[A Plasmid-Expressed CRISPR/Cas9 System Suppresses Replication of HSV Type I in a Vero Cell Culture]

Herpesviruses are widespread in the human population. Herpes simplex virus type 1 (HSV1) alone infects more than 3.7 billion people. In most of these, the virus establishes a latent form resistant to the action of all antiviral drugs. Moreover, completely drug-resistant strains of herpesviruses are known, which has prompted the search for alternative approaches to the treatment of herpesviruses, including genome editing with prokaryotic CRISPR/Cas. The CRISPR/Cas9 system of Streptococcus pyogens effectively suppresses HSV1 infection when expressed from genome-integrated lentiviral vectors. However, there are concerns about the safety of this approach. Here we describe the system built upon the plasmid-encoded CRISPR/Cas9 targeted against UL52 and UL29 genes of the HSV1 primase-helicase complex. The construct was transfected into Vero cells with no significant cytotoxic effects detected. Complete suppression of HSV1 infection within two days was observed, raising the possibility that the proposed plasmid-expressed CRISPR/Cas9 system may be used for the screening of genes important for the HSV1 life cycle and for development of novel strategies for targeted therapy of herpesvirus infections.

[Mesenchymal stem cells enhance immune response and protect mice against lethal herpes viral infection.]

The objective of this study was to evaluate immunoregulatory and protective potential of mesenchymal stem cells (MSC) in a mouse model of lethal HSV1 infection. MSC were isolated from bone marrow of DBA mice and cultured in flasks with DMEM containing 10% FBS, insulin, transferrin, selenite, fbroblast growth factor, glutaminе and gentamicin. Antiviral activity was tested on HSV1-infected Vero cells. In vivo experiments were performed on DBA mice divided into 5 groups (10 animals each): group 1, intact (naïve) mice; group 2, intravenous (iv) MSC injection; group 3, ntraperitoneal infection with 20 LD50 HSV1 followed by MSC injection; group 4, HSV1 infection followed by acyclovir (ACV) injection; group 5, HSV1 infection and iv injection of saline. Isolated cells were consistent with MSC morphologically, by adhesive ability and surface receptors. Conditioned media from MSC collected after 4-5 passages inhibited HSV1 infection in vitro by 64-70% and contained IL-6 and TNF-α, whose concentrations were 5- and 20-fold higher, respectively, than in the control. MSC and ACV injections protected 70% and 60% of DBA mice, respectively, compared with the control (group 5, 10% survival). High activity of virus neutralizing anti-HSV1 antibodies and activation of T cell proliferation were observed in survived mice from group 3. Serum levels of IL-6 and TNF-α in these mice were lower and that of INF-γ much higher than in agonizing animals of this group (Р<0.05). These fndings indicate that MSC therapy is a prospective approach to the development of new effective management of generalized HSV1 infection.

[Dimeric bisbenzimidazoles suppress the herpes simplex virus and human cytomegalovirus infections in cell сultures]

Antiviral activity of new AТ-specific fluorescent symmetric dimeric bisbenzimidazoles of DBА(n) series was assessed in the cell models of infections caused by type 1 herpes simplex virus (HSV1) and human cytomegalovirus (CMV). In DBA(n) molecules bisbenzimidazole fragments are bound to an oligomethylene liner with varied number of methylene groups in the linker (n = 1, 3, 5, 7, 9, 11). In contrast to DB(n) dimeric bisbenzimidazoles, in DBA(n) series terminal fragments of macromolecules contain N-dimethylaminopropylcarboxamide groups instead of N-methylpiperazine groups. DBА(n) compounds better dissolve in water, pass across plasma and nuclear membrane, and stain DNA in living cells. DBA(1) and DBA(7) produced therapeutic effects in HSV1 infection; DBA(7) completely suppressed the infection. DBA(11) displayed in vitro therapeutic activity in HSV1 and CMV infections. In addition, DBA(7) and DBA(1) showed microbicidal activity. Thus, DBA(11), which is active against two viruses causing severe diseases with serious health consequences for immunodeficient individuals, should be further investigated. High antiviral activity of DBA(7) in all test models indicates that this compound is a promising active agent for innovative antiviral drugs.

