Structure-Guided Approach for the Development of MUC1-Glycopeptide-Based Cancer Vaccines with Predictable Responses

Mucin-1 (MUC1) glycopeptides are exceptional candidates for potential cancer vaccines. However, their autoantigenic nature often results in a weak immune response. To overcome this drawback, we carefully engineered synthetic antigens with precise chemical modifications. To be effective and stimulate an anti-MUC1 response, artificial antigens must mimic the conformational dynamics of natural antigens in solution and have an equivalent or higher binding affinity to anti-MUC1 antibodies than their natural counterparts. As a proof of concept, we have developed a glycopeptide that contains noncanonical amino acid (2S,3R)-3-hydroxynorvaline. The unnatural antigen fulfills these two properties and effectively mimics the threonine-derived antigen. On the one hand, conformational analysis in water shows that this surrogate explores a landscape similar to that of the natural variant. On the other hand, the presence of an additional methylene group in the side chain of this analog compared to the threonine residue enhances a CH/π interaction in the antigen/antibody complex. Despite an enthalpy-entropy balance, this synthetic glycopeptide has a binding affinity slightly higher than that of its natural counterpart. When conjugated with gold nanoparticles, the vaccine candidate stimulates the formation of specific anti-MUC1 IgG antibodies in mice and shows efficacy comparable to that of the natural derivative. The antibodies also exhibit cross-reactivity to selectively target, for example, human breast cancer cells. This investigation relied on numerous analytical (e.g., NMR spectroscopy and X-ray crystallography) and biophysical techniques and molecular dynamics simulations to characterize the antigen-antibody interactions. This workflow streamlines the synthetic process, saves time, and reduces the need for extensive, animal-intensive immunization procedures. These advances underscore the promise of structure-based rational design in the advance of cancer vaccine development.

P929 Routine Left Atrium Strain in acute STEMI: to do or not to do

Introduction and purpose

Left atrium strain (LAS) is a very useful, modern method of establish left atrium (LA) function and rarely use in predicting adverse events (AE) in acute anterior ST-elevated myocardial infarction (STEMI). The purpose of our study was to compare LAS among other echocardiographic parameters of LA and left ventricle (LV) function, in patients that developed AE (heart failure, all cause mortality, reinfarction and rehospitalization) after acute anterior STEMI during one year follow up.

Methods

All 101 patients with a first acute anterior STEMI treated by primary PCI had early echocardiography in first 24 hours. After one year follow up, patients were divided in two groups: AE group (27 patients; 27%) and non-AE group (74 patients; 73%). We compared: LA size, LA maximal volume index, LAS, systolic and diastolic left ventricle parameters, between groups for the purpose of identifying early AE predictors.

Results

Among all left atrium parameters, LA strain was most prognostic for AE between groups (AE group vs. non-AE group): LA diameter (3,7cm vs. 3,5cm, p = 0,03), LA maximal volume index (27 ml/m2 vs. 24,5 ml/m2, p = 0,03), LAS (30% vs.37%, p < 0,0001)

Statistically significant differences in systolic and diastolic LV function between AE and non-AE groups were: ejection fraction (p < 0.0001), stroke volume index (p < 0.0001), fractional shortening (p < 0.0001), cardiac index (p < 0.0001), LV systolic work (p < 0,0001), WMSI- wall motion score index (p < 0,0001), average LV peak systolic longitudinal global strain- LGSav (p < 0,001), mitral inflow peak early velocity/average mitral annular peak early velocity- E/e"av (p < 0,001).

After adjustment for all echocardiographic parameters, LA strain (OR 0,91 95% CI, p = 0,04), WMSI ≥ 2 (OR 6.1 95% CI, p < 0.001), average peak systolic left ventricle LGS (OR = 15.1 95% CI, p < 0.0001) and cardiac index (OR 2.6 95% CI, p = 0.01) were independently associated with adverse outcomes.

Conclusion

Routine left atrium strain is very prognostic parameter of high-risk STEMI patients for adverse events and could possibly be considered as an important component of the new predictive score system for MACE and mortality of STEMI patients in the near future.

P280 Evaluation of right atrium in patients with gestational hypertension

Introduction

Some authors have confirmed changes in function of the right hearth in different conditions with endothelial dissfunction, such as systemic hypertension and metabolic syndrome. During gestational hypertension (GH), endothelial disfunction is one of the main pathogenic causes of vasoconstriction and placental insuficiety and following intrauterine growth restriction. Few authors evaluated function of the right ventricle during gestational hypertension, but to our knoledge, there are no studies about right atrial function during gestational hypertension.

Purpose

We hypothesized that there are changes in right atrial function durig gestational hypertension, and wondered if they are reversible.

Methods

Study included 45 pregnant women. 25 with GH (defined as blood pressure ≥140/90mmHg that appeared after 20th week of gestation and disappeared within six weeks postpartum) and 20 normotensivewomen,as control. Function of right atrium and right ventricle was evaluated according to the last guidelines for chamber quantification. Additionally, right atrial function was assessed with p-p cycle speckle tracking. Echo was performed in the third trimester of pregnancy and 6 weeks after delivery.

