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NfL and GFAP in serum are associated with microstructural brain damage in progressive multiple sclerosis. Mult Scler Relat Disord 2023; 77:104854. [PMID: 37418931 DOI: 10.1016/j.msard.2023.104854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/04/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The potential of neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) as biomarkers of disease activity and severity in progressive forms of multiple sclerosis (MS) is unclear. OBJECTIVE To investigate the relationship between serum concentrations of NfL, GFAP, and magnetic resonance imaging (MRI) in progressive MS. METHODS Serum concentrations of NfL and GFAP were measured in 32 healthy controls and 32 patients with progressive MS from whom clinical and MRI data including diffusion tensor imaging (DTI) were obtained during three years of follow-up. RESULTS Serum concentrations of NfL and GFAP at follow-up were higher in progressive MS patients than in healthy controls and serum NfL correlated with the EDSS score. Decreasing fractional anisotropy (FA) in normal-appearing white matter (NAWM) correlated with worsening EDSS scores and higher serum NfL. Higher serum NfL and increasing T2 lesion volume correlated with worsening paced autitory serial addition test scores. In multivariable regression analyses with serum GFAP and NfL as independent factors and DTI measures of NAWM as dependent factors, we showed that high serum NfL at follow-up was independently associated with decreasing FA and increasing MD in NAWM. Moreover, we found that high serum GFAP was independently associated with decreasing MD in NAWM and with decreasing MD and increasing FA in cortical gray matter. CONCLUSION Serum concentrations of NfL and GFAP are increased in progressive MS and are associated with distinct microstructural changes in NAWM and CGM.
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Untangling the role of social relationships for overcoming challenges in local food systems: a case study of farmers in Québec, Canada. AGRICULTURE AND HUMAN VALUES 2022; 40:141-156. [PMID: 35911633 PMCID: PMC9315838 DOI: 10.1007/s10460-022-10343-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Advocates for re-localizing food systems often encourage consumers to support local farmers and strengthen local food economies. Yet, local food systems hinge not only on consumers' willingness to buy local food but also on whether farmers have the social support networks to address diverse challenges during food production and distribution. This study characterizes the challenges and support systems of farmers selling to local markets in Québec, Canada, across multiple growing seasons using a mixed-methods research design. We sent an online questionnaire to 1046 farmers and conducted follow-up interviews with 15 of the 133 respondents. Our findings show that farmers relied on an average of four support actor groups, particularly employees, customers, and other farmers. Actors played distinct roles in terms of the importance, frequency, and formality of interactions, providing immediate and long-term support through formal and informal relationships across multiple spatial scales (farm, local community, and regional/international). Our thematic analysis showed that support actors helped farmers in four key domains: (1) Knowledge sharing and emotional support; (2) Labour and workforce; (3) Material and financial aid; and (4) Consumer education and business promotion. Farmer associations provided resources to tackle various challenges, acting as bridges across multiple support actor groups. Yet, our results suggest that political desires to encourage local food systems are in some cases poorly matched with resources to address specific types of challenges farmers face. Specifically, overlooking the role of diverse social support actors in helping farmers build food production and distribution capacity could undermine efforts to foster localization. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10460-022-10343-0.
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POS0199 DETECTION OF SARS CoV-2 ANTIBODIES FOLLOWING VACCINATION IN PATIENTS WITH RHEUMATIC MUSCULOSKELETAL DISEASE (DECODIR) – AN INTERIM REPORT FROM A DANISH PROSPECTIVE COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundDuring the COVID-19 pandemic, it remains a major concern whether patients with rheumatic musculoskeletal disease treated with conventional (cs) or biologic (b) disease modifying drugs (DMARDs) exhibit an adequate immune response to the currently available SARS-CoV2 vaccines. There remains an urgent need for more data on SARS-CoV-2 vaccine efficacy to inform healthcare providers on the efficiency of the applied vaccination, potential need of and period for booster and/ or re-vaccination.ObjectivesTo assess and compare the efficacy of the SARS-CoV2 vaccines BNT162b2 vaccine (Pfizer/BioNTech) and mRNA-1273 vaccine (Moderna). (The vaccines were administered as part of the Danish vaccine roll out and offered each with two doses and approximately four weeks apart).Patients’ SARS-CoV2 IgG serum level was used as proxy to determine vaccination response.MethodsWe established the ‘Detection of SARS-CoV2 antibodies in Danish Inflammatory Rheumatic Outpatients’ study (DECODIR) as a longitudinal prospective cohort study. Patients with rheumatoid arthritis (RA), spondyloarthropathies (SpA) or psoriatic arthritis (PsA) receiving their outpatient treatment and monitored in the Danish DANBIO registry at the Danish Hospital for Rheumatic Diseases (DG), Sonderborg were included (April - June 2021).Bloods, patient reported outcome measurements (PROMS), clinical data and treatment information (cs/bDMARD) were collected at baseline (prior to vaccination) and after six weeks and six months. SARS-CoV2 IgG levels in serum were assessed by ELISA (ThermoFischer), and manufacturer’s cut-off (>=10 EliA U/mL) selected as definition of sufficient IgG response.Associations between antibody response, age, gender, disease (RA/PsA/SpA), treatment with no or cs/bDMARDs and disease activity were tested using proportional odds regression and bootstrapped tests of medians. Results were reported using mean, median (IqR) and bootstrapped 95% confidence interval (CI) of the median.ResultsA total of 243 patients were included at baseline and after six weeks; at six months’ follow-up data were available for 233 patients.After six weeks, vaccination was followed by a significant increase in IgG levels (median of <0.7 EliA U/mL at baseline versus 36.5 EliA U/mL). Patients treated with a combination of both cDMARD and bDMARD had significantly lower IgG levels compared to patients without any DMARD treatment (8,2 EliA U/mL vs 19.5 EliA U/mL (p<0.001)). Patients treated with oral prednisolone (any dose) also showed significantly lower median IgG levels compared to patients without DMARD treatment (3,8 EliA U/mL vs 19.5 EliA U/mL (p<0.01)).The actual measurements six months after baseline demonstrated a significant decrease of IgG levels for the whole study population (median of 16 EliA U/mL at six month vs 36.5 EliA U/mL at six weeks, p < 0.001) (Figure 1).Figure 1.IgG-level stratified by treatmentSimilar to week 6, lowest response rates were found in patients treated with prednisolone or combination of csDMARD and bDMARD. After 6 months, the proportional odds model revealed significantly lower median IgG antibody level in patients who received Pfizer compared to Moderna (median 15 EliA U/mL (95%CI: 13-18) vs 44.5 EliA U/mL (95%CI: 36-83) (p<0.001).ConclusionIgG levels decreased markedly six months after the initial double dose regimen. Patients treated with a combination of cs/bDMARD or oral prednisolone are at higher risk of inadequate vaccine response as measured by IgG level.Our results support the decision for the need of a third booster vaccine in patients with inflammatory rheumatic diseases, especially in the case of cs/bDMARD combination treatment and prednisolone. The data may indicate a need for further revaccination in these patients.Reference[1]Schreiber K. et al. Reduced Humoral Response of SARS-CoV-2 Antibodies following Vaccination in Patients with Inflammatory Rheumatic Diseases— an Interim Report from a Danish Prospective Cohort Study. Vaccines 2022, 10(1), 35.AcknowledgementsWe acknowledge all patients contributing to the DANBIO registry. The DanishRheumatologic Biobank is acknowledged for handling and storage of biological material. Lab technician Charlotte Drachmann is acknowledged for her assistanceDisclosure of InterestsChristine Graversgaard: None declared, Karen Schreiber Consultant of: UCB Advisory Board, Randi Petersen: None declared, Henning Jakobsen: None declared, Anders Bo Bojesen: None declared, Niels Steen Krogh: None declared, Bente Glintborg Grant/research support from: AbbVie, BMS, Pfizer, Merete Lund Hetland Grant/research support from: AbbVie, Biogen, BMS, Celtrion, Eli Lilly Denmark A/S, Janssen Biologics B.V, Lundbeck Fonden, MSD, Pfizer, Roche, Samsung Biopis, Sandoz. MLH chairs the steering committee of the Danish Rheumatology Quality Registry (DANBIO), which receives public funding from the hospital owners and funding from pharmaceutical companies. MLH co-chairs EuroSpA, which generates real-world evidence of treatment of psoriatic arthritis and axial spondylorthritis based on secondary data and is partly funded by Novartis., Oliver Hendricks Grant/research support from: AbbVie, Novartis, Pfizer