[The problem of cardiac safety of nonsteroidal anti-inflammatory drugs]

The paper considers an update on the mechanisms for the development of adverse reactions of nonsteroidal anti-inflammatory drugs on the cardiovascular system.

[Preventive Vaccination with Mesenchymal Stem Cells Protects Mice from Lethal Infection Caused by Herpes Simplex Virus 1]

Herpes simplex viruses 1 and 2 (HSV-1 and HSV-2) infect almost all organs and tissues, cause genital herpes-the most common sexually transmitted disease-disorders of the central nervous system (CNS), and lead to severe complications in children. Despite the available drugs, the incidence of HSV-1/2 continues to rise. None of the prophylactic vaccine candidates have shown a protective effect in trials nor approval for use in clinical practice. We have investigated the protective properties of mesenchymal stem cells (MSC) isolated from the bone marrow of mice. A comparative analysis of the protective response to the introduction of primary and modified MSCs (mMSC) was carried out using the plasmid containing gene of the HSV and an inactivated virus in a model of lethal HSV-1 infection in mice. mMSCs were obtained by transfection of the Us6 gene encoding glycoprotein D (gD) of the HSV, the plasmid contained the same gene. After twofold immunization with primary MSCs, the formation of antibodies interacting with the viral antigen (according to enzyme immunoassay data) and neutralizing the infectious activity of HSV-1 in the reaction of biological neutralization was observed in the peripheral blood of mice. In addition, the introduction of primary MSCs induced the production of interferon gamma (INF-γ) which is detected in the peripheral blood of mice. After infection with HSV-1, the immunized mice showed significantly increased titers of virus-specific antibodies, an increased level of IFNγ, and were completely protected from lethal HSV-1 infection. The protective effect of the other three immunogens was lower and did not exceed 50-65%. Considering the wide availability of MSCs, the proven safety of intravenous administration, and the results obtained in this work on the ability to induce innate, adaptive and protective immunity to HSV-1, MSCs can be considered a promising basis for the development of new cellular vaccines for the prevention of herpesvirus and other viral infections.

P4434The first report of significantly improvement of NT-proBNP level in rheumatoid arthritis patients treated with tofacitinib during 12-month follow-up

Objectives

To prospectively investigate the effect of tofacitinib (TOFA), the first oral reversible inhibitor of JAK approved for RA treatment, on the levels of NT-proBNP, as a predictor of congestive heart failure (CHF) in patients (pt) with active RA.

Methods

Twenty six RA pt (median age 54 [40; 62] years, 81% female, disease duration 44 [24; 63,0] month (m), moderate to high activity (SDAI–27 (22; 35)), positive for ACCP (73%)/RF (77%), who were non-responders to methotrexate (MTX) at least 15 mg/week and other synthetic DMARDs) free of clinical overt cardiovascular disease were treated with TOFA and followed for 12 m. TOFA therapy was started in all pt in dose 5 mg BID per os with dose escalation to 10 mg BID in 8 (31%) pt. TOFA used in combination with MTX in 24 (92%) pt, leflunomide in 1 (4%). Low-dose oral corticosteroids (<10 mg/day prednisone or equivalent) were received by 9 (35%) pt. Remission was achieved in 38,5% (SDAI). Cardiovascular risk factors (CVRF) and the NT-proBNP levels were measured at baseline and after 12m. At baseline the most of pt had multiple CVRF and subclinical organ damage. Cardioprotective therapy received 16 (57%) pt (beta-AB–7, ARA/ACE inhibitors–11, statins–11, dihydropyridine CCB-7). Twenty controls matched for CVRF were included for comparison of normal NT-proBNP levels.

