Red and brown seaweeds extracts: A source of biologically active compounds

The biological activities of Porphyra sp., Gracilaria gracilis, Alaria esculenta and Saccharina latissima extracts prepared by enzymatic and ball milling-assisted methods and hot water were evaluated. Enzyme-assisted methods allowed the highest extraction yields. Alcalase-assisted extraction (EAA) was the most effective in the recovery of polyphenolic compounds and Porphyra sp. had the highest content. The efficiency of flavonoids extraction was highly dependent on the used method. Globally, Porphyra sp. and EAA extracts exhibited the highest antioxidant and chelating activities. The highest α-amylase inhibitory activity was determined in HW Porphyra sp. extract while EAA A. esculenta extract had the highest α-glucosidase inhibitory activity. The highest ACE inhibitory activity was obtained in EAA from S. latissima. None of the extracts showed antimicrobial activity against the tested bacteria. The results showed that Porphyra sp. and S. latissima are potentially useful as ingredient in functional foods and nutraceuticals.

POS0238 SIDE EFFECT PROFILE OF HYDROXYCHLOROQUINE USE IN PATIENTS WITH RA, SLE, AND OTHER RMDs OVER 20 YEARS

Background

During the pandemic, hydroxychloroquine (HCQ) became a household name, yet despite more than 70 years as a csDMARD treatment, relatively little is known about its overall side effect (SE) profile.

Objectives

To understand the types, severity, and rates of patient-reported side effects of HCQ in adults with RA, SLE, and other RMDs alone and in comparison with methotrexate (MTX).

Methods

Adult participants in the Forward Databank observational registry reported all medication use and medication side effects through biannual questionnaires from 1999 through 2021. Incident use of HCQ and MTX were measured at enrollment and longitudinally with additional reporting of severity of side effects, certainty of medication as cause of side effect, and affected body systems. We analyzed incident rates of side effects overall and by HCQ or MTX categorical use, respectively: monotherapy, with concomitant use of another csDMARD, or with concomitant use of a bDMARD or tsDMARD. Finally, the likelihood of having any side effects was analyzed in Cox regression models by comparing HCQ initiators to MTX initiation, and within each, combination MTX or HCQ with csDMARD or bDMARD to monotherapy; these models were adjusted for age, sex, RD Comorbidity Index, patient global, pain, disease duration, and number of bDMARDs used.

Results

Overall, 5874 patients initiated HCQ and 10420 initiated MTX, with RA as the predominant diagnosis. Mean baseline characteristics were similar for RA: 59 years old, 80% female and 12 years of RA duration. HCQ was mostly used with other csDMARDs, while MTX was mostly used with bDMARDs. In the other RMD and SLE groups, most were on HCQ monotherapy. For all RMDs, SE incidence for HCQ (16 – 17%) was lower than MTX (26 – 39%). The Table 1 provides incidence rates by HCQ/MTX for any SE, a SE that forces medication discontinuation, and SE leading to hospitalization. Reported SE rates were always higher for MTX vs. HCQ for all SE severity and diagnoses.

Table 1.

Incidence rates (IR) per 1000 patient-years of SEs by diagnoses for HCQ and MTX initiators

