[Strategies and recommendations to face respiratory syncytial virus disease in 2024]

During the winter of 2023, Chile faced a complex situation related to the respiratory syncytial virus (RSV). After experiencing a decline in RSV circulation during the years of the SARS-CoV-2 pandemic, a late outbreak was observed in the spring of 2022 and an early onset of the outbreak in 2023, with a significant increase in the number of serious cases. The ineffectiveness of strategic planning and risk communication contributed to the complexity of the situation. To avoid the above next winter, measures such as active surveillance, unification of definitions for acute respiratory infections, identification of RSV variants, public education about infections and advance preparation regarding hospital beds and health personnel are suggested. The importance of immunization and intersectoral collaboration to acquire new preventive alternatives is highlighted, as well as the need for early communication about the importance of immunization and identification of high-risk groups, improvement in training of medical personnel and strategic planning of the Ministry of Health. seeking a proactive and collaborative approach to address the complex RSV situation in future winters. The Chilean Immunization Advisory Committee has already carried out an analysis and recommendation on a new prevention alternative. This working group will support any decision of the Ministry of Health in public policies that attempt a change in the paradigm of control of this disease for the health of the children of our country.

Health-Related Quality of Life after Combined External Beam and Either High Dose Rate (HDR) or Low Dose Rate (LDR) Brachytherapy: Does the Rectal Dose from the LDR Brachytherapy Make a Difference?

PURPOSE/OBJECTIVE(S)

The recently reported randomized Phase III trial comparing health related quality of life (HRQOL) after combined external beam radiation therapy (EBRT) and either HDR or LDR brachytherapy (BT) found a significant decline in the EPIC Bowel domain HRQOL score at 24- 48 months after treatment in the LDR arm of the trial. As all patients in the trial received the same EBRT dose, and HDR rectal dose was strictly controlled to be <9.5 Gy to 1cc of rectal wall (RD1cc), we investigated whether the variable rectal dose from the LDR component of treatment was related to the decline in Bowel HRQOL for these patients.

MATERIALS/METHODS

A total of 195 men with upper tier intermediate or high-risk prostate cancer were assigned by a random number generator to receive either an HDR (15 Gy, n = 108) or LDR (110Gy, n = 87) brachytherapy boost combined with 46Gy/23 fractions EBRT. All LDR patients had 1 month post implant quality assurance using CT-MRI fusion. The Expanded Prostate Cancer Composite (EPIC) questionnaire was used to evaluate HRQOL at baseline, q3 mo for 1 year, q6mo for 3 yr and then annually. A multivariate linear regression model was used to investigate the dose-response relationship between EPIC bowel domain score at 24- 48 months and RD1cc.

RESULTS

With a median follow up of 48 months, the previous analysis confirmed the expected time course of acute bowel/urinary symptoms, with LDR showing more prolonged decline in HRQOL bowel domain at 3 and 6 months, but equivalence to HDR by 12 months. HRQOL urinary domain remained equivalent from 12-60 mo. The decline in the HRQOL bowel domain observed for LDR patients from 24-48 mo was analyzed for the 79 patients with sufficient data. The mean baseline HRQOL bowel domain score was 92 and fell on average to 85 at 24-48 mo. Mean RD1cc for the LDR patients was 82Gy (SD 22 Gy), with a maximum value of 129 Gy. In this range of rectal doses, a 20Gy increase in RD1cc, was associated on average with a 1.5-point decrease in EPIC HRQOL bowel domain score (p = 0.21).

CONCLUSION

The rectal dose received by the LDR patients showed a non-significant dose-response with the EPIC Bowel domain HRQOL score. This confirms the accepted rectal dose constraints for LDR brachytherapy but does not explain the observed decline in bowel scores from 24-48 months.

Drug-Induced Liver Injury Used in the Treatment of Inflammatory Bowel Disease

Therapeutic options for the management of inflammatory bowel disease [IBD] have been expanding in recent decades. New biological and small molecule therapies have been incorporated into the pharmacological arsenal, allowing a more personalized management, and seeking increasingly strict remission goals. However, the fear of developing adverse events represents one of the most important limitations in deciding its use by patients and by a multidisciplinary team. Despite the risk of hepatotoxicity of thiopurines and methotrexate, these drugs are still used either as monotherapy or as combined therapy with anti-tumour necrosis factor [anti-TNF] biological agents. Although drug-induced liver injury [DILI] appears to be less frequent with anti-TNF agents, newer biologics and small molecules, liver tests should be considered in the follow-up of these patients, especially regarding future combined therapy of biologics or of these drugs with small molecules. The objective of this review is to show data on the risk of developing DILI in patients with IBD who are undergoing treatment with traditional therapy or new drugs, whether biological or small molecules.

