Clinical, Serological, and Immunological Characteristics of Greek Patients with Polymyalgia Rheumatica and/or Giant Cell Arteritis: A Research Protocol

Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA) are chronic inflammatory disorders that usually affect older people. Although the aetiology of these diseases remains unknown, genetic, environmental, and immune factors have been implicated. Specific cytokines such as the IL-6, IL-1β, IL-12, IL-17, and interferon -γ seem to play an essential role. The diagnosis of the disease is usually based on clinical manifestations and the use of histology or imaging, while disease monitoring is based on physical examination, laboratory, and imaging findings. However, there is the unmet need in identifying possible biomarkers that could help the diagnosis and the monitoring as well. The present study aims to investigate the epidemiological, clinical, and immunological characteristics of PMR and/or GCA patients in the region of northwest Greece and to evaluate the role of specific molecules associated with the pathogenesis of the diseases, giving evidence to possible future biomarkers.

Arrhythmias in Patients with Congenital Heart Disease: An Ongoing Morbidity

With the aging of congenital heart disease (CHD) patients, the burden of arrhythmias is expanding. Atrial arrhythmias, especially intra-atrial reentrant tachycardia and atrial fibrillation, are the most prevalent forms of arrhythmia. Managing comorbidities, such as obesity, using pharmacotherapy, including antiarrhythmics and anticoagulants, and ablation therapy has become the cornerstone of arrhythmia management. Ventricular tachycardias are also not rare; however, except for tetralogy of Fallot patients, recommendations for the use of implantable cardioverter defibrillators for primary prevention in other CHD patients are still not well established. Patients with CHD might also present with atrioventricular blockages because of their anatomy or following a surgical procedure. The scope of this article is to review the current knowledge and discuss the future directions regarding arrhythmia management in CHD patients.

The value of myocardial strain imaging in the evaluation of patients with repaired Tetralogy of Fallot: a review of the literature

Tetralogy of Fallot (ToF) is considered to be the most common, complex, cyanotic congenital heart disease (CHD) representing 7-10% of all congenital heart defects, whereas the patients with ToF are the most frequently operated in their early infancy or childhood. Cardiac magnetic resonance (CMR) consists a valuable imaging technique for the diagnosis and serial follow-up of CHD patients. Furthermore, in recent years, advanced echocardiography imaging techniques have come to the fore, aiming to achieve a complete and more accurate evaluation of cardiac function using speckle tracking imaging modalities. We conducted a review of the literature in order to assess the myocardial deformation of patients with repaired ToF (rToF) using echocardiographic and CMR parameters. Patients with rToF have impaired myocardial strain parameters, that are well standardized either with the use of speckle tracking echocardiography or with the use of CMR imaging. Subclinical left ventricular dysfunction (low GLS) and myocardial dyssynchrony are commonly identified in rToF patients. Impaired left atrium (LA) and right atrium (RA) mechanics are, also, a common finding in this study population, but the studies using atrial strain are a lot fewer than those with LV and RV strain. No studies using myocardial work were identified in the literature, as far as rToF patients are concerned, which makes it an ideal field for further investigation.

Impaired left atrial reservoir strain in patients with ischaemic stroke is associated with atrial fibrillation development

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

The investigation of patients with ischaemic stroke includes undoubtedly their evaluation for atrial fibrillation (AF). On the other hand, the role of left atrial (LA) function in cardiovascular disease is increasingly researched, while echocardiography strain analysis is a novel attractive technique.

Purpose

In this retrospective study, we investigated the association between LA function assessed with reservoir strain and the follow-up development of AF.

Methods

The study population consisted of consecutive ischaemic stroke patients with preserved left ventricular ejection fraction who were on sinus rhythm at the moment of enrollment and had no history of AF. Baseline LA reservoir strain was assessed with 2-dimensional transthoracic echocardiography (apical 4-chamber view) using longitudinal speckle-tracking technique. Afterwards, patients were investigated for AF with ambulatory electrocardiography during one-year follow-up. Differences in the distribution of LA reservoir strain values within the groups of patients with and without AF development were examined with Mann-Whitney U test (new procedure). The level of statistical significance was set to a p value of <0.05.