Results

Parameters showed impairment of RV diastolic function. Women with gestational hypertension had E/e" over the normal value and higher than healthy pregnants, althow difference was not significant. ( 6.46 +- 4.7 vs 5.16 +- 1.9, p =0.66). TDI derived E" from lateral tricuspid annulus was significantly lower in hypertensive group (0.11 +- 0.03 vs 0.14 +- 0.03 p= 0.023). Atv – right ventricle late filling velocity was significantly higher in patients with GH (0.61 +- 0.1 vs 0.51+-0.12, p= 0.08) .

All pregnant women had normal values of RA dimensions, RA endsystolic area, RA endsystolic volume (RAVs). RAVs was significantly larger in GH group (34.64 +-12 vs 27.9+- 9.89, p= 0.041) comparing to the controls, but when we indexed it to the BSA, difference disappeared. Peak longitudinal strain was signfificantly higher in hypertensive group (33.49+- 2.48 vs 28.05+- 4.52, p= 0.001). After Pearson correlation of peak longitudinal strain with parameters of right ventricle diastolic function was done, there was possitive correlation between peak longitudinal strain and Etv (right ventricle early filling velocity) in hypertensive group (r 0.646, p 0.017). Also RAVs positively correlated with LAVsI (r= 0.577, p= 0.019), and RAVsI positively correlated with LAVsI (r= 0.690, p = 0.019).

After delivery all changes disappeared.

Conclusion

Our study indicates that right atrium accommodates to the hemodynamic and functional changes during gestational hypertension. It changes because of modified right ventricle diastolic function and probably in the same mode as left atrium. RA peak longitudinal strain is high, so function of the right atrium is preserved, and we assume that short time of mentioned changes during pregnancy, is the reason why.

P948 Assessment of maternal cardiac remodeling and systolic function by 3D echocardiography in gestational hypertension and preeclampsia

Background

It was recently showed that there is a difference between 3D and 2D evaluation of the left ventricular (LV) myocardial mass and cardiac function in gestational hypertension (GH) probably due to more pronounced heart shape changes in hypertensive pregnant women. It is also known that preeclampsia (PE) is associated with a deterioration in maternal cardiac function. Purpose: We were interested whether there was a difference in 3D morphological and functional parameters of the LV in relation to the blood pressure (BP) profile in GH, but also between GH and PE. Methods: 22 women and 55 with GH (28 with dipping pattern of BP, and 27 non-dippers) underwent 3D echocardiography and ambulatory blood pressure monitoring in the third trimester. LV mass index, LV volumes, SV index and parameters of systolic function of the LV: CO index, EF, longitudinal strain (LS), circumferential strain (CS), radial strain (RS) and area strain (AS) were estimated using 3D software. These three groups (PE, dippers and non-dippers) were each other"s control. Results: Groups did not differ in age and LV massi. SVi was significantly lower in non-dippers (p = 0,045) and PE (p = 0,031) compared with dippers, without significant difference between non-dippers and PE (p = 0,59). Similar results were obtained when we analyzed the EF in these three groups. COi was the lowest in PE (2,76 ± 0,3), compared with dippers (3,43 ± 0,5; p< 0,0005), with significant difference between non-dippers (2,97 ± 0,4; p< 0,0005) and dippers, and with a small difference between PE and non-dippers (p = 0,045). Evaluation of the systolic function by 3D strain, also showed that the systolic function was significantly lower in PE, but also in non-dippers compared to dippers (Table 1). Multivariate regression analysis revealed that nocturnal BP (p = 0,001; OR 1,106; 95% CI 1,029 - 1,142) and presence of proteinuria (p< 0,0005; OR 7,2; 95% CI 1,896 – 36,5) strongly predict preterm delivery. Conclusions: Deterioration of 3D systolic function is more pronaunced in PE, but also in non-dipping pattern of BP in GH compared with dippers, without significant difference in 3D LV massi between groups.

Values od 3D strain in groups Dippers Non-dippers PE p1 p2 p3 LS -18,62 -16,99 -16,91 p< 0,0005 p< 0,0005 ns CS -18,22 -16,22 -16,21 p< 0,0005 p< 0,0005 ns RS 52,85 48,3 48,1 p< 0,0005 p< 0,0005 ns AS -31,77 -27,67 -27,98 p< 0,0005 p< 0,0005 ns p1 - difference between dippers and non-dippers; p2 - difference between dippers and PE; p3 - difference between non-dippers and PE

P5545Predictors of 10-year mortality and re-intervention in patients with multivessel coronary disease, reduced systolic left ventricular function, after complete revascularization by PCI or CABG

Introduction

In patients with multivessel coronary disease, the decision on revascularization should be made through a heart team. Whether there is an optimal method and what are the predictors of mortality and repeated interventions is the subject of numerous studies.

Purpose

To determine what are the predictors of 10-year mortality and repeated interventions in patients with multivessel coronary disease and reduced systolic left ventricular function in which complete revascularization is done through percutaneous coronary intervention (PCI) and surgical aortocoronary bypass (CABG).

