First Measurement of the B^{+}→π^{+}π^{0}π^{0} Branching Fraction and CP Asymmetry

We study B^{+}→π^{+}π^{0}π^{0} using 711  fb^{-1} of data collected at the ϒ(4S) resonance with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. We measure an inclusive branching fraction of (19.0±1.5±1.4)×10^{-6} and an inclusive CP asymmetry of (9.2±6.8±0.7)%, where the first uncertainties are statistical and the second are systematic, and a B^{+}→ρ(770)^{+}π^{0} branching fraction of (11.2±1.1±0.9_{-1.6}^{+0.8})×10^{-6}, where the third uncertainty is due to possible interference with B^{+}→ρ(1450)^{+}π^{0}. We present the first observation of a structure around 1  GeV/c^{2} in the π^{0}π^{0} mass spectrum, with a significance of 6.4σ, and measure a branching fraction to be (6.9±0.9±0.6)×10^{-6}. We also report a measurement of local CP asymmetry in this structure.

Measurement of the Λ_{c}^{+} Lifetime

An absolute measurement of the Λ_{c}^{+} lifetime is reported using Λ_{c}^{+}→pK^{-}π^{+} decays in events reconstructed from data collected by the Belle II experiment at the SuperKEKB asymmetric-energy electron-positron collider. The total integrated luminosity of the data sample, which was collected at center-of-mass energies at or near the ϒ(4S) resonance, is 207.2  fb^{-1}. The result, τ(Λ_{c}^{+})=203.20±0.89±0.77  fs, where the first uncertainty is statistical and the second systematic, is the most precise measurement to date and is consistent with previous determinations.

Evidence of a New Excited Charmed Baryon Decaying to Σ_{c}(2455)^{0,++}π^{±}

We present the study of B[over ¯]^{0}→Σ_{c}(2455)^{0,++}π^{±}p[over ¯] decays based on 772×10^{6}  BB[over ¯] events collected with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. The Σ_{c}(2455)^{0,++} candidates are reconstructed via their decay to Λ_{c}^{+}π^{∓} and Λ_{c}^{+} decays to pK^{-}π^{+}, pK_{S}^{0}, and Λπ^{+} final states. The corresponding branching fractions are measured to be B(B[over ¯]^{0}→Σ_{c}(2455)^{0}π^{+}p[over ¯])=(1.09±0.06±0.07)×10^{-4} and B(B[over ¯]^{0}→Σ_{c}(2455)^{++}π^{-}p[over ¯])=(1.84±0.11±0.12)×10^{-4}, which are consistent with the world average values with improved precision. A new structure is found in the M_{Σ_{c}(2455)^{0,++}π^{±}} spectrum with a significance of 4.2σ including systematic uncertainty. The structure is possibly an excited Λ_{c}^{+} and is tentatively named Λ_{c}(2910)^{+}. Its mass and width are measured to be (2913.8±5.6±3.8)  MeV/c^{2} and (51.8±20.0±18.8)  MeV, respectively. The products of branching fractions for the Λ_{c}(2910)^{+} are measured to be B(B[over ¯]^{0}→Λ_{c}(2910)^{+}p[over ¯])×B(Λ_{c}(2910)^{+}→Σ_{c}(2455)^{0}π^{+})=(9.5±3.6±1.6)×10^{-6} and B(B[over ¯]^{0}→Λ_{c}(2910)^{+}p[over ¯])×B(Λ_{c}(2910)^{+}→Σ_{c}(2455)^{++}π^{-})=(1.24±0.35±0.10)×10^{-5}. Here, the first and second uncertainties are statistical and systematic, respectively.

Efficacy and safety of plasma exchange in interstitial lung diseases with anti-melanoma differentiation-associated 5 gene antibody positive clinically amyopathic dermatomyositis

OBJECTIVE

Clinically amyopathic dermatomyositis (CADM) patients frequently develop refractory interstitial lung disease (ILD), with a poor prognosis. We aimed to verify the efficacy and safety of plasma exchange (PE) treatment for ILD in CADM.

METHOD

A retrospective case-control study was conducted to compare clinical outcomes with and without PE treatment in CADM-ILD patients refractory to combination therapy of high-dose glucocorticoids, calcineurin inhibitors, and cyclophosphamide. Among 19 enrolled patients, 11 were further treated with PE. We compared survival rates and other clinical characteristics. PE consisted of either fresh-frozen plasma or albumin as a replacement solution.

RESULTS

Basal clinical characteristics at diagnosis, including age, gender, serum ferritin, Krebs von den Lungen-6 (KL-6), C-reactive protein, and respiratory function tests, did not differ between the two groups. The survival rate for treatment with PE was higher than for treatment without PE (91% and 50%, respectively, p < 0.05). Among PE-treated patients, anti-melanoma differentiation-associated gene-5 (anti-MDA-5) antibody titre, ferritin, and KL-6 as serological activity markers were sustainably reduced only after initiating PE. Therapeutic intervention with PE reduced the frequency of exacerbation of ILD requiring methylprednisolone pulse therapy. The occurrence of bacterial, fungal, and cytomegalovirus infection did not differ between the groups with and without PE, and adverse events associated with PE resolved with appropriate intervention.

CONCLUSION

Combination therapy with PE was associated with an improved survival rate, and may be effective for the management of refractory ILD in CADM patients. A personalized therapeutic strategy including PE could be introduced for fatal rapidly progressive ILD.

Bi-directional relationships of arterial stiffness with hypertension and diabetes mellitus from the early pathophysiological stages: a 16-year prospective observational study

Background

Hypertension and diabetes mellitus frequently coexist; however, it has not yet been clarified if the bidirectional longitudinal relationships between arterial stiffness and hypertension are independent of those between arterial stiffness and diabetes mellitus.

Methods

In this 16-year prospective observational study, 3960 middle-aged employees of a Japanese company without hypertension/diabetes mellitus at the study baseline underwent annual repeated measurements of the blood pressure, serum glycosylated hemoglobin A1c levels (HbA1c), and brachial-ankle pulse wave velocity (baPWV).

Results

By the end of the study period, 664, 779, 154, and 406 subjects developed hypertension, prehypertension, diabetes mellitus, and prediabetes, respectively. Increased baPWV at the baseline was associated with a significant odds ratio (per 1 standard deviation increase) for new onset of prehypertension/hypertension with (2.45/3.28, P&lt;0.01) or without (2.49/2.76, P&lt;0.01) coexisting prediabetes/diabetes mellitus, but not for new onset of prediabetes/diabetes mellitus without coexisting hypertension. Analyses using the latent growth curve model confirmed the bidirectional relationships between baPWV and hypertension, but no such relationship was observed between baPWV and abnormal glucose metabolism. Moreover, after the adjustments, higher mean blood pressure at baseline accelerated the increases in the baPWV over follow-up (unstandardized coefficient [B] = 0.39, standard error [SE] = 0.05x10–1, P&lt;0.01). Similarly, higher baPWV at baseline accelerated the increases in mean blood pressure over follow-up (B = 0.02x10–1, SE = 0.01x10–1, P&lt;0.01) (Figure 1). On the other hands, higher HbA1c levels at baseline accelerated the increases in the baPWV over follow-up (B = 0.43, SE = 0.05x10–1, P&lt;0.01), but higher baPWV at baseline did not accelerate the increases in HbA1c levels over follow-up (B &lt;0.01, SE &lt;0.01, P=0.52) (Figure 2).

Conclusions

In middle-aged employees of a Japanese company, in contrast to the bidirectional relationships that exist between arterial stiffness and hypertension, increased arterial stiffness preceding the development of diabetes mellitus may represent that associated with the development of hypertension, as it is observed only in cases of diabetes mellitus coexisting with hypertension. Therefore, arterial stiffness may be associated to a greater degree with the development of hypertension than with the development of diabetes mellitus.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Omron Health Care Company (Kyoto, Japan),Teijin Pharma Company (Tokyo, Japan)

Age-related differences in longitudinal associations between alcohol intake and arterial stiffness, pressure wave reflection, and inflammation in male employees

Backgrounds

While arterial stiffness and abnormal pressure wave reflection are independent cardiovascular risk, the difference of their association with alcohol intake have not been fully clarified.

Aim

This prospective observational study, which utilized repeated annual measurements performed over a 9-year period, applied mixed model analyses to examine age-related differences in longitudinal associations between alcohol intake and arterial stiffness, pressure wave reflection, and inflammation.

Methods

In 4016 middle-aged (43±9 years) healthy Japanese male employees, alcohol intake, brachial-ankle pulse wave velocity (baPWV), radial augmentation index (rAI), and serum C-reactive protein (CRP) levels were measured annually during a 9-year study period. Based on the questionnaire, alcohol intake was classified as non-drinker, mild-moderate drinker (ethanol 1–20 g/day) and heavy drinker (&gt;20 g/day).