Results

Sixty-three patients (41 males, 22 females) of a mean age of 50.94 years [minimum = 20, maximum = 65, standard deviation (SD)=10,02] were enrolled in the study. Eight (12.7%) patients developed atrial fibrillation on follow-up. Overall, the mean LA reservoir strain was 32.75% (minimum = 5.62%, maximum = 71.88%, SD=%) and the median value was 32.91%. The values were shown to be lower in the group with later AF development (mean rank = 13.94, Mann-Whitney U = 75.5, p = 0.003) than in those without this finding (mean rank = 13.94). Neither the gender nor the age was associated with AF diagnosis.

Conclusion

Lower LA reservoir strain values were found to be associated with AF development in ischaemic stroke patients of our study. Pending more research data from large studies, this novel technique appears to be promising in identifying AF risk in stroke patients.

Figure

Non parametric assessment with Mann-Whitney U test (new procedure) of left atrial reservoir strain analysis with 2-dimensional transthoracic echocardiography in the groups of ischaemic stroke patients with and without atrial fibrillation development. Abstract Figure.

Assessment of novel echocardiographic indices of myocardial function in patients with significant primary mitral regurgitation

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

Assessment of left ventricular (LV) function in primary mitral regurgitation remains challenging due to ejection fraction preservation, even in late stages of the disease. Global longitudinal strain (GLS) remains a valuable tool for the assessment of systolic function which is affected, like ejection fraction, by loading conditions. Lately, novel methods, such as myocardial work estimated by echocardiography, have been developed in assessment of LV systolic function, along with left atrial strain in assessment of diastolic function. Early identification of systolic or diastolic dysfunction in primary mitral regurgitation is crucial for further management of these patients.

PURPOSE

In this study we assessed several indices of LV systolic and diastolic function, such as myocardial work, global longitudinal strain and left atrial strain, in patients with significant primary mitral regurgitation, in order to evaluate early myocardial dysfunction.

METHODS

We retrospectively assessed echocardiograms of 64 patients, referred to an echocardiography laboratory of a tertiary hospital between 2019 and 2021 with the diagnosis of significant primary MR. Measurements included several echocardiographic indices of LV anatomy and function, such as left atrial volume indexed (LAVi), left atrial strain, global longitudinal strain (GLS), pulmonary hypertension and global myocardial work. Finally we correlated various indices of systolic and diastolic function with severity of mitral regurgitation.

RESULTS

We analyzed echocardiograms of 64 patients (50 men, mean age 60 ± 13,8) with at least moderate organic MR, 75,8% of which had severe MR, and normal ejection fraction (mean EF 63%±4,9). We identified negative correlation between left atrial strain (reservoir) and pulmonary hypertension measurements (correlation coefficient -358, p < 0,05)  in patients with at least moderate MR. However, we were not able to find any statistically significant differences in GLS (21,98 vs 22,26) or myocardial work,  even though we noticed a difference in myocardial work between patients with moderate and severe MR (Global Work Index 2302mmHg% vs 2262mmHg% with normal values 2209 ± 307mmHg% in STAAB cohort, Global Constructed Work 2540mmHg%  vs 2327mmHg%, Global Waste Work 136,89mmHg%  vs 136,43mmHg%, Global Work Efficiency 94,22% vs 93,76%).

CONCLUSIONS

These data suggest that an early assessment of indices of diastolic function, such as left atrial strain linked to pulmonary hypertension, can guide to a more effective evaluation of patients with severe MR and normal systolic function. Additionally, novel indices of LV function less load-dependent, such as myocardial work, are promising tools in the assessment of left ventricle and early recognition of myocardial dysfunction in patients with severe organic MR, but more prospective studies are needed. Abstract Figure.  Abstract Figure.

Assessment of left atrial strain reservoir in patients with ischaemic stroke: a case-control study

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Left atrial (LA) function is considered a seperate marker of cardiovascular disease and its assessment with echocardiography strain analysis has been gaining interest lately. The association of LA characteristics with ischaemic stroke has not been fully understood.

Purpose

This is a case-control study aiming to identidy differences in LA reservoir strain between ischaemic stroke patients and healthy controls.

Methods

Consecutive ischaemic stroke patients with preserved left ventricular ejection fraction and sinus rhythm were enrolled in the study. Patients were assessed with 2-dimensional transthoracic echocardiography (apical 4-chamber view) using longitudinal speckle-tracking technique. Non-parametric testing with Mann-Whitney U analysis (new procedure) was carried out to identify differences in the distribution of LA reservoir strain values within the patients group and the controls. A p value of <0.05 was considered statistically significant.

