AB0038 DUAL TARGETING PEPTIDE RLS-0071 REDUCES AND INHIBITS MYELOPEROXIDASE (MPO) IN HEALTHY HUMAN VOLUNTEER

Background

RLS-0071-101 was a first in human clinical trial to evaluate safety of the peptide RLS-0071 in healthy volunteers in a single ascending dose and multiple ascending dose format. RLS-0071, previously referred to as Peptide Inhibitor of Complement C1 (PIC1) is a dual-targeting peptide being developed for clinical use to moderate humoral and cellular inflammation via inhibition of complement activation and neutrophil effectors including myeloperoxidase (MPO) and Neutrophil extracellular trap formation (NETosis).1,2 Humans that are otherwise asymptomatic are considered at risk for cardiovascular complications if they have a plasma MPO level of > 420 pmol.3 A post hoc analysis of plasma samples from subjects participating in RLS-0071-101 identified an individual with mildly elevated baseline MPO level (142 pmol/L).

Objectives

Evaluate if RLS-0071 dosing would change MPO level or activity in a subject with elevated baseline MPO.

Methods

Frozen plasma samples prepared from blood collected by venipunture into K2EDTA tubes (BD) was utilized to determine MPO quantity and activity levels. MPO quantity in the plasma was analyzed using a human MPO ELISA kit (BMS2038INST, Invitrogen) and MPO activity within the plasma was analyzed using a fluorescence-based myeloperoxidase assay kit (K745-100, BioVision).

Results

Upon screening 54 subjects from RLS-0071-101 we identified one individual with a mildly elevated MPO level at baseline, a 21-year-old white female with BMI of 21.7. The subject received 9 intravenous infusions of RLS-0071 each at a dose of 10 mg/kg. Her vital signs and body temperature remained normal throughout the study and the only blood laboratory abnormality were a mildly low plasma protein concentration of Day 2 and Day 4 which was noted both among recipients of the peptide and placebo subjects. Analysis of MPO blood concentrations demonstrated a mildly elevated baseline plasma MPO concentration that decreased after multiple doses of RLS-0071 with partial recovery to baseline 24 hours after cessation of dosing. MPO activity analyzed using a fluorescence-based myeloperoxidase assay kit demonstrated an elevated baseline plasma MPO activity level that decreased after multiple doses of RLS-0071 with partial recovery after 24 hours.

Conclusion

These results suggest promise for RLS-0071 to reversibly moderate plasma MPO activity and potentially affect MPO-mediated diseases including acute coronary syndrome (ACS), atheromatous plaque vulnerability and auto immune conditions.4,5,6,7.

References

[1]Sharp, Julia A., et al. “Peptide inhibitor of complement c1, a novel suppressor of classical pathway activation: mechanistic studies and clinical potential.” Frontiers in immunology 5 (2014): 406.

[2]Hair, Pamela S., et al. “Inhibition of myeloperoxidase activity in cystic fibrosis sputum by peptide inhibitor of complement C1 (PIC1).” PLoS One 12.1 (2017): e0170203.

[3]Tang WH, Wu Y, Nicholls SJ, Hazen SL. Plasma myeloperoxidase predicts incident cardiovascular risks in stable patients undergoing medical management for coronary artery disease. Clin Chem. 2011;57(1):33-9.

[4]Malle, E.; Marsche, G.; Panzenboeck, U.; Sattler, W. Myeloperoxidase-mediated oxidation of high-density lipoproteins: Fingerprints of newly recognized potential proatherogenic lipoproteins. Arch. Biochem. Biophys., 2006, 445 (2), 245-255.

[5]Nurcombe, H. L.; Bucknall, R. C.; Edwards, S. W. Activation of the neutrophil myeloperoxidase-H2O2 system by synovial fluid isolated from patients with rheumatoid arthritis. Ann. Rheum. Dis., 1991, 50 (4), 237-242

[6]Malle, E.; Buch, T.; Grone, H. J. Myeloperoxidase in kidney disease. Kidney Int., 2003, 64 (6), 1956-1967.

