofoli: None declared, Matthieu resche-rigon: None declared, Maxime Dougados Grant/research support from: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Speakers bureau: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Christian Roux: None declared, Anna Moltó Grant/research support from: Pfizer, UCB, Consultant of: Abbvie, BMS, MSD, Novartis, Pfizer, UCB

FRI0095 SARILUMAB IMPROVED PATIENT-PERCEIVED IMPACT OF RHEUMATOID ARTHRITIS WHATEVER THE BASELINE DISEASE ACTIVITY: FIRST RESULTS FROM AN INTERVENTIONAL NON CONTROLLED STUDY: SARIPRO, IN MODERATE AND SEVERE RHEUMATOID ARTHRITIS PATIENTS

Background:

Sarilumab, an anti-IL-6R antibody, is approved for the treatment of moderate to severe RA and shown efficacy on disease activity and patient-reported outcomes (PROs). Detailed analyses of drug efficacy from the patient point of view is important. SariPRO is a pragmatic interventional study close to the daily practice.

Objectives:

To assess the effectiveness of sarilumab on several PROs using the RAID (Rheumatoid Arthritis Impact of Disease) score.

Methods:

The SariPRO study (NCT 03449758) was a French multicenter interventional study assessing the effects of sarilumab 200 mg on PROs in patients with moderately to severely active RA with an inadequate response or intolerance to conventional synthetic or biologic DMARDs. The primary endpoint was change in total RAID score from baseline to week 24 (RAID ranges 0-10 where 10 is maximal impact). Changes from baseline for RAID, DAS28-ESR and CDAI according to baseline disease activity were analyzed as secondary outcomes. Safety was assessed by monitoring adverse events (AE). All statistical analyses were descriptive, 95% CI was given when appropriate.

Results:

84 patients were included in 31 centers and 62 were evaluable and analyzed for effectiveness. They had similar characteristics to the 84 patients at baseline and were as expected for an RA population initiating a biologic: mean (SD) age: 59.9 (12.4) years, 71.0% female, disease duration 9.7 (10.3) years, rheumatoid factor positivity 82.5%, ACPA positivity 86.4%, and DAS28=4.9 (11). Total RAID score decreased significantly from 5.7 (2.0) at baseline to 3.3 (2.5) at W24; mean change was -2.4 [95% CI: -3.0; -1.8]. Furthermore, this improvement was noted both for highly and less active patients at baseline: for patients with DAS28-ESR < 5.1 (n=31), mean change was -1.56 [-2.28; -0.83] and for patients with DAS28-ESR≥5.1 (n=27), mean change was -1.98 [-2.91; -1.05]. Changes in DAS28-ESR and CDAI were significant (-2.8 [-3.2; -2.4] and -15.2 [-18.5; -11.8], respectively). AEs were consistent with the safety profile of anti-IL-6R antibodies and with results from RCTs (data not shown).

Conclusion:

In this real world study, treatment with sarilumab during 24 weeks in RA patients led to an improvement in the total RAID score irrespective of baseline levels of disease activity. This is the first time RAID score is used as the primary endpoint in a study.

References:

[1]Study was sponsored by Sanofi Genzyme

Disclosure of Interests:

Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, René-Marc Flipo Consultant of: Johnson and Johnson, MSD France, Novartis, Sanofi, Speakers bureau: Johnson and Johnson, MSD France, Novartis, Sanofi, Thierry Schaeverbeke: None declared, Christine Albert: None declared, Athan Baillet Consultant of: Athan BAILLET has received honorarium fees from Abbvie for his participation as the coordinator of the systematic literature review, marie-Christophe Boissier: None declared, Cyrille Confavreux: None declared, Gregoire CORMIER: None declared, Emmanuelle Dernis Speakers bureau: Lilly, Novartis, Elisabeth Gervais Solau: None declared, Sophie Godot: None declared, Jacques-Eric Gottenberg Grant/research support from: BMS, Pfizer, Consultant of: BMS, Sanofi-Genzyme, UCB, Speakers bureau: Abbvie, Eli Lilly and Co., Roche, Sanofi-Genzyme, UCB, Philippe Goupille Grant/research support from: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Slim Lassoued: None declared, Thierry Lequerre: None declared, Frederic Lioté Consultant of: CME: Nordic Pharma, Christian Marcelli: None declared, Yves Maugars: None declared, Minh Nguyen: None declared, Aleth Perdriger: None declared, Yves-Marie Pers: None declared, Edouard Pertuiset: None declared, Lucile Poiroux: None declared, Carole Rosenberg: None declared, Christian Roux: None declared, Adeline Ruyssen-Witrand Grant/research support from: Abbvie, Pfizer, Consultant of: Abbvie, BMS, Lilly, Mylan, Novartis, Pfizer, Sandoz, Sanofi-Genzyme, Martin SOUBRIER: None declared, Pascale Vergne-Salle: None declared, Charles Zarnitsky: None declared, Eric Fakra Consultant of: Janssen, Lundbeck, Otsuka, Sanofi, Hubert MAROTTE Grant/research support from: Bristol Myers Sqibb, Lilly France, MSD, Novartis, Nordic Pharma, Pfizer, SanofiAventis, Consultant of: AbbVie, Amgen, Bristol Myers Sqibb, Lilly France, MSD, Novartis, Nordic Pharma, Pfizer, SanofiAventis, Paid instructor for: Sanofi-Aventis, Speakers bureau: Sanofi-Aventis, Florence E Lévy-Weil Employee of: Sanofi Genzyme employee

Characterization of the microbiome associated with in situ earthen materials

BACKGROUND

The current increase in public awareness of environmental risks is giving rise to a growth of interest in the microbiological safety of buildings. In particular, microbial proliferation on construction materials can be responsible for the degradation of indoor air quality that can increase health-risk to occupants. Raw earth materials are still widely used throughout the world and, in some cases, are linked to heritage habitats, as in the southwest of France. Moreover, these building materials are currently the subject of renewed interest for ecological and economic reasons. However, the microbial status of earthen materials raises major concerns: could the microbiome associated with such natural materials cause disease in building occupants? Very few analyses have been performed on the microbial communities present on these supports. Characterizing the raw earth material microbiome is also important for a better evaluation and understanding of the susceptibility of such materials to microbial development. This study presents the distribution of in situ bacterial and fungal communities on different raw earth materials used in construction. Various buildings were sampled in France and the microbial communities present were characterized by amplicon high-throughput sequencing (bacterial 16S rRNA gene and fungal ITS1 region). Bacterial culture isolates were identified at the species level by MALDI-TOF mass spectrometry.

RESULTS

The major fungal and bacterial genera identified were mainly associated with conventional outdoor and indoor environmental communities, and no specific harmful bacterial species were detected on earthen materials. However, contrary to expectations, few human-associated genera were detected in dwellings. We found lower microbial alpha-diversity in earthen material than is usually found in soil, suggesting a loss of diversity during the use of these materials in buildings. Interestingly enough, the main features influencing microbial communities were building history and room use, rather than material composition.

CONCLUSIONS

These results constitute a first in-depth analysis of microbial communities present on earthen materials in situ and may be considered as a first referential to investigate microbial communities on such materials according to environmental conditions and their potential health impact. The bacterial and fungal flora detected were similar to those found in conventional habitats and are thought to be mainly impacted by specific events in the building's life, such as water damage.

In silico definition of new ligninolytic peroxidase sub-classes in fungi and putative relation to fungal life style

Ligninolytic peroxidases are microbial enzymes involved in depolymerisation of lignin, a plant cell wall polymer found in land plants. Among fungi, only Dikarya were found to degrade lignin. The increase of available fungal genomes allows performing an expert annotation of lignin-degrading peroxidase encoding sequences with a particular focus on Class II peroxidases (CII Prx). In addition to the previously described LiP, MnP and VP classes, based on sequence similarity, six new sub-classes have been defined: three found in plant pathogen ascomycetes and three in basidiomycetes. The presence of CII Prxs could be related to fungal life style. Typically, necrotrophic or hemibiotrophic fungi, either ascomycetes or basidiomycetes, possess CII Prxs while symbiotic, endophytic or biotrophic fungi do not. CII Prxs from ascomycetes are rarely subjected to duplications unlike those from basidiomycetes, which can form large recent duplicated families. Even if these CII Prxs classes form two well distinct clusters with divergent gene structures (intron numbers and positions), they share the same key catalytic residues suggesting that they evolved independently from similar ancestral sequences with few or no introns. The lack of CII Prxs encoding sequences in early diverging fungi, together with the absence of duplicated class I peroxidase (CcP) in fungi containing CII Prxs, suggests the potential emergence of an ancestral CII Prx sequence from the duplicated CcP after the separation between ascomycetes and basidiomycetes. As some ascomycetes and basidiomycetes did not possess CII Prx, late gene loss could have occurred.