Results

Sixty-six patients (44 males, 22 females) of a mean age of 49.97 years [minimum = 20, maximum = 61, standard deviation (SD)=8.90] were enrolled in the stroke group. The control group included 39 healthy volunteers (27 males, 12 females) of a mean age of 42.23 years (minimum = 19, maximum = 71, SD = 12.77). In the stroke group, the mean LA reservoir strain was 34.24% (minimum = 5.62, maximum = 71.88%, SD = 10.21%) and the median was 34.06%, whereas the mean and median values of control subjects were 42.84% (minimum = 24.20, maximum = 90, SD = 13.87%) and 39.59% respectively. Mann-Whitneu U analysis (new procedure) showed lower LA strain values in the stroke group (mean rank = 45.29, Mann-Whitney U = 778, p = 0.001) compared to controls (mean rank = 66.05).

Conclusion

Our study showed that ischaemic stroke patients on sinus rhythm at presentation had impaired LA reservoir strain compared to healthy adults. The role of speckle-tracking echocardiography in assessing LA function and predicting stroke needs to be further evaluated thorougly.

Figure

Mann-Whitney U testing (new procedure) of left atrial reservoir strain in the stroke group and in healthy controls. Abstract Figure.

Cohesin RAD21 Gene Promoter Methylation in Patients with Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults and is characterized by the presence of specific cytogenetic abnormalities. CLL research has been focused on epigenetic processes like gene promoter methylation of CpG islands. In the present study, the methylation status of the RAD21 gene is studied and associated with cytogenetic findings in CLL patients in order to investigate its possible implication in CLL pathogenesis and the formation of CLL chromosomal abnormalities.

Biodosimetry for High-Dose Exposures Based on Dicentric Analysis in Lymphocytes Released from the G2-Block by Caffeine

High-dose assessments using the conventional dicentric assay are essentially restricted to doses up to 5 Gy and only to lymphocytes that succeed to proceed to first post-exposure mitosis. Since G2-checkpoint activation facilitates DNA damage recognition and arrest of damaged cells, caffeine is used to release G2-blocked lymphocytes overcoming the mitotic index and dicentric yield saturation problems, enabling thus dicentric analysis even at high-dose exposures. Using the fluorescence in situ hybridization technique with telomere and centromere peptide nucleic acid probes, the released lymphocytes, identified as metaphases with decondensed chromosomes following 1.5 h caffeine treatment, show increased yield of dicentrics compared to that obtained in lymphocytes that reach metaphase without G2-checkpoint abrogation by caffeine. Here, a 3-h caffeine/colcemid co-treatment before harvesting at 55 h post-exposure is used so that the dicentric analysis using Giemsa staining is based predominantly on lymphocytes released from the G2-block, increasing thus dicentric yield and enabling construction of a dose-response calibration curve with improved precision of high-dose estimates.

Dose assessment intercomparisons within the RENEB network using G0-lymphocyte prematurely condensed chromosomes (PCC assay)

PURPOSE

Dose assessment intercomparisons within the RENEB network were performed for triage biodosimetry analyzing G₀-lymphocyte PCC for harmonization, standardization and optimization of the PCC assay.

MATERIALS AND METHODS

Comparative analysis among different partners for dose assessment included shipment of PCC-slides and captured images to construct dose-response curves for up to 6 Gy γ-rays. Accident simulation exercises were performed to assess the suitability of the PCC assay by detecting speed of analysis and minimum number of cells required for categorization of potentially exposed individuals.

RESULTS

Calibration data based on Giemsa-stained fragments in excess of 46 PCC were obtained by different partners using galleries of PCC images for each dose-point. Mean values derived from all scores yielded a linear dose-response with approximately 4 excess-fragments/cell/Gy. To unify scoring criteria, exercises were carried out using coded PCC-slides and/or coded irradiated blood samples. Analysis of samples received 24 h post-exposure was successfully performed using Giemsa staining (1 excess-fragment/cell/Gy) or centromere/telomere FISH-staining for dicentrics.

CONCLUSIONS

Dose assessments by RENEB partners using appropriate calibration curves were mostly in good agreement. The PCC assay is quick and reliable for whole- or partial-body triage biodosimetry by scoring excess-fragments or dicentrics in G₀-lymphocytes. Particularly, analysis of Giemsa-stained excess PCC-fragments is simple, inexpensive and its automation could increase throughput and scoring objectivity of the PCC assay.