Results

The NT-proBNP level was significantly higher in RA pt than in the control group (median 62.2 (26.9–101.7) pg/mL vs 44.0 (34.0–54.3) pg/mL, p<0.05). At baseline NT-proBNP level was higher in female than in male (p=0,019). All 3 (11,5%) RA pt with a NT-proBNP level over 125 pg/mL were asymptomatic and exhibited normal echocardiography. Median SDAI were significantly reduced following TOFA treatment (from 26.8 to 4.7, p<0.001, respectively). During follow-up, no RA pt exhibited a cardiovascular event or CHF. NT-proBNP levels decreased by 63% over the 12-m of TOFA treatment (from 62.16 pg/mL to 14.8 pg/mL, p=0.011). The incidence rate of arterial hypertention (58% vs 65%), overweight (62% vs 62%), abdominal obesity (58% vs 62%), smokers (27% vs 27%), menopausal status (52% vs 52%), DM type 2 (7% vs 7%), mSCORE≥5% (23% vs 27%), subclinical carotid atherosclerosis (58% vs 58%) did not change significantly. An increase in body mass index (BMI) was observed from 26.5 [22.9; 29.0] to 26.9 [24.0; 30.1], p<0.001 and in HDL level from 1.37 [1.06; 1.87] to 1.90 [1.29; 2.16], p<0.01. The percentage change in the NT-proBNP level significantly correlated with the percentage change in the BMI (r=0,6, p=0,007), SDAI (r=0.51, p=0.009). Changes in NT-proBNP levels in RA pt with remission was greater than that observed in pt who didn't achieve remission (−87% vs −26%, p=0,005). The percentage change in the NT-proBNP level was not correlated with the percentage change in other CVRF.

Conclusion

TOFA decreased the NT-proBNP level in patients with RA without clinical overt cardiovascular disease and CHF. TOFA may have a cardioprotective effect in those with active RA.

[Adjuvant effect of dispersed fullerene C60 on the immune response to constructs harboring amino acid and nucleotide sequences of hepatitis C virus nonstructural NS5B protein]

INTRODUCTION

A vaccine against hepatitis C has not yet been developed. Recombinant proteins and plasmids encoding hepatitis C virus (HCV) proteins, the components of candidate vaccines, induce a weak immune response and require the use of adjuvants. The aim of the work was to study the adjuvant action of an aqueous solution of fullerene C60 during immunization of mice with HCV recombinant protein NS5B (rNS5B) that is an RNA-dependent RNA polymerase, or with NS5B-encoding pcNS5B plasmid.

MATERIALS AND METHODS

An aqueous solution of dispersed fullerene (dnC60) was obtained by ultrafiltration. C57BL/6 mice were immunized with rNS5B subcutaneously, pcNS5B intramuscularly mixed with different doses of dnC60 three times, then the humoral and cellular response to HCV was evaluated.

RESULTS

Mice immunization with rNS5B in a mixture with dnC60 at doses of 250 g/mouse significantly induced humoral response: a dose-dependent increase in IgG1 antibody titers was 720 times higher than in the absence of fullerene. There was no increase in the cellular response to rNS5B when administered with dnC60. The humoral response to DNA immunization was weak in mice of all groups receiving pcNS5B. The cellular response was suppressed when the plasmid was injected in a mixture with dnC60.

CONCLUSIONS

Dispersed fullerene dnC60 is a promising adjuvant for increasing the immunostimulating activity of weakly immunogenic proteins including surface and other HCV proteins, important for a protective response. Further research is needed to enhance the ability of dnC60 to boost the cellular immune response to the components of the candidate vaccine.

AB0672 Functional capacity and quality of life in patients with systemic sclerosis – data from Moscow register of patients with systemic sclerosis

Background

Systemic sclerosis (SSc) is a multisystem, connective tissue disease characterized by fibrosis of the skin and internal organ involvement, which can influence quality of life and functional capacity. SSc patients show some problems associated with reduced quality of life.

Objectives

Systemic sclerosis (SSc) is a multisystem, connective tissue disease characterized by fibrosis of the skin and internal organ involvement, which can influence quality of life and functional capacity. SSc patients show some problems associated with reduced quality of life.

Methods

In total, 51 patients with SSc were included: 50 women and 1 man (mean age: 63,2 ± 10,1 year, limited SSc 28/diffuse SSc 23, median duration since first non-Raynaud symptom: 10,1 years) who fulfilled the ACR/EULAR classification criteria (2013), filled in questionnaires assessing disability (HAQ, Health Assessment Questionnaire) and quality of life (SF-36, Medical outcomes study Short Form 36 - Physical Component Summary and Mental Component Summary).