Hepatobiliary manifestations in inflammatory bowel disease: A practical approach

Inflammatory bowel diseases (IBD) are associated with various hepatobiliary disorders. They can occur at any moment in the course of the disease or associated with the treatment. The prevalence of liver dysfunction can reach up to 50% in different studies. Nonalcoholic fatty liver disease is considered the most common hepatobiliary complication in IBD, while primary sclerosing cholangitis is the most specific. Management of hepatic manifestations in IBD involves a multidisciplinary approach that includes a high index of suspicion and joint management with hepatologists. The medical confrontation with abnormal liver tests must include an exhaustive study to determine if these patterns can be related to IBD, associated diseases or to the therapies used.

The paradox of endangered European rabbits regarded as pests on the Iberian Peninsula: trends in subspecies matter

The European rabbit Oryctolagus cuniculus faces a paradoxical situation in its native range on the Iberian Peninsula. While many populations have declined sharply due to a new variant of the rabbit haemorrhagic disease virus (RHDV-b), others remain healthy. The latter populations, which flourish mostly on farmland, cause significant crop damage. We explored if this difference could be related to the existence of the 2 rabbit subspecies (O. c. algirus and O. c. cuniculus) that coexist allopatrically on the Iberian Peninsula. Potential differences in population trends between rabbit subspecies may also be relevant in assisting the conservation of endangered rabbit-dependent predators which mainly occur in the distribution area of O. c. algirus. To test this, we assessed rabbit trends after the outbreak of RHDV-b by an online questionnaire to the senior administrative officers of all provincial official game departments throughout peninsular Spain (n = 47). A generalized negative trend was reported by officers in the distribution area of O. c. algirus, while a more stable or even positive trend was reported in the distribution area of O. c. cuniculus. We point to the need for establishing a long-term rabbit population monitoring programme on the Iberian Peninsula to further confirm the observed patterns, but also to contribute to evidence-based management decision-making. Our results suggest a need to apply different management systems for each rabbit subspecies.

FRI0426 EMOTIONAL COMPONENTS AND INFLAMMATION ARE HIGHLY RELEVANT IN PAIN REPORTED BY KNEE OSTEOARTHRITIC PATIENTS

Background:

Osteoarthritis (OA) is a leading cause of disability in elderly and the most frequent form is knee OA (KOA) (1). Pain is the principal symptom that leads patients to visit clinicians, and it is the main reason, together with functionality, for patients to undergo a total knee replacement (TKR) after apparently unsuccessful conservative (CNV) treatments (2). It is well-known that there is a poor correlation between the radiographic severity (based on Kellgren & Lawrence (KL) score) and the reported pain (3), so other variables may be responsible for the intensity of pain.

Objectives:

Identifying the leading causes of pain in each patient would improve the management of the disease. In this study we aim to investigate the role of emotional components, nociception process and inflammation in treatment decision, as a global measure of pain suffered by KOA patients, taking into account sex, age and BMI.

Methods:

KOA patients, carefully selected to be idiopathic, graded 2-3 in KL, were recruited at Hospital del Mar. The following variables were recorded: WOMAC, Hospital Anxiety and Depression Scale (HAD), Pain Catastrophizing Scale (PCS), tender points (TP) (measure with a pressure algometer at points defined in the Arendt-Nielsen extended peripatellar map), synovial hypertrophy (SH) and effusion (SE) (measure by ultrasounds), and PCR and ESR serum levels. Patients were classified according to 4 factors: treatment (CNV/TKR), sex, age (60-67/68-75) and BMI (<30/>30). All groups were balanced. Multivariate and correlations analysis were performed.

Results:

Eighty-seven patients have been recruited. Patients from the TKR group present significant higher WOMAC (p=0.000), PCS (p=0.002) and SE (p= 0.038) values than CNV ones, without interaction with the other factors, except for SE, that presents interaction with BMI (Fig. 1). Women reported significant upper WOMAC (p=0.001) and HAD rates (p=0.020), but also higher number of TP and ESR levels (p= 0.000 and 0.002, respectively). The level of sensitization was significantly higher in women than in men (p=0.000). Several significant correlations were found, mainly between WOMAC and emotional components, as well as between TP and WOMAC, PCS, and inflammation markers (Table 1).

Conclusion:

PCS is an emotional component that could explain in part the lack of correlation between joint status and patient’s symptomatology. Working out strategies for pain management could improve this PCS values and therefore reduce the need for TKR. Furthermore, this study also highlights the two mainly types of OA etiology: mechanical and inflammatory. It suggests that inflammation is mostly responsible for OA progression in patients with low BMI, and plays a strong role in women pathology. Finally, specific treatments targeting central pain sensitization could also improve the management of the pathology in women.

References:

[1]Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health. 1994 Mar;84(3):351-8.

[2]O’Neill TW, Felson DT. Mechanisms of Osteoarthritis (OA) Pain. Curr Osteoporos Rep. 2018 Oct;16(5):611-6.

[3]Dieppe PA. Relationship between symptoms and structural change in osteoarthritis. what are the important targets for osteoarthritis therapy? J Rheumatol Suppl. 2004 Apr;70:50-3.

