OP0076 L-ARGININE REPROGRAMS OSTEOCLAST PURINE METABOLISM AMELIORATING BONE LOSS IN RHEUMATOID ARTHRITIS

Background

Bone erosion is a clinical feature of rheumatoid arthritis related to disease severity and poor functional prognosis. Excessive osteoclast differentiation and insufficient osteoblast function are the main reasons for the erosive process in RA. Our previous investigation indicated that L-arginine supplementation not only diminished arthritic inflammation in the serum-induced arthritis (K/BxN) model but also decreased inflammatory joints osteoclast numbers (1).

Objectives

In the present study, we aim to investigate the metabolic action of L-arginine supplementation in RA, especially on periarticular bone erosion and systemic bone loss. We plan to depict the metabolic features of TNFα induced inflammatory osteoclasts after in vitro L-arginine supplementation.

Methods

Three murine arthritis models (serum-induced arthritis (K/BxN) model, collagen-induced arthritis model, and hTNFtg mice model) were analysed in this study. L-arginine was supplemented within the drinking water after the onset of arthritis. Bone parameters for axial skeleton (spine) and peripheral skeleton (tibia) from the respective group were quantified by μCT. HE and TRAP staining were performed to address further the erosion area and osteoclast numbers in periarticular sites. In vitro osteoclast differentiation was conducted with or without L-arginine treatment, in the presence or not of TNFα activation. Seahorse and SCENITH analyses were adopted to delineate the metabolic features. JC-1 staining and transmission electron microscopy (TEM) were used to depict the mitochondria metabolism. RNA-seq and mass spectrometry (MS) were performed to investigate the underlying molecular mechanism.

Results

Inflammation was diminished in all three arthritis models after L-arginine supplementation with a significant reduction in arthritic score. Moreover, an amelioration of periarticular bone erosion, systemic bone loss, and decreased osteoclast numbers in periarticular sites were observed in arthritic mice after L-arginine treatment. L-arginine also inhibited osteoclastogenesis in vitro, particularly under TNFα activation. Seahorse and SCENITH analyses indicated TNFα promoted glycolysis while blocking mitochondria-driven oxidative phosphorylations (OXPHOS) in pre-osteoclasts. Meanwhile, JC-1 staining and TEM images also showed that TNFα decreased mitochondria membrane potential and prompted damage of mitochondria. Surprisingly, L-arginine rescued the TNFα inhibition of OXPHOS while promoting ATP production.

RNA-seq and MS data confirmed the boost of OXPHOS after L-arginine treatment under TNFα activation. To interfere with OXPHOS, L-arginine inhibited cJun thus altered arginase-1 and arginase-2 expression. Moreover, the increased ATP in L-arginine treated cells facilitated purine metabolism, especially the production of inosine and hypoxanthine, contributing to the inhibition of osteoclastogenesis. Increasing Adenosine deaminase (ADA) is essential for the production of inosine and hypoxanthine due to the decreased inhibitory regulation of the transcription factor c-Jun.

Conclusion

These data strongly demonstrated that L-arginine ameliorates bone erosion in RA through metabolic reprogramming and perturbation of purine metabolism in osteoclasts. L-arginine might therefore benefit RA therapy by reducing joint inflammation and also ameliorating bone destruction.

References

[1]Hannemann, Nicole, et al. “Transcription factor Fra-1 targets arginase-1 to enhance macrophage-mediated inflammation in arthritis.” The Journal of clinical investigation 129.7 (2019): 2669-2684.

Disclosure of Interests

Shan Cao: None declared, Rui Song: None declared, Xianyi Meng: None declared, Katerina Kachler: None declared, Maximilian Fuchs: None declared, Xinyu Meng: None declared, Yixuan Li: None declared, Verena Taudte: None declared, Meik Kunz: None declared, Ursula Schloetzer-Schrehardt: None declared, Ulrike Schleicher: None declared, Xiaoxiang Chen Speakers bureau: AbbVie, Roche and Novartis, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, Aline Bozec: None declared.

POS0409 INTESTINAL HIF1α EXPRESSION PROTECTS AGAINST EPITHELIAL CELL DEATH IN ARTHRITIS

Background

While a so-called gut-joint axis is supported by many clinical observations, the current knowledge on such axis is mostly confined to descriptive and correlative data, e.g. showing the microbiota changes are associated with arthritis. In contrast, mechanistic data on how molecular changes in the intestinal epithelium influence the development of arthritis are scarce.

Objectives

To investigate, whether the mucosal barrier in the intestine dependent of the epithelial cell survival maintenance, influences the development of arthritis.