Results

Average HAQ in patients with limited and diffuse SSc was 0,66±0,58 and 0,9±0,59. Data analysis showed that 59% of the patients were in the mild to moderate HAQ disability category (0 ⩽ HAQ < 1), 39% in the moderate to severe disability category (1 ⩽ HAQ < 2), and 2% in the severe to very severe disability category (2 ⩽ HAQ ⩾ 3). The SF36 mean scores of the total group were 34,8±8,7 on the Mental Component Summary and 37,0±13,1 on the Physical Component Summary.

Conclusion

Ssc and its complications decrease quality of life and functional capacity. Although validated in SSc, the HAQ disability index underestimates respiratory failure due to interstitial lung disease, gastrointestinal symptoms, cardiovascular complications and severity of Raynaud phenomenon. Alternative measures of functional impairment should be examined. Health-related quality of life, which was assessed by the SF-36 is reduced in both physical and mental domains. It should be taken into account by clinicians for further improvement of treatment and development rehabilitation program.

References

[1]Almeida C, Almeida I, Vasconcelos C. Quality of life in systemic sclerosis. Autoimmun Rev. 2015;14(12):1087-1096

Disclosure of Interests

None declared

AB0225 THE NATURAL COURSE OF EARLY RA WITH LATE ONSET IN EVERYDAY CLINICAL PRACTICE ACCORDING TO THE RUSSIAN RA PATIENT REGISTER OREL

Background:

The opinion about the severity and prognosis of rheumatoid arthritis (RA) with late onset balanced between more favorable and more severe over various periods of rheumatology development. We studied this group of patients according to the Russian RA Patient Register OREL.

Objectives:

To study clinical, laboratory and radiological characteristics in patients with early RA with late onset of the disease (50 years and older) who are DMARD (disease modifying antirheumatic drugs), biological DMARD and glucocorticoid (GC) (systemic administration) – naive.

Methods:

All patients were included in the OREL register in the period from 01.01.2014 to 12.31.2018. There were 151 patients in the study (M:41, W:110; average age 60 ± 7.0 years). There were 73 patients (48%) with the duration of RA up to 3 months, 45 (30%) - 4-6 months, 33 (22%) - 7-12 months. The ratio of men and women was only 1: 2.8 (50 -64 years = 1:3.8; 64 years and older = 1: 1.8).

Results:

99/151 (66%) patients had high disease activity (according to DAS-28), 52/151 (34%) – medium activity.

22/151 (15%) patients had II functional class (FC), 103 (68%) – III FC, 26 (17%) – IV FC.

Table 1 illustrates that with an increase in the duration of the disease, a gradual increase in the frequency of detection of radiological erosion in the hands and distal parts of the feet is noted: 1.5 - 3 months - 33/73 (45%) patients; 4-6 months - 22/45 (49%) patients and in the period 7-12 months - 23/33 (70%) patients.

Table 1.

X-ray Stage and RA duration

X-ray StageDuration of disease (months)<34567-12TotalNon ErosiveRAI11(1*)6(1*)3(1*)1526(3*)II29(1*)553547(1*)ErosiveII318742070RAIII211138IV-Total73(2*)20(1*)16(1*)933151(4*)

* - Erosion according to MRI of the hands

Table 1.

illustrates higher incidence of joint erosions in the presence of RF and / or anti-CPA antibodies (ACPA) compared to patients who are seronegative for RF and ACPA. Таблица 2. X-ray-Stage and RF and ACPA Detection Frequency

X-ray-StageThe frequency of RF and AСPA detectionRF (+) ACPA (+)RF (+)ACPA (-)RF (-)ACPA (+)RF (-)ACPA (-)Non-erosive RA:Stages I and II30%20%22%58%Erosive RA:II, III and IV stages70%80%78%42%

The frequency of RF and AСPA detection in non-erosive patients, in all patients with radiological erosion and in patients with advanced stages only (III and IV) was 67% (RF) -78% (ACPA), 75% -90% and 100% -100%, respectively.

Conclusion:

Everyday clinical practice (OREL register) shows that in patients aged 50 years and older with early clinical stage of RA who are naive about the treatment of DMARD, biological DMARD and GC, the detection of RF, ACPA and erosive changes in the joints are often observed in the onset of the disease. RF and ACPA are markers of early joint destruction.