Methods

The survey included 178 patients who underwent elective revascularization of multivessel coronary disease in one center during 2008 through PCI or bypass, according to the heart team's decision. All subjects had a reduced left ventricular systolic function, ejection fraction less than 50%. The study excluded patients with acute coronary syndrome. The basic demographic and clinical characteristics of the subjects and risk factors were analyzed.

Results

Ten-year mortality was 31.4%, without a significant difference between the examined groups (in the PCI group 25 patients (30.5%) in the bypass group 30 (32.3%), p>0.05). In subjects with letal outcome during 10-year follow-up, lower hemoglobin levels in discharge, enlarged cardiac cavities, increased internal diameter of left ventricle in systole (LVIDs) and enlarged left atrium, lower systolic left ventricular function, higher EUROscore and higher NYHA class in discharge. The enlarged left ventricular diameter in systole (OR 2.28 (1.27–4.11), p=0.006) and the NYHA class (OR 2.49 (1.22–5.08), p=0.012) are independent predictors ten-year mortality. In the group of patients undergoing surgical revascularization, independent predictors of 10-year mortality are higher levels of uric acid (OR 1,006 (1,000–1,011), P=0,047) and lower serum hemoglobin at discharge (OR 0,959 (0,919–0,999), P=0.046), while in PCI group LVIDs (OR 2.89 (1.351–6.196), p=0.006). During the 10-year follow-up, repeated PCI was performed in 12 (14.5%) patients in the PCI group and in 3 (3.2%) patients in the CABG group, p=0.012. No surgical revascularization was performed during follow up. Diabetes mellitus is an independent predictor of reintervention in the PCI group (OR 4.12 (1.153–14.703), p=0.029).

Conclusion

Mortality predictors during ten years of follow-up in subjects following a revascularization of multivessel coronary disease, and with reduced left ventricular systolic function, are increased systolic left ventricular diameter and higher NYHA class in discharge. Reintervention is more commonly performed after PCI and the presence of diabetes mellitus is an independent predictor.

P2639The influence of non-dipping pattern of blood pressure in gestational hypertension on early onset of hypertension later in life

Background

It is known that gestational hypertension (GH) and preeclampsia have been associated with the onset of hypertension later in life. We wondered if the blood pressure (BP) pattern affects the incidence of hypertension in the future.

Purpose

The aim of this study was to determine whether hypertension occurs more frequently if a non-dipping pattern was registered during GH, but also if non-dipping pattern in GH afects deterioration of systolic function of the left ventricle (LV) later in life.

Methods

This longitudinal study included 56 pregnant women with gestational hypertension (of which 28 met criteria for non-dipping pattern of BP, according to the values registrated by the ambulatory blood pressure monitoring (ABPM) – non-dippers, while other 28 were classified in dippers) and 27 normotensive pregnant women, as control. All of women became normotensive after delivery, but they continued to be periodically controlled in term of values of blood pressure. The function and morphology of the left ventricle (LV) were analyzed by echocardiography exam in the third trimester of pregnancy and 5 years after delivery, as well as ABPM, while 2D longitudinal strain (LS) was performed only after delivery in order to evaluate systolic function of the LV. All echo and ABPM parameters recorded during pregnancy, also as parameters of pregnancy outcome – intrauterine growth restriction (IUGR) and preterm delivery, were analyzed, in order to relate them with later onset of hypertension.

Results

After, average 5 years, diagnosis of hypertension was determined in 8 women (2 from dipper group – during pregnancy – 7,1%, and 6 from non-dipper group 21,4%). Those 8 hypertensive women had significantly reduced LS: −18,12±1,3 compared to normotensive −19,9±1,4 (p=0,001). It is very interesting that, 5 years after delivery, values of 2D LS were, although in reference values, significantly reduced in women who were non-dippers (−19,32±1,38) during GH, compared with both, normotensive (−20,69±1,18; p<0,0005) and dippers (−20,10±1,29; p=0,026). Univariate regression analysis revealed that higher values of day and night BP, the mean arterial BP, LV mass index, preterm delivery and IUGR were associated with onset of hypertension later in life, while parameters of systolic and diastolic function of the LV during pregnancy, didn't affect occurrence of it. As revealed by multivariate regression analysis, the peak value of night-time diastolic blood pressure during pregnancy (p=0,016; OR=1,127; 95% CI: 1,022–1,242) and the LV mass index, also during pregnancy (p=0,041; OR=1,099; 95% CI: 1,004–1,203) had strong relation with hypertension in future life.

Conclusion

The non-dipping pattern of blood pressure in gestationl hypertension is significant associate with onset of hypertension later in life, but also with decreased systolic function of the left ventricle.

Acknowledgement/Funding

Provincial Secretariat for Health of the Autonomous Province of Vojvodina

Breast cancer survivorship symptom management: current perspective and future development

Increasing numbers and longevity of cancer survivors has furthered our insight into the factors affecting their health outcomes, suggesting that multiple factors play a role (e.g., effects of cancer treatments and health behaviors). Emotional and physical symptoms may not always receive sufficient attention. In this short narrative review highlighting recent literature, we describe the most common physical and emotional symptoms of breast cancer survivors aged 50 years and older and outline a multidisciplinary symptom management approach, regardless of symptom etiology.