Acknowledgments:

MICINN Funds are acknowledged (HOLOA-DPI2016-80283-C2-1/2-R)

Disclosure of Interests:

None declared

AB0874 FUNCTIONALITY IN OSTEOARTHRITIC GAIT IS RELATED TO TREATMENT DECISION. A MULTIFACTORIAL ANALYSIS

Background:

Osteoarthritis (OA) is a degenerative disease with complex underling mechanisms1–3. The interactions among several factors make the study of the disease very complex and often lead to different treatment, i.e. surgical or conservative, decisions for subjects clinically and radiographically similar. Recent explorations performed at the body level pointed out that macro-factors, like overweight or gait, can influence the development of the disease4. The number of related factors is high, and they are very likely to interact with each other. However, the literature lacks randomized and balanced studies to verify such effects of multiple factors5.

Objectives:

The aim of this work was to develop a multifactorial analysis to explore whether and how gait functionality and dynamics can be related to treatment decision.

Methods:

A multifactorial analysis of gait dynamics in OA subjects was developed. 81 OA subjects, graded 2-3 in KL, were selected based on 4 clinical factors: Gender (male – female), Age (60-67 – 68-75), BMI (25–29.9 – 30+) and Treatment (total knee replacement (TKR) – conservative treatment). Gait analysis was performed using 8 cameras BTS Smart-DX 700, 1.5 Mpixels 250 fps and 2 force plates BTS P-6000 500 Hz sampling (BTS S.p.A., Milan, Italy). Helen Hayes marker protocol with medial markers was used for the study. Each volunteer was asked to perform a minimum of 5 valid gait sequences. Functionality and dynamics parameters were measured.

Functionality: Velocity of gait and the time needed to perform a gait cycle were computed.

Dynamics:The reaction forces and torques at the ankles, knees and hips were computed through inverse dynamic analyses.

Analysis of variance was performed for the four factors described among the functionality and dynamics parameters.

Results:

The multifactorial analysis showed that functionality values are more subjective to the studied factors than the dynamics ones.

Functionalityseems to be directly related to the clinical treatment. Patients who selected TKR needed more time to make a step, spent more time in double stand position and walked slower (p<0.002). Older subject also walked slower but this dependency seemed to variate with age (interaction between clinical treatment and age – p<0.02 – Figure 1).

Figure 1

Interaction between Clinical treatment and age.

Dynamics: Forces at the joints seemed to be affected by the gender and an interaction between age and BMI (p< p<0.005, p<0.02) but not by the kind of therapy. Differently, torques were statistically related to the clinical treatment (p<0.007). Age was also significant as was the interaction between age and BMI (both p<0.007).

Conclusion:

Reduced functionality seems to be related to the selection of therapy. In contrast to current paradigm, forces at the joints may have no role in the definition of the best therapy for OA subjects. Subjects requiring TKR do not present higher loads at the joints. However, torques seems to be related to the therapy selected. Instead of forces, kinematics and posture assessments might support rational definitions of the therapy and future multifactorial analysis should take them into consideration.

References:

[1]Ding M. et al.J Bone Joint Surg Br. 2003;85(6):906-912.

[2]Kamibayashi L. et al.Calcif Tissue Int. 1995;57:69-73.

[3]Li B, Aspden RM.J Bone Miner Res. 1997;12(4):641-651.

[4]Berenbaum F et al.Curr Opin Rheumatol. 2013;25(1):114-118.

[5]Ioannidis JPA.Soc Sci Med. 2018;210(April):53-56.

Acknowledgments:

MICINN Funds are acknowledged (HOLOA-DPI2016-80283-C2-1/2-R, RYC-2015-18888)

Disclosure of Interests:

None declared

P199 Mitral valve annular disjunction prevalence and significance amongst patients with mitral valve prolapse

Background

Mitral valve prolapse (MVP) is a common and usually benign entity. Occasionally, patients with MVP present with mitral annular disjunction (MAD), whose prevalence and clinical significance are still not clearly established.

Purpose

This study aimed to define the prevalence of MAD in a population of patients with MVP and study its echocardiographic and clinical implication.

Methods

A total of 31 patients with MVP who underwent echocardiographic evaluation in our laboratory were retrospectively evaluated. Echocardiographic, demographic and clinical variables were assessed. Disjunction amplitude (DA) was measured in parasternal long axis view (PLAX) and MAD was considered present if a separation of ≥ 5mm was verified. Annular diameter was measured in PLAX and apical four chamber view (A4C) both in systole and diastole.

