Comparative effectiveness of exercise-based cardiac rehabilitation for heart failure: a Bayesian network analysis of 44 randomized trials and 5896 patients

Introduction

The prevalence of heart failure (HF) is increasing nowadays. Exercise-based cardiac rehabilitation (CR) reduces mortality and further improves the outcome of patients with HF. However, the effect of different types of CR on HF remains unclear. Data comparing these CR have not been synthesized. Thus, the purpose of this study is to determine the relative efficacy of different types of exercise-based CR for individuals with HF using a Bayesian network meta-analysis.

Methods

We followed a pre-specified protocol (PROSPERO: CRD42021278351). We conducted a systematic literature review of any randomized controlled trials which evaluated exercise-based CR for patients with HF. Databases including Embase, Medline, the Cochrane Central Register of Controlled Trials, and Web of Science were screened up to 31 December 2021. The primary outcomes focus on functional capacity (peak oxygen uptake and 6-minute walk distance) and health-related quality of life (hr-QOL). The main analysis was complemented by network subanalysis, standard pairwise comparisons, and subgroup and sensitivity analyses. The pooled estimates were quantified as mean differences (MD) or standardized mean difference (SMD)where appropriate, at 95% confidence intervals (CI).

Results

We identified 44 randomized controlled trials with a total of 5896 HF participants. Among 23 studies that compared exercise-based CR and usual care, participants in center-based CR (CBCR) had improvement of peak oxygen uptake (MD: 2.30 mL/kg per minute; 95% CI, 0.43–4.40) and 6-minute walk distance (MD: 33 meters; 95% CI, 11.00–58.00).18 studies that compared exercise-based CR with usual care showed that CBCR and cardiac telerehabilitation (CTR) had greater improvements in hr-QOL (SMD: −0.38; 95% CI, −0.49 to −0.15 and SMD: −0.18,95% CI, −0.36 to −0.00 respectively). Treatment ranking indicated CTR has the highest probability (46.0%, 50.2%) of being the most effective CR for peak oxygen uptake and hr-QOL elevation respectively. CBCR was similarly indicated as the most effective treatment for 6-min walk distance (38.7%).

Conclusion

Exercise-based CR programs provide broader cardiovascular benefits compared with UC. CBCR significantly improved functional capacity. CBCR and CTR have favorable effects on hr-QOL.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): China Scholarship Council

JS04.6.A The landscape of tumor cell states and spatial organization in H3-K27M mutant diffuse midline glioma across age and location

Background

Histone 3 lysine27-to-methionine mutations (H3-K27M) frequently occur in childhood diffuse midline gliomas (DMGs) of the pons, thalamus and spinal cord, presumed to be driven by the specific spatiotemporal context of these midline locations during postnatal development. While most common in the pons and at mid-childhood ages, the same oncohistone mutation is recurrently detected in adult DMGs and throughout different midline regions. The potential heterogeneity of tumors at different ages and in different anatomical locations of the midline are vastly understudied.

Material and Methods

Through dissecting the transcriptomic, epigenomic and spatial architectures of a comprehensive cohort of patient H3-K27M DMGs - spanning the age range from 2-68 years and locations from spinal cord to thalamus - at single cell resolution, we delineate how age- and location-dependent contexts shape glioma cell-intrinsic and -extrinsic features in light of the shared driver mutation.

Results

We identify that oligodendrocyte precursor (OPC)-like cells constitute the stem-like compartment in H3-K27M DMGs across all clinico-anatomical groups, however, depending on location, display varying levels of maturity resembling less differentiated pre-OPCs or more mature OPCs further differentiated along the oligodendroglial lineage. We further demonstrate increased mesenchymal cell states in adult tumors, which we link to age-related differences in glioma-associated immune cell compartments. We for the first time resolve the spatial organization of H3-K27M DMG cell types in intact patient tissues, identifying a local niche of the oligodendroglial lineage.

Conclusion

Our study provides a powerful resource for rational modeling and therapeutic frameworks taking into account determinants of age and location in this lethal glioma group.