Results

The estimated marginal mean baPWV (non-drinkers = 1306 cm/s, mild-moderate drinkers = 1311 cm/s, and heavy drinkers = 1337 cm/s, P&lt;0.01) and that of rAI showed significant stepped increases in an alcohol dose-dependent manner in the entire cohort, but an increase in rAI was not observed in subjects aged ≥50 years. The estimated slope of the annual increase in baPWV, but not rAI, was higher for heavy drinkers than for non-drinkers (slope difference, 2.73; P&lt;0.01), especially for subjects aged &lt;50 years. The estimated marginal mean of the serum CRP levels was lower for drinkers than for non-drinkers.

Conclusion

In middle-aged male Japanese employees, alcohol intake may attenuate inflammatory activity. While alcohol intake may exacerbate the progression of arterial stiffening in a dose-dependent manner without mediating inflammation, especially in subjects under 50 years of age, it may promote pressure wave reflection abnormalities with aging at earlier ages without further exacerbation at older ages.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Omroncarpis

OP0110 CELL-TYPE-SPECIFIC TRANSCRIPTOME ARCHITECTURE UNDERLYING THE ESTABLISHMENT AND EXACERBATION OF SYSTEMIC LUPUS ERYTHEMATOSUS

Background

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with unknown etiology involving multiple immune cells and has diverse clinical phenotypes. This heterogeneous nature has hampered a better understanding of SLE pathogenesis and the development of effective therapeutic agents. While recent single-cell RNA sequencing studies of SLE identified several important cell subpopulations, they were limited by sparse expression information at single-cell level and small sample sizes.

Objectives

This study aimed to elucidate the dysregulated gene expression pattern linked to multiple clinical statuses of SLE with a fine cellular resolution and higher sensitivity. We also attempted to resolve a complex interaction between risk variants and the transcriptome dysregulation seen in SLE patients.

Methods

We conducted a large-scale bulk transcriptome study of 6,386 RNA-sequencing data including 27 purified immune cell types in peripheral blood from 136 SLE and 89 healthy donors in the Immune Cell Gene Expression Atlas from the University of Tokyo (ImmuNexUT) cohort1. At enrollment, SLE patients had diverse clinical manifestations (disease activity, organ involvement and treatment profiles) and 22 patients were re-evaluated after belimumab treatment.

Results

We first profiled two distinct cell-type-specific transcriptomic signatures: disease-state and disease-activity signatures, reflecting disease establishment and exacerbation, respectively.

After confirming the high replicability of both signatures in independent cohorts, we identified candidates of biological processes unique to each signature: e.g., upregulated E2F transcriptional activity in Th1, CD8+ memory T-lineage and NK cells, and dynamic increase of IL21 and CXCL13 in Th1 cells in an active phase of SLE. Pathway analysis highlighted the importance of immunometabolic process for SLE (e.g., oxidative phosphorylation) in cell-type-specific resolution.

Moreover, we demonstrated cell-type-specific contributions to diverse organ involvement, e.g., Th1 for mucocutaneous, monocyte-lineage cells for musculoskeletal, neutrophil-lineage cells for renal activity, respectively.

We also observed the strong associations of disease-activity signatures with treatment effect: (i) belimumab suppressed activity signatures from B-lineage cells, especially in good responders and (ii) mycophenolate mofetil substantially suppressed activity signatures from plasmablast, Th1, and central memory CD8 cells.

However, through stratified LD score regression using large-scale SLE-GWASs, we revealed that disease-activity signatures were less enriched around SLE risk variants than disease-state signatures. Consistent with this result, the directions of SLE risk alleles’ expression quantitative trait locus (eQTL) effects were significantly concordant with the directions of disease-state signatures, but not with those of activity signatures. These findings suggested that the current genetic case-control studies may not well capture clinically vital biology linked to drug target discovery for SLE. Meanwhile, we also detected some examples of activity signatures that might contribute to the disease risk by modulating risk allele’s eQTL effects.

Figure 1.

Conclusion

We identified comprehensive gene signatures reflecting the establishment and exacerbation of SLE, which provide essential foundations for future genomic, genetic, and clinical studies.

References

[1]Ota, M. et al. Dynamic landscape of immune cell-specific gene regulation in immune-mediated diseases. Cell 2021;184:3006-21.e17.

Acknowledgements

This study was supported by Chugai Pharmaceutical Co., Ltd., Tokyo, Japan; the Ministry of Education, Culture, Sports; and the Japan Agency for Medical Research and Development (AMED) (JP21tm0424221 and JP21zf0127004).

Disclosure of Interests

Masahiro Nakano: None declared, Mineto Ota Grant/research support from: Mineto Ota belongs to the Social Cooperation Program, Department of functional genomics and immunological diseases, supported by Chugai Pharmaceutical., Yusuke Takeshima Grant/research support from: Yusuke Takeshima belonged to the Social Cooperation Program, Department of functional genomics and immunological diseases, supported by Chugai Pharmaceutical., Yukiko Iwasaki: None declared, Hiroaki Hatano: None declared, Yasuo Nagafuchi Grant/research support from: Yasuo Nagafuchi belongs to the Social Cooperation Program, Department of functional genomics and immunological diseases, supported by Chugai Pharmaceutical., Kwangwoo Kim: None declared, So-Young Bang: None declared, Hye Soon Lee: None declared, Hirofumi Shoda: None declared, Xuejun Zhang: None declared, Sang-Cheol Bae: None declared, Chikashi Terao: None declared, Kazuhiko Yamamoto: None declared, Tomohisa Okamura Grant/research support from: Tomohisa Okamura belongs to the Social Cooperation Program, Department of functional genomics and immunological diseases, supported by Chugai Pharmaceutical., Kazuyoshi Ishigaki: None declared, Keishi Fujio Speakers bureau: Keishi Fujio receives speaker fees from Chugai Pharmaceutical., Consultant of: Keishi Fujio receives consulting honoraria from Chugai Pharmaceutical., Grant/research support from: Keishi Fujio receives research support from Chugai Pharmaceutical.

Measurement of Two-Particle Correlations of Hadrons in e^{+}e^{-} Collisions at Belle

The measurement of two-particle angular correlation functions in high-multiplicity e^{+}e^{-} collisions at sqrt[s]=10.52  GeV is reported. In this study, the 89.5  fb^{-1} of hadronic e^{+}e^{-} annihilation data collected by the Belle detector at KEKB are used. Two-particle angular correlation functions are measured in the full relative azimuthal angle (Δϕ) and three units of pseudorapidity (Δη), defined by either the electron beam axis or the event-shape thrust axis, and are studied as a function of charged-particle multiplicity. The measurement in the thrust axis analysis, with mostly outgoing quark pairs determining the reference axis, is sensitive to the region of additional soft gluon emissions. No significant anisotropic collective behavior is observed with either coordinate analyses. Near-side jet correlations appear to be absent in the thrust axis analysis. The measurements are compared to predictions from various event generators and are expected to provide new constraints to the phenomenological models in the low-energy regime.

Search for a Light Higgs Boson in Single-Photon Decays of ϒ(1S) Using ϒ(2S)→π^{+}π^{-}ϒ(1S) Tagging Method

We search for a light Higgs boson (A^{0}) decaying into a τ^{+}τ^{-} or μ^{+}μ^{-} pair in the radiative decays of ϒ(1S). The production of ϒ(1S) mesons is tagged by ϒ(2S)→π^{+}π^{-}ϒ(1S) transitions, using 158×10^{6} ϒ(2S) events accumulated with the Belle detector at the KEKB asymmetric energy electron-positron collider. No significant A^{0} signals in the mass range from the τ^{+}τ^{-} or μ^{+}μ^{-} threshold to 9.2  GeV/c^{2} are observed. We set the upper limits at 90% credibility level (C.L.) on the product branching fractions for ϒ(1S)→γA^{0} and A^{0}→τ^{+}τ^{-} varying from 3.8×10^{-6} to 1.5×10^{-4}. Our results represent an approximately twofold improvement on the current world best upper limits for the ϒ(1S)→γA^{0}(→τ^{+}τ^{-}) production. For A^{0}→μ^{+}μ^{-}, the upper limits on the product branching fractions for ϒ(1S)→γA^{0} and A^{0}→μ^{+}μ^{-} are at the same level as the world average limits, and vary from 3.1×10^{-7} to 1.6×10^{-5}. The upper limits at 90% credibility level on the Yukawa coupling f_{ϒ(1S)} and mixing angle sinθ_{A^{0}} are also given.

Precise Measurement of the D^{0} and D^{+} Lifetimes at Belle II

We report a measurement of the D^{0} and D^{+} lifetimes using D^{0}→K^{-}π^{+} and D^{+}→K^{-}π^{+}π^{+} decays reconstructed in e^{+}e^{-}→cc[over ¯] data recorded by the Belle II experiment at the SuperKEKB asymmetric-energy e^{+}e^{-} collider. The data, collected at center-of-mass energies at or near the ϒ(4S) resonance, correspond to an integrated luminosity of 72  fb^{-1}. The results, τ(D^{0})=410.5±1.1(stat)±0.8(syst)  fs and τ(D^{+})=1030.4±4.7(stat)±3.1(syst)  fs, are the most precise to date and are consistent with previous determinations.