Imbalanced Regulation of Fungal Nutrient Transports According to Phosphate Availability in a Symbiocosm Formed by Poplar, Sorghum, and Rhizophagus irregularis

In arbuscular mycorrhizal (AM) symbiosis, key components of nutrient uptake and exchange are specialized transporters that facilitate nutrient transport across membranes. As phosphate is a nutrient and a regulator of nutrient exchanges, we investigated the effect of P availability to extraradical mycelium (ERM) on both plant and fungus transcriptomes and metabolomes in a symbiocosm system. By perturbing nutrient exchanges under the control of P, our objectives were to identify new fungal genes involved in nutrient transports, and to characterize in which extent the fungus differentially modulates its metabolism when interacting with two different plant species. We performed transportome analysis on the ERM and intraradical mycelium of the AM fungus Rhizophagus irregularis associated to Populus trichocarpa and Sorghum bicolor under high and low P availability in ERM, using quantitative RT-PCR and Illumina mRNA-sequencing. We observed that mycorrhizal symbiosis induces expression of specific phosphate and ammonium transporters in both plants. Furthermore, we identified new AM-inducible transporters and showed that a subset of phosphate transporters is regulated independently of symbiotic nutrient exchange. mRNA-Sequencing revealed that the fungal transportome was not similarly regulated in the two host plant species according to P availability. Mirroring this effect, many plant carbohydrate transporters were down-regulated in P. trichocarpa mycorrhizal root tissue. Metabolome analysis revealed further that AM root colonization led to a modification of root primary metabolism under low and high P availability and to a decrease of primary metabolite pools in general. Moreover, the down regulation of the sucrose transporters suggests that the plant limits carbohydrate long distance transport (i.e. from shoot to the mycorrhizal roots). By simultaneous uptake/reuptake of nutrients from the apoplast at the biotrophic interface, plant and fungus are both able to control reciprocal nutrient fluxes.

Flow period influence on uranium and trace elements release in water from the waste rock pile of the former La Commanderie uranium mine (France)

Uranium mining activities expose uranium ore and mine tailings to the surface environment, where the release of radionuclides is facilitated by weathering at rates exceeding those typically found in nature. Therefore, close to former uranium mining sites, radionuclides and especially uranium concentrations in water may surpass local background levels. The methodology proposed herein, entails coupling, gamma-ray mapping, water sampling and chemical analyses including DGT (Diffusive Gradient in Thin Film) measurements, provides new insights into describing the environment of the La Commanderie site (France). Gamma-ray mapping allows identifying water seepage, output from a waste rock pile, as a potential pathway for radionuclides into the environment. Water seepage monitoring has shown: a low pH value (4.2), high sulfate content (179 mg.L^-1) and high uranium concentrations of up to 436 μg.L^-1. These recordings indicate that an acid mining drainage (AMD) process is occurring inside or under the oxidized parts of the waste rock pile. Monitoring data over three flow periods revealed the release of the highest uranium concentrations during a high-flow period downstream of the site, which is compliant with local regulations. The AMD process is also responsible for the release of significant amounts of Fe, Mn and As within the immediate environment in both dissolved and particulate forms. Changes in dissolved oxygen concentration and redox potential during low flow periods, modify the speciation of Fe (in AMD waters) which acts as a scavenger for other elements such as As, Mn and U. The use of DGT under environmental conditions, and specifically AMD waters, seems to be relevant in comparison to filtered spot water sampling strategies. Moreover, based on DGT measurements, the dissolved part of the released uranium is considered as labile with concentrations above the environmental standards for freshwater organisms.