RASLEOtherPt-yrsIR (95% CI)Pt-yrsIR (95% CI)Pt-yrsIR (95% CI)Any HCQ SE1271126 (23, 29)130525 (18, 36)56741 (27, 61)Mono HCQ339728 (24, 33)79728 (18, 42)34752 (32, 82)HCQ + csDMARDs547328 (24, 33)41624 (13, 45)12732 (12, 84)HCQ + bDMARDs384122 (17, 27)9311 (2, 77)9311 (2, 76)SE stopping HCQ1271113 (11, 15)130512 (7, 19)56714 (6, 35)Mono HCQ339712 (9, 16)79711 (6, 22)34714 (6, 35)HCQ + csDMARDs547315 (12, 18)41613 (5, 31)12724 (8, 73)HCQ + bDMARDs384112 (9, 16)930930HCQ SE hospitalization127110.31 (0.12, 0.84)13050.77 (0.1, 5.4)5670Any MTX SE8123451 (49, 52)151659 (48, 72)214572 (61, 84)Mono HCQ2298049 (46,52)36941 (25, 67)80262 (47, 82)MTX + csDMARDs1544772 (68, 77)87269 (53, 89)229131 (91, 187)MTX + bDMARDs4274843 (41, 45)26549 (29, 85)110667 (53, 84)SE stopping MTX9147726 (25, 27)163841 (32, 52)233544 (36, 53)Mono MTX2606019 (17, 20)39033 (19, 57)88527 (17, 39)MTX + csDMARDs1743038 (36, 42)93348 (36, 65)25590 (60, 136)MTX + bDMARDs4783225 (23, 26)30526 (13, 53)118847 (36, 61)MTX SE hospitalization964362.4 (2.1, 2.8)16745.4 (2.8, 10.3)25023.2 (1.6, 6.4)

By body system, the patterns of any SE were similar between HCQ or MTX initiators. Gastrointestinal SEs were the most common for both. Only ocular SEs were higher for HCQ vs. MTX. Multivariable Cox regression models of HCQ vs MTX SEs had a HR 0.46 (0.41 - 0.51) for RA, HR 0.47 [0.27 – 0.82] for SLE, and HR 0.51 [0.25 – 1.02] for other RMDs. While there was no difference in HCQ SEs by concomitant category or diagnoses, there was consistently higher SE rates in MTX for those on concomitant csDMARD vs monotherapy: RA HR 1.27 (1.16 - 1.38), SLE HR 1.97 (1.03 - 3.52), and other RMDs HR 2.04 (1.28 - 3.24).

Conclusion

This is the largest study yet to review patient-reported SEs from HCQ and MTX in RA and other RMDs over a 20-year period. While validating SEs was beyond the scope of the current study, we found an overall low incidence of SEs from HCQ use, with an adjusted rate half of those reported for MTX, and that this low rate did not differ by diagnosis or concomitant DMARD use.

Disclosure of Interests

None declared

OP0039 HOSPITALIZATION AND MORTALITY OUTCOMES IN RHEUMATOID ARTHRITIS PATIENTS WITH LUNG DISEASE

Background:

Pulmonary manifestations such as interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) are frequent extra-articular features that carry a poor prognosis in rheumatoid arthritis (RA). Prior studies have demonstrated that respiratory-related mortality is the most overrepresented cause of death in RA.

Objectives:

To assess the risk of all-cause and respiratory-related hospitalization and mortality in RA patients with comorbid lung disease (LD) in comparison to those without and the differential risks associated with DMARD treatments.

Methods:

Eligible RA patients included those enrolled in the Forward Databank with ≥1 year observation after 2000 and had initiated a DMARD. Forward is a large longitudinal rheumatic disease registry in the US. RA patients’ diagnoses were rheumatologist-confirmed, and every 6 months participants completed comprehensive questionnaires regarding symptoms, disease outcomes, medications, and clinical events. LD was defined as one of the following: emphysema, asthma, bronchitis, COPD, pleural effusion, fibrosis of the lung, “RA lung“, or ILD (England 2019). DMARDs were categorized hierarchically into four groups: csDMARDs, TNFi and NTNFi (bDMARDs), and tsDMARDs. Patients were followed from DMARD initiation until event (death and/or hospitalization) or end of follow-up, whatever came first. Events were validated using medical records and the US National Death Index. Respiratory hospitalizations and deaths were identified with ICD9 (460-519). Events were analyzed using incidence rates (IR) and Cox regression models. Models were adjusted for LD, DMARDs, age, sex, education, HAQ disability, Rheumatic Disease comorbidity index, smoking, pain, glucocorticoids, year of entry, prior bDMARDs and csDMARDs counts and MRC breath scale.