Search for B^{+}→K^{+}νν[over ¯] Decays Using an Inclusive Tagging Method at Belle II

A search for the flavor-changing neutral-current decay B^{+}→K^{+}νν[over ¯] is performed at the Belle II experiment at the SuperKEKB asymmetric energy electron-positron collider. The data sample corresponds to an integrated luminosity of 63  fb^{-1} collected at the ϒ(4S) resonance and a sample of 9  fb^{-1} collected at an energy 60 MeV below the resonance. Because the measurable decay signature involves only a single charged kaon, a novel measurement approach is used that exploits not only the properties of the B^{+}→K^{+}νν[over ¯] decay, but also the inclusive properties of the other B meson in the ϒ(4S)→BB[over ¯] event, to suppress the background from other B meson decays and light-quark pair production. This inclusive tagging approach offers a higher signal efficiency compared to previous searches. No significant signal is observed. An upper limit on the branching fraction of B^{+}→K^{+}νν[over ¯] of 4.1×10^{-5} is set at the 90% confidence level.

Clinical features and long-term prognosis of patients with congestive heart failure taking tolvaptan: a comparison between preserved and reduced left ventricular ejection fraction

Background

There were few reports which investigated the clinical benefit of long-term use of tolvaptan (TLV) for heart failure (HF). The purpose of this study was to evaluate the long-term prognosis of patients administrated TLV for more than 1 year in the HF patients with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF).

Method

In a total of 591 consecutive patients who were admitted to our hospital and administered TLV for HF between 2011 and 2018, we retrospectively enrolled 147 patients who were administered TLV for more than 1 year. The patients were classified into 2 groups, the HFpEF group (n=77, 52.4%) and the HFrEF group (n=70, 47.6%), and clinical backgrounds and long-term prognosis were examined. Furthermore, we performed stratified analysis based on the response to TLV defined by urine osmolality (The responder group n=40, the non-responder group n=52).

Results

The HFpEF group was significantly older (77.7±9.2 vs. 71.3±11.5 years, P&lt;0.01) and included more female (41.6 vs. 21.4%, P&lt;0.01) compared with the HFrEF group. Other baseline characteristics were not different between the two groups. During the average 2.7 years follow up, the HFpEF group showed significantly lower all-cause mortality and cardiovascular mortality compared to the HFrEF group (24.7 vs. 38.6%, Log-Rank P=0.014, 13.0 vs. 25.7%, Log-Rank P=0.007, respectively). Univariate analysis revealed that male, HFpEF, serum creatinine changes from baseline (ΔCre) were the factors correlated with all-cause mortality (HR 2.12, 95% CI 1.02 – 4.40, P=0.045, HR 0.48, 95% CI 0.26 - 0.87, P=0.016 and HR 1.50, 95% CI 1.00 - 2.24, P=0.049, respectively). According to multivariate analysis, HFpEF was the independent influencing factor of all-cause mortality (HR 0.44, 95% CI 0.23 - 0.86, P=0.017). Stratified analysis revealed that in the non-responder group all-cause mortality was significantly lower in the HFpEF group than in the HFrEF group (24.2% vs 48.3%, P=0.049).

Conclusion

Long-term administration of TLV maybe more beneficial for HFpEF compared with HFrEF. This tendency was remarkable at non-responder group.

Funding Acknowledgement

Type of funding sources: None.

Effect of antithrombin III among patients with disseminated intravascular coagulation in obstetrics: a nationwide observational study in Japan

OBJECTIVE

Pregnant women may develop disseminated intravascular coagulation (DIC), possibly resulting in massive maternal haemorrhage and perinatal death. The Japan guideline recommends use of antithrombin III (ATIII) for DIC in obstetrics; however, its effect remains uncertain. The present study aimed to investigate the effect of ATIII for DIC in obstetrics, using a national inpatient database in Japan.

DESIGN

Nationwide observational study.

SETTING

Japan.

POPULATION

We used the Diagnosis Procedure Combination inpatient database to identify patients who delivered at hospital and were diagnosed with DIC from July 2010 to March 2018.

METHODS

Propensity score matching analyses were performed to compare in-hospital maternal mortality and hysterectomy during hospitalisation between users and non-users of ATIII on the day of delivery.

MAIN OUTCOME MEASURES

In-hospital mortality, hysterectomy.

RESULTS

A total of 9920 patients were enrolled, including 4329 patients (44%) who used ATIII and 5511 patients (56%) who did not use ATIII. One-to-one propensity score matching created 3290 pairs. In-hospital maternal mortality did not differ significantly between the propensity-matched groups (0.3% in the ATIII group versus 0.5% in the control group; odds ratio 0.73; 95% CI 0.35-1.54). A significantly lower proportion of patients in the ATIII group, compared with those in the control group, underwent hysterectomy during hospitalisation (5.3% versus 8.7%; absolute risk difference -2.9%; 95% CI -4.2 to -1.6%).

CONCLUSIONS

Although the present study did not show a mortality-reducing effect of ATIII for patients with DIC in obstetrics, it may have clinical benefit in terms of reducing the number of patients undergoing hysterectomy.

TWEETABLE ABSTRACT

This study did not show mortality-reducing effect of antithrombin III for patients with DIC in obstetrics.

Measurements of the Branching Fractions of the Semileptonic Decays Ξ_{c}^{0}→Ξ^{-}ℓ^{+}ν_{ℓ} and the Asymmetry Parameter of Ξ_{c}^{0}→Ξ^{-}π^{+}

Using data samples of 89.5 and 711  fb^{-1} recorded at energies of sqrt[s]=10.52 and 10.58 GeV, respectively, with the Belle detector at the KEKB e^{+}e^{-} collider, we report measurements of branching fractions of semileptonic decays Ξ_{c}^{0}→Ξ^{-}ℓ^{+}ν_{ℓ} (ℓ=e or μ) and the CP-asymmetry parameter of Ξ_{c}^{0}→Ξ^{-}π^{+} decay. The branching fractions are measured to be B(Ξ_{c}^{0}→Ξ^{-}e^{+}ν_{e})=(1.31±0.04±0.07±0.38)% and B(Ξ_{c}^{0}→Ξ^{-}μ^{+}ν_{μ})=(1.27±0.06±0.10±0.37)%, and the decay parameter α_{Ξπ} is measured to be 0.63±0.03±0.01 with much improved precision compared with the current world average. The corresponding ratio B(Ξ_{c}^{0}→Ξ^{-}e^{+}ν_{e})/B(Ξ_{c}^{0}→Ξ^{-}μ^{+}ν_{μ}) is 1.03±0.05±0.07, which is consistent with the expectation of lepton flavor universality. The first measured asymmetry parameter A_{CP}=(α_{Ξ^{-}π^{+}}+α_{Ξ[over ¯]^{+}π^{-}})/(α_{Ξ^{-}π^{+}}-α_{Ξ[over ¯]^{+}π^{-}})=0.024±0.052±0.014 is found to be consistent with zero. The first and the second uncertainties above are statistical and systematic, respectively, while the third ones arise due to the uncertainty of the Ξ_{c}^{0}→Ξ^{-}π^{+} branching fraction.

Immobilizing Bactericides on Dental Resins via Electron Beam Irradiation

Polymerizable bactericides, such as quaternary ammonium compound-based monomers, have been intensively studied as candidates for immobilizing antibacterial components on dental resin. However, they predominantly exhibit a bacteriostatic behavior, rather than bactericidal, as the immobilized components are left with insufficient molecular movement to disrupt the bacterial surface structure through contact-mediated action. In this study, we developed a novel strategy to increase the density of the immobilized bactericide and enhance its antibacterial/antibiofilm properties by combining a surface-grafting technique with electron beam irradiation. A solution of the quaternary ammonium compound-based monomer, 12-methacryloyloxydodecylpyridinium bromide (MDPB), was coated on polymethyl methacrylate (PMMA) resin specimens at the concentrations of 30, 50, and 80 wt%. The coated resins were subsequently exposed to 10 MeV of electron beam irradiation at 50 and 100 kGy, followed by thermal stabilization at 60 °C. The antibacterial effect was evaluated by inoculating a Streptococcus mutans suspension on the coated PMMA resin samples, which exhibited bactericidal effects even after 28 d of aging (P < 0.05, Tukey's honestly significant difference test). Transmission electron microscopy and bacteriolytic activity evaluation revealed that the S. mutans cells had sustained membrane depolarization. Furthermore, the antibiofilm effects against S. mutans and bacteria collected from human saliva were assessed. The thickness and the percentage of membrane-intact cells of the S. mutans and multispecies biofilms formed on the MDPB-immobilized surfaces were significantly lower than the uncoated PMMA specimens, even after 28-d aging (P < 0.05, Tukey's honestly significant difference test). Thus, the immobilization of antibacterial MDPB via electron beam irradiation induced rapid membrane depolarization, increasing membrane permeability and eventually causing cell death. Our strategy substantially enhances the antibacterial properties of the resinous materials and inhibits biofilm formation, therefore demonstrating significant potential for preventing infectious diseases in the oral environment.