Development of Ovarian Tissue Autograft to Restore Ovarian Function: Protocol for a French Multicenter Cohort Study

Background

Sterility is a major late effect of radiotherapy and chemotherapy treatments. Iatrogenic sterility is often permanent and greatly impacts long-term quality of life. Ovarian tissue cryopreservation (OTC) performed before gonadotoxic treatments with subsequent autograft is a method of fertility preservation available for girls and women. Its application in prepubertal girls is of particular value as it is the only possible approach in this patient group. In addition, it does not require a delay in cancer therapy and no ovarian stimulation is needed.

Objective

The primary aim of this protocol is to help increase the implementation of ovarian tissue autografting in France. Knowledge is still lacking regarding the efficacy of ovarian transplantation in restoring ovarian function and regarding the safety of this procedure, especially the risk of cancer cell reseeding in certain types of cancer. A secondary aim of this study is to generate data to improve our understanding of these two essential aspects.

Methods

The DATOR (Development of Ovarian Tissue Autograft in Order to Restore Ovarian Function) study is ongoing in 17 university hospitals. The DATOR protocol includes the autograft of ovarian cortex fragments. Candidates are identified from an observational prospective cohort (called the Prospective Cohort of Patients Candidates for Ovarian Tissue Autograft [PERIDATOR]) of patients who have undergone OTC. Enrollment in the study is initiated at the patient’s request and must be validated by the center’s multidisciplinary team and by the study steering committee. The DATOR study begins with a total medical checkup. Ovarian tissue qualification and residual disease detection, if required, are performed.

Results

The study is ongoing. Currently, 38 patients have provided informed consent and have been entered into the DATOR study. Graft has been performed for 34 of these patients. An interim analysis was conducted on the first 25 patients for whom the period of at least 1 year posttransplantation was achieved. Out of these 25 patients, 11 women succeeded in becoming pregnant (pregnancy rate=44% [11/25]; delivery rate=40% [10/25]). Among these, 6 women conceived twice, and 1 pregnancy led to a miscarriage.

Conclusions

Our preliminary analysis appears to be coherent with the accumulating body of evidence indicating the potential utility of ovarian tissue autograft for patients with premature ovarian failure. All these elements justify the pursuit of our study.

Trial Registration

ClinicalTrials.gov NCT02846064; https://clinicaltrials.gov/ct2/show/NCT02846064

International Registered Report Identifier (IRRID)

DERR1-10.2196/12944

Ultrasound-Based Estimates of Cortical Bone Thickness and Porosity Are Associated With Nontraumatic Fractures in Postmenopausal Women: A Pilot Study

Recent ultrasound (US) axial transmission techniques exploit the multimode waveguide response of long bones to yield estimates of cortical bone structure characteristics. This pilot cross-sectional study aimed to evaluate the performance at the one-third distal radius of a bidirectional axial transmission technique (BDAT) to discriminate between fractured and nonfractured postmenopausal women. Cortical thickness (Ct.Th) and porosity (Ct.Po) estimates were obtained for 201 postmenopausal women: 109 were nonfractured (62.6 ± 7.8 years), 92 with one or more nontraumatic fractures (68.8 ± 9.2 years), 17 with hip fractures (66.1 ± 10.3 years), 32 with vertebral fractures (72.4 ± 7.9 years), and 17 with wrist fractures (67.8 ± 9.6 years). The areal bone mineral density (aBMD) was obtained using DXA at the femur and spine. Femoral aBMD correlated weakly, but significantly with Ct.Th (R = 0.23, p < 0.001) and Ct.Po (R = -0.15, p < 0.05). Femoral aBMD and both US parameters were significantly different between the subgroup of all nontraumatic fractures combined and the control group (p < 0.05). The main findings were that (1) Ct.Po was discriminant for all nontraumatic fractures combined (OR = 1.39; area under the receiver operating characteristic curve [AUC] equal to 0.71), for vertebral (OR = 1.96; AUC = 0.84) and wrist fractures (OR = 1.80; AUC = 0.71), whereas Ct.Th was discriminant for hip fractures only (OR = 2.01; AUC = 0.72); there was a significant association (2) between increased Ct.Po and vertebral and wrist fractures when these fractures were not associated with any measured aBMD variables; (3) between increased Ct.Po and all nontraumatic fractures combined independently of aBMD neck; and (4) between decreased Ct.Th and hip fractures independently of aBMD femur. BDAT variables showed comparable performance to that of aBMD neck with all types of fractures (OR = 1.48; AUC = 0.72) and that of aBMD femur with hip fractures (OR = 2.21; AUC = 0.70). If these results are confirmed in prospective studies, cortical BDAT measurements may be considered useful for assessing fracture risk in postmenopausal women. © 2019 American Society for Bone and Mineral Research.