Methods

Intestinal hypoxia inducible factor (HIF)-1α expression was assessed before, at onset and during experimental arthritis and human rheumatoid arthritis (RA). Intestinal epithelial cell-specific HIF1α conditional knock-out mice were generated (HIF1αΔIEC) and subjected to collagen-induced arthritis (CIA). Clinical and histological courses of arthritis were recorded, and T and B cell subsets were analyzed in the gut and secondary lymphatic organs, and intestinal epithelial cells were subjected to molecular mRNA sequencing in HIF1αΔIEC and littermate control mice. Furthermore, pharmacologic HIF1α stabilization by PHD inhibitor was used for the treatment of arthritis.

Results

Intestinal HIF1α expression peaked at onset and remained high in experimental arthritis and RA. Conditionally deletion of HIF1α in gut epithelial cells strongly exacerbate arthritis and was associated with increased gut epithelial cell death, intestinal and lymphatic Th1 and Th17 activation. Mechanistically, HIF1α inhibits the transcription of necroptotic and apoptotic markers, which leads to a defect in the intestinal barrier integrity. Furthermore, treatment with HIF1α stabilization reinforced the gut epithelial cell survival and inhibited arthritis.

Conclusion

These findings show that the HIF1α regulating epithelial cells survival is critical for the breakdown of the intestinal barrier function in arthritis highlighting the functional link between intestinal homeostasis and arthritis.

Disclosure of Interests

None declared.

POS1022 RELATIONSHIPS BETWEEN INHIBITION OF RADIOGRAPHIC PROGRESSION AND ACHIEVEMENT OF LOW DISEASE ACTIVITY OR REMISSION AND THEIR CORE COMPONENTS IN PATIENTS WITH PSORIATIC ARTHRITIS TREATED WITH SECUKINUMAB IN FUTURE 5 DURING THE FIRST 24 WEEKS

Background

Patients with active psoriatic arthritis (PsA) experience inflammation that may result in structural damage and disability. In the phase 3 FUTURE 5 study, treatment with secukinumab (SEC) inhibited radiographic progression and led to sustained remission and low disease activity (LDA) through Week 104.1,2

Objectives

This post hoc analysis of FUTURE 5 explored relationships between radiographic progression status and achievement of LDA or remission in patients treated with SEC.

Methods

Patients were randomized 2:2:2:3 to receive SEC 300 mg with loading dose (LD), 150 mg LD, SEC 150 mg without LD, or placebo (PBO) at Baseline, Weeks 1, 2, 3, 4, and every 4 weeks thereafter until Week 24. In this post hoc analysis, patients were grouped by radiographic progression status at Week 24 (non-radiographic progressors: change from baseline in modified total Sharp score [mTSS] ≤0.0; radiographic progressors: change from baseline in mTSS >0.0). Efficacy (achievement of Minimal Disease Activity [MDA] or Very Low Disease Activity [VLDA] and their individual components, and Disease Activity Index for Psoriatic Arthritis [DAPSA] LDA or remission) was assessed at Week 24.

Results

Of 933 patients with available data, 675 (72.3%) were classified as non-radiographic progressors and 258 (27.7%) were radiographic progressors at Week 24. Non-progressors at Week 24 were more likely than progressors to achieve DAPSA LDA and remission at Week 24 across all treatment arms (Figure 1A). In addition, non-progressors were more likely to achieve MDA and VLDA at Week 24 than progressors across all treatment arms (Figure 1B). Similar trends were observed for all of the individual MDA/VLDA criteria at Week 24 among patients treated with SEC 300 mg or SEC 150 mg LD (Table 1). Notably, non-progressors were more likely to achieve improvements in physical function, pain, and patient global assessment of disease activity than progressors across all treatment arms.

Table 1.

Proportion of Patients Achieving MDA/VLDA Components at Week 24 Grouped by Radiographic Progression Status at Week 24

Week 24 non-progressorsWeek 24 progressorsOutcome, n/N (%)SEC 300 mg n = 166SEC 150 mg n = 150SEC 150 mg NL n = 159PBO n = 200SEC 300 mg n = 51SEC 150 mg n = 63SEC 150 mg NL n = 51PBO n = 93TJC78 ≤152/161 (32.3)46/146 (31.5)37/150 (24.7)38/196 (19.4)15/50 (30.0)13/62 (21.0)13/49 (26.5)11/90 (12.2)SJC76 ≤1105/160 (65.6)85/146 (58.2)83/150 (55.3)88/196 (44.9)32/50 (64.0)28/62 (45.2)20/49 (40.8)30/90 (33.3)PASI ≤1 or BSA ≤3%99/128 (77.3)90/128 (70.3)69/109 (63.3)64/153 (41.8)29/38 (76.3)27/47 (57.4)28/40 (70.0)26/70 (37.1)Patient pain VAS ≤1557/144 (39.6)50/133 (37.6)50/141 (35.5)33/179 (18.4)14/42 (33.3)15/60 (25.0)13/43 (30.2)7/82 (8.5)PtGA VAS ≤2063/145 (43.4)47/125 (37.6)50/135 (37.0)39/173 (22.5)13/41 (31.7)14/61 (23.0)13/41 (31.7)7/81 (8.6)HAQ-DI ≤0.572/135 (53.3)55/118 (46.6)54/122 (44.3)47/158 (29.7)13/39 (33.3)18/58 (31.0)17/39 (43.6)19/77 (24.7)Tender entheseal points ≤170/87 (80.5)44/63 (69.8)42/76 (55.3)45/88 (51.1)13/18 (72.2)17/31 (54.8)11/19 (57.9)23/38 (60.5)