[7]Nicholls, S. J.; Hazen, S. L. Myeloperoxidase and cardiovascular disease. Arterioscler., Thromb., Vasc. Biol., 2005, 25 (6), 1102- 1111.

Disclosure of Interests

Parvathi Kumar Shareholder of: I have stock options available, Consultant of: Served as a consultant for ReAlta life Sciences INC from April- July 2020, Employee of: I am employed by ReAlta Life Sciences, Kenji Cunnion Shareholder of: Shareholder of ReAlta life sciences, Employee of: ReAlta Life Sciences, Neel Krishna Employee of: I am an employee of ReAlta Life Sciences., Ulrich Thienel Shareholder of: Shareholder of ReAlta and JNJ, Employee of: ReAlta Life Sciences, Pamela Hair Employee of: ReAlta Life Sciences, Jessica Goss Employee of: ReAlta Life Sciences, Christos Gabriel: None declared

AB1501 EFFECT OF SARS-COV-19 PANDEMIC ON RHEUMATOLOGY TRAINING IN INDIA

Background

The current study aims to gauge the magnitude of the effect the pandemic has had on Rheumatology training (including the effect on clinical, academic and research training) in India, their physical, mental and social wellbeing during the pandemic and the perceived changes in Rheumatology training and care during the pandemic from the trainee’s view

Objectives

1.To asses the Impact of COVID-19 Pandemic on the training of Rheumatology Residents (DM, DNB and Fellows)

2.Understand the issues faced by trainees and the extent of affection.

Methods

Study design: We conducted an observational cross-sectional study using an online survey sent to rheumatology trainees in India.

Sample: Convenience sampling was used, so the sample size was not calculated.

Inclusion and exclusion criteria: Rheumatology trainees from India including DM/DNB residents and fellows with the ability and desire to complete the survey were included.

Data collection and instruments: The link to the survey was sent to the rheumatology trainees through social media platforms like WhatsApp, Telegram and email.

Statistical analysis: Descriptive statistics were performed by calculating measures of central tendency for quantitative variables and using counts and percentages for qualitative and nominal variables.

Results

A total of 78 trainees from 24 institutes in 12 states participated in the study. Mean age of the participants was 31 with 70% of trainees being male and 30 % females. 56 (70%) participants were DM students, 15 (19%) participants were DNB students, 5 fellowship students and 2 Non- academic Senior Residents. An overwhelming majority of residents (84%) felt COVID-19 Pandemic Negatively impacted their residency and their Physical (65%), Mental(74%) and Social wellbeing (80%). 79% of trainees felt burnt-out due to the pandemic. Majority of trainee felt the pandemic negatively impacted their training with clinical teaching(91%), Clinical examination skill (74%), current(80%) and future(70%) research opportunities suffered during the pandemic. Most residents felt diminution and significant reduction of the overall footfall(99% & 72%) of patients in rheumatology including OPD(100% & 77%) and indoor(99% & 67%) admissions along with academics(85% & 35%), procedures(97% & 66%) and exposure to musculoskeletal ultrasound(96% & 71%). Almost 60% and 40% of trainees had their OPDs and indoor admissions stopped during COVID-19 pandemic of these 20% had their OPDs and Admissions closed for more than 6 months. 85% of the participants had one or the other psychological symptoms with almost half experiencing anxiety(44%), low mood(47%) or lack of sleep(41%); 85% were concerned about their family members being infected and 40% lost a close relative to COVID. 91% of the trainee were posted in COVID-duties 2/3rd of them in ICUs, 50% being posted for 1-3 months and 20% more than 3 months, a quarter of trainees got infected during their duties (COVID and Non-COVID) and though most had asymptomatic to mild COVID, 15% still had moderate to severe COVID. Teleconsultation was started by more than half of the respondents after COVID related lockdowns with greater than half not being happy with teleconsultations.