Results:

Of the 21,525 eligible RA patients, 13.8% had LD at the time of DMARD initiation. Patients had 59 years old in both groups and 15% were male for LD+ vs 21% for LD-. Patients with LD+ showed worse disease outcomes (HAQ: 1.3 (0.7) vs 1.0 (0.7)) and comorbidities (2.9 (1.9) vs 1.5 (1.4)) overall and for all treatment groups, especially for NTNFi and tsDMARDi. The overall IR of any all-cause or respiratory-related events were higher in LD+ than LD- RA patients and across any DMARD treatments, with NTNFi having higher IR (Figure). In survival analyses, LD+ was associated with an increased risk for all-cause hospitalizations/deaths (HR 1.3; 95% CI 1.1-1.4) and a 3.95-fold increased risk of respiratory-related events (HR 4.0; 3.2-4.9) (Table). These risks did not differ significantly across DMARD treatment groups. Increased age, HAQ disability, comorbidities, glucocorticoids, prior bDMARDs and worse MRC breath scales were associated with an increased risk in both outcomes and smoking in respiratory-specific events.

Conclusion:

An increased risk of hospitalizations and/or deaths was demonstrated for RA patients with lung disease, most notably a 4-fold increased risk for respiratory-related events. No differences were found between incident DMARD groups. Additional studies accounting for channeling of treatments by baseline health status are needed.

References:

[1]England BR, et alArth Care Res. doi:10.1002/acr.24043.

Figure.

 IR (95% CI): all-cause and respiratory-related events by LD+/LD- and DMARDs

Table.

HR (95% CI) for Cox models.

VariablesAll causeAll respiratory specificLD+ vs LD-1.34.0(1.1 - 1.4)(3.2 - 4.9)Tnf vs csDMARD1.01.1(0.8 - 1.1)(0.8 - 1.5)NTNF vs csDMARD1.00.9(0.8 - 1.2)(0.6 - 1.5)tsDMARD vs csDMARD0.81.8(0.4 - 1.4)(0.7 - 4.7)

Disclosure of Interests:

Sofia Pedro: None declared, Ted Mikuls Grant/research support from: Horizon Therapeutics, BMS, Consultant of: Pfizer, Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Kaleb Michaud Grant/research support from: Janssen

FRI0072 DISCONTINUATION OF DMARD USE IN RHEUMATOID ARTHRITIS PATIENTS WITH LUNG DISEASE

Background:

Pulmonary manifestations such as interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) are frequent extra-articular features that carry a poor prognosis in Rheumatoid Arthritis (RA). Little data is available on how RA patients (pts) with pulmonary disease are managed in real-world settings.

Objectives:

To assess treatment patterns and DMARD discontinuation in RA patients with comorbid lung disease in comparison with other RA patients.

Methods:

The study included RA Patients enrolled in the Forward Databank with ≥1 year observation after 2000 initiating a DMARD. Forward is a large longitudinal rheumatic disease registry in the US. RA patients’ diagnoses were rheumatologist-confirmed, and every 6 months participants completed comprehensive questionnaires regarding symptoms, disease outcomes, medications, and clinical events. Lung disease (LD+) was defined as at least one of the following: emphysema, asthma, bronchitis, COPD, pleural effusion, fibrosis of the lung, “RA lung”, or ILD, the later classified by ICD9 codes (England 2019). DMARDs were categorized hierarchically into four groups: csDMARDs, TNFi and NTNFi (bDMARDs), and tsDMARDs. Percentage of patients who initiated different DMARDs were reported for pts with LD+/LD-. Discontinuation was analyzed by Kaplan Meier (KM) curves, log-ranks tests, and Cox regression models using time-varying covariates. Best models were created using backward selection models (10% probability of removal) and pre-defined clinical models.