Association of various risk factors with chronic lymphocytic leukemia and its cytogenetic characteristics

This study aimed to investigate whether occupational and environmental exposures, lifestyle, family, and medical history are associated with chronic lymphocytic leukemia (CLL) risk and its chromosomal abnormalities. The study included 138 CLL cases and 141 age- and sex-matched controls. Information data were collected through in-person interviews from cases and controls. Cytogenetic analysis was performed on CLL bone marrow cells. Positive associations were found between CLL and cancer family history, smoking, pneumonia, and exposure to petroleum, metals, pesticides/chemical fertilizers, detergents, and medical radiation. Chromosome deletions of 11q and 13q were more frequent in patients exposed to pesticides and rubber, respectively. This study investigated for the first time specific risk factors in relation to CLL aberrations and presented positive correlations. Moreover, it indicates the possible involvement of specific occupational and lifestyle risk factors in the onset of CLL.

The parallel application of karyotype interphase and metaphase FISH after DSP-30/IL-2 stimulation is necessary for the investigation of chronic lymphocytic leukemia

BACKGROUND

Genomic aberrations are important indicators of prognosis, clinical course and treatment of chronic lymphocytic leukemia (CLL). Two cytogenetic methods, karyotype, and FISH, with still ongoing improvements, are used for CLL investigation, but the panel of chromosomal abnormalities, their prognostic significance and contribution in CLL pathogenesis have not been elucidated yet.

OBJECTIVES AND METHODS

Our study deals with the cytogenetic investigation of 237 CLL patients trying to answer ambiguous issues of the disease in the light of new CLL stimulation methodology. More specifically, we compared the detection rate and type of chromosomal aberrations between cultures stimulated with and without the new mitogens and we combined them with the data obtained from interphase (iFISH) and metaphase FISH (mFISH).

RESULTS

Approximately 70% of the abnormal karyotypes and all the subclonal abnormalities were detected exclusively in DSP-30/IL-2 cultures. DSP-30/IL-2 exhibited ∼10-fold greater ability to detect abnormalities compared to TPA and unstimulated cultures, revealing >60 different chromosomal aberrations. Moreover, the comparison between DSP-30/IL-2 cultures and unstimulated cultures indicated that loss of chromosome Y is rather an age-related phenomenon and not a specific aberration of CLL. Clonal evolution was also detected in 50% of patients with available follow-up karyotypic data and changed the prognosis in 86.4% of them. Finally, it was shown that mFISH must be performed in DSP-30/IL-2 cultures in addition to iFISH to uncover submicroscopic translocations or insertions undetectable by iFISH.

CONCLUSION

All the above argue in favor of the parallel application of karyotype, iFISH and mFISH after DSP-30/IL-2 stimulation for CLL clinical practice and research.

Stress induced by premature chromatin condensation triggers chromosome shattering and chromothripsis at DNA sites still replicating in micronuclei or multinucleate cells when primary nuclei enter mitosis

Combination of next-generation DNA sequencing, single nucleotide polymorphism array analyses and bioinformatics has revealed the striking phenomenon of chromothripsis, described as complex genomic rearrangements acquired in a single catastrophic event affecting one or a few chromosomes. Via an unproven mechanism, it is postulated that mechanical stress causes chromosome shattering into small lengths of DNA, which are then randomly reassembled by DNA repair machinery. Chromothripsis is currently examined as an alternative mechanism of oncogenesis, in contrast to the present paradigm that considers a stepwise development of cancer. While evidence for the mechanism(s) underlying chromosome shattering during cancer development remains elusive, a number of hypotheses have been proposed to explain chromothripsis, including ionizing radiation, DNA replication stress, breakage-fusion-bridge cycles, micronuclei formation and premature chromosome compaction. In the present work, we provide experimental evidence on the mechanistic basis of chromothripsis and on how chromosomes can get locally shattered in a single catastrophic event. Considering the dynamic nature of chromatin nucleoprotein complex, capable of rapid unfolding, disassembling, assembling and refolding, we first show that chromatin condensation at repairing or replicating DNA sites induces the mechanical stress needed for chromosome shattering to ensue. Premature chromosome condensation is then used to visualize the dynamic nature of interphase chromatin and demonstrate that such mechanical stress and chromosome shattering can also occur in chromosomes within micronuclei or asynchronous multinucleate cells when primary nuclei enter mitosis. Following an aberrant mitosis, chromosomes could find themselves in the wrong place at the wrong time so that they may undergo massive DNA breakage and rearrangement in a single catastrophic event. Specifically, our results support the hypothesis that premature chromosome condensation induces mechanical stress and triggers shattering and chromothripsis in chromosomes or chromosome arms still undergoing DNA replication or repair in micronuclei or asynchronous multinucleate cells, when primary nuclei enter mitosis.