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AB0458 DISEASE ACTIVITY AT CONCEPTION PREDICTS LUPUS FLARE UP TO 2 YEARS AFTER BIRTH: A MULTICENTRE LONG TERM FOLLOW-UP STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSystemic lupus erythematosus (SLE) often affects women in their childbearing years, and pregnancy may affect SLE disease activity during pregnancy and post-partum (1,2). Limited data assessing the likelihood and characteristics of SLE activity in an extended time period post-partum which may be relevant as patients may wish further pregnancies exist.ObjectivesTo assess predicting factors that might influence SLE disease activity in women in an extended follow-up period of 2 years after giving birth and clinical assessment every three months.MethodsThe study was design as an international retrospective, data-driven case collection study, enrolling 119 women with a first birth and with a strictly monitored follow-up period of 2 years.ResultsTable 1 shows pregnancy outcomes of all pregnancies. When considering disease manifestations, joint involvement was present in 80% of patients, acute cutaneous in 64%, haematological in 54%and renal in 41%; 75% of patients were positive for anti-dsDNA, 49% for anti-ENA and 37% for anti-Ro/SSA positive. The mean SLE disease activity index 2000(SLEDAI-2k) at diagnosis was 13.5±6.8 and at first birth was 2.8±4.4.Table 1.Pregnancy outcomes of all pregnancies and relative breastfeeding dataPregnancy CharacteristicsAll (214)%OutcomesLive births16979Miscarriages3717.3Stillbirths83.7Maternal and Foetal ComplicationsPrematurity3918.2Pre-eclampsia2310.7HELLP syndrome41.9Placental Infarction125.6Breastfeeding (all pregnancies)Any breastfeeding (n, %)10964.5*Exclusive breastfeeding (n, %)8751.5*Breastfeeding (after first birth)Any breastfeeding (n, %)8773.1**Any breastfeeding duration (months) (m±sd)10.29±10.04Exclusive breastfeeding*** (n, %)6252.1**Exclusive breastfeeding*** duration (months) (m±sd)6.07±6*Percentages are calculated considering viable babies (total= 169)**Percentages are calculated considering first birth (total= 119)***Exclusive breastfeeding was defined as feeding infants only breast milkAt follow-up, 51.3% of patients had at least one flare after a mean time after birth of 9±6.3 months(mean flare per patient 0.94±1.1). The most frequent flare manifestations were joint involvement(48%), followed by renal(33%), cutaneous(28%) and haematologic(20%).Patients with remission of disease(SLEDAI-2K=0; no clinical or laboratory manifestations of SLE) at conception had significantly lower rates of flares than those not in remission (18/49–37% vs. 43/70–61%;p=0.008) (Figure 1).Figure 1.Flare proportion: Survival Curve based on remission status at conception of the patients included in the study.Patients who experienced a flare during pregnancy (17 patients), when compared to those who did not, had higher rates of flares during follow-up (76% vs. 47%, respectively, p=0.019), lower time for first flare (4.4±2.3 months vs. 10.3±6.5, respectively, p<0.001), lower rate of remission of disease at conception (12% vs. 46%, respectively, p<0.001), lower rates of SLEDAI 2K at conception (5.9±5.6 vs. 2.3±4, respectively, p<0.001) and lower rates of exclusive breastfeeding (24% vs. 57%, respectively, p=0.009).Remission of disease and flares during pregnancy remained significantly associated with the development of flares during follow-up after multivariate analysis.ConclusionRemission at conception can influence SLE disease positively, even at long-term. Planned pregnancy counseling is fundamental when managing SLE patients.References[1]Tincani A, Nalli C, Khizroeva J, Bitsadze V, Lojacono A, Andreoli L, et al. Autoimmune diseases and pregnancy. Best Pract Res Clin Endocrinol Metab 2019;33.[2]Clowse MEB, Magder LS, Witter F, Petri M. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum 2005;52:514–521.Disclosure of InterestsNone declared
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OP0211-HPR EXPERIENCES DURING THE COVID-19 PANDEMIC AMONG PEOPLE WITH INFLAMMATORY ARTHRITIS. “REOPENING OF SOCIETY IS HARDER THAN LOCK-DOWN” - A QUALITATIVE INTERVIEW STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPeople with inflammatory arthritis (IA) treated with conventional or biological immunosuppressive disease-modifying anti rheumatic drugs (DMARDs), were initially considered to have an increased risk of severe illness from SARS-CoV-19 (COVID-19) infection compared to the general population. Although resent studies have not confirmed this, people with IA have reported high level of anxiety and self-isolation during the pandemic (1). Only few studies have qualitatively explored how people with IA experience the impact the COVID-19 pandemic and the SARS-CoV-19 vaccinations.ObjectivesTo explore how people with IA experienced restrictions during the COVID-19 pandemic and the possible impact of vaccination on their protection against COVID-19 and their everyday lives.MethodsSemi-structured in-depth interviews were conducted via telephone or video with 19 people with IA in May – August 2021, shortly after they were enrolled in the national COVID-19 vaccination programme (all Danish citizens >18 years of age invited for SARS-CoV-19 vaccination, free of charge, with timing depending on age and comorbidities). At the same time, society gradually reopened after a complete lock-down. Qualitative content analysis, inspired by Graneheim and Lundman (2), was applied to analyse the data. Two patient research partners were involved in development of the study protocol, an interview guide and in the interpretation of findings.ResultsThe participants’ age ranged from 21 to 64 years, median 50 years. 7 male and 12 female, all diagnosed with IA (Psoriatic arthritis n=4, Axial Spondyloarthropathy n=4, Rheumatoid arthritis n=9, and Juvenile arthritis n=2) and 14 were treated with DMARDs. Two had not accepted vaccination.The analysis derived five themes: 1: “Changing and divergent information”. The participants experienced there was an overload of general information to the public, while targeted information on the specific risk for people with IA was lacking; 2: “Individual interpretation of own risk”, reflecting that participants had to find their own level of daily-life restrictions, a task they found to be very difficult; 3: “Impact on everyday life”. They took self-imposed precautions to protect themselves and their families from attracting COVID-19; 4: “Position in society and the vaccination programme”, emphasizing that participants were affected by the inconsistent announcements from authorities whether they were considered to be in particular risk or not, and some expressed concerns regarding the DMARDs influence on the effect of the vaccine and 5: “Reopening is somehow harder than lock down”. A societal spirit of being “in this together” emerged through the lock-down and some were concerned that fewer restrictions during reopening of the society would put them in higher risk of a COVID-19 infection and force them to continue self-isolation.Table 1.Quotation to illustrate the findings“… you felt like one in the crowd and then everything is easier. Even though it was difficult. But then; it was difficult for all of us. It had nothing to do with my rheumatic disease… we were in this together... But it was harder when the reopening started. Because it´s like; I’m back on the platform and can’t just jump on the train, can’t go anywhere, that is...I’m just not quite ready to jump into society like everyone else...”ConclusionThe COVID-19 pandemic affected the everyday lives of people with IA due to the authorities’ restrictions and further self-imposed precautions throughout lock down and reopening of society. People with IA experienced a lack of consistent information and felt alone to assess their own SARS-Cov-19 infection risk.References[1]GLINTBORG, B et al. 2021. Self-protection strategies and health behaviour in patients with inflammatory rheumatic diseases during the COVID-19 pandemic. RMD Open, 7.[2]GRANEHEIM, U. H. & LUNDMAN, B. 2004. Qualitative content analysis in nursing research. Nurse Educ Today, 24, 105-12.Disclosure of InterestsNone declared