AB0285 EFFECTIVENESS OF IMMUNOSUPPRESSIVE THERAPY FOR CONNECTIVE TISSUE DISEASE–ASSOCIATED PULMONARY ARTERIAL HYPERTENSION

Background:

Connective tissue disease (CTD) associated pulmonary arterial hypertension (PAH) is considered to be an indication for immunosuppressive therapy (IT) except scleroderma associated PAH. However, the response rate defined by improvement of WHO functional class and hemodynamic parameters is reported to be around 50% [1]. Since CTDs are systemic diseases, it may be difficult to evaluate the efficacy of IT by subjective symptoms. Although there are previous studies reporting that the combined use of IT and pulmonary vasodilators significantly improved hemodynamics [2], response to IT without titration of pulmonary vasodilators remains to be elucidated.

Objectives:

To examine whether IT is effective for CTD-PAH.

Methods:

We retrospectively examined the medical records of consecutive 13 patients with CTD-PAH (female 13, mean age 47 ± 15 years) treated with methylprednisolone (1 mg/kg/day, oral) and intravenous bolus cyclophosphamide (IVCY) (500 mg/m2) every four weeks for six times. Patient characteristics are described in Table 1. Right heart catheterization (RHC) was done at prior to IT, before adding PAH specific agents, and at the fifth or sixth course of IVCY. In treated cases, the previous vasodilators remained unchanged during the first term of IT.

Results:

At the first follow up RHC, decrease of mean pulmonary arterial pressure over 5 mmHg was observed in all patients, and decrease of pulmonary vascular resistance (PVR) was observed in twelve out of 13 patients (Figure 1). Over 20% of PVR reduction was observed more in the patients of pulmonary vasodilator naïve and started IT within one year from symptoms than others (6/7 vs 1/6, p=0.03). Although six-minutes walk distance (6MWD) tended to be prolonged between first and second RHC (298 ± 70 m vs 382 ± 81 m; p=0.054; n = 9), 6MWD was shortened in some cases with good hemodynamic improvement (2/5). All patients were prescribed oral PAH specific agents finally, but no one needed parenteral prostanoids. Two patients (15%) died during maintenance therapy for causes other than PAH. Three-year and five-year survival rates were 91.7% and 81.5%, respectively.

Conclusion:

IT without titration of pulmonary vasodilators significantly improved hemodynamic parameters despite of less improvement in 6MWD in CTD-PAH patients. Considering that CTDs itself might affect the exercise tolerance regardless of PAH, these hemodynamic changes may contribute to better prognosis and IT might be considered especially for patients early in clinical courses and treatment naïve.

References:

[1]Jais X, Launay D, Yaici A, et al. Immunosupressive therapy in lupus-and mixed connective tissue disease-associated pulmonary arterial hypertension. ARTHRITIS RHEUM. 2008; 58(2): 521-531.

[2]Yamamoto M S, Fukumoto Y, Sugimura K, et al. Intensive immunosuppressive therapy improves pulmonary hemodynamics and long-term prognosis in patients with pulmonary arterial hypertension associated with connective tissue diseasae. Circ J. 2011; 75: 2668-2674.

Table 1.

Characteristics of patients

PatientAge,yrConnective Tissue DiseaseYears from symptom to immunosuppressive therapyPrevious vasodilatorsvasodilators at final visit147SS1.5PGI2ERA262SS, RA2nonePDE5332SS1noneERA457SS, SSc0.5nonePDE5526SS,MCTD, SLE,SSc0.5nonePDE5670SSc, SS s/o13sGC, ERAsGC, ERA732SS s/o, SLE0.1nonePDE5831MCTD3ERA,PDE5, PGI2ERA,PDE5, PGI2943SSc, SLE0.6ERA, PDE5ERA,PDE5, PGI21067MCTD,PM0nonesGC1141SS0.1noneERA, PDE51269SS0.3nonePDE51344SS, MCTD s/o, SLE s/o0.1noneERA, sGC

N.A, not acquired; s/o, suspect of; SS, Sjögren’s syndrome; RA, rheumatoid arthritis; SSc systemic sclerosis; SLE, systemic lupus erythematosus; MCTD, mixed connective tissue disease; PM, Polymyositis; PGI2, prostacyclin derivative; sGC, soluble guanylate cyclase stimulator; ERA, endothelin receptor antagonist; PDE5, phosphodiesterase type 5 inhibitor.

Figure 1.

Hemodynamic changes during immunosuppressive therapy

Disclosure of Interests:

Risa Kishikawa: None declared, Masaru Hatano Speakers bureau: Janssen Pharmaceutical K.K, Bayer Yakuhin, Ltd., Grant/research support from: Janssen Pharmaceutical K.K, Nippon Shinyaku Co., Ltd., MOCHIDA PHARMACEUTICAL CO., LTD., Satoshi Ishii: None declared, Mai Shimbo: None declared, Akihito Saito: None declared, Shun Minatsuki: None declared, Yukiko Iwasaki: None declared, Keishi Fujio Speakers bureau: Tanabe Mitsubishi, Bristol Myers, Eli Lilly, Chugai, Jansen, Pfizer, Ono, AbbVie, Ayumi, Astellas, Sanofi, Novartis, Daiichi Sankyo, Eisai, Asahi Kasei, Japan Blood Products Organization, and Kowa, Grant/research support from: Tanabe Mitsubishi, Bristol Myers, Eli Lilly, Chugai, AbbVie, Ayumi, Astellas, Sanofi, Eisai, Tsumura & Co., and Asahi Kasei., Issei Komuro Speakers bureau: AstraZeneka, Daiichi Sankyo Company, Limited, Takeda Pharmaceutical Company Limited, Bayer Yakuhin, Ltd, Pfizer Japan Inc., and Ono Pharmaceutical Co., Ltd., Grant/research support from: Daiichi Sankyo Company, Ltd, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Ltd, Mitsubishi Tanabe Pharma Corporation, Teijin Pharma Limited, Idorsia Pharmaceuticals Ltd, Otsuka Pharmaceutical Co., Ltd., Bayer Yakuhin, Ltd. Ono Pharmaceutical Co., Ltd. Toa Eiyo Ltd

Test of Lepton-Flavor Universality in B→K^{*}ℓ^{+}ℓ^{-} Decays at Belle

We present a measurement of R_{K^{*}}, the branching fraction ratio B(B→K^{*}μ^{+}μ^{-})/B(B→K^{*}e^{+}e^{-}), for both charged and neutral B mesons. The ratio for the charged case R_{K^{*+}} is the first measurement ever performed. In addition, we report absolute branching fractions for the individual modes in bins of the squared dilepton invariant mass q^{2}. The analysis is based on a data sample of 711  fb^{-1}, containing 772×10^{6}  BB[over ¯] events, recorded at the ϒ(4S) resonance with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. The obtained results are consistent with standard model expectations.

Evidence for X(3872)→J/ψπ^{+}π^{-} Produced in Single-Tag Two-Photon Interactions

We report the first evidence for X(3872) production in two-photon interactions by tagging either the electron or the positron in the final state, exploring the highly virtual photon region. The search is performed in e^{+}e^{-}→e^{+}e^{-}J/ψπ^{+}π^{-}, using 825  fb^{-1} of data collected by the Belle detector operated at the KEKB e^{+}e^{-} collider. We observe three X(3872) candidates, where the expected background is 0.11±0.10 events, with a significance of 3.2σ. We obtain an estimated value for Γ[over ˜]_{γγ}B(X(3872)→J/ψπ^{+}π^{-}) assuming the Q^{2} dependence predicted by a cc[over ¯] meson model, where -Q^{2} is the invariant mass squared of the virtual photon. No X(3915)→J/ψπ^{+}π^{-} candidates are found.

Effect of empagliflozin versus placebo on body composition in patients with acute myocardial infarction and type 2 diabetes mellitus: subgroup analysis of the EMBODY trial

Background

Prevention of heart failure is one of the most important challenges after acute myocardial infarction (AMI). The development of heart failure is closely associated with fluid balance which can be evaluated by the measurement of body composition such as total body water (TBW), extracellular water (ECW), and intracellular water (ICW). This subgroup analysis of the EMBODY trial was designed to determine whether the Sodium–glucose cotransporter 2 (SGLT2) inhibitor affect fluid balance and improve heart failure in patients after AMI.