Deciphering the phylogeny of violets based on multiplexed genetic and metabolomic approaches

Molecular phylogenetics based on nucleotide sequence comparisons has profoundly influenced plant taxonomy. A comprehensive chemotaxonomical approach based on GC-MS and UHPLC-HRMS profiling was evaluated for its ability to characterize a large collection of plants all in the violet family Violaceae (n = 111) and thus decipher the taxonomy. A thorough identification of violets is challenging due to their natural hybridization and phenotypic variability. Phylogenetic inference performed on ribosomal internal transcribed spacer sequences using maximum likelihood and neighbor-joining distance methods allowed the clear identification of 58% of the collection. Metabolomic approaches with multivariate data analysis were performed on SPME/GC-MS chromatograms of volatile compounds emitted by fresh mature flowers and on UHPLC-HRMS/MS leaf extracts for non-volatile compounds. Interestingly, molecular and biochemical approaches provided separate classifications while highlighting several common clusters. The profiling of secondary metabolites was proved most suitable for the classification of hundreds of extracts. The combination of phylogenetic and chemotaxonomic approaches, allowed the classification of 96% of the entire collection. A correlation network revealed specific chemotaxonomic biomarkers, in particular flavonoids, coumarins and cyclotides. Overall, our pioneering approach could be useful to solve misclassification issues within collections of close plant species.

Comparative genomics of Rhizophagus irregularis, R. cerebriforme, R. diaphanus and Gigaspora rosea highlights specific genetic features in Glomeromycotina

Glomeromycotina is a lineage of early diverging fungi that establish arbuscular mycorrhizal (AM) symbiosis with land plants. Despite their major ecological role, the genetic basis of their obligate mutualism remains largely unknown, hindering our understanding of their evolution and biology. We compared the genomes of Glomerales (Rhizophagus irregularis, Rhizophagus diaphanus, Rhizophagus cerebriforme) and Diversisporales (Gigaspora rosea) species, together with those of saprotrophic Mucoromycota, to identify gene families and processes associated with these lineages and to understand the molecular underpinning of their symbiotic lifestyle. Genomic features in Glomeromycotina appear to be very similar with a very high content in transposons and protein-coding genes, extensive duplications of protein kinase genes, and loss of genes coding for lignocellulose degradation, thiamin biosynthesis and cytosolic fatty acid synthase. Most symbiosis-related genes in R. irregularis and G. rosea are specific to Glomeromycotina. We also confirmed that the present species have a homokaryotic genome organisation. The high interspecific diversity of Glomeromycotina gene repertoires, affecting all known protein domains, as well as symbiosis-related orphan genes, may explain the known adaptation of Glomeromycotina to a wide range of environmental settings. Our findings contribute to an increasingly detailed portrait of genomic features defining the biology of AM fungi.

Susceptibility of earth-based construction materials to fungal proliferation: laboratory and in situ assessment

The impact of building materials on the environment and the health of occupants is nowadays a priority issue. Ecological construction materials such as earthen materials are currently experiencing a regain of interest due to both ecological and economic factors. The microbial proliferation on indoor materials can induce a deterioration of the building air quality and lead to an increase of health risks for the occupants. The issue of indoor air quality raises questions about the use of earthen building materials and their possible susceptibility to fungal development. The microflora of earthen materials and their ability to grow on such support are indeed poorly studied. This study focused on the quantification of both bacterial and fungal microflora along the manufacturing process. The impact of extreme humidity, simulating a hydric accident, on microflora development was analyzed on the surface and inside earthen bricks. The initial microflora of these materials was dramatically reduced during the manufacturing process, especially after heat treatment for drying. Proliferation of remaining microorganisms was only observed under high humidity condition, in particular for earthen materials with vegetal aggregates. Moreover, in situ samplings were performed on naturally dried earthen materials used in buildings. The characterization of the microbial density revealed a higher microbial density than on manufactured specimens, while microbial concentration and detected taxa seemed mainly related to the room use and building history. These results provide a better understanding of microbial proliferation on these materials.