A semiparametric model for between-subject attributes: Applications to beta-diversity of microbiome data

The human microbiome plays an important role in our health and identifying factors associated with microbiome composition provides insights into inherent disease mechanisms. By amplifying and sequencing the marker genes in high-throughput sequencing, with highly similar sequences binned together, we obtain operational taxonomic units (OTUs) profiles for each subject. Due to the high-dimensionality and nonnormality features of the OTUs, the measure of diversity is introduced as a summarization at the microbial community level, including the distance-based beta-diversity between individuals. Analyses of such between-subject attributes are not amenable to the predominant within-subject-based statistical paradigm, such as t-tests and linear regression. In this paper, we propose a new approach to model beta-diversity as a response within a regression setting by utilizing the functional response models (FRMs), a class of semiparametric models for between- as well as within-subject attributes. The new approach not only addresses limitations of current methods for beta-diversity with cross-sectional data, but also provides a premise for extending the approach to longitudinal and other clustered data in the future. The proposed approach is illustrated with both real and simulated data.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

Construction of C-S and C-Se Bonds Mediated by Hypervalent Iodine Reagents Under Metal-free Conditions

Abstract:

In the past few decades, the chemistry of hypervalent iodine reagents has undergone a flourishing development in synthetic organic chemistry owing to their mild oxidative, low toxicity, air and moisture stability and environmentally benign features. A plethora of oxidative coupling reactions have been conducted using hypervalent iodine reagents as a nonmetallic oxidant. In particular, the C-S and C-Se bond forming reactions mediated by hypervalent iodine reagents have emerged as a powerful approach in the construction of S-containing and Se-containing heterocycles or building blocks. In these reactions, hypervalent iodine reagents behave as strong oxidants or electrophiles and activate the S-containing or Se-containing species to form more electrophilic cationic or radical intermediates which participate in subsequent coupling reactions. It is anticipated that this review summarizes all C–S and C-Se bonds forming reactions enabled by hypervalent iodine reagents under metal-free conditions.

Search for an Excess of Electron Neutrino Interactions in MicroBooNE Using Multiple Final-State Topologies

We present a measurement of ν_{e} interactions from the Fermilab Booster Neutrino Beam using the MicroBooNE liquid argon time projection chamber to address the nature of the excess of low energy interactions observed by the MiniBooNE Collaboration. Three independent ν_{e} searches are performed across multiple single electron final states, including an exclusive search for two-body scattering events with a single proton, a semi-inclusive search for pionless events, and a fully inclusive search for events containing all hadronic final states. With differing signal topologies, statistics, backgrounds, reconstruction algorithms, and analysis approaches, the results are found to be either consistent with or modestly lower than the nominal ν_{e} rate expectations from the Booster Neutrino Beam and no excess of ν_{e} events is observed.

POS0274 PREDICTION OF VASCULAR COMPLICATIONS IN TAKAYASU ARTERITIS BY MACHINE LEARNING: A PROOF-OF-CONCEPT STUDY BASED ON A PROSPECTIVE COHORT

Background

Vascular complications are common poor prognosis in Takayasu arteritis (TAK). A reliable prediction model for this outcome has not been performed using machine learning (ML) due to the lack of a dataset with sufficient sample size.

Objectives

We aimed to develop ML models for prediction of vascular complications in TAK based on the prospective data of the largest sample in China from the East China Takayasu Arteritis (ECTA) cohort.

Methods

Data were collected from the ECTA cohort in which patients were enrolled from January 2009 to August 2020 and followed till February 2021 (n = 517). Predictor variables included 53 baseline features and outcome of interest was incident vascular complications. Data were randomly split into a training (85%) and test (15%) set. Logistic regression (LR), support vector machine, random forest (RF), k-nearest neighbors, XGBoost (XGB), and light gradient boosting machine models were trained using five-fold cross validation, and evaluated on the test set for recall, specificity, precision and area under ROC (AU-ROC) and precision-recall curves (AU-PRC). Permutation score was applied to assess feature importance to the outcome.