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Diverse adaptation strategies helped local food producers cope with initial challenges of the Covid-19 pandemic: Lessons from Québec, Canada. JOURNAL OF RURAL STUDIES 2022; 90:124-133. [PMID: 35185273 PMCID: PMC8841159 DOI: 10.1016/j.jrurstud.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/11/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
The Covid-19 pandemic has demonstrated the vulnerability of food systems to disturbances. Advocates have promoted short food supply chains as more resilient and adaptable thanks to their embeddedness in local economic and ecological networks. As part of a broader case study on challenges facing farmers in local food supply chains in Québec, Canada, we asked farmers about the pandemic's impacts on food production and marketing in the province, including how food producers coped with these challenges. We sent an online questionnaire to 1,046 farmers who distribute food through direct marketing in Québec, identified through consumer-facing online platforms. We conducted follow-up interviews with 15 of the 133 farmers that completed the questionnaire to gain a better understanding of their pandemic-related challenges and opportunities, as well as their adaptation needs and strategies. We identified four main types of challenges among farmers: workforce shortages, balancing food demand and supply, changes in sales outlets and marketing channels, and other operational and development issues. In turn, six key adaptation strategies helped farmers reorganize their marketing and sales, which we categorize as: redistribution, streamlining, replacement, collaboration, farm adjustment, and outlet adjustment. Most surveyed local farmers felt well-prepared to adapt to the four major challenges that the Covid-19 pandemic forged or escalated, and our findings suggest that they demonstrated remarkable resilience to additional challenges posed by the pandemic. Our study therefore contributes important insights about how flexibility and redundancy among local farmers stabilized the local food system during the onset of a global pandemic.
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A bridge over troubled waters: Anti-inflammatory therapy for patients with refractory obstetric antiphospholipid syndrome? Thromb Res 2021; 207:55-57. [PMID: 34547612 DOI: 10.1016/j.thromres.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
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PARE0024 AWARENESS ABOUT FAMILY PLANNING AND PREGNANCY EXPECTATION AMONG PATIENTS WITH CHRONIC INFLAMMATORY DISEASE OF THE SKIN OR JOINTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Patients affected by chronic inflammatory diseases of the skin or joints (CIDs; including psoriasis [PSO], rheumatoid arthritis [RA], juvenile idiopathic arthritis [JIA], psoriatic arthritis [PsA], non-radiographic axial spondyloarthritis [nr-axSpA; reported in the survey as ‘axSpA’], or ankylosing spondylitis [AS]) may be challenged in their attempts to have children. A multinational survey conducted in Europe and the US, including 969 patients, revealed that most patients’ concerns regarding family planning and pregnancy (FPP) were inadequately or inconsistently addressed.1Objectives:To investigate the general level of information on FPP and the potential concerns among Danish patients with CIDs.Methods:An online survey to identify FPP issues was designed, and CID patients aged 18–50 years (yrs) were included. Respondents were recruited through patient organisations providing their members with a link to the questionnaire. In addition to demographics, information relating to time of diagnosis, treatments received, pregnancies, and course of disease were collected along with access to and concerns regarding FPP. Descriptive statistics were applied.Results:Eligible patients included 368 with rheumatological diagnoses (RA, PsA, JIA, nr-axSpA, or AS; 304 [83%] female, mean age: 40 yrs; 64 [17%] male, mean age: 42 yrs) and 95 with dermatological diagnoses (PSO or PsA; 64 [67%] female, mean age: 37 yrs; 31 [33%] male, mean age: 42 yrs). Among the rheumatic patients, 43% of females and 53% of males were currently receiving systemic treatment and 37% of females and 22% of males had received >3 different systemic treatments (other than painkillers and non-steroidal anti-inflammatory drugs [NSAIDs]). Lack of access to FPP information was consistent across age groups, but higher in those with dermatological diagnoses (Table).In total, 68% of patients with rheumatological and 73% with dermatological diagnoses had biological children and among these 18% and 23% of patients, respectively, indicated their disease had affected how many children they had or planned to have. The most frequent concerns among patients with rheumatological diagnoses were the potential physical impact of a pregnancy, disease worsening, heredity and being able to take care of the child (19, 16, 16 and 13%, respectively), whilst disease worsening and heredity (12 and 16%, respectively) were the most frequent concerns in those with dermatological diagnoses. Many patients experienced disease worsening during or after pregnancy (rheumatologic diagnoses: 16% and 34%; dermatologic: 20% and 59%, respectively).Conclusion:Danish CID patients of reproductive age have concerns related both to their disease and to FPP, which affect their decisions around family planning. The majority of patients responding to this survey reported limited access to information about FPP, pointing to a need for healthcare professionals to provide standardised family planning information.References:[1] Chakravarty E. BMJ Open 2014;4:e004081.Table.Thematic analysis and quotesThemeDescriptionQuoteOral-RA linksRA medications caused dry mouthThe medications, really, really are awful on your mouth, in particular prednisone. I get very raw gums… it [was] painful to brush my teeth.We don’t have saliva to wash things away. We have a different mouth floraComplicated oral careTime-demanding oral care routines.Multiple oral health care tools and adaptations used depending on current oral health, and RA activity.The severe pain made it very hard to open my mouth to brush my teeth. The joint damage [makes it] really hard to handle a toothbrush.We have to have toothbrushes with a wide handle… and different attachments when we need them.Even with those [special] products, the pain sometimes was just overwhelming. I’m dedicated about brushing my teeth, but boy, it was a struggle. It took me a long time to brush my teeth.Access to professional oral careLack of dental insurance and costs of careLogistical access: multiple dental visits.Physical access: attending appointments; prolonged sitting in a dental chair.I have a hygienist, and a dentist, and a gum dentist and a bunch of dentists with fancy names. I see them every 3 months.Dental offices have dental hygienists. And some of them are an A+, and some of them are C-…it’s important that hygienists are trained, that they really understand the tools.When I go back in the [dental] chair, it was uncomfortable [when first diagnosed]. I struggled. I couldn’t keep my mouth open.Shame due to oral healthShame relating to