UGT1A1*28 polymorphism in chronic lymphocytic leukemia: the first investigation of the polymorphism in disease susceptibility and its specific cytogenetic abnormalities

Chronic lymphocytic leukemia (CLL) has been recently attributed to a combination of genetic predisposition and exposure to environmental factors. UDP-glucuronosyltransferase (UGT)1A1*28 is an inborn polymorphism that results in significant downregulation of uridine diphosphate glucuronyltransferase 1-1 (UGT1A1) activity, one of the most critical metabolizing enzymes involved in the detoxification of toxic substances, some of which contribute to CLL pathogenesis. Here, for the first time, we investigated the putative impact of UGT1A1*28 on CLL incidence and on the formation of the most common chromosomal abnormalities of CLL. UGT1A1*28 was investigated in 109 CLL patients and 108 healthy controls, and was associated with karyotypic and fluorescence in situ hybridization (FISH) results. A significant high frequency of the mutant genotype was observed in patients carrying abnormal FISH patterns, especially del(11q) and +12, which are CLL-specific abnormalities. We also observed a significant association between UGT1A1*28 and the intermediate to unfavorable cytogenetic CLL risk groups. No difference, though, was observed in genotypes between patients and controls. Therefore, we could suggest that UGT-deficient individuals may be at a greater risk for developing CLL-specific abnormalities. Our study might serve as a starting point to consider UGT1A1*28 polymorphism as one of the possible predisposing factors of CLL pathogenesis.

Contribution of G71R mutation to Gilbert’s syndrome phenotype in a Greek patient: A case report

Gilbert’s syndrome is characterized by a benign indirect hyperbilirubinemia. It has often been underestimated and undiagnosed because of its mild symptoms; although it is not as rare as was once believed when its frequency was estimated using data originating from biochemical tests. Based on molecular techniques, the occurrence of Gilbert’s syndrome has changed, increasing to 10% in the Caucasian population. This molecular defect was described, by Bosma et al, in 1995, and affects the promoter region of the UGT 1A1 gene. In this case report, our aim is to present a new combination of two molecular defects in a Greek patient with Gilbert’s syndrome. A 13-year-old Greek girl was examined for Gilbert’s syndrome using molecular techniques, and an uncommon genotype was revealed comprising the rare mutation G71R in trans with A(TA)7TAA motif. The G71R mutation according to the literature, as well as our epidemiological data, is rare in Caucasians, while it is common in Asian populations. This is the first case study in the Greek population to report a new genotype for Gilbert’s syndrome manifestation in the Caucasian population.

Isochromosome der(17)(q10)t(15;17) in acute promyelocytic leukemia resulting in an additional copy of the RARA-PML fusion gene: report of 4 cases and review of the literature

Isochromosome of the long arm of the derivative chromosome 17, originating from the translocation t(15;17) [ider(17)(q10)t(15;17) or ider(17q)] in acute promyelocytic leukemia (APL), is a rare chromosome aberration which has been associated with a poor prognosis. In the present study, we report on 4 male APL patients with ider(17q) and review the clinical, cytogenetic and molecular characteristics of all previously reported APL patients with ider(17q) in order to clarify the clinical features and outcome of these patients. The data presented in this study demonstrated that ider(17q), which resulted in an extra RARA-PML fusion gene, was more frequent in males than females (male/female ratio of 2.12/1), was associated with a rather low initial white blood cell count and did not confer an adverse prognosis in APL patients treated with all-trans-retinoic acid and chemotherapy. The most frequent additional chromosome change to ider(17q) was trisomy 8. Ider(17q) was observed in all subtypes of the PML-RARA fusion gene, but the frequency of the bcr1 subtype was increased. Cases of overrepresentation of the RARA-PML fusion gene and ider(17q) cases may help in elucidating the role of RARA-PML in leukemogenesis.