Results

MAD was identified in 9 patients (29%), having a mean DA of 12.3 ± 3.2 mm. The group of patients with MAD was significantly younger than the group without MAD (mean age of 54 ± 18 vs 67 ± 15 years; p = 0.001), but there were no significant differences regarding gender, height, weight or cardiovascular risk factors. DA was inversely correlated with body surface area (r=-0.8, p = 0.009). Systolic annular diameters in PLAX and A4C views were increased in patients with MAD (4.2 ± 0.6 vs 3.6 ± 0.7 mm, p= 0.04 and 4.8 ± 0.7 vs 4.1 ± 0.7 mm, p = 0.025, respectively). The difference between systolic and diastolic diameters in PLAX was also greater in MAD (0.5 ± 0.2 vs 0.1 ± 0.3 mm, p = 0.007). Posterior wall thickness (8.5 ± 1.1 vs 9.7 ± 1.4 mm, p = 0.035), indexed left ventricular mass (89.0 ± 15.8 vs 110.6 ± 40,2 g/m2, p = 0.04) and ascending aortic dimensions (28.7 ± 6.7 vs 37.4 ± 3.6 mm, p = 0.018) were notably inferior in MAD patients, as was left ventricle ejection fraction (LVEF) (57.5 ± 5.8 vs 62.6 ± 4.9 %, p = 0.0023). No differences were found in chamber volumes. Similarly, eletrocardiographic parameters were identical in both groups. Five patients (56%) in the group with MAD had documentation of events (palpitations, dizziness, syncope or sudden cardiac death), in contrast with just 3 (21%) in the group without MAD, although statistical significance was not achieved (p = 0.078).

Conclusion

This study revealed that MAD is common among patients with MVP and is associated with altered annulus dynamics during the cardiac cycle. Its association with younger individuals, lower LVEF and, apparently, more clinical events highlight the importance of this entity.

52 Blocking of embryonic development by nanoparticles derived from endometrial and oviductal cells isolated with an Amicon filter system

The success of development of invitro embryo production needs to mimic culture conditions in the maternal environment. Recently, it has been seen that extracellular vesicles (EVs) secreted by oviducal or endometrial cells may improve development and quality of embryos produced invitro. Extracellular vesicles are a mechanism of cellular communication; they carry molecules that are delivered into the target cells changing gene expression and function. Due to the size range and characteristics of EVs, they require specific methods for purification and characterisation. However, the possible contamination with other nanoparticles and their effect on embryo development have not been considered. Based on that, the goal of this work was to evaluate the effect on invitro bovine embryo development, of the addition to culture medium EVs secreted by oviducal and endometrial cells and isolated by centrifugation and concentrates with Amicon filters. For this purpose, cells were isolated from bovine oviduct and endometrium collected in local abattoir and primary cultures of epithelial and stromal cells were derived. The primary cultures from both sources were exposed or not to progesterone (P4; 15ngmL−1) for 4 days and then cultured for 24h in EV depleted media. The supernatant was harvested and EVs were isolated by serial centrifugations and subsequently concentrated by a 100 kDa Amicon filter system. The isolated EVs were characterised by transmission electron microscopy, nanoparticle tracking analysis, and flow cytometry. Oocytes were obtained from ovaries collected in the abattoir. The cumulus-oocyte complexes were matured invitro for 22h and subsequently fertilised for 18h. Presumptive zygotes were invitro cultured in synthetic oviducal fluid with EVs (1000ngmL−1 of total proteins) or not according to experimental group (1: EVs− (control); 2: EVs−OP4+; 3: EVs−OP4−; 4: EVs−EP4+ and 4: EVs−EP4−). Embryos were cultured for 7 days in 5% CO2, 5% O2, and 90% N2 (25 embryos/well in 4-well plates). At Day 7, embryo development was evaluated considering the blastocyst yield. Transmission electron microscopy showed typical structures and morphology of EVs and they were positive for CD9, CD63, and CD81 markers, and negative for CD40. According to nanoparticle tracking analysis, the mean size of EVs was 160±62nm and concentration of 3.29×1011 particlesmL−1 for oviducal and endometrial cells, respectively. A significant reduction of blastocyst rate was observed when embryos were cultured with cell-derived EVs; control: 152/44 (28.9%) vs. treatments with EVs; OP4+: 74/3 (4.1%), OP4−:76/2 (2.6%), EP4+: 74/6 (8.1%), and EP4−: 73/2 (2.7%) (P ≤ 0.01). Our results indicate that the use of nanoparticles, including EVs, isolated from cells of oviduct or endometrium, has a blocking effect on embryonic development and compromises the performance of blastocysts on Day 7 when used at concentrations of 1000ngmL−1 total protein, independent of the use or not of P4 and the source. These data provide insights regarding the use and protocols of acquiring exosomes for embryo supplementation. This research was supported by FONDECYT, Chile-1170310.

208 Effect of growth factors and reprogramming molecules on induction to multipotency of dermal fibroblasts from colocolo (Leopardus colocolo)