poor oral health.Seeking oral care possibly considered unusual for their age.I would feel ashamed. Something’s wrong. Everyone around me has these beautiful teeth. I don’t, and something is wrong.I’m getting braces. At my age, I’m getting braces.Table.Proportion of patients with rheumatological or dermatological diagnoses who reported having little or no access to FPP information, stratified by ageAgeRheumatological diagnosisN (%)Dermatological diagnosisN (%)18–29 yrs19 (49)14 (74)30–39 yrs61 (58)16 (73)40–50 yrs134 (60)34 (63)Acknowledgments:This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.Disclosure of Interests:Karen Schreiber Consultant of: UCB Pharma (Advisory Board), Caecilie Johansen Consultant of: UCB Pharma (Advisory Board), Ulla-Fie Jensen Consultant of: UCB Pharma (Advisory Board), Employee of: UCB Pharma, Alexander Egeberg Grant/research support from: Pfizer, Eli Lilly, Novartis, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation and the Kgl Hofbundtmager Aage Bang Foundation, Consultant of: UCB Pharma (Advisory Board), Speakers bureau: AbbVie, Almirall, Leo Pharma, Samsung Bioepis Co. Ltd., Pfizer, Eli Lilly, Novartis, Galderma, Dermavant, UCB Pharma, Mylan, Bristol-Myers Squibb and Janssen Pharmaceuticals, Simon F. Thomsen Grant/research support from: UCB Pharma, AbbVie, Novartis, Sanofi, Leo Pharma, and Janssen Pharmaceuticals, Consultant of: UCB Pharma (Advisory Board), AbbVie, Novartis, Sanofi, Eli Lilly, Roche, Janssen Pharmaceuticals, Pfizer, Celgene, Leo Pharma, Almirall, Speakers bureau: UCB Pharma, AbbVie, Novartis, Sanofi, Eli Lilly and Leo Pharma, Asbjorn L Hansen Consultant of: UCB Pharma (Advisory Board), Employee of: UCB Pharma, Trine Bay Laurberg Consultant of: UCB Pharma (Advisory Board), Lone Skov Grant/research support from: Pfizer, AbbVie, Novartis, Sanofi, Janssen Pharmaceuticals, and LEO Pharma, Consultant of: UCB Pharma (Advisory Board), AbbVie, Janssen Pharmaceuticals, Novartis, Eli Lilly, LEO Pharma, Almirall, and Sanofi, Speakers bureau: AbbVie, Eli Lilly, Novartis, and LEO Pharma. Investigator for AbbVie, Janssen Pharmaceuticals, Boehringer Ingelheim, AstraZeneca, Eli Lilly, Novartis, Regeneron, and LEO Pharma, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma
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THU0050 CXCL13 IS A KEY DRIVER FOR MIGRATION AND DIFFERENTIATION OF REGULATORY B CELLS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Regulatory B cells in human still need to be characterized. Given the absence of a phenotypical definition of these cells, a functional definition based on their ability to secrete IL-10 is often used (corresponding to B10+ cells). Chemokine receptors (CKR) profiles are useful to characterize some populations of T cells but have never been explored among B10+cells. Moreover, very little is known about B10+cell migration. Chemokines (CK) have also been implicated in the differentiation of naïve T cells towards regulatory T cells.Objectives:Therefore, the aims of our study were to first characterize the profile of CKR on B10+cells, and second to investigate CK implicated in their migration and differentiation, this, both in control (CTL) and in patients with rheumatoid arthritis (RA).Methods:B cells were isolated with Rosette Sep Human B cells enrichment followed by Ficoll separation. B cells were then activated 24 hours with CpG and CD40L to generate B10+cells. IL-10 secretion from B cells was assessed by FACs and ELISA. We compared the expression of several CKR between B10+and IL-10negB cells (B10neg) from CTL and RA patients by flow cytometry. For migration assay, B10+and B10negcells were sorted by FACSaria. Their ability to migrate, in response to ligand of CKR found differentially expressed in the first part (CCL21, CCL22, CXCL11, CXCL12 or CXCL13) or synovial fluid (SF) from RA patients, were evaluated by migration assay in 5μM Transwell chambers and expressed as fold increase compare to basal migration towards control media.Results:B10+cells expressed a different profile of CKR compared to B10negboth in CTL and RA patients and these profiles differed between B10+cells of CTL and RA patients. However, no CKR profile could phenotypically define B10+cells. Of note, CXCR5 was under-expressed on B10+cell surface compared to B10negin CTL (75% [IQR 72.9-81.4] positive cells among B10+vs 99.2% [98.4-99.4] positive cells among B10neg, p=0.006, n=10) and also in RA patients (78.3% [70.8-82.3] vs 98.2% [96.9-99.54, p=0.008, n=8). Nevertheless, mRNA expression of CXCR5 was higher among B10+versus B10negcells in CTL and RA patients. As CpG-stimulated cells over-expressed CXCL13, ligand of CXCR5, we hypothesized that the binding of its ligand induced the internalisation of CXCR5. Indeed, among all CK tested, only CXCL13, attracted significantly more B10+than B10negfrom CTL (9.1[5.6-14.6] fold increase migration of B10+vs 5.2 [3.1-7.5] fold increase migration of B10neg, p<0.0001, n=21). This was also true in RA patients (10.9 [3.6-29.9] fold increase migration of B10+vs 4.8[2.1-7.7] fold increase migration of B10neg, p=0.009, n=12). SF from RA patients induced a significant migration of B10+cells in CTL (7.3-fold increase [4.1-21.7], p=0.004, n=9) and RA patients (5.7-fold increase [2.3-7.9], p=0.008, n=10). This migration was correlated with the levels of CXCL13 in these SF, in CTL (r=0.7, p=0.05, n=9) but not in RA patients (n=10). Lastly, CXCL13 was also found to increase IL-10 secretion in B cells stimulated with CpG in CTL (1.5-fold increase [1.3-1.5], p=0.0002, n=13) and in RA patients (1.2-fold increase [1.1-1.3], p=0.005, n=12).Conclusion:We showed that CXCL13 is a key driver for migration and differentiation of B10+ cells in CTL and in RA patients. However, the migration of B10+cells in RA patients was not correlated with the level of CXCL13 in SF from RA patients, suggesting the implication of other CK in the migration of B10+cells in RA.Disclosure of Interests:None declared
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Pregnancy success rate and response to heparins and/or aspirin differ in women with antiphospholipid antibodies according to their Global AntiphosPholipid Syndrome Score. Semin Arthritis Rheum 2020; 50:553-556. [PMID: 32089355 DOI: 10.1016/j.semarthrit.2020.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The current treatment to prevent pregnancy morbidity (PM) associated with antiphospholipid antibodies (aPL) is based on the use of low dose aspirin and low molecular weight heparin (henceforth defined as standard of care (SoC) treatment). Despite the SoC, up to 30% of women with aPL continue to have pregnancy complications. The global antiphospholipid syndrome (APS) score (GAPSS) is a tool to quantify the risk for the aPL-related clinical manifestations. In this study, we investigated the individual clinical response to SoC in women with aPL after stratifying them according to their GAPSS. METHODS One-hundred-fourty-three women (352 pregnancies) with aPL ever pregnant treated with SoC therapy were included. The patients GAPSS was then grouped according to the patients' GAPSS into low risk (< 6), medium risk (6-11), and high risk (≥12). RESULTS The live birth rate was 70.5% (248 out of the 352 pregnancies), 45 patients (31%) experienced at least one event of PM, defined as early or late. Patients were stratified according to GAPSS values, in order to identify a low risk group (GAPSS <6, n = 72), a medium risk group (GAPSS 6-11, n = 66) and a high risk group (GAPSS ≥12, n = 5). When considering patients who ever experienced any PM while treated with SoC, all patients in the high risk group experienced PM, while patients in the medium group had a significant higher rate of PM when compared to the low risk group [29 (43.9%) patients V.s. 11 (15.3%), respectively; p < 0.001]. When analysing the number of pregnancies in the three groups, patients in the high risk group had significantly lower live birth rates, when compared to the other groups [11 (40.7%) live births vs. 100 (62.1%) and 137 (82.5%), respectively; p < 0.05]. Furthermore, patients with medium risk group also had significantly lower live birth rates, when compared to the lower risk group (p < 0.001). CONCLUSIONS GAPSS might be a valuable tool for to identify patients with a higher likelihood of response to SoC.