Results

Over a median follow-up of 30 (15–44) months, incident vascular complications were observed in 29.0% (150/517) patients. The RF model demonstrated the best overall predictive performance (AU-ROC = 0.84, AU-PRC = 0.63). Both the RF and LR models had the highest specificity (0.98), and the XGB model had the highest recall (0.87). Progressive clinical course was an important feature significantly associated with the outcome for all models.

Conclusion

It demonstrated the feasibility of developing ML models for prediction of vascular complications in TAK. The XGB model could help for early identification of high-risk patients, and RF and LR models could further confirm.

Figure 1.

Disclosure of Interests

None declared

POS0826 CIRCULAR RNA EXPRESSION PROFILES AND IDENTIFICATION OF HSA_CIRC_0028381 AS A POTENTIAL BIOMARKER OF ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS

Background

Growing evidence indicated that dysregulated circRNAs play a vital role in autoimmune diseases. However, their role in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) has never been illustrated.

Objectives

This study aims to determine the expression profiles of circRNA in plasma of AAV patients and explore the potential of circRNA as biomarker of AAV.

Methods

RNA-sequencing (RNA-seq) was performed to identify the circRNAs and mRNAs expression profiles in plasma from 5 AAV patients and 5 healthy controls (HCs). Hsa_circ_0028381, one of the four candidate circRNAs were validated by quantitative reverse-transcription (qRT)-PCR in a validation cohort of 51 AAV patients and 30 HCs and was confirmed to be significantly upregulated. And it was further verified in other connective tissue diseases (CTDs) by qRT-PCR. The receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic value.

Results

RNA expression profiles revealed that 143 circRNAs and 304 mRNAs were aberrantly expressed, among which, 62 circRNAs were upregulated and 81 circRNAs were downregulated in AAV patients compared to HCs. The result of qRT-PCR verification suggested that hsa_circ_0028381 was significantly increased in plasma from AAV patients compared to that in HCs and CTDs. The receiver operating characteristic (ROC) curves analysis showed has_circ_0028381 had a good diagnostic value to distinguish AAV patients from controls (HCs and other CTDs) with area under the curve (AUC) of 0.81. In addition, has_circ_0028381 was associated with renal involvement. Most importantly, increased baseline level of has_circ_0028381 had a predictive value for renal progression to end-stage renal disease (ESRD).

Conclusion

RNA-seq revealed that circRNAs were aberrantly expressed in plasma of AAV patients. Has_circ_0028381 might function as a potential biomarker for AAV diagnosis and renal prognosis.

References

[1]Jennette, J.C., et al., 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum, 2013. 65(1): p. 1-11.

[2]Li, Y., et al., Circular RNA is enriched and stable in exosomes: a promising biomarker for cancer diagnosis. Cell Res, 2015. 25(8): p. 981-4.

[3]Li, L.J., et al., Circular RNA expression profile and potential function of hsa_circ_0045272 in systemic lupus erythematosus. Immunology, 2018. 155(1): p. 137-149.

[4]Gou, S.J., et al., Alternative complement pathway activation products in urine and kidneys of patients with ANCA-associated GN. Clin J Am Soc Nephrol, 2013. 8(11): p. 1884-91.

Disclosure of Interests

None declared

POS0812 CAROTID INTIMA-MEDIA THICKNESS/DIAMETER RATIO AND PEAK SYSTOLIC VELOCITY AS RISK FACTORS FOR NEUROLOGICAL SEVERE ISCHEMIC EVENTS IN TAKAYASU’S ARTERITIS

Background

Takayasu’s arteritis (TAK) is an idiopathic systemic vasculitis characterized by the involvement of the aorta and its major branches [1]. The supra-aortic arteries are often involved in TAK, with the reported prevalence ranging from 40% to 84% [2-3]. Importantly, patients with supra-aortic involvement carry a higher risk of neurological severe ischemic events (SIE) [4-5]. The common carotid artery (CCA) is the most affected artery and is more closely associated with neurologic symptoms than other supra-aortic arteries [6]. Ultrasonography (US) has been regarded as the most popular, user-friendly, and repeatable tool for the diagnosis and follow-up of CCA injuries.