Results:

Of the 21,525 eligible RA patients, 13.8% had LD+ at the time they initiated a DMARD (follow-up: 69,597 pt-yrs (median 1.9 yrs/pt)). LD+ patients tended to have more severe RA outcomes and comorbidities. MTX-monotherapy (48% vs 44%, p<0.001) and NTNFi were initiated more frequently in LD+ pts with lower use of TNFi (Figure). DMARD discontinuation rates were higher among LD+ patients for all DMARD groups, but KM curves were only significantly different for csDMARDs and TNFi. Different HRs for LD+ were found depending on the model used ranging from 1.18 to 1.28, and all models revealed an increased risk of discontinuation for LD+ patients. Compared to csDMARDs, TNFi were more often discontinued (Table). Other variables associated with an increased risk of discontinuation included: HAQ, Rheumatoid Disease (RD) comorbidity index, pain, prior bDMARDs, and csDMARDs.

Conclusion:

Different DMARD treatment patterns were found for LD+ patients, who tended to initiate more csDMARD and NTNFi and less likely to initiate a TNFi. LD+ patients were at a higher risk of discontinuation irrespectively of the DMARD treatment, but with greater risk for TNF users.

References:

[1]England BR, et al. Arth Care Res. doi:10.1002/acr.24043.

Figure.

DMARD treatment initiators by disease group

Table .

Cox models for DMARD discontinuation by stepwise (removal probability 10%) and clinical models including DMARD treatment.

Model of DMARD persistence*Model 1- Stepwise-Without drugsModel 2 – StepwiseModel 3 - ClinicalLD+ vs LD–1.181.281.20(1.08 - 1.29)(1.13 - 1.45)(1.08 - 1.34)TNF vs csDmard1.321.22(1.08 - 1.63)(1.04 - 1.44)NTNF vs csDmard1.131.13(0.83 - 1.52)(0.90 - 1.41)tsDmard vs csDmard1.301.02(0.65 - 2.60)(0.64 - 1.62)

*Best models searched/Clinical adjusted for LD+/LD-, DMARDs, age, sex, education, HAQ disability, RD comorbidity index, smoking, pain, glucocorticoids, year of entry, prior bDMARDs and csDMARDs counts and MRC breath scale.

Disclosure of Interests:

Sofia Pedro: None declared, Ted Mikuls Grant/research support from: Horizon Therapeutics, BMS, Consultant of: Pfizer, Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Kaleb Michaud: None declared

Are vitamins A and E associated with persistent organic pollutants and fatty acids in the blubber of highly contaminated killer whales (Orcinus orca) from Greenland?

We quantified blubber concentrations of vitamins A (retinol) and E (α-tocopherol) and evaluated associations with persistent organic pollutants (ΣPOPs) in 14 highly-contaminated killer whales (Orcinus orca) sampled in Greenland from 2012 to 2014. We considered the influence of blubber depth, sex/age class and diet (based on biomass % of major fatty acids) in these relationships. Blubber concentrations of vitamin A averaged 34.1 ± 4.7 μg g^-1 wet weight (ww) and vitamin E averaged 35.6 ± 4.4 μg g^-1 ww. Although overall vitamin A concentrations did not vary between inner (closer to the muscle) and outer (closer to the skin) blubber layer or between sub-adults and adult females, concentrations in the outer layer of sub-adults were lower compared to the outer layer of adult females (p = 0.03). Outer layer may therefore reflect age accumulation of vitamin A, while in the more active inner layer, age effects might be masked by metabolic needs such as lactation. Neither diet nor ΣPOPs affected vitamin A variation, suggesting this vitamin is highly regulated in the body. Given the high exposures in these killer whales, vitamin A might not be a sensitive biomarker for POPs adverse effects. Vitamin E concentrations were significantly higher in inner compared to outer layer (p < 0.001), likely associated with blubber composition, suggesting that biopsies may not fully represent vitamin E concentrations in blubber. Age-accumulation of vitamin E also occurred with higher concentrations in adult females compared to sub-adults, independent of blubber depth (p < 0.01). Diet, ΣPOPs, and an interaction between these two variables significantly affected vitamin E variation in inner blubber, explaining 91% of this variation. The negative relationship between ΣPOPs (especially Σdichlorodiphenyltrichloroethane (DDT) and Σchlordanes in outer layers) and vitamin E was observed only in killer whales with a diet poorer in polyunsaturated fatty acids, suggested that killer whales feeding more consistently on marine mammals in Arctic environments over a fish-based diet, may be at higher risk of POP-induced disruption in vitamin E homeostasis. Considering diet is therefore important to understand the potential effects of elevated contaminant exposures on levels of certain essential nutrients, i.e., vitamin E, in killer whales.