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Abnormal vaginal bleeding in women of reproductive age treated with edoxaban or warfarin for venous thromboembolism: a post hoc analysis of the Hokusai-VTE study. BJOG 2018; 125:1581-1589. [PMID: 29940089 PMCID: PMC6221000 DOI: 10.1111/1471-0528.15388] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 11/28/2022]
Abstract
Objective To investigate the characteristics and outcome of abnormal vaginal bleeding in women receiving edoxaban or warfarin for treatment of venous thromboembolism (VTE). Design and setting Post hoc analysis of the Hokusai‐VTE study, a multicentre, randomised, double‐blind trial comparing edoxaban with warfarin for acute symptomatic VTE. Population Women below 50 years receiving edoxaban or warfarin for treatment of VTE. Methods We collected data on diagnostic measures, treatment, and clinical outcome of abnormal vaginal bleeding events. Main outcome measures Occurrence of major and clinically relevant nonmajor (CRNM) abnormal vaginal bleeding events. Results In all, 628 women aged under 50 years were treated with edoxaban and 665 with warfarin. The rate of abnormal vaginal bleeding was 15/100 person‐years (py) (95% CI 11–19) in women receiving edoxaban and 9/100 py (95% CI 6–12) in the warfarin group (hazard ratio: 1.7, 95% CI 1.1–2.5). Major abnormal vaginal bleeding occurred in eight (1.3%) women on edoxaban and in three (0.9%) women receiving warfarin [odds ratio (OR) 2.8; 95% CI 0.8–10.8], and CRNM abnormal vaginal bleeding occurred in 53 (8.4%) women treated with edoxaban and in 37 (5.6%) on warfarin therapy (OR 1.6, 95% CI 1.0–2.4). Over 85% of all vaginal bleeds were characterised by heavy menstrual bleeding. Major bleeds frequently required treatment, and in more than 75% of patients anticoagulant therapy was adjusted. The severity of clinical presentation and course of major and CRNM bleeds was mild in most patients. Conclusions Abnormal vaginal bleeding occurred more frequently in women treated with edoxaban than with warfarin. Reassuringly, most events could be managed conservatively and had a mild outcome. Tweetable abstract Abnormal vaginal bleeding occurred more frequently in women treated with edoxaban than with warfarin. Abnormal vaginal bleeding occurred more frequently in women treated with edoxaban than with warfarin.
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Abstract
Summary
Aim: Evaluation of F-18-FDG-hybrid-camera-PET imaging in patients with undetermined postoperative fever (POF). Methods: Prospective study of 18 patients (9 women, 9 men; age 23-85 years) suffering from POF with 2-fluoro-2’-deoxyglucose (F-18-FDG) using a dual headed coincidence camera (DHCC). Surgery had been performed 5-94 days prior to our investigation. 13 of the 18 patients received antibiotic therapy during the time of evaluation. Ten (55%) had an infectious and eight (45%) a non infectious cause of fever. Results: Increased F-18-FDG-uptake outside the surgical wound occurred in 13 regions (infection n = 11, malignancy n = 2). The sensitivity of F-18-FDG-hybrid-camera-PET in imaging infection in areas outside the surgical wound was 86% and the specificity 100%, respectively. Antibiotic therapy did not negatively influence the results of F-18-FDG-scanning. Increased F-18-FDG-uptake within the surgical wound was seen in 8 of 18 patients. The sensitivity of F-18-FDG-hybrid-camera-PET in imaging infection within the surgical wound was 100% and the specificity 56%, respectively. The interval between surgery and F-18-FDG-scanning was significantly shorter in patients with false positive results compared with patients showing true negative results (median 34 vs. 54 days; p = 0,038). Conclusion: In POF-Patients, F-18-FDG transaxial tomography performed with a F-18-FDG-hybrid-camera-PET is sensitive in the diagnosis of inflammation and malignant disease within and outside the surgical wound. Because of the accumulation of the tracer both in granulation tissue and infection, the specificity in detecting the focus of fever within the surgical wound is poor.
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Disability in progressive MS is associated with T2 lesion changes. Mult Scler Relat Disord 2017; 20:73-77. [PMID: 29324249 DOI: 10.1016/j.msard.2017.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/17/2017] [Accepted: 12/15/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Progressive multiple sclerosis (MS) is characterised by diffuse changes on brain magnetic resonance imaging (MRI), which complicates the use of MRI as a diagnostic and prognostic marker. The relationship between MRI measures (conventional and non-conventional) and clinical disability in progressive MS therefore warrants further investigation. OBJECTIVE To investigate the relationship between clinical disability and MRI measures in patients with progressive MS. METHODS Data from 93 primary and secondary progressive MS patients who had participated in 3 phase 2 clinical trials were included in this cross-sectional study. From 3T MRI baseline scans we calculated total T2 lesion volume and analysed magnetisation transfer ratio (MTR) and the diffusion tensor imaging indices fractional anisotropy (FA) and mean diffusivity (MD) in T2 lesions, normal-appearing white matter (NAWM) and cortical grey matter. Disability was assessed by the Expanded Disability Status Scale (EDSS) and the MS functional composite. RESULTS T2 lesion volume was associated with impairment by all clinical measures. MD and MTR in T2 lesions were significantly related to disability, and lower FA values correlated with worse hand function in NAWM. In multivariable analyses, increasing clinical disability was independently correlated with increasing T2 lesion volumes and MTR in T2 lesions. CONCLUSION In progressive MS, clinical disability is related to lesion volume and microstructure.
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The risk of ischaemic stroke in primary antiphospholipid syndrome patients: a prospective study. Eur J Neurol 2017; 25:320-325. [PMID: 29082583 DOI: 10.1111/ene.13499] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/20/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE The most common neurological manifestation of antiphospholipid syndrome (APS) is ischaemic stroke. Identifying patients with APS at high risk for developing any thrombotic event remains a major challenge. In this study, the aim was to identify predictive factors of ischaemic stroke in a cohort of primary APS (PAPS) patients who presented with new onset symptoms suggestive of acute stroke. METHODS This prospective multicentre study included 36 consecutive PAPS patients who presented with new onset symptoms suggestive of an acute stroke. Patients were prospectively followed up for 12 months. RESULTS In 10 (28%) out of 36 PAPS patients [mean age 41 years (SD 13.4), 70% female], the suspicion of an acute stroke was confirmed by brain magnetic resonance imaging. Sixty per cent of these patients were <50 years old. Eight of the 10 patients had a history of previous venous thrombosis and were receiving vitamin K antagonist (VKA), with international normalized ratio target 2-3; one patient had a history of a previous arterial event receiving treatment with VKA target international normalized ratio 2-3 plus low dose aspirin; and one patient had a history of previous pregnancy morbidity receiving only low dose aspirin. Time in the therapeutic range for patients receiving VKA was 77.7% (SD 6.6%). Hypercholesterolaemia was significantly higher in patients with confirmed stroke compared to those without (P < 0.05). Similarly, a significantly higher rate of anti-β2 glycoprotein-I (β2GPI) antibodies (immunoglobulin G/immunoglobulin M; P < 0.05) and higher adjusted global APS score (aGAPSS) values were found in patients with a confirmed stroke [mean aGAPSS 8.9 (SD 4.7) vs. mean aGAPSS 6.4 (SD 2.5); P < 0.05]. CONCLUSIONS Patients with PAPS, including young patients, have a high risk of recurrent thrombosis despite anticoagulation treatment. A careful risk assessment is mandatory to identify patients at risk for recurrence.