Reprogramming of terminally differentiated cells to higher plasticity levels can be achieved with small molecules. This can be of value for somatic cell nucleus transfer, deriving multi and pluripotent cells and conservation purposes. Recently, induced mesenchymal stem cells were derived from differentiated human and mouse cells by using small molecules and growth factors. The pampas cat or colocolo (Leopardus colocolo) is a South American felid categorrized as near threatened by the International Union for Conservation of Nature (IUCN) Red List of Threatened Species. Major historical threats to the pampas cat include illegal hunting, habitat loss or transformation, and conflict retaliation for poultry predation. Here, we tested 5-azacytidine (an epigenetic modifier) and A8301 (a potent inhibitor of transforming growth factor-β type I receptor superfamily), linked to platelet-rich plasma (PRP) and platelet-derived growth factor (PDGF-B) to induce changes in the expression of pluripotency genes and differentiation capacity of colocolo fibroblasts towards other mesodermal lineages. For this, dermal fibroblasts were treated with (I) 5-azacytidine + PRP + A8301 + VitC, or (II) 5- azacytidine + VitC + A8301 + PDFG for 12 days. On Days 0, 5, and 12 of reprogramming, expression of OCT4, NANOG, E-cadherin and SNAIL was evaluated by reverse transcription-PCR, and tri-lineage differentiation was induced. For treatment I, no statistical difference was found in the expression of OCT4 and NANOG. Chondrogenic and osteogenic differentiation was observed. In treatment II, significant expression of OCT4 and NANOG (P&lt;0.05) was induced, and reprogrammed fibroblasts were differentiated into chondrogenic and osteogenic lineages. Immunohistochemistry positivity for OCT4 was detected in treatment II. In summary, we showed that dermal fibroblasts of pampas cat can be reprogrammed into cells with multipotent characteristics, particularly when a cocktail of 5-azacytidine + VitC + A8301 + PDFG was used. Treatment I probably failed because of other growth factors and proteins present in PRP, which might inhibit successful reprogramming or activate other pathways leading to a nonmultipotent phenotype. Further refinements of these protocols are required to improve the reprogramming protocol. This in turn should help us obtain cells that can be used in nucleus transfer or cellular therapies in endangered felid species.

210 Horse allogeneic mesenchymal stem cells perform homing and ameliorate endometrial inflammation after induced endometritis of mares

Post-mating induced endometritis (PMIE) is an acute inflammatory response of the endometrium to spermatozoa, linked to an incapability of some mares to drain out the fluids associated with inflammation. This is of pivotal importance for reproductive success in mares. Mesenchymal stem cells (MSCs) are potential candidates for anti-inflammatory uterine therapies. Here, we aimed to study inflammatory markers in the endometrium of healthy mares and of those with induced endometritis, before and after intrauterine inoculation of MSCs, and to characterise their homing potential invivo in an induced endometritis horse model. Nine mares during their ovulatory season were selected after gynaecologic examination (absence of free liquid in the uterus, no polymorphonuclear leucocytes (PMNs) at cytology, negative bacteriology, and grade I in Kenney's scale on uterine biopsies). Mares were infused in the uterine body with 2mL of 500×106 spermmL−1 previously killed by repeated frozen-thawing cycles. At 3h, uteri were flushed with 250mL of sterile saline and the inflammatory response was monitored in the lavages and biopsies. Parameters measured included cytology, protein expression of inflammatory markers (supernatant) after lavage centrifugation (800×g, 10min), ELISA, and immunostaining for interleukin (IL)-6 and tumor necrosis factor alpha (TNFα). The mares were divided into three groups (3 mares each). Then, 24h after dead sperm challenge, group 1 received intrauterine infusion of 2×107 adipose MSC in 0.9% sterile saline; group 2, received the same amount of endometrial MSCs in the same vehicle; and group 3 received only saline. The volume of infusion in the uterine body was 20mL for all groups. Cells (passage 4) were previously labelled with 10μM Vybrant CFDA SE Cell Tracer Kit (ThermoFisher Scientific). After 48h, the same lavages, biopsies, and measurements as described above were performed. Additional biopsies were taken at Days 10 and 30 after intrauterine infusions. Biopsies were split in two, one for confocal microscopy and the other for quantitative PCR. Endometritis was induced in all mares, as judged by cytology and expression of protein markers of inflammation. After 48h, reduction in IL-6 and TNFα was detected by immunostaining of biopsies and confirmed by ELISA in the lavages, as well as by PCR. Homing was detected in all mares infused with MSC and it persisted at Days 10 and 30 after infusion. No homing was found in the control mares. As a result of these experiments, we conclude that inoculation of MSCs significantly reduced inflammation independently of the origin of the cells (adipose or endometrial). Both types of cells were nested in the endometrium at low quantities, although the number of cells actually detected at fixed time points was not quantified. Overall, we can propose that, given the number of homed cells detected and the marked decrease in inflammatory markers after inoculation of cells, MSCs exert their anti-inflammatory function preferentially by a paracrine mechanism and not necessarily by nesting and proliferation, although both events occur. Funding for this study was provided by Fondecyt 1150757.