Methods

The EMBODY trial was a prospective, multicenter, randomized, double-blind, placebo-controlled trial in patients with AMI and type 2 diabetes in Japan. A total of 105 patients were randomized (1:1) to receive once-daily 10 mg empagliflozin, an SGLT2 inhibitor or placebo 2 weeks after the onset of AMI. In this subanalysis, we investigated the time-course of body composition measured by a bioelectrical impedance analyzer “InBody®”. The primary endpoints were changes in every particular parameter of body composition at week 0, 4, 12, and 24. Secondary endpoints were changes in blood pressure (BP), body weight and N-terminal pro b-type natriuretic peptide (NT-proBNP).

Results

Overall, 55 patients were included in the full analysis set (67.2±10.0 years, male 78.2%, and n=30 in empagliflozin group and 25 in placebo group). Baseline characteristics were not significantly different between the two groups. The change between at baseline and 24 weeks in TBW was −0.44 L (P=0.19) in the empagliflozin group and +1.14 L (P=0.0002) in the placebo group, adjusted difference −1.58 L, 95% confidence interval (CI) −2.46 to −0.70 L (P=0.0006). The empagliflozin group showed significant decreases in the body weight, ECW, ICW and systolic BP compared with the placebo group (−2.2 kg vs, +0.01 kg, P=0.004, −0.21 L vs, +0.40 L, P=0.001, −0.23 L vs, +0.74 L, P=0.0007, and −11.0 mmHg vs, +5.0 mmHg, P&lt;0.0001, respectively). On the other hand, NT-Pro BNP levels significantly decreased in the empagliflozin group and placebo group (1028.7 pg/mL to 370.3 pg/ml, p=0.0001 and 1270.6 pg/mL to 673.7 pg/ml, p=0.006, respectively). In the multiple regression analysis of the change in TBW and ICW for the empagliflozin group, systolic BP was identified as a significant factor (P=0.001, and 0.003, respectively). In stratified analysis of BMI 25 kg/m2 or more, the empagliflozin group showed significant decreases in body weight, TBW, ECW and ICW compared with the placebo group, but not below BMI 25 kg/m2 group.

Conclusion

Empagliflozin reduced not only body weight, but also TBW, ECW and ICW. Interestingly, this tendency was remarkable at BMI 25 or more. This study suggested that early SGLT2 inhibitor administration in obesity patients with AMI and DM might be effective to reduce body weight and TBW.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Boehringer Ingelheim

Not the pacing site but the underlying structural heart disease is a reason for wider QRS duration during right ventricular pacing

Background

Right ventricular (RV) pacing causes changes of the electrical and mechanical activation pattern of the heart. QRS duration is reported to be a useful surrogate marker of electrical dyssynchrony, and wider QRS duration during RV pacing indicates poor prognosis. However, the mechanism of widening QRS duration during RV pacing remains to be elucidated.

Methods

A total of 211 patients who underwent catheter ablation for supraventricular tachyarrhythmias and have no bundle-branch-block on ECG were enrolled. During electrophysiological study, 3-dimensional mapping for QRS duration during RV pacing from RV outflow to RV apex was created, and the difference of QRS duration between RV outflow and RV apex was calculated. The relationship between QRS duration during RV pacing and patients' baseline characteristics including echocardiography data was analyzed.

Results

QRS duration at baseline, during RV pacing from RV outflow, and RV apex were 85.0±7.5msec, 156.2±16.1msec, and 163.7±17.1msec, respectively. The difference of QRS duration between RV outflow and RV apex among patients was only 12.5±10.4msec. The logistic multivariable regression analysis showed baseline QRS duration (odds ratio (OR) 1.24, 95% CI 1.15 to 1.34, p&lt;0.01), interventricular septum thickness (OR 1.35, 95% CI 1.05 to 1.73, p=0.018), and E/e' (OR 1.23, 95% CI 1.12 to 1.36, p&lt;0.01) were significant predictors for QRS duration over 160msec during RV apical pacing.

Conclusions

QRS duration during RV pacing depends largely not on the pacing site, but on the underlying structural heart disease.

QRS duration mapping during RV pacing

Funding Acknowledgement

Type of funding source: None

The mechanisms of age-realted difference of annual changes in ankle-brachial pressure index

 

In addition to both pulse wave velocity (PWV; a marker of arterial stiffness) and augmentation index (AI; a marker of central hemodynamics), not only the decrease of ankle-brachial pressure index (ABI) but also its increase predict the future cardiovascular events. While arterial stiffness and central hemodynamics have been proposed to affect the increase in ABI logically, their effects on increase in ABI have not been fully clarified. The present cross-sectional and longitudinal studies were conducted to examine the associations of arterial stiffness and central hemodynamics with increase in ABI and also examine the age-related difference of those associations. In 4016 men (42±9 years old), ABI, brachial-ankle PWV (baPWV) and radial AI (rAI) were measured annually for 9 years' observation period. In the cross-sectional analyses adjusted with age, heart rate and mean blood pressure, both baPWV and rAI were associated with ABI in men aged &lt;50, but not in men aged &gt;50. As shown in Figure, ABI was annually increased in subjects aged &lt;50 (n=2870), but not in those aged &gt;50 (n=1146) during the follow-up period. The mixed model linear regression analysis (MMA) conducted in 9 years' annual repeated measurement data demonstrated that increased baPWV (estimate = 0.017, p&lt;0.05) and increased rAI (estimate 0.254, p&lt;0.05) were significant determinant of annual increase of ABI (p&lt;0.01) in men aged &lt;50, but not in men aged &gt;50. In conclusion, the arterial stiffness and central hemodynamics may individually affect the increase in ABI in men aged &lt;50, but not in men &gt;50. Thus, further studies are needed to clarify whether ABI, arterial stiffness, and central hemodynamics individually predicts future cardiovascular events, and their age-related difference of their predictabilities.

figure1

Funding Acknowledgement

Type of funding source: Private hospital(s). Main funding source(s): Tokyo Medical University

The associations among arterial stiffness, endothelial dysfunction and the progression of carotid atherosclerosis in hypertensive subjects with/without carotid atherosclerosis

Background

While arterial stiffness and endothelial dysfunction, which are diffuse vascular damage, are phenotypes of vascular damage, their associations with the progression of atherosclerosis, which is focal vascular damage, has not been fully clarified. The present prospective observational study was conducted to examine whether arterial stiffness and endothelial dysfunction predict the progression of carotid atherosclerosis in subjects medicated for hypertension with/without carotid atherosclerosis.

Methods and results

In 617 subjects receiving antihypertensive treatment, we conducted flow-mediated vasodilatation (FMD), brachial-ankle pulse wave velocity (baPWV) and common carotid artery intima-media thickness mean and maximal (IMTmean and IMTmax) at the baseline and the end (3 years' later) of study periods. During the study period, FMD was decreased and baPWV, IMTmean and IMTmax were increased significantly. In subjects without carotid atherosclerosis (IMTmax &lt;1.1mm, n=416), baPWV, but not FMD, at baseline had significant associations with IMTmean and IMTmax at both the baseline and end of study period. As shown in Figure, the changes of IMTmean and also IMTmax during the study period were higher in the highest tertile ranges of baPWV at the baseline than in the lowest tertile range of baPWV. On the other hand, in subjects with carotid atherosclerosis (IMTmax &gt;1.1mm, n=201), both baPWV and FMD were not associated with any markers of carotid atherosclerosis and also their changes during the study period.

Conclusion

In subjects with hypertension, arterial stiffness rather than endothelial dysfunction may be associated with the progression of carotid atherosclerosis, and this association may be significant in the premature stage of atherosclerosis.

Figure 1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Omron Healthcare, Asahikasei Calpis

TRIIODOTHYRONINE ACTIVATES GLYCEROL-3-PHOSPHATE ACYLTRANSFERASE 3 VIA AGGTCA-LIKE-DIRECT-REPEAT-4 TYPE THYROID HORMONE RESPONSE ELEMENT

Background

Thyroid hormone participates in lipid metabolism regulation. However, the effects on triacyleride or triacylglycerol metabolism are complex and not fully clarified yet. In this study, we try to identify novel thyroid hormone-targeting lipogenic metabolic genes and analyze their molecular regulative mechanism.

Method

Thirty-five promoters of twenty-nine human lipogenic regulative enzyme genes were constructed into pXP1 luciferase reporter plasmid (PFK2/FBP2-luc) and transfected into HeGP2 cells, respectively. Gene expression induced by triiodothyronine (T3) was detected by luciferase assay. The T3-activated gene promoter was then analyzed by sequence analysis, deletion and mutation, and electrophoretic mobility shift assay (EMSA).

Results

After 10 nM T3 stimulation for 36 h, phosphogluconate dehydrogenase, malic enzyme, Glycerol-3-phosphate acyltransferase (GPAT) 3, and 1-acylglycerol-3-phosphate O-acyltransferase (AGPAT) 2 were significantly activated, respectively. A AGGTCA-like-direct-repeat-4 consensus thyroid hormone response element (DR4-TRE)-like sequence was found in the GPAT3 promoter, which was then verified to be necessary for T3-induced GPAT3 activation by gene deletion and mutation analysis. EMSA further identified that T3-thyroid receptor (TR) α-retinoid-X receptor (RXR) complex directly bound on the GPAT3 promoter.