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(405) Use of a brief, portable bedside quantitative sensory test in mastectomy patients: longitudinal assessment of individual differences in pain sensitivity and prediction of clinical pain. THE JOURNAL OF PAIN 2017. [DOI: 10.1016/j.jpain.2017.02.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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The adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) for risk stratification in young APS patients with acute myocardial infarction. Int J Cardiol 2017; 240:72-77. [PMID: 28385357 DOI: 10.1016/j.ijcard.2017.02.155] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/21/2017] [Accepted: 02/28/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Young adults with acute myocardial infarction are a critical group to examine for the purpose of risk factor stratification and modification. In this study we aimed to assess the clinical utility of the adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) for the risk stratification of acute myocardial infarction in a cohort of young patients with antiphospholipid syndrome (APS). METHODS The analysis included 83 consecutive APS patients (≤50years old) who presented with arterial or venous thromboembolic events. Data on cardiovascular risk factors and antiphospholipid antibodies (aPL) positivity were retrospectively collected. The aGAPSS was calculated by adding the points corresponding to the risk factors, based on a linear transformation derived from the ß-regression coefficient as follows: 3 for hyperlipidaemia, 1 for arterial hypertension, 5 for aCL IgG/IgM, 4 for anti-b2 glycoprotein I IgG/IgM and 4 for LA. RESULTS Higher aGAPSS values were observed in patients with acute myocardial infarction when compared to the others [mean aGAPSS 11.9 (S.D. 4.15, range 4-18) Vs. mean aGAPSS 9.2 (S.D. 5.1, range 1-17); T test: p<0.05]. Significantly higher aGAPSS values were also seen in patients with acute coronary syndrome compared to patients with a history of peripheral or cerebrovascular arterial thrombotic events [mean aGAPSS 11.9 (S.D. 4.15, range 4-18) Vs. mean aGAPSS 6.7 (S.D. 5.7, range 1-17); T test: P<0.005]. CONCLUSIONS The aGAPSS is based upon a quantitative score and could aid risk stratifying APS patients younger than 50years for the likelihood of developing coronary thrombotic events and may guide pharmacological treatment for high-risk patients.
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Oral contraception and menstrual bleeding during treatment of venous thromboembolism: Expert opinion versus current practice: Combined results of a systematic review, expert panel opinion and an international survey. Thromb Res 2017; 153:101-107. [PMID: 28376343 DOI: 10.1016/j.thromres.2017.03.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The optimal management of oral contraception and menstrual bleeding during treatment of venous thromboembolism (VTE) is largely unknown. We aimed to elicit expert opinion and compare that to current practice as assessed by a world-wide international web-based survey among physicians. METHODS 10 international thrombosis experts and 10 abnormal uterine bleeding experts independently completed a questionnaire containing three hypothetical patient cases each with four different scenarios, and additional queries covering different severities of VTE, patient circumstances, hormonal contraceptives and both thrombotic and bleeding complications. The consensus percentage was set a priori at ≥70%. The same questionnaire with randomized case scenarios was presented to international physicians via newsletters of the ISTH and national scientific communities. Differences between the expert groups and daily clinical care were assessed. RESULTS Expert recommendations were divergent and differed in several important points from clinical practice. In contrast to common practice in which contraceptives are discontinued at the moment of a VTE diagnosis, the thrombosis experts agreed to continue oral contraception (OC) during the anticoagulation treatment period. Also, experts reached consensus on treating patients with anticoagulation-associated abnormal uterine bleeding with tranexamic acid, although this is not supported by strong evidence from the literature. No consensus was reached on the optimal anticoagulant drug class. CONCLUSIONS International experts' opinions on handling of contraceptives and management of anticoagulant-associated abnormal uterine bleeding in female VTE patients are divergent and management in clinical practice is heterogeneous. There is a great need of further studies on these topics.
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Pregnancies in women with systemic lupus erythematosus and antiphospholipid antibodies. Lupus 2016; 25:343-5. [DOI: 10.1177/0961203315627201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 12/21/2015] [Indexed: 11/15/2022]
Abstract
Systemic lupus erythematosus (SLE) has preponderance in women in their childbearing years; consequently pregnancy has always been an important issue of concern for the patient and the treating physician. Based upon numerous reports on successful pregnancy outcomes in the past decades, the initial advice against pregnancy in the 1950s has been replaced by a common understanding that women with SLE often have successful pregnancy outcomes, and clinicians therefore advise on pregnancy planning, including possible drug adjustments, timing and close surveillance. The recently published Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus (PROMISSE) study, so far the largest multicentre cohort study of pregnant women with underlying stable SLE, has given some important answers to long-discussed questions. Future studies on data collected from the PROMISSE cohort will hopefully identify serological biomarkers, possibly genes, and in addition, give valuable information about underlying disease mechanisms.
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FRI0093 A Systematic Analysis of the Safety of Prescribing of Anti-Rheumatic, Immunosuppressive and Biologic Drugs in Men Trying to Conceive. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cervical Carcinoma in Early Pregnancy - Successful Birth by Caesarean Section Followed by Radical Hysterectomy. Geburtshilfe Frauenheilkd 2014; 74:284-287. [PMID: 24882879 DOI: 10.1055/s-0033-1360329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/03/2014] [Accepted: 01/09/2014] [Indexed: 10/25/2022] Open
Abstract
A cervical carcinoma was diagnosed in a 32-year-old patient in the 17th week of her pregnancy. The histological confirmation revealed a well-differentiated squamous cell carcinoma. It was a clinical stage Ib1 tumour, without enlarged lymph nodes according to the image. After a staging MRI, intensive education of the patient and case discussion at the interdisciplinary tumour board as well as consultation with the neonatologist, it was agreed to prolong the pregnancy under close monitoring. The carcinoma was confined to the cervix in the further course of the pregnancy. The elective delivery was planned after 32 weeks of gestation. The primary Caesarean section followed by radical hysterectomy Piver II were carried out without complications. After regular postoperative progression of the mother, brachytherapy was performed at the appropriate time. The premature newborn was under neonatal care and exhibited good postnatal adaptation. Mother and child were discharged in good health.
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OP0120 A Systematic Analysis of the Safety of Prescribing Anti-Rheumatic Immunosuppressive and Biologic Drugs in Pregnant Women with Inflammatory Arthritis: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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(315) Pain modulation in chronic pain patients: the relationship of pain sensitivity, pain inhibition, and distraction analgesia. THE JOURNAL OF PAIN 2014. [DOI: 10.1016/j.jpain.2014.01.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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THU0184 Identification of biomarkers in SLE pregnancies using urinary proteomics. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Basic Science * 208. Stem Cell Factor Expression is Increased in the Skin of Patients with Systemic Sclerosis and Promotes Proliferation and Migration of Fibroblasts in vitro. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Human embryonic stem cells and embryonal carcinoma cells have overlapping and distinct metabolic signatures. PLoS One 2012; 7:e39896. [PMID: 22768158 PMCID: PMC3387229 DOI: 10.1371/journal.pone.0039896] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 05/28/2012] [Indexed: 11/17/2022] Open
Abstract
While human embryonic stem cells (hESCs) and human embryonal carcinoma cells (hECCs) have been studied extensively at the levels of the genome, transcriptome, proteome and epigenome our knowledge of their corresponding metabolomes is limited. Here, we present the metabolic signatures of hESCs and hESCs obtained by untargeted gas chromatography coupled to mass spectrometry (GC-MS). Whilst some metabolites are common to both cell types, representing the self-renewal and house-keeping signatures, others were either higher (e.g., octadecenoic acid, glycerol-3-phosphate, 4-hydroxyproline) or lower (e.g., glutamic acid, mannitol, malic acid, GABA) in hESCs (H9) compared to hECCs (NTERA2), these represent cell type specific signatures. Further, our combined results of GC-MS and microarray based gene expression profiling of undifferentiated and OCT4-depleted hESCs are consistent with the Warburg effect which is increased glycolysis in embryonic cells and tumor cells in the presence of O2 while oxidative phosphorylation (OXPHOS) is impaired or even shut down. RNAi-based OCT4 knock down mediated differentiation resulted in the activation of the poised OXPHOS machinery by expressing missing key proteins such as NDUFC1, UQCRB and COX, increase in TCA cycle activity and decreased lactate metabolism. These results shed light on the metabolite layer of pluripotent stem cells and could potentially establish novel metabolic markers of self renewal and pluripotency.