Measurement of Trabecular Bone Score of the Spine by Low-Dose Imaging System (EOS®): A Feasibility Study

Purpose/Introduction: Measurement of trabecular bone score (TBS^®) of the lumbar spine on dual energy X-ray absorptiometry (DXA) devices improves fracture risk prediction. We conducted a proof of concept study to assess the feasibility of TBS^® measured on the low-dose imaging system EOS^®.

METHODS

TBS was assessed on both DXA and EOS^® in 122 patients aged ≥ 50 yr, receiving no anti-osteoporotic treatment. The TBS^® was computed on full-body EOS^® images, focusing on the lumbar spine region. The patients were also scanned with a DXA bone densitometer (Hologic) and the spine and hip bone mineral density (g/cm²) were computed.

RESULTS

TBS^® measurement on EOS^® was not possible in 34 patients due to technical problems. It could be measured on both DXA and EOS^® in 88 patients (28 with severe low-trauma fracture and 60 without fracture). TBS-EOS values were significantly lower in fractured patients compared to nonfractured patients. TBS-EOS was associated with the presence of fractures as reported by an AUC of 0.70. Odds ratio of TBS-EOS for the presence of severe low-trauma fracture was 2.00 [1.24-3.25], p = 0.005.

CONCLUSIONS

This proof of concept study, based on a prototype version of the TBS-EOS, demonstrated the feasibility of the measurement of TBS^® on low-dose EOS^® imaging devices. Results show that the TBS-EOS was lower in patients with severe low-trauma fractures compared to nonfractured patients independently from bone mineral density. Some technical issues need to be solved before its eventual use in routine clinical settings. Additional prospective studies are still needed to define the actual contribution of this new technique.

Vertebral fractures cascade: potential causes and risk factors

We performed a study to identify potential causes and risk factors of vertebral fracture cascade. Vertebral fracture cascade is a severe clinical event in patients with bone fragility. Only half of patients have an identified cause of secondary osteoporosis.

INTRODUCTION

Vertebral fracture (VF) is the most common osteoporotic fracture, and a strong risk factor of subsequent VFs leading to VF cascade (VFC). We prompted a study to identify potential causes and risk factors of VFC.

METHODS

VFC observations were collected retrospectively between January 2016 and April 2017. VFC was defined as an occurrence of at least three VFs within 1 year.

RESULTS

We included in 10 centers a total of 113 patients with VFC (79.6% of women, median age 73, median number of VFs in the cascade, 5). We observed 40.5% and 30.9% of patients with previous major fractures and a previous VF, respectively, and 68.6% with densitometric osteoporosis; 18.9% of patients were currently receiving oral glucocorticoids and 37.1% in the past. VFC was attributed by the physician to postmenopausal osteoporosis in 54% of patients. A secondary osteoporosis associated with the VFC was diagnosed in 52 patients: glucocorticoid-induced osteoporosis (25.7%), non-malignant hemopathies (6.2%), alcoholism (4.4%), use of aromatase inhibitors (3.6%), primary hyperparathyroidism (2.7%), hypercorticism (2.7%), anorexia nervosa (2.7%), and pregnancy and lactation-associated osteoporosis (1.8%). A total of 11.8% of cases were reported following a vertebroplasty procedure. A total of 31.5% patients previously received an anti-osteoporotic treatment. In six patients, VFC occurred early after discontinuation of an anti-osteoporotic treatment, in the year after the last dose effect was depleted: five after denosumab and one after odanacatib.

CONCLUSION

The results of this retrospective study showed that only half of VFC occurred in patients with a secondary cause of osteoporosis. Prospective studies are needed to further explore the determinants of this severe complication of osteoporosis.