BSA, body surface area; HAQ-DI, Health Assessment Questionnaire Disability Index; MDA, Minimal Disease Activity; NL, no loading dose; PASI, Psoriasis Area and Severity Index; PBO, placebo; PtGA, patient global assessment of disease activity; SEC, secukinumab; SJC, swollen joint count; TJC, tender joint count; VAS, visual analog scale; VLDA, Very Low Disease Activity.

Conclusion

Patients who did not have radiographic progression over 6 months of SEC treatment were more likely to achieve LDA or remission and improvement in physical function at Week 24. Additional analyses will explore relationships between radiographic progression and additional clinical and patient-reported outcomes over longer time periods.

References

[1]Mease P, et al. RMD Open. 2021;7:e001600.

[2]Coates LC, et al. Ann Rheum Dis. 2021;80:803-4.

Acknowledgements

This study was funded by Novartis Pharmaceuticals Corporation. Medical writing support was provided by Eric Deutsch, PhD, CMPP, of Health Interactions, Inc, and was funded by Novartis Pharmaceuticals Corporation. This abstract was developed in accordance with Good Publication Practice (GPP3) guidelines. Authors had full control of the content and made the final decision on all aspects of this publication.

Disclosure of Interests

Philip J Mease Speakers bureau: AbbVie, Amgen, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, and UCB, Ana-Maria Orbai Consultant of: Bristol Myers Squibb, Janssen, Lilly, Novartis, Pfizer, and UCB, Grant/research support from: To Johns Hopkins University from AbbVie, Amgen, Celgene, Horizon, Janssen, Lilly, and Novartis, Bhumik Parikh Employee of: Novartis Pharmaceuticals Corporation, Corine Gaillez Employee of: Novartis Pharma AG, Xiangyi Meng Employee of: Novartis Pharmaceuticals Corporation, Christopher T. Ritchlin Consultant of: AbbVie, Amgen, Eli Lilly, Janssen, Pfizer, Novartis, Gilead, and UCB

[Antibodies persistence after revaccination with three doses of hepatitis B vaccine in non-responsive adults: results from 8-year follow-up study]

Objective: To evaluate the persistence of HBsAg-specific antibodies eight years after revaccination with hepatitis B vaccine (HepB) among adults who were non-responsive to primary immunization. Methods: From August to September 2009, rural communities in Zhangqiu district of Ji'nan city were selected as the study site. The subject's inclusion criteria were 18 to 49 years old, local resident population, without HBV infection history and HepB vaccination history, and good health status. Antibodies against hepatitis B surface antigen (anti-HBs) were detected in adults following the standard primary vaccination. Those who were non-responders (anti-HBs titer <10 mIU/ml) were revaccinated with three doses of HepB and included in the study. Blood samples were collected from all of them at one month (T₁), two years, four years, and eight years after revaccination. The three indexes of anti-HBs, hepatitis B surface antigen (HBsAg), together with antibody against hepatitis B core antigen (anti-HBc), were measured by chemiluminescence microparticle immunoassay (CMIA). Results: The proportion of subjects with anti-HBs titers ≥10 mIU/ml was 85.12% (549/645) at T₁, 60.60% (283/467) at two years, 55.90% (199/356) at four years and 55.09% (222/403) at eight years after revaccination. The first two years' annual decline rates, three to four years and five to eight years, were 15.62%, 3.96%, and 0.36%. The GMC of anti-HBs was 153.92 mIU/ml at T₁, 21.43 mIU/ml at two years, 15.02 mIU/ml at four years, and 13.68 mIU/ml at eight years. In the first two years, three to four years and five to eight years, the annual decline rate of GMC was 62.69%,16.28%, and 2.31%, respectively. Multivariable analysis showed that the titer of anti-HBs at T₁ was independently associated with the persistence of anti-HBs at eight years after revaccination. Compared with anti-HBs titer <100 mIU/ml , those whose anti-HBs titers were 100-mIU/ml and ≥1 000 mIU/ml at T₁ had a higher positive rate of anti-HBs (OR=14.13, P<0.001; OR= 62.91, P<0.001) and a higher probability of anti-HBs titer (β=1.88, P<0.001; β=3.24, P<0.001) at 8 years after revaccination. Nobody was found seroconversion of HBsAg, and the anti-HBc positive rate was 14.14% (57/403). Conclusions: Following revaccination with three doses of HepB in adults who were non-responsive to primary immunization, anti-HBs titers declined rapidly within the first four years. They then maintained a stable level after the fifth year. More than half still kept anti-HBs protective titer at eight years after revaccination. The immunity persistence was associated with anti-HBs titer at one month after revaccination.