Yeast derivatives and wheat germ in the adult diet modulates fecundity in a tephritid pest

Anastrepha fraterculus (Wiedemann), a pest of great economic importance in South America, needs urgently to be controlled by environmentally friendly methods such as the sterile insect technique for which mass rearing of insects is required. Because oogenesis takes place during the adult stage, mass-rearing facilities should provide the females a diet that maximizes egg production at the lowest cost. Accordingly, we investigated the effect of artificial protein sources in the adult diet (yeast derivatives of different cost but with similar amino acids profiles, and the addition of wheat germ) on fecundity. Additionally, we evaluated different ratios of yeast derivatives or wheat germ on ovary maturation, fecundity, and fertility as well as their association with the nutrient content of females. Females fed hydrolyzed yeast and yeast extract attained the highest fecundity level, and those fed brewer's yeast the lowest. Reducing the amount of hydrolyzed yeast, an expensive protein source, in the diet negatively affected fecundity and ovary maturation. Increasing the amount of brewer's yeast, a low-cost protein source, did not favor fecundity. The addition of wheat germ in the adult diet improved fecundity regardless of the yeast derivate considered. Percentage of egg hatch was not affected by the diet. Nutrient content of A. fraterculus females varied according to the adult diet provided and mating status. Our findings provide novel baseline information to understand the role of nutrition on reproductive performance of A. fraterculus females and are discussed in the context of resource allocation. They also provide valuable advances in the search for cost-effective adult diets at fruit fly mass rearing facilities.

Abstract P1-15-19: Carboplatin-addition in neoadjuvant treatment of women with triple negative breast cancer (TNBC): Prognostic value in real-world patients

Background

The addition of carboplatin to an anthracycline/taxane-based chemotherapy(CT) in neoadjuvant setting has been suggested to improve pathological complete response(pCR) in TNBC. However, the impact of pCR in prognosis is unknown. We aim to study the value and feasibility of the addition of carboplatin in neoadjuvant setting.

Methods

Demographic and clinical data of TNBC patients treated with neoadjuvant CT in a comprehensive cancer center between 2010-2018 were retrospectively collected. Two cohorts were defined: one treated with Carboplatin/Paclitaxel followed by dose-dense Doxorrubicin/Cyclophosphamide(CP-AC) and other with AC followed by Docetaxel(AC-D). Median follow-up time was 3.1 and 6.9 years, respectively. pCR was defined as absence of residual invasive tumor in breast/axilla. Survival analysis using Kaplan-Meier method and Cox proportional-hazards model were applied. Statistical significance was set at p&lt;0.05.

Results

One-hundred and sixty patients were enrolled: 78 CP-AC and 38 AC-D. Groups were balanced regarding patients and tumor characteristics with exception of pre-menopausal status, more frequent in CP-AC(68% vs 47%;p=.04). Age at diagnosis was 47(28-76)years, the majority had ECOG 0(92%) ductal carcinomas(82%), clinicalT2/3 stages(76%), grade 3(81%) with lymph node involvement(N+)(57%). 14% had Inflammatory breast cancer(IBC)(CP-AC 14%;AC-D 13%; p=.9).

Neutropenia was the most prevalent adverse event(G3/4: CP-AC 61%;AC-D 16%;p=.02), 12% and 16% of febrile neutropenia(p=.8). G3/4 thrombocytopenia occurred only in CP-AC(6%). Hypersensitivity reactions were more prevalent in CP-AC(19% vs 2.7%;p=.02), majority to paclitaxel, all G1/2. Hospital admission occurred in 12%(CP-AC 13%;AC-D 9%; p=.8). There were no treatment-related deaths. Treatment schedule was complete in 89%(CP-AC 87%;AC-D 92%;p=.5), with 20% dose reductions(CP-AC 25%;AC-D 11%;p=0.9).

pCR was achieved in 42%(CP-AC 50%;AC-D 28%;p=.03). 1- and 3-year disease-free survival(DFS) was 94%/85% for CP-AC and 72%/58% for AC-D(p=.3). Risk of recurrence was higher in IBC(HR 25.1;CI95% 7.7-81.3;p&lt;.0001), N+ disease(HR 3.6;CI95% 1.2-10.5;p=.02) and non-pCR(HR 10.9;CI95% 2.3-52.3,p=.003). N+ disease was associated with higher recurrence only in AC-D(HR 11.7;CI95% 1.3-104;p=.03).

Cancer-related deaths were 20%(CP-AC 10%;AC-D 40%;p=.001). 1- and 2-year overall survival (OS) was 99%/95% for CP-AC and 70%/61% for AC-D(p=.06). N+ disease was associated with higher risk of death in AC-D(HR 6.3;CI95% 1.1-24.6;p=.04). Risk of death was independently associated with IBC(HR 4.1;CI95% 2.1-18.7; p=.001) but not with N+ disease(HR 2.7;CI95% 0.8-9.5;p=.13) or pCR(HR 4.1;CI95% 0.9-19.7;p=.08) although pCR was statistically significant in univariate analysis (1- and 2-year OS 97% vs 92% and 94% vs 86% for pCR and non-PCR;p=.003).

Conclusions

Carboplatin addition clearly increased pCR with a trend to DFS and OS benefit. This regimen was associated with more, nevertheless manageable, adverse events with most of the patients able to tolerate and complete the full-dose regimen. Though we did not find a subgroup of patients that benefit with carboplatin regimen, we should consider avoiding AC-D at least in N+ disease.