Objectives

Our aim was to characterize TAK with supra-aortic involvement and determine the associations between clinical features, carotid US parameters, and neurological SIE.

Methods

Patients with supra-aortic involvement including brachiocephalic trunk, bilateral common carotid artery and internal carotid artery, and bilateral subclavian and vertebral artery and baseline carotid US examination were enrolled. Bilateral carotid diameter, intima-media thickness (IMT), and peak systolic velocity (PSV) were measured by US. Then, IMT/diameter ratio (IDR) was calculated. Risk factors associated with neurological SIE were analyzed by multivariate logistic regression.

Results

Totally, 295 patients were included, of whom 93 (31.5%) experienced neurological SIE, with common carotid artery involved (81.7%). Involved supra-aortic artery distribution (p=0.04) and number (p<0.01) differed between neurologic and non-neurologic SIE subjects, showing higher prevalence of common carotid and vertebral artery involvement in cases with neurological SIE and 57.1% neurological SIE patients having more than four involved arteries. The left carotid IMT (p=0.03) and IDR (p<0.01) differed between patients with and without neurological SIE. The left carotid IDR (cut-off value ≥0.55, odds ratio [OR] 4.46; 95% confidence interval [CI] 2.05-9.71; p<0.01) and PSV (≤76 cm/s, OR 3.38; 95% CI 1.62-7.04; p<0.01) and involved supra-aortic artery number (≥4, OR 3.16; 95% CI 1.54-6.47; p<0.01) were independently associated with neurological SIE.

Conclusion

The left carotid IDR, PSV and involved supra-aortic artery number would perform as valuable markers for recognizing neurological SIE in TAK patients with supra-aortic lesions.

References

[1]Kerr GS, Hallahan CW, Giordano J, et al. Takayasu arteritis. Ann Intern Med 1994; 120: 919-29.

[2]Cong XL, Dai SM, Feng X, et al. Takayasu’s arteritis: clinical features and outcomes of 125 patients in China. Clin Rheumatol 2010; 29: 973-81.

[3]Mirouse A, Biard L, Comarmond C, et al. Overall survival and mortality risk factors in Takayasu’s arteritis: a multicenter study of 318 patients. J Autoimmun 2019; 96: 35-9.

[4]Porter A, Youngstein T, Tombetti E, Mason JC. Biologic therapy in supra-aortic Takayasu arteritis can improve symptoms of cerebral ischaemia without surgical intervention. Rheumatology (Oxford) 2020; 59 Suppl 3: iii28-32.

[5]Michailidou D, Rosenblum JS, Rimland CA, Marko J, Ahlman MA, Grayson PC. Clinical symptoms and associated vascular imaging findings in Takayasu’s arteritis compared to giant cell arteritis. Ann Rheum Dis 2020; 79: 262-7.

[6]Schäfer VS, Jin L, Schmidt WA. Imaging for diagnosis, monitoring, and outcome prediction of large vessel vasculitides. Curr Rheumatol Rep 2020; 22: 76.

Disclosure of Interests

None declared

POS0799 BIOMARKER CHANGES IN TAKAYASU ARTERITIS AFTER TOFACITINIB TREATMENT AND THE MOLECULAR SIGNATURE ASSOCIATED WITH DISEASE CHARACTERISTICS

Background

Takayasu’s arteritis (TAK) is a chronic, non-specific, granulomatous macrovasculitis and its pathogenesis is still unclear. The increasing evidence indicated that multiple pathological process involved in the development of TAK. According to previous reports, multiple biomarkers representative different pathological process (1-3), However, which biomarker can closely reflect disease activity or vascular changes and whether these abnormal processes can be prevented by current therapies remained unknown.