Fabrication of Ag/TiO2 Cotton Fabric to Enhance Photocatalytic Degradation of Anionic Dye

Ag/TiO2 composite fabric was prepared by coprecipitation with TiCl4 as a titanium source and AgNO3 as a silver source. The samples were characterized by scanning electron microscope (SEM), thermogravimetric analyzer (TG) and Fourier transform infrared spectrometer (FTIR). The photocatalytic activity of synthetic fabrics was measured by the degradation of anion dyes under ultraviolet light. The effects of silver loading concentration, fabric area, initial concentration, and photocatalytic time on photocatalytic activity were investigated. The experimental results showed that the degradation rate of Ag/TiO2 composite fabric on anion dyes could reach 70.76% in 50 minutes, indicating that the prepared Ag/TiO2 composite fabrics had high photocatalytic activity.

[Effects of different calcium intakes on metabolism in healthy adults under strict dietary intervention]

Objective: To explore the effect of different calcium intakes on metabolism in healthy adults with traditional Chinese dietary pattern. Methods: A total of 64 college students (32 males and 32 females) were recruited from the School of Public Health, Harbin Medical University from September to October 2015. A prospective, randomized, double-blind, placebo-controlled trial design (RCT trial) was used to strictly control the diet of the volunteers through meal preparation, so that the background of the experimental and the control group was exactly the same. In our study, 64 healthy adults were randomly divided into two groups (calcium supplementation and control). The two groups were given the same diet every day. One group was given 400 mg/d of calcium supplementation, which was close to the recommended intake in China (800 mg/d); the other group was given pacebo, the average calcium intake was close to the average intake of Chinese (400 mg/d), calcium intervention lasted for 35 days. Serum and urine samples from pre-intervention, mid-intervention, and post-intervention were collected for metabolomics studies and detection of serum hormone levels and biochemical indicators. PCA and PLS-DA were used to compare the differences in serum and urine metabolites. After adjusting for age and BMI, the differences of hormones [parathyroid hormone, 1, 25(OH)₂D₃] and biochemical indicators were compared by repeated measurement variance analysis. Results: The 64 subjects were aged 23-28 years, including 32 males and 32 females. The baseline characteristics of the calcium supplementation group and the control group were balanced. The results showed that there were no significant differences in blood and urine metabolites, metabolic hormone [parathyroid hormone, 1, 25(OH)₂D₃] levels and biochemical indicators(serum Ca, serum P, glycolipid metabolism and hepatorenal function indicators)between the calcium supplementation group and control group at each time point throughout the trail (P>0.05). Conclusion: No health hazards associated with calcium deficiency was observed in healthy adults in the short term at current calcium intake level (300-400 mg/d).

[Identification of Synthetic Cannabinoid 5F-EDMB-PICA in Suspicious Herbal Products]

Objective To study the qualitative analysis strategy for unknown synthetic cannabinoid in the suspicious herbal product when no reference substance is available. Methods The synthetic cannabinoid in herbal blend was extracted with methanol. The extract was concentrated by rotary evaporator and separated and purified by preparative liquid chromatography, to obtain high purity synthetic cannabinoid sample. Gas chromatography-mass spectrometry （GC-MS）, ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry （UPLC-QTOF-MS） and nuclear magnetic resonance （NMR） were used to determine the structure of the prepared compound. Results High purity unknown sample （10 mg） was obtained by preparative liquid chromatography. The sample was analyzed by GC-MS, UPLC-TOF-MS and NMR, and through spectrum analysis, the unknown synthetic cannabinoid was determined as 5F-EDMB-PICA. Conclusion The method to extract unknown synthetic cannabinoid from low content herbal products by preparative liquid chromatography was established, and the structure of the unknown sample was identified by comprehensive use of GC-MS, UPLC-QTOF-MS and NMR. The information will assist forensic laboratories in identifying this substance or other compounds with similar structures in their casework.

Alternative polyadenylation events differ dramatically between Tongcheng and Large White pigs in response to PRRSV infection

Alternative polyadenylation (APA) is a widespread post-transcriptional regulation mechanism that increases the biological complexity of transcriptome and proteome. However, it is unclear whether APA regulation plays a role in genetic resistance to porcine reproductive and respiratory syndrome virus (PRRSV). Here, we reported genome-wide APA regulation of porcine alveolar macrophages in PRRSV-resistant Tongcheng (TC) pigs and PRRSV-susceptible Large White (LW) pigs upon PRRSV infection. Using 3' mRNA sequencing strategy, we detected 75 981 high-quality APA sites in porcine alveolar macrophages of TC and LW pigs. Furthermore, 1202 and 1089 differentially expressed APA sites, as well as 79 and 117 untranslated region-APA switching genes were identified in TC pigs and LW pigs upon PRRSV infection respectively. The APA events in TC pigs and LW pigs were involved in different biological pathways, while APA events in TC pigs are directly associated with the immune response to PRRSV infection. In addition, we identified genetic variations affecting polyadenylation signal between TC pigs and LW pigs. These findings would provide helpful information on APA regulation for further understanding of genetic resistance to PRRSV.