Conclusion

Triiodothyronine could activate the GPAT3 through DR4-TRE-like sequence binding to participate in lipogenic regulation. AGPAT2 may be another thyroid hormone target enzyme.

Proteomics Analysis of Plasma Membrane Fractions of the Root, Leaf, and Flower of Rice

The plasma membrane regulates biological processes such as ion transport, signal transduction, endocytosis, and cell differentiation/proliferation. To understand the functional characteristics and organ specificity of plasma membranes, plasma membrane protein fractions from rice root, etiolated leaf, green leaf, developing leaf sheath, and flower were analyzed by proteomics. Among the proteins identified, 511 were commonly accumulated in the five organs, whereas 270, 132, 359, 146, and 149 proteins were specifically accumulated in the root, etiolated leaf, green leaf, developing leaf sheath, and developing flower, respectively. The principle component analysis revealed that the functions of the plasma membrane in the root was different from those of green and etiolated leaves and that the plasma membrane protein composition of the leaf sheath was similar to that of the flower, but not that of the green leaf. Functional classification revealed that the root plasma membrane has more transport-related proteins than the leaf plasma membrane. Furthermore, the leaf sheath and flower plasma membranes were found to be richer in proteins involved in signaling and cell function than the green leaf plasma membrane. To validate the proteomics data, immunoblot analysis was carried out, focusing on four heterotrimeric G protein subunits, Gα, Gβ, Gγ1, and Gγ2. All subunits could be detected by both methods and, in particular, Gγ1 and Gγ2 required concentration by immunoprecipitation for mass spectrometry detection.

gw2 mutation increases grain width and culm thickness in rice (Oryza sativa L.)

Grain size is one of the most important agricultural traits in rice. To increase grain yield, we screened a large grain mutant from mutants with the 'Koshihikari' background. As a result, we obtained a mutant, KEMS39, that has a large grain size and increased yield. Cultivation tests revealed that this mutant had improved lodging resistance with thicker internodes. Next-generation sequencing analysis revealed the presence of a 67 bp deletion in the GW2 mRNA, owing to a mutation in the 3' splice site of the sixth intron of the GW2 gene. To determine whether this mutation was responsible for the larger grain and thicker internodes, we performed gene editing and obtained a mutant with a 7 bp deletion, including this 3' splice site. As this gw2 mutant had large grains and thicker internodes, the causal gene of KEMS39 was determined as GW2. Thicker internodes are attributed to the pleiotropic effect of gw2 mutation. On the basis of these results, we conclude that gw2 mutation has the potential to be an important genetic resource with the ability to achieve a well-balanced and high-yielding effect that simultaneously improves grain productivity and lodging resistance.

THU0225 INTEGRATIVE PLASMA METABOLOME AND TRANSCRIPTOME ANALYSIS REVEALED THE IMPORTANCE OF HISTIDINE HOMEOSTASIS IN SLE PATHOGENESIS WITH POTENTIAL FOR IMPROVED SLE PATIENTS STRATIFICATION

Background:

Recently, immunometabolism has gathered attention of many immunologists. It has been widely recognized that metabolic reprogramming in each immune cell brings different effects on different cells and is important for regulating their functions. Along with the progress of statistical genetics, serum metabolites were shown to be under genetic regulations1). Metabolic changes are now considered not only to be mere phenotypes of cells but also to be key factors for controlling immune cell differentiation, proliferation and function through regulating gene expressions eventually. Although genome-wide association studies have brought deep insights into SLE pathogenesis, the precise pathway from genome to metabolome has been largely unknown, and vice versa.

Objectives:

The aim of this study is to investigate metabolomic regulation in SLE in relation to gene expressions by integrating plasma metabolome data and transcriptome data.

Methods:

We collected plasma samples from patients with SLE (n=57) who met the 1997 American College of Rheumatology criteria for SLE. Gender- and age-matched healthy controls (HCs) (n=56) were recruited. Metabolic profiles focusing on 39 amino acids were analyzed with liquid chromatography (LC)-mass spectrometry. Transcriptome data of SLE patients were obtained from our RNA-sequencing data of each immune cell subset (total 19 subsets). Whole-genome sequencing was also performed.

Results:

Our previous experiment showed that about 160 peaks were detected from comprehensive LC-TOFMS and amino acids were useful for distinguishing SLE patients from HCs. Both partial least squares discriminant analysis (PLS-DA) and random forest, a machine learning algorithm, revealed the importance of histidine (His), one of the essential amino acids, to classify SLE patients from HCs, whose plasma level was lower in SLE patients. In addition, inverse correlation between His level and titer of ds-DNA as well as damage index (SDI) was detected. His level was correlated neither with PSL dosage nor with type I interferon (IFN) signature. Receiver operating characteristic (ROC) analysis showed the best predictability for SLE with the combination of specific amino acids including His. Our transcriptome analysis has revealed the significance of oxidative phosphorylation (OXPHOS) in B cells for SLE pathogenesis. Interestingly, OXPHOS signature was inversely correlated with His level in SLE B cells.

Conclusion:

His may be an important factor for SLE pathogenesis especially in B cells independently from IFN signal. SLC15A4, a transporter of His on lysosome, is one of the SLE GWAS SNPs and has been reported to play an important role in IFN production in B cells through regulation of TLR7/9 activation 2). We also identified that SLE patients with risk allele of SLC15A4 had tendency to show higher plasma His level, indicating His homeostasis could become a novel treatment target for SLE. Moreover, the inverse correlation of His level to SDI as well as OXPHOS signature suggests that His might play a key role for promoting organ damages in SLE.

References:

[1]Nat Genet.2017;49:568. 2)Immunity. 2014;41:375. 3)Semin Arthritis Rheum.2019;48:1142

Disclosure of Interests: :

Yukiko Iwasaki: None declared, Yusuke Takeshima: None declared, Masahiro Nakano: None declared, Mineto Ota: None declared, Yasuo Nagafuchi: None declared, Akari Suzuki: None declared, Yuta Kochi: None declared, Tomohisa Okamura: None declared, Takaho Endo: None declared, Ichiro Miki: None declared, Kazuhiro Sakurada: None declared, Kazuhiko Yamamoto Grant/research support from: Astellas, BMS, MitsubishiTanabe, Pfizer, Ayumi, Takeda, Chugai, Eisai, Taisho Toyama, UCB, and ImmunoFuture, Keishi Fujio Grant/research support from: Astellas, BMS, MitsubishiTanabe, Pfizer, Ayumi, Takeda, Chugai, Eisai, Taisho Toyama, Eli Lilly, Sanofi, and UCB

Measurement of R(D) and R(D^{*}) with a Semileptonic Tagging Method

The experimental results on the ratios of branching fractions R(D)=B(B[over ¯]→Dτ^{-}ν[over ¯]_{τ})/B(B[over ¯]→Dℓ^{-}ν[over ¯]_{ℓ}) and R(D^{*})=B(B[over ¯]→D^{*}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]→D^{*}ℓ^{-}ν[over ¯]_{ℓ}), where ℓ denotes an electron or a muon, show a long-standing discrepancy with the standard model predictions, and might hint at a violation of lepton flavor universality. We report a new simultaneous measurement of R(D) and R(D^{*}), based on a data sample containing 772×10^{6}  BB[over ¯] events recorded at the ϒ(4S) resonance with the Belle detector at the KEKB e^{+}e^{-} collider. In this analysis the tag-side B meson is reconstructed in a semileptonic decay mode and the signal-side τ is reconstructed in a purely leptonic decay. The measured values are R(D)=0.307±0.037±0.016 and R(D^{*})=0.283±0.018±0.014, where the first uncertainties are statistical and the second are systematic. These results are in agreement with the standard model predictions within 0.2, 1.1, and 0.8 standard deviations for R(D), R(D^{*}), and their combination, respectively. This work constitutes the most precise measurements of R(D) and R(D^{*}) performed to date as well as the first result for R(D) based on a semileptonic tagging method.

Search for an Invisibly Decaying Z^{'} Boson at Belle II in e^{+}e^{-}→μ^{+}μ^{-}(e^{±}μ^{∓}) Plus Missing Energy Final States

Theories beyond the standard model often predict the existence of an additional neutral boson, the Z^{'}. Using data collected by the Belle II experiment during 2018 at the SuperKEKB collider, we perform the first searches for the invisible decay of a Z^{'} in the process e^{+}e^{-}→μ^{+}μ^{-}Z^{'} and of a lepton-flavor-violating Z^{'} in e^{+}e^{-}→e^{±}μ^{∓}Z^{'}. We do not find any excess of events and set 90% credibility level upper limits on the cross sections of these processes. We translate the former, in the framework of an L_{μ}-L_{τ} theory, into upper limits on the Z^{'} coupling constant at the level of 5×10^{-2}-1 for M_{Z^{'}}≤6  GeV/c^{2}.