Objectives

To analyze changes of serum cytokine, chemokine, and growth factor profiles in patients with Takayasu arteritis (TAK) after tofacitinib treatment and explore potential molecular signatures related with various disease characteristics

Methods

Seventeen patients from a TAK cohort treated with tofacitinib and 12 healthy controls were recruited in this study. Potential biomarkers with TAK including cytokines, MMPs, chemokines and growth factors were detected in these patients (0, 6, 12 months) and healthy controls. Molecular changes, disease activity, disease remission, and vascular imaging changes were analyzed in these patients after treatment. Furthermore, molecule signatures associated with these clinical features/outcomes were explored via radar plot and correlation analysis.

Results

At baseline, all the patients were in active status. Meanwhile, patients’ cytokines (PTX3, IL-6, IFN-γ), chemokines (IL-16, CCL22, CCL2), growth factor (VEGF) and MMP9 were significantly higher than those of healthy controls (all p<0.05), while FGF-2 was significantly lower in patients with TAK (p=0.02). After treatment, 94.12% of patients achieved complete remission at 6 and 12 months; patients’ ESR and CRP levels were significantly reduced at 6 months (p=0.02, p=0.046 respectively); vascular improvement were observed in 6 (35.29%) patients at 12 months. With regards to these molecules, IL-10 was increased at 6 months compared with its baseline level (p=0.007). No changes were observed in other cytokines, chemokines, or growth factors. Besides, the radar plot demonstrated that PTX3 was closely correlated with disease activity. In addition, patients with vascular imaging improvement had relatively higher baseline levels of TNFα, ESR, and CRP (p=0.04, p=0.056, p=0.07, respectively), lower CCL22, FGF, and PDGF-AB levels (p=0.056, p=0.06 and p=0.08 respectively) compared with patients without it.

Conclusion

Multiple molecules representative different pathological mechanism participated in the pathogenesis of TAK. PTX3 was a prominent marker for disease activity, and CCL22 may have a predictive value for vascular imaging changes.

References

[1]Dagna L, Salvo F, Tiraboschi M, et al. Pentraxin-3 as a marker of disease activity in Takayasu arteritis. Ann Intern Med. 2011;155(7):425-433. doi:10.7326/0003-4819-155-7-201110040-00005

[2]Sun Y, Kong X, Wu S, et al. YKL-40 as a new biomarker of disease activity in Takayasu arteritis. Int J Cardiol. 2019; 293: 231-237

[3]Dong H, Zhang Y, Zou Y, et al. Elevated chemokines concentration is associated with disease activity in Takayasu arteritis. Cytokine. 2021; 143: 155515

Disclosure of Interests

None declared

POS0397 SSD6453, A NOVEL AND HIGHLY SELECTIVE BTK/JAK3 DUAL INHIBITOR IS EFFICACIOUS IN MULTIPLE PRE-CLINICAL MODELS OF INFLAMMATION

Background

The mechanism of inflammatory diseases is complicated and dysfunction of multiple immune cells is thought to be directly related to the pathogenesis. Targeting either JAK-STAT or BCR signaling has been proved solid clinical efficacy in multiple inflammatory diseases, such as rheumatoid arthritis (RA) and multiple sclerosis (MS). And the combination of BTK and JAK inhibitors demonstrated synergistic effects for the treatment of inflammation models in pre-clinic. JAK3 expression is largely restricted to leukocytes and involves functions in JAK1/JAK3 heterodimer in signal transduction, it might be a more effective and safer target. Meanwhile, both BTK and JAK3 possess a cysteine residue in their active site and this feature makes it possible to design a dual inhibitor. SSD6453 is a highly selective and irreversible JAK3/BTK dual inhibitor which may have synergistic effects for the treatment of RA and other inflammatory diseases such as MS.

Objectives

To develop a potent, oral, highly selective JAK3/BTK inhibitor for treatment of multiple inflammatory diseases.

Methods

ADP-GLO based biochemical assays were performed to determine the enzymatic inhibitory effect and selectivity for JAK family. The target engagement was evaluated by IgM induced pBTK and IL-2 induced pSTAT5 in human PBMCs. In vivo efficacy was evaluated by rat collagen-induced arthritic (CIA) model and mice experimental autoimmune encephalomyelitis (EAE) models induced by MOG1-125 or MOG35-55, respectively. BTK occupancy in spleens post last dose 24h and IL-2 induced pSTAT5 in whole blood post last dose 0.5h were used to evaluate targets inhibitions. Osteoclast was stained by IHC in pathological section of rat paws.