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Progression and CSF Inflammation after Eradication of Oligoclonal Bands in an MS Patient Treated with Allogeneic Hematopoietic Cell Transplantation for Follicular Lymphoma. Case Rep Neurol 2012; 4:101-6. [PMID: 22740825 PMCID: PMC3383234 DOI: 10.1159/000339738] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Allogeneic hematopoietic cell transplantation (allo-HCT) has been proposed as treatment for multiple sclerosis (MS) and other autoimmune diseases. Aims To describe the effects of allo-HCT on the course of MS in a 49-year-old woman with longstanding progressive MS who was treated with allo-HCT for follicular lymphoma. Methods Non-myeloablative conditioning allo-HCT, examination for IgG oligoclonal bands and measurement of CXCL13 and matrix metalloproteinase-9 (MMP-9) concentration in the cerebrospinal fluid (CSF). Results Despite the disappearance of oligoclonal bands in CSF, disease progression and CSF inflammation was observed. Conclusions We hypothesize that CXCL13 and MMP-9 detected in CSF may reflect ongoing, pathogenic immune activation even after the eradication of intrathecal IgG synthesis. This suggests that progressive MS may depend more on innate than on adaptive immune activation.
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Natalizumab Reduces Fatigue as Measured by the Fatigue Scale for Motor and Cognitive Functions (FSMC) - First Results from the TYNERGY Trial (P07.081). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Closely related Campylobacter jejuni strains from different sources reveal a generalist rather than a specialist lifestyle. BMC Genomics 2011; 12:584. [PMID: 22122991 PMCID: PMC3283744 DOI: 10.1186/1471-2164-12-584] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 11/28/2011] [Indexed: 11/22/2022] Open
Abstract
Background Campylobacter jejuni and Campylobacter coli are human intestinal pathogens of global importance. Zoonotic transmission from livestock animals or animal-derived food is the likely cause for most of these infections. However, little is known about their general and host-specific mechanisms of colonization, or virulence and pathogenicity factors. In certain hosts, Campylobacter species colonize persistently and do not cause disease, while they cause acute intestinal disease in humans. Results Here, we investigate putative host-specificity using phenotypic characterization and genome-wide analysis of genetically closely related C. jejuni strains from different sources. A collection of 473 fresh Campylobacter isolates from Germany was assembled between 2006 and 2010 and characterized using MLST. A subset of closely related C. jejuni strains of the highly prevalent sequence type ST-21 was selected from different hosts and isolation sources. PCR typing of strain-variable genes provided evidence that some genes differed between these strains. Furthermore, phenotypic variation of these strains was tested using the following criteria: metabolic variation, protein expression patterns, and eukaryotic cell interaction. The results demonstrated remarkable phenotypic diversity within the ST-21 group, which however did not correlate with isolation source. Whole genome sequencing was performed for five ST-21 strains from chicken, human, bovine, and food sources, in order to gain insight into ST-21 genome diversity. The comparisons showed extensive genomic diversity, primarily due to recombination and gain of phage-related genes. By contrast, no genomic features associated with isolation source or host were identified. Conclusions The genome information and phenotypic data obtained in vitro and in a chicken infection model provided little evidence of fixed adaptation to a specific host. Instead, the dominant C. jejuni ST-21 appeared to be characterized by phenotypic flexibility and high genetic microdiversity, revealing properties of a generalist. High genetic flexibility might allow generalist variants of C. jejuni to reversibly express diverse fitness factors in changing environments.
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Präparative Trennung stereoisomerer Imino-cholestane und weiterer Steroide durch Dünnschicht-Chromatographie unter Verwendung von Jod als indifferentes Nachweisreagens. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/zfch.19630030305] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Detrimental effect of head motion covariates on GLM and multivoxel classification analysis of FMRI data. J Vis 2010. [DOI: 10.1167/10.7.967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Retinal Correspondence and the Theoretical Horopter. J Vis 2010. [DOI: 10.1167/7.15.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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36
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Are the positions of corresponding points adaptive for natural viewing? J Vis 2010. [DOI: 10.1167/8.6.1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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A method for enzyme quenching in microbial metabolome analysis successfully applied to gram-positive and gram-negative bacteria and yeast. Anal Biochem 2009; 394:192-201. [DOI: 10.1016/j.ab.2009.07.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 07/10/2009] [Accepted: 06/14/2009] [Indexed: 10/20/2022]
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Growth phase-dependent global protein and metabolite profiles of Phaeobacter gallaeciensis strain DSM 17395, a member of the marine Roseobacter-clade. Proteomics 2009; 9:3677-97. [PMID: 19639587 DOI: 10.1002/pmic.200900120] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The marine heterotrophic roseobacter Phaeobacter gallaeciensis DSM 17395 was grown with glucose in defined mineral medium. Relative abundance changes of global protein (2-D DIGE) and metabolite (GC-MS) profiles were determined across five different time points of growth. In total, 215 proteins were identified and 147 metabolites detected (101 structurally identified), among which 60 proteins and 87 metabolites displayed changed abundances upon entry into stationary growth phase. Glucose breakdown to pyruvate apparently proceeds via the Entner-Doudoroff (ED) pathway, since phosphofructokinase of the Embden-Meyerhof-Parnas pathway is missing and the key metabolite of the ED-pathway, 2-keto-3-desoxygluconate, was detected. The absence of pfk in other genome-sequenced roseobacters suggests that the use of the ED pathway is an important physiological property among these heterotrophic marine bacteria. Upon entry into stationary growth phase (due to glucose starvation), sulfur assimilation (including cysteine biosynthesis) and parts of cell envelope synthesis (e.g. the lipid precursor 1-monooleoylglycerol) were down-regulated and cadaverine formation up-regulated. In contrast, central carbon catabolism remained essentially unchanged, pointing to a metabolic "stand-by" modus as an ecophysiological adaptation strategy. Stationary phase response of P. gallaeciensis differs markedly from that of standard organisms such as Escherichia coli, as evident e.g. by the absence of an rpoS gene.
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"Hot standards" for the thermoacidophilic archaeon Sulfolobus solfataricus. Extremophiles 2009; 14:119-42. [PMID: 19802714 PMCID: PMC2797409 DOI: 10.1007/s00792-009-0280-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 09/08/2009] [Indexed: 11/24/2022]
Abstract
Within the archaea, the thermoacidophilic crenarchaeote Sulfolobus solfataricus has become an important model organism for physiology and biochemistry, comparative and functional genomics, as well as, more recently also for systems biology approaches. Within the Sulfolobus Systems Biology (“SulfoSYS”)-project the effect of changing growth temperatures on a metabolic network is investigated at the systems level by integrating genomic, transcriptomic, proteomic, metabolomic and enzymatic information for production of a silicon cell-model. The network under investigation is the central carbohydrate metabolism. The generation of high-quality quantitative data, which is critical for the investigation of biological systems and the successful integration of the different datasets, derived for example from high-throughput approaches (e.g., transcriptome or proteome analyses), requires the application and compliance of uniform standard protocols, e.g., for growth and handling of the organism as well as the “–omics” approaches. Here, we report on the establishment and implementation of standard operating procedures for the different wet-lab and in silico techniques that are applied within the SulfoSYS-project and that we believe can be useful for future projects on Sulfolobus or (hyper)thermophiles in general. Beside established techniques, it includes new methodologies like strain surveillance, the improved identification of membrane proteins and the application of crenarchaeal metabolomics.