Conclusion

The COVID-19 Pandemic has completely altered the status quo for rheumatology trainees and has affected their physical, social and mental wellbeing. Academic and clinical training has reduced, Current and future Research has become difficult, disruptions in OPDs and Admissions, recurrent COVID postings and reduction in patient footfall, Procedures and MSK-US have been detrimental to trainees.

References

[1]Chandwar K, Dixit J, Kishor K, Ekbote D,Dogga P. COVID‑19 anniversary – The hits, the misses, and the wayforward: A resident’s view. Indian J Rheumatol 2021; 10.4103/injr.injr_97_21

Disclosure of Interests

None declared

AB0006 ESTABLISHED RISK LOCI FOR SYSTEMIC LUPUS ERYTHEMATOSUS AT NCF2, STAT4, TNPO3, IRF5 AND ITGAM ASSOCIATE WITH DISTINCT CLINICAL MANIFESTATIONS: A DANISH GENOME-WIDE ASSOCIATION STUDY

Background

Systemic lupus erythematosus (SLE) has been associated with more than 100 genetic loci. This parallels positively to the clinical diversity that is reflected by the classification of SLE.

Objectives

We aimed to investigate associations between disease manifestations of SLE and risk gene variants relevant to Danish subjects of European ancestry.

Methods

We included 427 SLE patients of European ancestry similar to previous reports.[1] We also included 89,699 controls from the Danish Blood Donor Study Genomic Cohort. SLE risk loci in this population were identified by genome-wide association methodology and hereafter correlated to cumulative occurrence of SLE classification items.

Results

Fourteen variants mapped to the following genes: NCF2, STAT4, TNPO3/TPI1P2, IRF5, and ITGAM, were significantly associated (p<5E-8) with SLE.

The five lead variants were associated (p<0.05) with the following manifestations; NCF2: proteinuria and anti-phospholipid antibodies, STAT4: arthritis, serositis, neurologic disorder, lymphopenia, and anti-Smith antibodies, IRF5: seizures and proteinuria, TNPO3: proteinuria, and ITGAM: photosensitivity (Table 2).

Conclusion

Our findings support the future use of select, relevant genetic markers in predicting various SLE phenotypes.

References

[1]Leffers HCB, Troldborg A, Voss A, et al. Smoking associates with distinct clinical phenotypes in patients with systemic lupus erythematosus: a nationwide Danish cross-sectional study. Lupus Sci Med 2021;8(1).

Table 1.

Associations between five SLE risk loci and specific disease manifestations in 427 Danish patients with SLE*.