Citation Format: Coelho S, Abreu MH, Sales C, Lopes AR, Sousa MF, Couto R, Pousa I, Ferreira A, Ferreira M, Vieira C, Leal C, Castro F, Sousa S, Pereira D. Carboplatin-addition in neoadjuvant treatment of women with triple negative breast cancer (TNBC): Prognostic value in real-world patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-19.

First assessment of the potential introduction by hunters of eastern cottontail rabbits (Sylvilagus floridanus) in Spain

Context Humans have introduced lagomorph species in areas outside their native ranges for their meat, fur or value as game species. Assessing the rate of success of lagomorph introductions is vital to address the ecological damage they may cause. Cases of failed lagomorph introductions in apparently suitable areas may also shed light on mechanisms that may deter invasion, which are useful in developing strategies for population control. In Spain, it has been suggested that hunters introduced the non-native eastern cottontail (Sylvilagus floridanus) to compensate for the recent drastic declines of the native European rabbit (Oryctolagus cuniculus). Aims Our main goals were to investigate (1) whether Sylvilagus rabbits have indeed been introduced by hunters across Spain, and (2) whether the species has become established in Spanish ecosystems. Methods We interviewed 311 hunters or naturalists across Spain. The questionnaires inquired about the characteristics of game management in each locality, including the frequency of rabbit restocking, and particularly whether Sylvilagus rabbits had been released in the surveyed localities. In addition, we sampled 192 rabbit populations (n=3974 individuals) across Spain by using molecular analysis to determine whether Sylvilagus rabbits were present in these areas. Key results Our interview results suggest that Sylvilagus rabbits may have been released in 6% of the 311 localities surveyed. However, molecular analyses failed to confirm their persistence, because all samples belonged to O. cuniculus. Conclusions We infer that Sylvilagus rabbits failed to establish themselves in Spain, although interviewees reported their introduction. Several reasons may explain the unsuccessful establishment of this species, such as a low propagule pressure, competition with native species, predation, inability to cope with local pathogens and unsuitable climatic conditions. Implications The risk of future introductions of non-native game species can be reduced through the implementation of stricter regulations of animal releases into the wild. Long-term monitoring networks should be developed to help identify non-native game species before they become established and spread to neighbouring areas, thereby preventing any ecological or economic impacts these species may cause.

Gravity-driven soap film dynamics in subcritical regimes

We undertake the analysis of soap-film dynamics with the classical approach of asymptotic expansions. We focus our analysis in vertical soap film tunnels operating in subcritical regimes with elastic Mach numbers M(e)=O((10(-1))). Considering the associated set of nondimensional numbers that characterize this flow, we show that the flow behaves as a two-dimensional (2D) divergence free flow with variable mass density. When the soap film dynamics agrees with that of a 2D and almost constant mass density flow, the regions where the second invariant of the velocity gradient is non-null correspond to regions where the rate of change of film thickness is non-negligible.

The role of targeted BRCA1/BRCA2 mutation analysis in hereditary breast/ovarian cancer families of Portuguese ancestry

We report the analysis of altogether 1050 suspected hereditary breast/ovarian cancer (HBOC) families, 524 fully screened for BRCA1/BRCA2 mutations and 526 tested only for the most common mutations. Of the 119 families with pathogenic mutations, 40 (33.6%) had the BRCA2 c.156_157insAlu rearrangement and 15 (12.6%) the BRCA1 c.3331_3334del mutation, the former being specific of Portuguese ancestry and the latter showing a founder effect in Portugal. Interestingly, the two most common mutations were found in a significant proportion of the HBOC families with an a priori BRCAPRO mutation probability <10%. We recommend that all suspected HBOC families from Portugal or with Portuguese ancestry, even those fulfilling moderately stringent clinical-criteria for genetic testing, should be specifically analyzed for the two most common BRCA1/BRCA2 founder mutations, and we here present a simple method for this first tier test. Screening of the entire coding regions of BRCA1 and BRCA2 should subsequently be offered to those families with a mutation probability ≥10% if none of those founder mutations are found.

Changes in iron transporter divalent metal transporter 1 in proximal jejunum after gastric bypass

AIM: To describe the variation that divalent metal transporter 1 (DMT1) shows in patients after Roux-en-Y gastric bypass (RYGB) surgery.

METHODS: Prospective and analytical study of DMT1 level at the brush border of proximal jejunum in patients having undergone RYGB surgery. The mucosa of proximal jejunum forming the gastrojejunal anastomosis was biopsied during surgery and after 6 mo later with an endoscopic biopsy. All the patients received precise instructions regarding feeding and nutritional supplementation. Both samples were processed at the same time by immunohistochemistry and western blot. Samples were analysed by a pathologist. For statistical analysis, the χ² and Wilcoxon tests were used.