Disclosure of Interests:

None declared

[Pulmonary hypertension in rheumatic heart disease: current approaches to diagnosis and therapy]

Pulmonary hypertension is a complex multidisciplinary problem in modern medicine. This review discusses its clinical and pathophysiological type associated with rheumatic heart disease. Current approaches to the pathogenesis and diagnosis of the disease are reflected; basic approaches to its treatment are discussed in terms of current clinical guidelines and new scientific achievements.

Preventive Vaccination with Mesenchymal Stem Cells Protects Mice from Lethal Infection Caused by Herpes Simplex Virus 1

Herpes simplex viruses 1 and 2 (HSV-1 and HSV-2) infect almost all organs and tissues, cause genital herpes-the most common sexually transmitted disease-disorders of the central nervous system (CNS), and lead to severe complications in children. Despite the available drugs, the incidence of HSV-1/2 continues to rise. None of the prophylactic vaccine candidates have shown a protective effect in trials nor approval for use in clinical practice. We have investigated the protective properties of mesenchymal stem cells (MSC) isolated from the bone marrow of mice. A comparative analysis of the protective response to the introduction of primary and modified MSCs (mMSC) was carried out using the plasmid containing gene of the HSV and an inactivated virus in a model of lethal HSV-1 infection in mice. mMSCs were obtained by transfection of the Us6 gene encoding glycoprotein D (gD) of the HSV, the plasmid contained the same gene. After twofold immunization with primary MSCs, the formation of antibodies interacting with the viral antigen (according to enzyme immunoassay data) and neutralizing the infectious activity of HSV-1 in the reaction of biological neutralization was observed in the peripheral blood of mice. In addition, the introduction of primary MSCs induced the production of interferon gamma (INF-γ) which is detected in the peripheral blood of mice. After infection with HSV-1, the immunized mice showed significantly increased titers of virus-specific antibodies, an increased level of IFNγ, and were completely protected from lethal HSV-1 infection. The protective effect of the other three immunogens was lower and did not exceed 50-65%. Considering the wide availability of MSCs, the proven safety of intravenous administration, and the results obtained in this work on the ability to induce innate, adaptive and protective immunity to HSV-1, MSCs can be considered a promising basis for the development of new cellular vaccines for the prevention of herpesvirus and other viral infections.

Thrombotic Lesion of the Pulmonary Vessels in Patients with Pulmonary Embolism

After suffering pulmonary embolism (PE), doctors are confronted with various consequences of the disease, from asymptomatic residual pulmonary thrombosis to the formation of chronic thromboembolic pulmonary hypertension (CTEPH). There is also a subgroup of patients who have undergone pulmonary embolism, who experience shortness of breath during physical exertion, absent before pulmonary embolism, or shortened dyspnea preceding PE, combined with residual thrombosis of pulmonary artery (PA) and normal average pressure in PA at rest during catheterization of the right heart (CRH). This condition is defined as chronic thromboembolic pulmonary disease or post thromboembolic syndrome. Pathogenetic aspects of this condition are not fully investigated. It is important to predict the development of postembolic syndrome and to develop algorithms for the diagnosis, treatment and rehabilitation of patients with symptoms and residual pulmonary thrombosis. In case of the development of pulmonary vasculopathy in some patients who have undergone pulmonary embolism, a severe life-threatening condition forms - CTEPH, characterized by an increase in pressure in the pulmonary artery, right heart failure due to the presence of organized blood clots that have entered the pulmonary vascular bed during PE. The volume of thrombotic masses does not always correlate with clinical symptoms, which indicates the importance of microvascular remodeling. If CTEPH is suspected, a diagnostic algorithm is required, including ventilation-perfusion scintigraphy, CT angiopulmonography and catheterization of the right heart. Treating a patient with CTEPH is a difficult task fora doctor. The timely referral of the patient to the center where they are involved in treatment, including surgery and CTEPH is extremely important. Timely performed thrombendarterectomy in some cases allows to completely cure the patient. In the case of inoperable CTEPH or residual pulmonary hypertension after thrombendarterectomy, balloon angioplasty of the PA is used as well as drug treatment with specific drugs that reduce the pressure in the PA (riociguat), endothelin receptor antagonists (bosentan, macitentan), prostanoids (inhalant illoprost) phosphodiesterase-5 inhibitor and combined therapy. In this article we considered some consequences directly related to PE: asymptomatic residual pulmonary thrombosis, chronic thromboembolic pulmonary disease, chronic thromboembolic pulmonary hypertension.