Results

In biochemical assays, SSD6453 inhibited BTK and JAK3 with the IC50 values of 3.4 nM and 1.1 nM, respectively. Notably, SSD6453 displayed high selectivity against JAK1 (510 fold), JAK2 (75 fold) and TYK2 (525 fold). In cellular assays, SSD6453 inhibited anti-IgM induced pBTK and IL-2 induced pSTAT5 in human PBMCs with the IC50 values of 18.8 nM and 168.8 nM, respectively. SSD6453 demonstrated favorable PK properties in broad pre-clinical species. Single oral administration of SSD6453 in rat or mouse, resulted in dose-dependent inhibition of BTK and JAKs concurrently. In the rat CIA model in which disease development was accompanied by a robust T-cell and B-cell inflammation response to collagen, SSD6453 dose-dependently inhibited paw edema. And SSD6453 at 10mpk achieved complete (95%) BTK occupancy and JAK3 inhibition and superior efficacy in comparison of tofacitinib (JAK@10 mpk) or evobrutinib (BTK @30mpk) alone, suggesting that concurrent inhibition of JAK3 and BTK lead to synergistic anti-inflammation effects. In addition, ED-1+ osteoclast count decrease was observed in paws, suggesting the prevention of SSD6453 in joint destruction. In two EAE models either induced by MOG1-125 or MOG35-55, which represented T or B dominant inflammation model, respectively, SSD6453 robustly ameliorated disease in both two models. In comparison, BTK inhibitor is efficacious only in the MOG1-125 induced model.

Conclusion

SSD6453 is a novel and high selective BTK/JAK3 dual inhibitor, and demonstrated synergistic efficacy in multiple pre-clinic inflammation models. SSD6453 showed good pharmacokinetic characteristics and well-tolerant in multiple pre-clinical species, and is moving to IND in 2022.

Disclosure of Interests

Feng Zhou Shareholder of: I own the shares of Simcere, Grant/research support from: The work is financially support by Simcere, Employee of: Simcere, Lei Jiang Shareholder of: I own the shares of Simcere, Grant/research support from: The work is financially supported by Simcere, Employee of: I am employee of Simcere, Yuxi Yan Grant/research support from: The work is financially supported by Simcere, Employee of: I am employee of Simcere, Wenqing Yang Shareholder of: I own the shares of Simcere, Grant/research support from: the work is financially supported by Simcere, Employee of: I am employee of Simcere, Feng Tang Shareholder of: I own the shares of Simcere, Grant/research support from: The work is financially supported by Simcere, Employee of: I am employee of simcere, Ping Chen Shareholder of: I own the shares of Simcere, Grant/research support from: The work is financially supported by Simcere, Employee of: I am employee of Simcere, Renhong Tang Shareholder of: I own the shares of Simcere, Grant/research support from: The work is financially supported by Simcere, Employee of: I am employee of Simcere.

POS0491 A COMPREHENSIVE PROFILE OF CHEMOKINES IN THE PERIPHERAL BLOOD AND VASCULAR TISSUE OF PATIENTS WITH TAKAYASU ARTERITIS

Background

Takayasu arteritis (TAK) is a chronic granulomatous large vessel vasculitis with multiple immune cells involved [1]. In TAK, vascular lesions originate from the vascular adventitia. The vascular adventitia is rich in vasa vasorum, which can transport peripheral immune cells to active vascular lesions in the early stage of lesion development [2]. Thus, chemokines played critical roles in the pathogenesis of TAK. It has been reported that the levels of RANTES, CCL2, CCL20, CXCL8, and CXCL10 were elevated in TAK, and their levels were correlated with disease activity [3, 4]. However, the profile of chemokines in TAK has not been clearly elucidated.

Objectives

This study aimed to investigate chemokine profile in peripheral blood and vascular tissue of patients with TAK.