POS1050 SECUKINUMAB LEADS TO IMPROVEMENT ACROSS PSORIATIC ARTHRITIS MANIFESTATIONS OVER 2 YEARS REGARDLESS OF PREVIOUS EXPOSURE TO A TNF INHIBITOR: A POST HOC ANALYSIS OF FUTURE 5

Background:

The goal of treating psoriatic arthritis (PsA) is to achieve very low disease activity or remission across disease manifestations. In the phase 3 FUTURE 5 study (NCT02404350), patients receiving secukinumab (SEC) demonstrated sustained clinical improvements across PsA manifestations through Week 104.1 However, the effect of previous tumor necrosis factor inhibitor (TNFi) exposure on achievement of remission across PsA manifestations was not explored.

Objectives:

To report exploratory efficacy analyses of SEC at Week 104 on stringent endpoints across PsA manifestations in patients who were TNFi naive or inadequate responders (TNF-IR).

Methods:

Patient data from FUTURE 5 were stratified by previous TNFi exposure and analyzed by treatment arm. At Week 104, patients received SEC 300 or 150 mg with subcutaneous loading dose (LD), SEC 150 mg without LD, or had received placebo up to Week 16 and were switched to SEC 300 or 150 mg between Weeks 16 or 24 based on tender and swollen joint count response. Patients with suboptimal clinical response to SEC 150 mg could escalate to SEC 300 mg after Week 52 per investigator judgment.2 Exploratory efficacy analyses at Week 104 included resolution of TJC/SJC (0 tender/swollen joints), resolution of enthesitis and dactylitis, 75% improvement in the modified Nail Psoriasis Severity index (mNAPSI75), 100% improvement in the Psoriasis Area and Severity Index (PASI100), very low disease activity (VLDA), and Disease Activity in Psoriatic Arthritis (DAPSA) remission. Descriptive statistics are provided for each endpoint using an observed-case approach.

Results:

Regardless of previous TNFi exposure, SEC-treated patients achieved several stringent endpoints across PsA domains, including TJC/SJC resolution, resolution of dactylitis/enthesitis, mNAPSI75, and PASI100 at Week 104 (Table 1). TNFi-naive patients generally experienced greater improvements than TNF-IR patients (Table 1 above). Similar trends were observed for achievement of VLDA and DAPSA remission at Week 104 (Figure 1).

Conclusion:

SEC treatment resulted in sustained achievement of stringent endpoints across key PsA manifestations through Week 104 in both TNFi-naive and TNF-IR patients, with generally greater clinical responses among TNFi-naive patients.

References:

[1]Mease P, et al. Ann Rheum Dis. 2018;77:890-897.

[2]Mease P, et al. Arthritis Rheumatol. 2019;71:(suppl 10) [abstract 1554].

Table 1.

Achievement of Key Outcomes Across PsA Manifestations at Week 104 Among TNF-IR and TNFi-Naive Patients Treated With SEC

SEC 300 mgSEC 150 mgaSEC 150 mg No LoadbPBO–SEC 300 mgPBO–SEC 150 mgcOutcomes, n/M (%)TNFi-naiven=154TNF-IRn=68TNFi-naiven=153TNF-IRn=67TNFi-naiven=157TNF-IRn=65TNFi-naiven=109TNF-IRn=44TNFi-naiven=114TNF-IRn=39TJC/SJC resolution51/140 (36.4)19/51 (37.3)46/136 (33.8)11/46 (23.9)53/125 (42.4)14/43 (32.6)40/90 (44.4)11/31 (35.5)32/96 (33.3)10/28 (35.7)Resolution of dactylitis42/48 (87.5)11/16 (68.8)37/43 (86.0)16/19 (84.2)56/62 (90.3)11/13 (84.6)35/41 (85.4)5/7 (71.4)30/33 (90.9)10/12 (83.3)Resolution of enthesitis70/88 (79.5)22/30 (73.3)70/85 (82.4)24/32 (75.0)50/69 (72.5)16/26 (61.5)37/50 (74.0)12/17 (70.6)39/56 (69.6)14/20 (70.0)mNAPSI7561/73 (83.6)15/26 (57.7)66/76 (86.8)16/23 (69.6)61/80 (76.3)13/18 (72.2)42/51 (82.4)13/17 (76.5)34/64 (53.1)7/14(50.0)PASI10034/68 (50.0)14/29 (48.3)41/85 (48.2)5/19(26.3)33/73 (45.2)4/18(22.2)23/45 (51.1)9/18(50.0)19/46 (41.3)6/13(46.2)

IR, inadequate responder; M, number of evaluable patients; mNAPSI, modified Nail Psoriasis Severity Index; PASI, Psoriasis Area and Severity Index; PBO, placebo; SEC, secukinumab; TJC/SJC resolution, 0 tender/swollen joints; TNFi, tumor necrosis factor inhibitor.

a Includes 53 TNFi-naive and 23 TNF-IR patients with dose escalation.

b Includes 58 TNFi-naive and 19 TNF-IR patients with dose escalation.

c Includes 40 TNFi-naive and 12 TNF-IR patients with dose escalation.