Quality Changes During Storage of Minced Fish Products Containing Dietary Fiber and Fortified with ω3 Fatty Acids

Two ready-to-eat minced fish products from hake were developed, their proximate composition and fatty acid profiles determined and their quality changes followed during 3.5 months under refrigeration at 2 ± 1 °C and 10 ± 1 °C. These products contain dietary fiber and are innovative and healthy. The formulation was identical, except vegetable oil (VO), 5.6% (w/w) in one group and 2.7% (w/w) plus 2.9% (w/w) cod liver oil (CLO) in the other. CLO products had a higher ω3/ω6 ratio (0.54 ± 0.02 versus 0.08 ± 0.02) and ensured, per 100 g serving, the 500 mg recommended daily intake of eicosapentaenoic and docosahexaenoic acids. CLO products showed lower gel strength (p ≤ 0.05), however, other textural properties were similar to those of the VO group. Thiobarbituric acid reactive substances values were higher in CLO products. All groups presented acceptable sensory scores and no microbiological growth. During storage products became redder and less yellow, while seafood aroma and flavor declined and saltiness perception augmented. Temperature had a negative effect on sensory elasticity and instrumental texture.

Patients- and physicians- priorities for improvement. The case of rheumatic diseases

OBJECTIVES

To compare the health priorities elected by patients with rheumatic diseases and by their attending rheumatologists.

PATIENTS AND METHODS

We undertook a cross-sectional study among patients and rheumatologists in Portuguese rheumatology outpatient clinics. 75% of all Portuguese Rheumatology Departments agreed to participate. Rheumatologists from non-participating hospital departments were asked to collaborate through their private practices. All patients were eligible for inclusion except if they were under 18 years of age or had a mental disorder that would affect their participation. Data were collected through dedicated questionnaires. Patients were asked to indicate 3 priorities for improvement out of 12 health domains (Arthritis Impact Measurement Scale 2) regarding their rheumatic disease. Rheumatologists were asked similar questions focused around rheumatoid arthritis (RA) and osteoarthritis (OA).

RESULTS

1,868 patients and 56 rheumatologists entered the study. The most commonly selected priorities by patients with rheumatic diseases were: "Rheumatic pain" (70%), "Walking and bending" (45%), and "Hand and Finger Function" (40%). The main priority for improvement among patients with RA was "Rheumatic Pain" (69%), while rheumatologists more commonly elected "Work" (55%) as their main priority for these patients. Among patients with OA, "Rheumatic Pain" was the first priority for both patients and doctors (elected by 75%, and 55% of respondents, respectively).

CONCLUSIONS

Our study showed discordance between the priorities for improvement elected by patients and by their respective physicians. This was more pronounced in RA than in OA. Studying and addressing such differences may support physicians and institutions to better achieve the prime goal of incorporating and responding to patients' needs and preferences.

Breast Cancer Patients Receiving Neoadjuvant, Adjuvant and Palliative Chemotherapy Have Different DNA Oxidative Damage and Repair Profiles