[Development and properties of neutralizing monoclonal antibodies for fusion protein of respiratory syncytial virus.]

INTRODUCTION

Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections in infants and the elderly. The absence of a wide range of therapeutic drugs and vaccines indicates to the high relevance of the development of new effective drugs for the prevention and treatment of RSV infections.

PURPOSE

to obtain highly active and specific monoclonal antibodies (MAbs) capable of detecting RSV in infected cells and neutralizing the infectious activity of the virus in vitro.

MATERIAL AND METHODS

RSV reference strains of group A 2 subgroups (A2 and Long) were propagated in HEp-2 and MA-104 cell lines, respectively. Mice were immunized with purified RSV A2 virus. MAbs were obtained using hybridoma technology.

RESULTS

A panel of 6 MAbs reacting with RSV strains А2 and Long has been obtained. Four MAbs were IgG (IgG2a or IgG2b subtype), two MAbs were IgM. All MAbs reacted with RSV F-protein in immunochemical tests. The MAbs actively reacted with RSV in ELISA, in immufluorescence and peroxidase staining of infected cells, and in immunodot test. Five out of 6 MAbs neutralized of RSV in cell culture. Different properties of MAbs suggest that they target different antigenic sites of F-protein.

DISCUSSION

Comparative analysis suggests that the obtained MAbs can be used for the development of diagnostic preparations, for RSV detection in clinical materials and confirmation of infection etiology by rapid culture method.

CONCLUSION

High activity and specificity of MAbs indicate that they can serve as a basis for development vaccines and preventive medicines.

[The place of riociguat in the treatment of patients with pulmonary arterial hypertension associated with systemic connective tissue diseases]

Pulmonary hypertension (PH) can develop in different systemic autoimmune rheumatic diseases (SARD), such as systemic scleroderma (SSD), systemic lupus erythematosus, rheumatoid arthritis, and mixed connective tissue disease In most cases, patients with SARD develop WHO group I PH (pulmonary arterial hypertension associated with systemic connective tissue diseases, PAH-SCTD). General prevalence of this pathology reaches 15 cases per million adults. Most cases of PAH-SCTD are induced by SSD. Survival of PAH-SCTD patients is generally lower than survival of patients with other forms of LAH. Treatment of any SARD, including in LAH, implies a complex approach using glucocorticoids, disease-modifying anti-rheumatic drugs (cyclophosphamide, methotrexate, azathioprine, and others), and genetically engineered biologics. Specific targeted therapy is indicated for most patients with PAH-SCTD. The representative of a new class (soluble guanylate cyclase (sGC) stimulators), riociguat, has been approved for the treatment of PAH. This drug has a unique double mechanism of action: (i) sGC sensibilization to endogenous nitric oxide (NO) by stabilizing the NO-sGC bond; and (ii) direct, NO-independent sGC stimulation. For patients with PAH-SCTD, riociguat is the major alternative to phosphodiesterase-5 inhibitors both as monotherapy and combination therapy.

AB0187 UNTREATED EARLY RHEUMATOID ARTHRITIS WITH ONSET IN THE YOUNGER (18-49 YEARS) AND OLDER (50 YEARS AND OLDER) AGE ACCORDING TO PRACTICAL HEALTH CARE. COMPARATIVE STUDY

Background

Comparative characteristics of various clinical manifestations in untreated early rheumatoid arthritis (RA) in younger and older age patients is not sufficiently covered in the literature.

Objectives

To compare the frequency of different clinical manifestations in younger (18-49 years) and older (50 years and older) age patients with early RA who had not received background therapy yet.