Observation of the Radiative Decays of ϒ(1S) to χ_{c1}

We report the first observation of the radiative decay of the ϒ(1S) into a charmonium state. The significance of the observed signal of ϒ(1S)→γχ_{c1} is 6.3 standard deviations including systematics. The branching fraction is calculated to be B[ϒ(1S)→γχ_{c1}]=[4.7_{-1.8}^{+2.4}(stat)_{-0.5}^{+0.4}(sys)×10^{-5}]. We also searched for ϒ(1S) radiative decays into χ_{c0,2} and η_{c}(1S,2S), and set upper limits on their branching fractions. These results are obtained from a 24.9  fb^{-1} data sample collected with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider at a center-of-mass energy equal to the ϒ(2S) mass using ϒ(1S) tagging by the ϒ(2S)→ϒ(1S)π^{+}π^{-} transitions.

P1032Efficacy and safety of radiofrequency catheter ablation for atrial fibrillation in patients undergoing hemodaialysis

Introduction

Although radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has become a standard therapy, the ablation outcomes in patients undergoing hemodialysis (HD) has not been fully elucidated. The present study aimed to evaluate the clinical outcomes of RFCA for AF in patients undergoing HD.

Methods

Twenty-three patients undergoing HD (17 men, age 65±8 years, 19 paroxysmal AF) who underwent RFCA for drug-refractory AF in two institutes were enrolled in the study and defined as HD group. The clinical parameters, recurrence free rate and frequency of periprocedural complications were compared to 46 randomly selected age, gender and left atrial diameter matched controls not requiring HD defined as non-HD group (34men, age 67±7 years, 38 paroxysmal AF).

Results

The patients in HD group had a significantly lower body mass index (21±3 vs. 25±3 P<0.01), higher prevalence of coronary artery disease (30% vs. 10% P=0.04), and higher prevalence of congestive heart failure (52% vs. 10% P<0.01) compared to patients in non-HD group. Echocardiography indicated lower left ventricular ejection fraction (57±17% vs. 65±9% P=0.02), higher E/e' (20±8 vs. 12±4 P<0.01), higher tricuspid regurgitation pressure gradient (30mmHg vs. 24mmHg P<0.01) and more impaired left ventricular diastolic function in HD group. All the subjects underwent bilateral pulmonary vein isolation plus additional linear lesion. The number of ablation procedure was similar between the two groups (1.43±0.5 vs. 1.46±0.6 P=0.88). During the follow-up period of 37±25 months after the last procedure, the arrhythmia free rate was similar between the two groups (86% vs. 84% log-rank P=0.82). Vascular access complication occurred in two patients in HD group, and pericardial effusion occurred in one patient in non-HD group, while no life-threatening complications were observed in either group. Cardiogenic cerebral infarction occurred in one patient in non-HD group. Discontinuation of oral anticoagulation after the ablation was more often seen in the HD group compared to non-HD group (91% vs. 60% P<0.01).

Conclusions

Although patients undergoing HD had more impaired left ventricular systolic and diastolic function, RFCA for AF in patients with HD was shown to be as effective and safe as in non-HD patients. RFCA may be an efficient approach to manage AF in patients undergoing HD.

P762Usefulness of 2-year iodine-123 metaiodobenzylguanidine-based risk model for the post-discharge risk stratification in patients with acute decompensated heart failure

Background

A four-parameter risk model including cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging and readily available clinical parameters has been recently developed for the prediction of 2-year cardiac mortality risk in patients with chronic heart failure (CHF) using a Japanese CHF database consisting of 1322 patients. On the other hand, the Acute Decompensated Heart Failure National Registry (ADHERE) and Get With The Guidelines-Heart Failure (GWTG-HF) risk scores, simple tools to predict risk of in-hospital mortality, have been reported to be predictive of post-discharge outcome in patients with acute decompensated heart failure (ADHF). However, there is no information available on the usefulness of 2-year MIBG-based cardiac mortality risk score for the prediction of post-discharge prognosis in ADHF patients and its comparison with the ADHERE and GWTG-HF risk scores.

Purpose

We sought to validate the predictability of the 2-year MIBG-based cardiac mortality risk score for post-discharge clinical outcome in ADHF patients, and to compare its prognostic value with those of ADHERE and GWTG-HF risk scores.

Methods

We studied 297 consecutive patients who were admitted for ADHF, survived to discharge, and had definitive 2-year outcomes. Venous blood sampling was performed on admission, and echocardiography and cardiac MIBG imaging were performed just before discharge. In cardiac MIBG imaging, the cardiac MIBG heart-to-mediastinum ratio (HMR) was measured from the chest anterior view images obtained at 20 and 200 min after isotope injection. The 2-year cardiac mortality risk score was calculated using four parameters, including age, left ventricular ejection fraction, NYHA functional class, and HMR on delayed image. The patients were stratified into three groups based on the 2-year cardiac mortality risk score: low- (<4%), intermediate- (4–12%), and high-risk (>12%) groups. The ADHERE and GWTG-HF risk scores were also calculated from admission data as previously reported. The predictive ability of the scores was compared using receiver operating characteristic curve analysis. The endpoint was a composite of all-cause mortality and unplanned hospitalization for worsening heart failure.

Results

During a follow-up period, 110 patients reached the primary endpoint. There was significant difference in the rate of primary endpoint among the three groups stratified by 2-year cardiac mortality risk score (low-risk group: 18%, intermediate-risk group: 36%, high-risk group: 64%, Figure 1A). The 2-year cardiac mortality risk score demonstrated a greater area under the curve for the primary endpoint compared to the ADHERE and the GWTG-HF risk scores (Figure 1B).

Figure 1

Conclusions

The 2-year MIBG-based cardiac mortality risk score is also useful for the prediction of post-discharge clinical outcome in ADHF patients, and its prognostic value is superior to those of the ADHERE and the GWTG-HF risk scores.

P4552The prognostic impact of worsening and improved renal function in acute decompensated heart failure with and without plasma volume expansion

Background

Recent studies showed that both worsening renal function (WRF) and improved renal function (IRF) during hospitalization are associated with poor prognosis in patients with acute decompensate heart failure (ADHF). On the other hand, plasma volume (PV) expansion plays an essential role in ADHF. However, there is little information about the difference of prognostic impact of WRF and IRF in ADHF patients, relating to PV status (PVS).

Methods

We prospectively studied 348 patients admitted for ADHF. PVS was defined as follows: actual PV = (1 - hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females); and PVS = [(actual PV - ideal PV)/ideal PV] × 100 (%). WRF and IRF were defined as an increase and a decrease in serum creatinine of ≥0.3 mg/dl from admission to discharge, respectively. The endpoint was readmission for worsening heart failure (WHF) within 1 year.

Result

Median PVS was 6.7% (IQR: −4.1%–16.7%). 43 and 21 patients had WHF in groups with high PVS (PVS ≥ median) and low PVS (PVS > median), respectively. In high PVS group, multivariate Cox analysis showed that IRF was independently and significantly associated with WHF (p=0.016, HR: 2.4 [1.2–4.8]), but WRF was not (p=0.55, HR: 0.7 [0.3–2.1]). On the other hand, in low PVS group, WRF was independently associated with WHF (p=0.035, HR: 3.0 [1.1–8.1]), but IRF was not (p=0.27, HR: 2.1 [0.6–8.0]). Kaplan-Meier analysis revealed that only patients with IRF had a significantly higher risk of WHF than those with stable renal function (SRF) in high PVS group, while patients with WRF had a significantly higher risk of WHF than those with SRF in low PVS group.

Worsening heart failure-free rate curves

Conclusion

In ADHF patients with PV expansion, IRF during hospitalization could predict poor outcomes, but WRF could not. On the other hand, in ADHF patients without PV expansion, not IRF but WRF could predict poor outcomes. PVS guided-therapy may be considered in secondary prevention for WHF.

P793Prediction of prognosis using combined objective nutritional score in the patients with acute decompensated heart failure

Background

It has been reported that the objective nutritional indices such as the Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) are useful for the prediction of prognosis in patients with heart failure. However, there is no information available on the prognostic value of the combination of these objective nutritional indices in patients with acute decompensated heart failure (ADHF).

Purpose

We sought to assess the usefulness of the Combined Objective Nutritional Score for the prediction of post-discharge clinical outcome in ADHF patients.

Methods

We studied 361 consecutive patients who were admitted for ADHF and survived to discharge. Venous blood sampling, echocardiography, and measurement of body weight were performed just before discharge. CONUT score, GNRI and PNI were calculated as previously reported. We determined the Combined Objective Nutritional Score by assigning 1 point each for high CONUT score (2–12), low GNRI (≤98) or low PNI (≤38). Patients were followed-up for up to 5 years. The study endpoint was all-cause death.