Figure 1.

Acknowledgements:

This study was funded by Novartis Pharma AG. The authors thank Prasanthi Mandalay, PhD, of ArticulateScience LLC, for providing medical writing support/editorial support, which was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ, in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Disclosure of Interests:

Ana-Maria Orbai Consultant of: Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Celgene, Horizon, Janssen, Eli Lilly, and Novartis, M Elaine Husni Consultant of: AbbVie, Amgen, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, Regeneron, and UCB, Grant/research support from: Pfizer, Dafna D Gladman Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Galapagos, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Pfizer, and UCB, Bhumik Parikh Employee of: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, Xiangyi Meng Employee of: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, Corine Gaillez Employee of: Novartis Pharma AG, Basel, Switzerland, Philip J Mease Speakers bureau: AbbVie, Amgen, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, and UCB.

POS0194 ENTHESITIS IN PATIENTS WITH PSORIATIC ARTHRITIS TREATED WITH SECUKINUMAB OR ADALIMUMAB: A POST HOC ANALYSIS OF EXCEED

Background:

Enthesitis is a key musculoskeletal manifestation of psoriatic arthritis (PsA). EULAR guidelines recommend biologics for patients with enthesitis and an inadequate response to or intolerance of nonsteroidal anti-inflammatory drugs, although no guidance on specific biologics is offered. In the EXCEED head-to-head, double-blind study (NCT02745080), secukinumab (SEC) and adalimumab (ADA) showed a similar efficacy in joints and in resolution of enthesitis at Week 52 for patients with PsA,1 although a detailed analysis of enthesitis was not conducted.

Objectives:

To explore detailed enthesitis treatment response, including temporal and additional enthesitis assessment data, in patients with PsA treated with SEC or ADA over 52 weeks.

Methods:

In this post hoc analysis, patient data from EXCEED were grouped by presence or absence of baseline enthesitis based on the Leeds Enthesitis Index (LEI) and the Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC). Baseline characteristics of these groups were summarized. Median time to resolution of LEI/SPARCC enthesitis score in patients receiving SEC or ADA was assessed using Kaplan-Meier analysis. Efficacy was further assessed among the enthesitis subset by LEI and SPARCC change from baseline, resolution of enthesitis (LEI/SPARCC) at Weeks 24 and 52, and resolution of enthesitis at Week 52 by baseline enthesitis severity. Relapse of enthesitis after a first resolution was evaluated at Weeks 24 and 52. Missing data were imputed by nonresponder imputation.

Results:

Baseline demographics were well balanced in the LEI/SPARCC enthesitis subsets, although a higher proportion of all patients with enthesitis were women vs those with no enthesitis (LEI: 54.6% vs 40.5%; SPARCC: 53.2% vs 36.2%). Patients with baseline enthesitis had higher disease activity vs patients without enthesitis (LEI/SPARCC enthesitis vs no LEI/SPARCC enthesitis: tender joint count of 78 joints [22.8/22.1 vs 15.8/13.8], Health Assessment Questionnaire-Disability Index [1.3/1.3 vs 1.1/1.1], and mean Psoriasis Area and Severity Index [6.4/6.1 vs 5.1/5.3]). Median time to resolution of LEI and SPARCC enthesitis was similar between patients receiving either SEC or ADA (Table 1). Both treatment groups experienced a similar mean change from baseline in LEI and SPARCC enthesitis counts and a similar resolution of LEI and SPARCC at Weeks 24 and 52 (Table 1). Achievement of enthesitis resolution was similar between treatment groups irrespective of disease severity (Figure 1). The proportion of patients who experienced relapse after achieving resolution was low across both treatments (Table 1).

Conclusion:

In EXCEED, patients with baseline enthesitis presented with higher disease burden, consistent with the FUTURE trials.2 SEC and ADA showed similar kinetics of response and efficacy on enthesitis, irrespective of baseline enthesitis severity.

References:

[1]McInnes IB, et al. Lancet. 2020;395(10235):1496-1505.

[2]Coates LC, et al. Arthritis Res Ther. 2019;21(1):266.

Table 1.