Methods

292 patients (men-65, women - 227, mean age 53.57±16.08 years) with early-stage RA were selected from 5327 patients included in the All-Russian register of patients with arthritis OREL from 01/01/2012 to 31/12-2018. They were studied during the first visit before prescription of background therapy (DMARDs: synthetic, biologics or other targeted drugs and systemic glucocorticoid therapy). 141/227 patients had RA onset at 18-49 years age (group 1): men-25, women-116, mean age (m±SD) 39.27±7.97 years. 151/227 patients had RA onset at 50 years or older age (group 2): men -41, women -110, mean age 66.05±7.34 years. RA was diagnosed according to ACR 1987 and ACR/EULAR 2010 criteria. Disease activity was assessed according to DAS-28 index, radiological stage – Steinbrocker classification, functional disorders - according to functional class (FC).

Results

The male/female ratio in group 1 was 1:4.6, in group 2 - 1:2.8 (p=0.055). Following disorders developed more often in group 2 than in group 1: morning stiffness (82% vs. 59%) (p< 0.05), lesions of small joints of the hands (76% vs. 65%) (p >0.05), wrist joints (65% vs. 52%) (p< 0.05), elbow (33% vs. 17%) (p< 0.05), knee (53% vs. 36%) (p< 0.05), shoulder (44% vs 19%) (p< 0.05), the total number of affected symmetrical pairs of joints (452 vs 285) (p< 0.001). Patients of group 2 showed more pronounced inflammatory process than in group 1: high activity - 66% vs. 35%, respectively (p< 0.05), as well as destructive changes in joints (erosive arthritis - 52% vs. 29%; p< 0.05) and functional disorders (FC 3 - 68% vs. 15%, respectively). RF was detected with equal frequency in both groups (72% vs 72%, respectively; p>0.05), and ACPA was more frequently positive in group 1 (89 vs 78%, respectively; p<0.037).

Conclusion

Comparative study of the clinical characteristics of the natural course of early RA with onset in younger age (18-49 years) and with onset in older age (50 years and older) according to the data of the All-Russian register of patients with arthritis OREL showed that RA with onset in older age is characterized by stronger inflammatory process, destructive and functional disorders in the joints than RA with onset at a younger age.

Disclosure of Interests

None declared

The adjuvant effect of polymuramil, a NOD1 and NOD2 agonist, differs when immunizing mice of different inbred lines with nonstructural hepatitis C virus (Flaviviridae: Hepacivirus)proteins and is synergistically enhanced in combination with pyrogenalum, a TLR4 agonist

INTRODUCTION

Hepatitis C is a liver disease with high chronicity, the cause of cirrhosis and hepatocarcinoma. The main obstacle to controlling hepatitis C is the lack of vaccines. The aim of the work was to compare the immunogenic activity of nonstructural recombinant proteins NS3, NS4 and NS5B of hepatitis C virus (HCV) as components of a subunit candidate vaccine and to analyze the adjuvant properties of two available commercial drugs, polymuramil and pyrogenalum.

MATERIALS AND METHODS

BALB/c, DBA/2J and C57BL/6 mice were immunized with nonstructural proteins without adjuvants or with polymuramyl (NOD1 and NOD2 agonist) and pyrogenalum (TLR-4 agonist). The activity of antibodies was determined in ELISA, the cellular response - by antigen-specific lymphocyte proliferation and by production of IFN-γ in vitro.

RESULTS

Recombinant proteins showed different immunogenicity. NS4 induced antibodies more efficiently than NS3 and NS5B. Significant differences were found in the immune response of three inbred lines mice: the level of IFN-γ in BALB/c and DBA/2J mice induced by NS5B protein was 30 times higher than in C57Bl/6 mice. In contrast, the induction of antibodies in BALB/c mice was lower than in C57Bl/6 and DBA/2J. Polymuramil did not increase the humoral response to NS5B and enhanced the cellular response only in C57BL/6 mice. The combined use of polymuramil with pyrogenalum significantly increased both the humoral and cellular response of mice to all recombinant HCV proteins.

CONCLUSION

Different immunogenic properties and different functions of recombinant non-structural HCV proteins indicate the feasibility of their combined inclusion in subunit vaccines. It was established for the first time that immunization with HCV proteins with a complex adjuvant (polymuramyl + pyrogenalum) has a synergistic effect, significantly exceeding the effect of each of them separately.