RESULTS: Sixteen patients were recruited, 13 of whom completed the study. Twelve were women. Average age and body mass index (BMI) were 44.1 and 40.4, respectively. Both body weight and BMI decreased significantly during the study period, with an average percent excess weight loss (%EWL) of 60% ± 13.3% and an average percent excess BMI loss (%EBMIL) of 79.6% ± 21.6%. Only two patients presented with mild anaemia 6 mo after surgery, but their ferritin levels stayed within normal ranges. Staining for DMT1 showed a significant increase in the cytoplasm of enterocytes located at the tips of the villi (χ² = 6.03; P = 0.049). Nevertheless, the total quantity of DMT1 decreased significantly (Z = 2.04; P = 0.04). Associated with these results, we observed a significant increase in goblet cells in the villi 6 mo postoperatively (Z = -2.47; P = 0.013).

CONCLUSION: Six months after RYGB surgery, patients exhibit an increase in DMT1 expression in the enterocytes of the tips of the villi at the proximal jejunum.

Widespread exposure to Sarcoptes scabiei in wild European rabbits (Oryctolagus cuniculus) in Spain

Sarcoptic mange was recently described in the wild European rabbit (Oryctolagus cuniculus) in north-eastern Mediterranean Spain, the first such infection reported in this species anywhere in the world. This finding has created concern in conservationists and game managers given that an outbreak of mange after a translocation would have catastrophic consequences for naïve rabbit populations in other parts of Spain. A retrospective serosurvey using an 'in house' ELISA test based on the use of a recombinant antigen aimed at determining the rates of contact with Sarcoptes scabiei was carried out on sera from 966 rabbits collected between 1993 and 2010 in Spain. Antibodies were found in 13% of wild rabbits in 60% of the 53 areas surveyed, as well as in 16 of the 17 Spanish provinces and islands studied. Seropositive rabbits were found amongst the oldest samples analyzed and in all studied years. Antibodies were also detected in 36% of rabbits from the protected island of Dragonera, where rabbits have probably not been released since the 1970s. On Mallorca, where 89 rabbits were inspected for both lesions and antibodies, the prevalence of lesions (5.6%) was much lower than the seroprevalence (22.5%), indicating that rabbits often survive infection or that ELISA detects infected rabbits before they develop visible lesions. Seroprevalence was higher in areas with medium levels of rabbit abundance, no restocking and high rainfall. The results show that mange is widespread in rabbits and that the mite is not a recent introduction. Thus, sarcoptic mange could be considered as an enzootic disease in the wild rabbit and so prophylactic measures implemented during rabbit translocations are to be encouraged to avoid local outbreaks in naïve populations.

Mage-b vaccine delivered by recombinant Listeria monocytogenes is highly effective against breast cancer metastases

New therapies are needed that target breast cancer metastases. In previous studies, we have shown that vaccination with pcDNA3.1-Mage-b DNA vaccine is effective against breast cancer metastases. In the study presented here, we have further enhanced the efficacy of Mage-b vaccination through the improved delivery of the vaccine using recombinant Listeria monocytogenes (LM). Three overlapping fragments of Mage-b as well as the complete protein-encoding region of Mage-b have been expressed as a fusion protein with a truncated non-cytolytic form of listeriolysin O (LLO) in recombinant LM. These different Mage-b vaccine strains were preventively tested for their efficacy against breast cancer metastases in a syngeneic mouse tumour model 4T1. The LM-LLO-Mage-b/2nd, expressing position 311–660 of the cDNA of Mage-b, was the most effective vaccine strain against metastases in the 4T1 mouse breast tumour model. Vaccination with LM-LLO-Mage-b/2nd dramatically reduced the number of metastases by 96% compared with the saline group and by 88% compared with the vector control group (LM-LLO), and this correlated with strong Mage-b-specific CD8 T-cell responses in the spleen, after restimulation with Mage-b. However, no effect of LM-LLO-Mage-b/2nd was observed on 4T1 primary tumours, which may be the result of a complete absence of Mage-b-specific immune responses in the draining lymph nodes. Vaccination with LM-LLO-Mage-b/2nd could be an excellent follow-up after removal of the primary tumour, to eliminate metastases and residual tumour cells.

The effect of exclusion of terrestrial predators on short-term survival of translocated European wild rabbits

Many translocation methods have been tested in southern Europe in recent decades to increase the translocation success of the European wild rabbit (Oryctolagus cuniculus L.) for both conservation and game purposes. The main problem experienced during such translocations is the high short-term (7 days) mortality attributed to predation during the days immediately following rabbit release. In this study, we test the effect of the exclusion of terrestrial predators on the survival of translocated rabbits for recovery purposes. Four translocation plots (4 ha with 18 artificial warrens each) were constructed, two of them with a fence to exclude terrestrial predators. In all, 724 rabbits were released to the translocation plots in five batches and forced to remain inside warrens for 7 days. Following liberation, exclusion of predators did not increase rabbit survival in the short term. Contrary to expectations, three months after release, survival of rabbits in the unfenced plot was slightly, but not significantly, higher than in the fenced plot (0.57 and 0.40 respectively). Although predator control is a frequent management practice associated with rabbit translocations, our results suggest that it may not favour rabbit survival rate as much as the adaptation of rabbits to the release site.