Background: Antineoplastic agents induce oxidative stress in biological systems leading to lipid, carbohydrate, protein and DNA damage and affecting cell structure and function. These adverse effects may fuel up the acquisition of new mutations and the development of treatment resistances and secondary malignancies.Methods: We selected 90 breast cancer patients receiving neoadjuvant, adjuvant or palliative chemotherapy, to test the effect of this treatment on the systemic oxidative stress. The patients were distributed in equal groups and paired blood samples, before and after chemotherapy, were extracted. DNA oxidative damage was assessed by alkaline comet assay and a specific inmnoenzymoassay was employed to determine RPA and Ku86 DNA repair activity.Results: We found that neoadjuvant patients presented a marked raise in DNA damage after chemotherapy (Figure 1A). DNA repair activity of KU86 was significantly higher in the adjuvant setting and significantly lower in the neoadjuvant and metastatic settings after chemotherapy. Before chemotherapy administration, KU86 activity was higher in the metastatic and neoadjuvant groups compared to the adjuvant group (Figure 1B).Discussion: Our results show that chemotherapy induces the production of free radicals to an extent that causes a severe DNA damage. High levels of DNA damage are maintained along successive clinical interventions, due to continued production of free radicals during breast cancer treatment, despite the activation of the repair mechanisms that are not sufficient to overcome the effects of the oxidative stress at this level. Our work shows that breast cancer treatment affects the redox status of the patients and, because of its effects into cellular signaling pathways and gene expression, it must be considered as a potential therapeutic target to improve breast cancer treatment and minimize the associated toxicity.Figure legend 1.- Oxidative DNA damage and DNA repair markers in neoadjuvant, adjuvant and metastatic patients, before and after chemotherapy. (A) Percentage of DNA in the tail of lymphocytes, as measured by comet assay. (B) DNA repair activity of KU86. Intragroup statistical differences owed to chemotherapy are indicated as ‡ (P&lt;0.001) or * (P&lt;0.05). Intergroup statistical differences for each period (before and after chemotherapy) (P&lt;0.05) are indicated by the letters a and b, in such a way that the measures with different superscript letters, are statistically different.Figure legend 2.- Fluorescent microscope images of damaged lymphocytes from a neoadjuvant patient before (A) and after (B) chemotherapy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1123.

Report on the measles situation in Portugal

A measles case, imported from the United Kingdom (UK), was reported in Portugal in late August 2008. Previously, measles cases imported from Romania, and import-related cases, were reported in 2005. There was no transmission to the autochthonous Portuguese population.

Prevalence and pattern of cognitive impairment in a community cohort of men in South Wales: methodology and findings from the Caerphilly Prospective Study

BACKGROUND/AIMS

The prevalence of dementia and cognitive impairment not dementia was investigated in the Caerphilly Prospective Study cohort (men currently aged 65-84 years).

METHODS

Of 1,633 men eligible for cognitive screening, 1,225 (75%) were seen, with those failing the screening criteria (CAMCOG <83 or decline in CAMCOG >9) being neurologically examined.

RESULTS

For dementia, diagnosed by DSM-IV criteria, the population prevalence was 5.2% rising to 6.1% in the screened population. For cognitive impairment not dementia, the prevalence in the screened population was 15.6% giving an overall prevalence of cognitive impairment of 21.8%. Prevalence rose fivefold between ages of 65 and 84 years to reach over 50%.

CONCLUSION

These figures are likely to underestimate actual prevalence in this population, and developing effective interventions should be a public health priority.

Molecular studies in Portuguese patients with Smith-Lemli-Opitz syndrome and report of three new mutations in DHCR7

Smith-Lemli-Opitz syndrome (SLO) is an autosomal recessive disorder characterised by craniofacial dysmorphism, mental retardation, multiple congenital anomalies, and increased levels of 7-dehydrocholesterol (7-DHC) in body tissues and fluids. SLO is caused by mutations in the DHCR7 gene which encodes 7-dehydrocholesterol reductase, the last enzyme of cholesterol biosynthesis pathway. In our investigation, we screened 682 dysmorphic/mentally retarded Portuguese patients for abnormal levels of 7-DHC in blood by UV spectrometry. We identified six unrelated patients with SLO (0.87% of total). Mutational analysis of the DHCR7 gene led to the identification of seven distinct mutations, three of which are new (F174S, H301R, and Q98X). The common IVS8-1G > C and T93M variants together with the H301R accounted for 70% of the all SLO alleles in our population. Our findings contribute to the variegate array of pathological changes in the DHCR7 gene among different European populations.