Results

During a follow-up period of 2.4±1.3 years, 106 patients had all-cause death. Multivariate Cox analysis showed that the Combined Objective Nutritional Score was independently associated with all-cause death after adjustment for age, gender, history of coronary artery disease, left ventricular ejection fraction, brain natriuretic peptide level and estimate glomerular filtration rate (p<0.0001). When the patients were stratified into the three groups based on the Combined Objective Nutritional Score (normal nutritional status: 0 point, mild-to-moderate malnutrition: 1–2 points, severe malnutrition: 3 points), the incidence of all-cause death appeared to increase in relation to the Combined Objective Nutritional Score (normal: 0%, mild-to moderate: 23%, severe: 52%, p<0.0001, Figure). Patients with severe malnutrition showed 2.9 fold (95% CI 1.8–4.6) increase in the total mortality in comparison to patients with mild-to-moderate malnutrition.

Figure 1

Conclusion

This study showed that the Combined Objective Nutritional Score is a useful tool to risk stratify the patients hospitalized with ADHF.

P5406Impact of the albumin level on the prognostic value of diuretic response in patients admitted for acute decompensated heart failure: a prospective study

Background

The reduced diuretic response (DR) has been shown to be associated with poor clinical outcome in patients with acute decompensated heart failure (ADHF). In addition, hypoalbuminemia, which is related to DR, has been also reported to predict poor prognosis in ADHF patients. However, there is no information available on the impact of albumin level on the prognostic value of DR in patients with ADHF.

Methods

We prospectively studied 296 consecutive patients who were admitted for ADHF and survived to discharge. The patients were divided into 2 groups according to the presence or absence of hypoalbuminemia at the admission, defined as the serum level of albumin at admission <3.5g/dl, and DR was defined as weight loss per 40mg intravenous dose and 80mg oral dose of furosemide up to day 4. The endpoint was a composite of all-cause mortality and unplanned hospitalization for worsening heart failure.

Results

There were 144 patients with hypoalbuminemia and 152 patients without hypoalbuminemia. During a mean follow-up period of 2.2±1.5 years, 88 patients with hypoalbuminemia and 53 patients without hypoalbuminemia reached the endpoint. In group with hypoalbuminemia, DR was significantly smaller in patients with than without the endpoint (0.85 [0.50–1.50] vs 1.60 [0.76–2.70] kg/40mg furosemide, p=0.003), while there was no significant difference in DR between them in group without hypoalbuminemia (1.17 [0.59–1.66] vs 1.07 [0.75–1.88] kg/40mg furosemide, p=0.381). At multivariate Cox analysis, in group with hypoalbuminemia, DR was significantly associated with the endpoint, independently of age, left ventricular ejection fraction, and serum creatinine and plasma BNP levels. On the other hand, in group without hypoalbuminemia, DR showed no significant association with the endpoint at univariate Cox analysis. Kaplan-Meier analysis showed that patients with poor DR (≤1.08 kg/40mg furosemide: median value) had a significantly higher risk of the endpoint in group with hypoalbuminemia, but not in group without hypoalbuminemia (Figure).

Figure 1

Conclusion

Our results suggested that prognostic value of DR in ADHF patients is affected by the presence or absence of hypoalbuminemia.

P2848Electrical reconnections after pulmonary vein isolation with or without contact force-guided catheters: a comparison of the proficiency of atrial fibrillation ablation

Background

Atrial fibrillation (AF) ablation is the most commonly performed catheter ablation (CA) procedure today. The 2015 ACC/AHA/HRS Advanced Training Statement reported that the success rate of AF ablation is higher in high-volume centers than in low-volume centers. We tested whether the procedure proficiency of each operator was associated with the outcome of AF ablation, and whether the ablation outcome depended on whether contact force (CF)-guided catheters were used or not, in a high-volume center.

Methods

We conducted a retrospective observational study including all AF patients who underwent radiofrequency CA with or without CF support since 2016 at our hospital. The patients who underwent CA at other hospitals or underwent a balloon or surgical ablation in the first session were excluded. Each ipsilateral pulmonary vein (PV) pair was divided into 8 segments. The reconnection numbers and sites of the PV segment were evaluated in the second session. Operators were divided into the experienced group (≥100 AF cases/year, at least every 3 years) and developing group (other than the experienced group), respectively.

Results

Among 728 patients who underwent an initial AF ablation and were followed for 510±306 days, 131 (90 males, 65±10 years) received a second ablation procedure and were analyzed. A total of 260 and 264 PV isolations (PVI) were performed by the experienced and developing group operators in the initial ablation, respectively. Compared to the experienced group, the developing group had a longer procedure time for the PVI (35±15 vs. 28±10 min, p<0.001), higher frequency of reconnections of the PVs (73% vs. 59%, p=0.01) and higher number of reconnection gaps (2.1±2.0 vs. 1.5±2.0, p=0.02), respectively. There were no significantly differences in the number of gaps between the catheters with and without CF (1.6±2.0 vs. 1.4±2.0, p=0.65) in the experienced group, however, in the developing group a smaller total number of gaps (1.5±1.6 vs. 2.4±2.1, p=0.006) and less frequency reconnection gaps of the posterosuperior segment of the right PV (10% vs. 45%, p=0.005) were seen with catheters with CF than without. There was no significant difference in the procedure time for the PVI between catheters with and without CF.

Conclusions

The operator proficiency may predict the outcome after AF ablation even in high-volume centers. It is preferable to perform PVI with a CF-sensing catheter for operators without adequate proficiency.

Acknowledgement/Funding

JSPS KAKENHI Grant Number JP18K15865

P4523Impact of comorbiditity on the predictive value of acute kidney injury in patients admitted for acute decompensated heart failure: a prospective study

Background

Comorbidities are associated with poor clinical outcome in patients with chronic heart failure, and acute kidney injury (AKI) also provides prognostic information in patients with heart failure. However, there is no information available on the impact of comorbidities on the prognostic value of AKI in patients admitted for acute decompensated heart failure (ADHF).

Methods

We prospectively studied 357 consecutive ADHF patients with survival discharge. Patients with hemodialysis were excluded. Comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI) which is commonly used for the evaluation of the comorbid condition which is weighted and scored, with additional points added for age. AKI was defined as an absolute increase in serum creatinine of 0.3mg/dl or more during hospitalization. The endpoint was all-cause death (ACD).

Results

During a follow-up period of 2.2±1.4 years, 97 patients had ACD. At multivariate Cox analysis, ACCI (p<0.0001) and AKI (p=0.0061) were significantly and independently associated with ACD. Patients with high ACCI (≥5: determined by ROC analysis) had a significantly greater risk of ACD (39% vs 16%). In the subgroup of high ACCI, patients with AKI had a significantly higher risk of ACD (60% vs 35%), whereas there was no significant difference in the risk of ACD between with and without AKI (15% vs 16%) in the subgroup of low ACCI.

Conclusions

The presence of AKI was associated with the increased risk of mortality in ADHF patients with higher comorbidity burden but not in those without them.

P842Calculated plasma volume status provides additional prognostic value to global registry of acute coronary event (GRACE) score in patients with acute myocardial infarction

Background

Plasma volume status (PVS) has been shown to be a well-validated prognostic indicator which relate to morbidity and mortality in heart failure. However, it remains unclear whether PVS would have the prognostic significance in patients with acute myocardial infarction (AMI). Global Registry of Acute Coronary Events (GRACE) risk score is a powerful predictor of prognosis after acute coronary event, but there is no information available on the additional prognostic value of PVS to GRACE in AMI patients.

Methods

We retrospectively studied 3930 AMI patients. GRACE score and PVS was obtained on the admission. PVS was calculated as follows: actual PV = (1 - hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females); and PVS = [(actual PV - ideal PV)/ideal PV] × 100 (%). The endpoint was All cause of death (ACD) within 5 years.

Results

During a mean follow-up period of 2.4±1.9 years, 406 patients had ACD. PVS was significantly greater in patients with ACD than without ACD (8.1±14.9% vs −1.7±13.3%, p<0.001). Each 5% increase in PVS was linked to a 27% estimated risk of 5-year mortality (p<0.001, HR: 1.05 [1.03–1.08]). PVS was still independently associated with ACD, after adjustment with GRACE score as a potential confounding factor. Kaplan-Meier analysis revealed that patients with PV expansion (PVS>0%) were significantly higher risk of ACD than those without PV expansion in patients both with high risk in GRACE score (>140) (28% (225/803) vs 19% (78/412), p=0.01, HR: 7.5) and with low risk in GRACE score (≤140) (6% (52/894) vs 3% (51/1821), p=0.009, HR: 6.2).

Survival rate curves

Conclusion

PVS, which represents intravascular compartment and congestion, could identify poor prognosis in patients with AMI. In addition, PVS would provide additional prognostic information to GRACE score.