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MetaboliteDetector: comprehensive analysis tool for targeted and nontargeted GC/MS based metabolome analysis. Anal Chem 2009; 81:3429-39. [PMID: 19358599 DOI: 10.1021/ac802689c] [Citation(s) in RCA: 291] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We have developed a new software, MetaboliteDetector, for the efficient and automatic analysis of GC/MS-based metabolomics data. Starting with raw MS data, the program detects and subsequently identifies potential metabolites. Moreover, a comparative analysis of a large number of chromatograms can be performed in either a targeted or nontargeted approach. MetaboliteDetector automatically determines appropriate quantification ions and performs an integration of single ion peaks. The analysis results can directly be visualized with a principal component analysis. Since the manual input is limited to absolutely necessary parameters, the program is also usable for the analysis of high-throughput data. However, the intuitive graphical user interface of MetaboliteDetector additionally allows for a detailed examination of a single GC/MS chromatogram including single ion chromatograms, recorded mass spectra, and identified metabolite spectra in combination with the corresponding reference spectra obtained from a reference library. MetaboliteDetector offers the ability to operate with highly resolved profile mass data. Finally, all analysis results can be exported to tab delimited tables. The features of MetaboliteDetector are demonstrated by the analysis of two experimental metabolomics data sets. MetaboliteDetector is freely available under the GNU public license (GPL) at http://metabolitedetector.tu-bs.de.
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41
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Loeffler endocarditis: findings on magnetic resonance imaging. CASE REPORTS 2009; 2009:bcr2006094599. [DOI: 10.1136/bcr.2006.094599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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42
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Methylprednisolone does not restore biological response in multiple sclerosis patients with neutralizing antibodies against interferon-β. Eur J Neurol 2009; 16:43-7. [DOI: 10.1111/j.1468-1331.2008.02336.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nitrate-responsive NarX-NarL represses arginine-mediated induction of the Pseudomonas aeruginosa arginine fermentation arcDABC operon. MICROBIOLOGY-SGM 2008; 154:3053-3060. [PMID: 18832311 DOI: 10.1099/mic.0.2008/018929-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Denitrification and arginine fermentation are major parts of the anaerobic metabolism of Pseudomonas aeruginosa, which is important for biofilm formation and infection. The two-component regulatory system NarX-NarL is part of the underlying network and is required for denitrifying growth. All target promoters identified so far are activated by NarL. In this study the effect of NarL on arginine fermentation was investigated using proteome, Northern blot and lacZ reporter gene analyses. NarL-dependent repression of the arcDABC operon was observed and the corresponding NarL-binding site in the arcD promoter region was functionally localized at -60 bp upstream of the transcriptional start site using site-directed promoter mutagenesis and reporter gene fusion experiments. The results clearly show that in the presence of nitrate NarL represses the arginine-dependent activation of the arcDABC operon mediated by ArgR. It does not influence the oxygen-tension-dependent activation via Anr. Thus, the anaerobic energy metabolism of P. aeruginosa is coordinated via NarX-NarL activity. In the presence of nitrate the highly efficient denitrification is preferred over the less attractive arginine fermentation.
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Tumor-promoting stroma impregnated by cancer cells is destroyed by specific T cells. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71428-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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46
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Abstract
In Pseudomonas aeruginosa, the narK(1)K(2)GHJI operon encodes two nitrate/nitrite transporters and the dissimilatory nitrate reductase. The narK(1) promoter is anaerobically induced in the presence of nitrate by the dual activity of the oxygen regulator Anr and the N-oxide regulator Dnr in cooperation with the nitrate-responsive two-component regulatory system NarXL. The DNA bending protein IHF is essential for this process. Similarly, narXL gene transcription is enhanced under anaerobic conditions by Anr and Dnr. Furthermore, Anr and NarXL induce expression of the N-oxide regulator gene dnr. Finally, NarXL in cooperation with Dnr is required for anaerobic nitrite reductase regulatory gene nirQ transcription. A cascade regulatory model for the fine-tuned genetic response of P. aeruginosa to anaerobic growth conditions in the presence of nitrate was deduced.
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Abstract
To provide an integrated bioinformatics platform for a systems biology approach to the biology of pseudomonads in infection and biotechnology the database SYSTOMONAS (SYSTems biology of pseudOMONAS) was established. Besides our own experimental metabolome, proteome and transcriptome data, various additional predictions of cellular processes, such as gene-regulatory networks were stored. Reconstruction of metabolic networks in SYSTOMONAS was achieved via comparative genomics. Broad data integration is realized using SOAP interfaces for the well established databases BRENDA, KEGG and PRODORIC. Several tools for the analysis of stored data and for the visualization of the corresponding results are provided, enabling a quick understanding of metabolic pathways, genomic arrangements or promoter structures of interest. The focus of SYSTOMONAS is on pseudomonads and in particular Pseudomonas aeruginosa, an opportunistic human pathogen. With this database we would like to encourage the Pseudomonas community to elucidate cellular processes of interest using an integrated systems biology strategy. The database is accessible at .
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Gründe für den Abbruch der CSII Therapie bei jugendlichen Typ 1 Diabetikern. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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Untersuchung von RRMS Patienten zu Therapietreue und Lebensqualität im ersten Behandlungsjahr mit Interferon beta-1a (i.m.) – Ergebnisse der Datenerhebung “Mensch im Mittelpunkt“. AKTUELLE NEUROLOGIE 2007. [DOI: 10.1055/s-2007-987993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Similarity and differences in the Lactobacillus acidophilus group identified by polyphasic analysis and comparative genomics. J Bacteriol 2006; 189:1311-21. [PMID: 17142402 PMCID: PMC1797336 DOI: 10.1128/jb.01393-06] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A set of lactobacilli were investigated by polyphasic analysis. Multilocus sequence analysis, DNA typing, microarray analysis, and in silico whole-genome alignments provided a remarkably consistent pattern of similarity within the Lactobacillus acidophilus complex. On microarray analysis, 17 and 5% of the genes from Lactobacillus johnsonii strain NCC533 represented variable and strain-specific genes, respectively, when tested against four independent isolates of L. johnsonii. When projected on the NCC533 genome map, about 10 large clusters of variable genes were identified, and they were enriched around the terminus of replication. A quarter of the variable genes and two-thirds of the strain-specific genes were associated with mobile DNA. Signatures for horizontal gene transfer and modular evolution were found in prophages and in DNA from the exopolysaccharide biosynthesis cluster. On microarray hybridizations, Lactobacillus gasseri strains showed a shift to significantly lower fluorescence intensities than the L. johnsonii test strains, and only genes encoding very conserved cellular functions from L. acidophilus hybridized to the L. johnsonii array. In-silico comparative genomics showed extensive protein sequence similarity and genome synteny of L. johnsonii with L. gasseri, L. acidophilus, and Lactobacillus delbrueckii; moderate synteny with Lactobacillus casei; and scattered X-type sharing of protein sequence identity with the other sequenced lactobacilli. The observation of a stepwise decrease in similarity between the members of the L. acidophilus group suggests a strong element of vertical evolution in a natural phylogenetic group. Modern whole-genome-based techniques are thus a useful adjunct to the clarification of taxonomical relationships in problematic bacterial groups.
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