Clinical Improvements Among Patients With Baseline LEI or SPARCC Enthesitis Treated with Secukinumab or Adalimumab (nonresponder imputation)

Secukinumab300 mgAdalimumab40 mgOutcomesaLEI(n=234)SPARCC(n=301)LEI(n=264)SPARCC(n=331)Baseline enthesitis count, mean (SD)2.6 (1.5)5.0 (3.8)2.8 (1.6)5.4 (4.0)Median time to enthesitis resolution, days (95% CI)85 (57–113)113 (85–169)85 (57–86)88 (85–114)Enthesitis count, mean improvement from baseline (SD) Week 24−1.6 (1.6)−3.3 (3.5)−1.6 (1.6)−3.1 (3.5) Week 52−1.8 (1.6)−3.6 (3.2)−2.1 (1.7)−3.9 (3.8)Resolution of enthesitis, n (%) Week 24116 (49.6)138 (45.8)115 (43.6)144 (43.5) Week 52142 (60.7)160 (53.2)146 (55.3)170 (51.4)Enthesitis relapse, n/M (%) Week 2437/210 (17.6)38/274 (13.9)49/232 (21.1)47/293 (16.0) Week 5240/208 (19.2)56/267 (21.0)32/208 (15.4)41/263 (15.6)

LEI, Leeds Enthesitis Index; M, number of evaluable patients; SPARCC; Spondyloarthritis Research Consortium of Canada Enthesitis Index.

a Based on respective enthesitis measures.

Figure 1.

Acknowledgements:

This study was funded by Novartis Pharma AG. The authors thank Richard Karpowicz, PhD, of Health Interactions, Inc, for providing medical writing support/editorial support, which was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ, in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Disclosure of Interests:

Gurjit S. Kaeley Consultant of: Novartis Pharmaceuticals Corporation, Georg Schett Speakers bureau: AbbVie, Bristol Myers Squibb, Celgene, Janssen, Eli Lilly, Novartis, and Pfizer, Consultant of: AbbVie, Bristol Myers Squibb, Celgene, Janssen, Eli Lilly, Novartis, and UCB, Grant/research support from: Bristol Myers Squibb, Celgene, GSK, Eli Lilly, and Novartis, Philip G Conaghan Consultant of: or Speakers bureau: AbbVie, AstraZeneca, Bristol Myers Squibb, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, Gilead, Novartis, and Pfizer, Grant/research support from: UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Dennis McGonagle Speakers bureau: Roche, Sobi, and Novartis, Grant/research support from: Novartis, Frank Behrens Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, Merck Sharp & Dohme, Celgene, Roche, and Chugai, Grant/research support from: Pfizer, Janssen, Chugai, Celgene, and Roche, and has received investigator fees from Eli Lilly, Philippe Goupille Grant/research support from: and/or Consultant of/Speakers bureau: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Celgene, Chugai, Janssen, Lilly, Medac, Merck Sharp & Dohme, Nordic Pharma, Novartis, Pfizer, Sanofi, and UCB, Corine Gaillez Employee of: Novartis Pharma AG, Bhumik Parikh Employee of: Novartis Pharmaceuticals Corporation, Xiangyi Meng Employee of: Novartis Pharmaceuticals Corporation, Catherine Bakewell Consultant of: and/or Speakers bureau: AbbVie, Novartis, Pfizer, Janssen, UCB, and Sanofi Genzyme/Regeneron

The protective effect of hesperidin against renal ischemia-reperfusion injury involves the TLR-4/NF-κB/iNOS pathway in rats

Renal injury is reported to have a high mortality rate. Additionally, there are several limitations to current conventional treatments that are used to manage it. This study evaluated the protective effect of hesperidin against ischemia/reperfusion (I/R)-induced kidney injury in rats. Renal injury was induced by generating I/R in kidney tissues. Rats were then treated with hesperidin at a dose of 10 or 20 mg/kg intravenously 1 day after surgery for a period of 14 days. The effect of hesperidin on renal function, serum mediators of inflammation, and levels of oxidative stress in renal tissues were observed in rat kidney tissues after I/R-induced kidney injury. Moreover, protein expression and mRNA expression in kidney tissues were determined using Western blotting and RT-PCR. Hematoxylin and eosin (H&E) staining was done for histopathological observation of kidney tissues. The data suggest that the levels of blood urea nitrogen (BUN) and creatinine in the serum of hesperidin-treated rats were lower than in the I/R group. Treatment with hesperidin also ameliorated the altered level of inflammatory mediators and oxidative stress in I/R-induced renal-injured rats. The expression of p-IκBα, caspase-3, NF-κB p65, Toll-like receptor 4 (TLR-4) protein, TLR-4 mRNA, and inducible nitric oxide synthase (iNOS) was significantly reduced in the renal tissues of hesperidin-treated rats. Histopathological findings also revealed that treatment with hesperidin attenuated the renal injury in I/R kidney-injured rats. In conclusion, our results suggest that hesperidin protects against renal injury induced by I/R by involving TLR-4/NF-κB/iNOS signaling.