Methods

A total of 58 patients with TAK and 53 healthy controls were enrolled. Chemokine array assay was performed in five patients with TAK and three controls. Chemokines with higher levels were preliminarily validated in 20 patients and controls. The validated chemokines were further confirmed in another group of samples with 25 patients and 25 controls. Their expression and distribution were also examined in vascular tissue from 8 patients and 5 controls. Correlations between these chemokines and peripheral immune cells, cytokines, disease activity parameters were analyzed. Their serum changes were also investigated in these 45 patients after glucocorticoids and immunosuppressive treatment.

Results

Patients and controls were age and sex-matched. Twelve higher chemokines and 4 lower chemokines were found based on the chemokine array. After validation, increase of 5 chemokines were confirmed in patients with TAK, including CCL22, RANTES, CXCL16, CXCL11, and IL-16. Their expressions were also increased in vascular tissue of patients with TAK. In addition, levels of RANTES and IL-16 were positively correlated with peripheral CD3+CD4+ T cell numbers. Close localization of CCL22, CXCL11 or IL-16 with inflammatory cells were also observed in TAK vascular tissue. No correlations were found between these chemokines and cytokines (IL-6, IL-17, IFN-γ) or inflammatory parameters (ESR, CRP). No differences were observed regarding with these chemokines between active and inactive patients. After treatment, increase of CCL22 and decrease of RANTES, CXCL16 were found, while no changes were showed in levels of CXCL11 and IL-16.

Conclusion

CCL22, RANTES, CXCL16, CXCL11, and IL-16 were identified as the major chemokines involved in the recruitment of immune cells in the vascular tissue of patients with TAK. Additionally, the persistently high levels of CCL22, CXCL11, and IL-16 observed after treatment indicate their role in vascular chronic inflammation or fibrosis and demonstrate the need for developing more efficacious treatment options.

References

[1]Seyahi E. Takayasu arteritis: an update. Curr Opin Rheumatol. 2017 Jan;29(1):51-56.

[2]Corbera-Bellalta M, Planas-Rigol E, Lozano E, Terrades-García N, Alba MA, Prieto-González S, García-Martínez A, Albero R, Enjuanes A, Espígol-Frigolé G, Hernández-Rodríguez J, Roux-Lombard P, Ferlin WG, Dayer JM, Kosco-Vilbois MH, Cid MC. Blocking interferon γ reduces expression of chemokines CXCL9, CXCL10 and CXCL11 and decreases macrophage infiltration in ex vivo cultured arteries from patients with giant cell arteritis. Ann Rheum Dis. 2016 Jun;75(6):1177-86.

[3]Noris M, Daina E, Gamba S, Bonazzola S, Remuzzi G. Interleukin-6 and RANTES in Takayasu arteritis: a guide for therapeutic decisions? Circulation. 1999 Jul 6;100(1):55-60.

[4]Dong H, Zhang Y, Zou Y, Chen Y, Yue J, Liu H, Jiang X. Elevated chemokines concentration is associated with disease activity in Takayasu arteritis. Cytokine. 2021 Jul;143:155515.

Disclosure of Interests

None declared.

[Impact of prolonging dual antiplatelet therapy on long-term prognosis of elderly patients with coronary heart disease complicated with diabetes mellitus undergoing drug-eluting stent implantation]