Rapid Qualitative and Quantitative Analysis of Caffeine and Sodium Benzoate in Annaca by Infrared Spectroscopy

Objective To establish an infrared spectroscopic method for the rapid qualitative and quantitative analysis of caffeine and sodium benzoate in Annaka samples. Methods Qualitative and quantitative modeling samples were prepared by mixing high-purity caffeine and sodium benzoate. The characteristic absorption peaks of caffeine and sodium benzoate in Annaka samples were determined by analyzing the infrared spectra of the mixed samples. The quantitative model of infrared spectra was established by partial least squares （PLS）. Results By analyzing the infrared spectra of 17 mixed samples of caffeine and sodium benzoate （the purity of caffeine ranges from 10% to 80%）, the characteristic absorption peaks for caffeine were determined to be 1 698, 1 650, 1 237, 972, 743, and 609 cm^-1. The characteristic absorption peaks for sodium benzoate were 1 596, 1 548, 1 406, 845, 708 and 679 cm^-1. When the detection of all characteristic absorption peaks was the positive identification criteria, the positive detection rate of caffeine and sodium benzoate in 48 seized Annaka samples was 100%. The linear range of PLS quantitative model for caffeine was 10%-80%, the coefficient of determination （ R²） was 99.9%, the root mean square error of cross validation （RMSECV） was 0.68%, and the root mean square error of prediction （RMSEP） was 0.91%; the linear range of PLS quantitative model for sodium benzoate was 20%-90%, the R² was 99.9%, the RMSECV was 0.91% and the RMSEP was 1.11%. The results of paired sample t test showed that the differences between the results of high performance liquid chromatography method and infrared spectroscopy method had no statistical significance. The established infrared quantitative method was used to analyze 48 seized Annaka samples, the purity of caffeine was 27.6%-63.1%, and that of sodium benzoate was 36.9%-72.3%. Conclusion The rapid qualitative and quantitative analysis of caffeine and sodium benzoate in Annaka samples by infrared spectroscopy method could improve identification efficiency and reduce determination cost.

Influence of the Internet of Things management system on hand hygiene compliance in an emergency intensive care unit

BACKGROUND

Hand hygiene is a critical strategy for infection prevention in all healthcare settings. Automated electronic monitoring systems are expected to improve hand hygiene performance.

AIM

To investigate the impact of the Internet of Things (IoT) management system on hand hygiene compliance among medical staff in an emergency intensive care unit (EICU).

METHODS

This retrospective observational study was conducted between July 1^st, 2017 and February 28^th, 2018 in a 19-bed EICU. The changes in hand hygiene compliance among 54 members of medical staff and the incidence of hospital infections were compared, counted, and analysed before and after implementing the IoT management system in the EICU that was initiated on November 1^st, 2017.

FINDINGS

After the application of the IoT management system, the hand hygiene compliance rates among the members of the medical staff before (29.5% (3347/11,338) vs 57.9% (4690/8094), P < 0.001) and after (59.9% (9915/16,556) vs 73.8% (17,194/23 286), P < 0.001) the contact with patients and surrounding environment significantly improved. However, hand hygiene compliance among three cleaning staff did not significantly improve after the application. Moreover, there was no significant difference in healthcare-acquired infection rates (2.535% (9/355) vs 2.047% (7/342), P = 0.667) nor in the detection rates of the four major multidrug-resistant bacteria in the EICU before and after the application of the IoT management system (P > 0.05).

CONCLUSION

The IoT management system significantly improved hand hygiene compliance among medical staff, except cleaners, in the EICU of one provincial hospital; however, the rates of nosocomial infection did not significantly decrease. The quality of hand hygiene implementation needs to be improved.

[Research on the spread of the book Shiyi Xinjian in ancient and modern times]

Three volumes of Shiyi Xinjian, written by Zan Yin of Tang Dynasty, contains the theories and prescriptions of food treatment in various branches, which have far-reaching influence on food treatment and clinical treatment. The book was written in the 9th century A. D. as a dietary therapy prescription. In the Northern Song Dynasty, the book of Shiyi Xinjian was still surviving. It has been cited in Taiping Shenghuifang: Shizhi, Yanglao Fengqinshu, Zhenglei Bencao(, Classified Materia Medica from Historical Classics for Emergency) and Shengji Zonglu: Shizhimen. After the Jingkang Incident, the book was rare, and even may have been lost. Until the Ming Dynasty, the book was completely disappeared in China. However, there are some Quotes in the book Zhenglei Bencao and other books, and the contents of this book are still often cited by later medical books. After that, the Japanese collected 211 prescriptions of Shiyi Xinjian from Euibangyoochui in Korea. Luo Zhenyu brought them back to China and published them in the Dongfang Xuehui in 1924, which made the Shiyi Xinjian appear in a separate volume in China for the first time since it was lost, which promoted the spread of the book in China. After the founding of the People's Republic of China, some of the scholars collected it again, which improved the content of the book.