Objective: To explore and compare the effect of standard or prolonged dual antiplatelet therapy (DAPT) on the long-term prognosis of elderly patients with coronary heart disease complicated with diabetes mellitus after drug-eluting stent (DES) implantation. Methods: Consecutive patients with diabetes mellitus, ≥65 years old, underwent DES implantation, and had no adverse events within 1 year after operation underwent percutaneous coronary intervention (PCI) from January to December 2013 in Fuwai Hospital were enrolled in this prospective cohort study. These patients were divided into three groups according to DAPT duration: standard DAPT duration group (11 ≤ DAPT duration≤ 13 months) and prolonged DAPT duration group (13<DAPT duration≤ 24 months; DAPT duration>24 months). All the patients were followed up at 1, 6 months, 1, 2 and 5 years in order to collect the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), and type 2 to 5 bleeding events defined by the Federation of Bleeding Academic Research (BARC). MACCE were consisted of all cause death, myocardial infarction, target vessel revascularization or stroke. The incidence of clinical adverse events were compared among 3 different DAPT duration groups, and Cox regression model were used to analyze the effect of different DAPT duration on 5-year long-term prognosis. Results: A total of 1 562 patients were enrolled, aged (70.8±4.5) years, with 398 female (25.5%). There were 467 cases in standard DAPT duration group, 684 cases in 13<DAPT duration≤ 24 months group and 411 cases in DAPT duration>24 months group. The patients in standard DAPT duration group and the prolonged DAPT duration groups accounted for 29.9% (467/1 562) and 70.1% (1 095/1 562), respectively. The 5-year follow-up results showed that the incidence of all-cause death in 13<DAPT duration≤ 24 months group (4.8%(33/684) vs. 8.6%(40/467),P=0.011) and DAPT duration>24 month group(4.1%(17/411) vs. 8.6%(40/467),P=0.008) were significantly lower than in standard DAPT group. The incidence of myocardial infarction in 13<DAPT duration≤ 24 months group was lower than in standard DAPT duration group (1.9%(13/684) vs. 5.1%(24/467),P=0.002). The incidence of MACCE in 13<DAPT duration≤ 24 months group was the lowest (standard DAPT duration group, 13<DAPT duration≤ 24 months group and DAPT duration>24 month group were 19.3% (90/467), 12.3% (84/684), 20.2% (83/411), respectively, P<0.001). There was no significant difference in the incidence of stroke and bleeding events among the three groups (all P>0.05). Multivariate Cox analysis showed that compared with the standard DAPT group, prolonged DAPT to 13-24 months was negatively correlated with MACCE (HR=0.601, 95%CI 0.446-0.811, P=0.001), all-cause death (HR=0.568, 95%CI 0.357-0.903, P=0.017) and myocardial infarction (HR=0.353, 95%CI 0.179-0.695, P=0.003). DAPT>24 months was negatively correlated with all-cause death (HR=0.687, 95%CI 0.516-0.913, P=0.010) and positively correlated with revascularization (HR=1.404, 95%CI 1.116-1.765, P=0.004). There was no correlation between prolonged DAPT and bleeding events. Conclusions: For elderly patients with coronary heart disease complicated with diabetes mellitus underwent DES implantation, and had no MACCE and bleeding events within 1 year after operation, appropriately prolonging of the DAPT duration is related to the reduction of the risk of cardiovascular adverse events. Patients may benefit the most from the DAPT between 13 to 24 months. In addition, prolonging DAPT duration does not increase the incidence of bleeding events in this patient cohort.

First Measurement of Energy-Dependent Inclusive Muon Neutrino Charged-Current Cross Sections on Argon with the MicroBooNE Detector

We report a measurement of the energy-dependent total charged-current cross section σ(E_{ν}) for inclusive muon neutrinos scattering on argon, as well as measurements of flux-averaged differential cross sections as a function of muon energy and hadronic energy transfer (ν). Data corresponding to 5.3×10^{19} protons on target of exposure were collected using the MicroBooNE liquid argon time projection chamber located in the Fermilab booster neutrino beam with a mean neutrino energy of approximately 0.8 GeV. The mapping between the true neutrino energy E_{ν} and reconstructed neutrino energy E_{ν}^{rec} and between the energy transfer ν and reconstructed hadronic energy E_{had}^{rec} are validated by comparing the data and Monte Carlo (MC) predictions. In particular, the modeling of the missing hadronic energy and its associated uncertainties are verified by a new method that compares the E_{had}^{rec} distributions between data and a MC prediction after constraining the reconstructed muon kinematic distributions, energy, and polar angle to those of data. The success of this validation gives confidence that the missing energy in the MicroBooNE detector is well modeled and underpins first-time measurements of both the total cross section σ(E_{ν}) and the differential cross section dσ/dν on argon.