NCF2STAT4IRF5TNPO3ITGAMrs17849502_Trs7574865_Trs4728142_Ars13239597_Ars11860650_TN (%)Malar rash233 (55%)1.28 (0.84-1.96)0.83 (0.62-1.11)1.01 (0.74-1.38)1.44 (0.97-2.12)1.14 (0.80-1.61)Discoid rash46 (11%)1.49 (0.81-2.73)0.90 (0.56-1.45)1.01 (0.62-1.66)1.16 (0.63-2.12)0.76 (0.42-1.41)Photosensitivity219 (51%)0.96 (0.63-1.46)1.09 (0.81-1.47)0.98 (0.71-1.34)0.84 (0.57-1.25)0.67 (0.47-0.97)Oral ulcers132 (31%)0.96 (0.61-1.50)0.90 (0.65-1.23)0.83 (0.60-1.16)1.30 (0.87-1.96)1.43 (0.99-2.05)Non-erosive Arthritis342 (80%)0.84 (0.52-1.37)1.49 (1.02-2.18)0.93 (0.63-1.36)1.04 (0.64-1.68)1.16 (0.74-1.80)Serositis-Pleuritis124 (29%)0.63 (0.38-1.05)1.38 (1.01-1.89)1.22 (0.87-1.72)0.85 (0.56-1.29)0.84 (0.57-1.24)-Pericarditis72 (17%)0.75 (0.41-1.40)1.35 (0.93-1.96)1.05 (0.70-1.58)1.15 (0.70-1.89)1.09 (0.70-1.72)Persistent proteinuria158 (37%)1.63 (1.07-2.49)1.08 (0.80-1.46)0.68 (0.49-0.94)1.74 (1.16-2.61)1.09 (0.76-1.57)Neurologic disorder-Seizures23 (5%)1.58 (0.75-3.35)1.49 (0.80-2.76)2.10 (1.04-4.25)0.61 (0.26-1.44)0.93 (0.42-2.06)-Psychosis8 (2%)0.76 (0.097-5.87)2.77 (0.94-8.15)0.35 (0.10-1.23)0 (0)2.96 (0.85-10.3)Haematologic disorder-Haemolytic anaemia38 (9%)0.78 (0.34-1.76)1.37 (0.85-2.22)0.75 (0.44-1.29)1.11 (0.57-2.19)1.24 (0.70-2.20)-Leukopenia130 (30%)1.04 (0.67-1.61)1.19 (0.87-1.63)1.00 (0.72-1.39)0.90 (0.60-1.37)0.94 (0.64-1.37)-Lymphopenia228 (53%)0.95 (0.63-1.44)1.35 (1.01-1.81)0.95 (0.70-1.29)1.16 (0.79-1.70)1.09 (0.77-1.54)-Thrombocytopenia102 (24%)1.42 (0.91-2.22)0.84 (0.60-1.18)0.83 (0.58-1.18)1.35 (0.86-2.11)0.91 (0.60-1.37)Immunologic disorder-anti-DNA ab.330 (77%)0.69 (0.44-1.09)1.02 (0.72-1.44)0.94 (0.65-1.35)0.97 (0.62-1.53)1.08 (0.71-1.65)-anti-Smith ab.44 (10%)1.44 (0.79-2.64)1.58 (1.00-2.49)1.23 (0.73-2.07)1.47 (0.80-2.69)1.07 (0.61-1.84)-anti-phospholipid ab.183 (43%)1.63 (1.07-2.49)1.05 (0.79-1.41)0.84 (0.61-1.14)1.14 (0.77-1.68)1.14 (0.80-1.62)

* Logistic regression models for each manifestation included all five lead variants (multivariate) and were adjusted for age and sex

Disclosure of Interests

Henrik Leffers: None declared, David Westergaard: None declared, Saedis Saevarsdottir: None declared, Ingileif Jonsdottir: None declared, Ole Birger Pedersen: None declared, Anne Troldborg: None declared, Anne Voss: None declared, Salome Kristensen: None declared, Jesper Lindhardsen: None declared, Prabhat Kumar: None declared, Asta Linauskas: None declared, Lars Juul: None declared, Niels Steen Krogh: None declared, Bent Deleuran: None declared, Lene Dreyer Speakers bureau: Speakers bureau: Eli Lilly, Galderma and Janssen, Grant/research support from: from BMS outside the present work, Michael Schwinn: None declared, Lise wegner Thørner: None declared, Lotte Hindhede: None declared, Christian Erikstrup: None declared, Henrik Ullum: None declared, Søren Brunak Shareholder of: SB has ownerships in Intomics A/S, Hoba Therapeutics Aps, Novo Nordisk A/S, Lundbeck A/S, Kari Stefansson: None declared, Karina Banasik: None declared, Søren Jacobsen: None declared

AB1086 VACCINE HESITANCY AGAINST COVID-19 VACCINES IN PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES AND EFFECT OF SPECIALIST COUNSELLING ON VACCINE HESITANT PATIENTS WILLINGNESS TO TAKE VACCINE

Background

Vaccination is one of the most significant public health achievements; however, the success has been marred with vaccine hesitancy. The reasons for vaccine hesitancy are neither singular nor straightforward and arise from a complex interplay between scientific, religious and political beliefs. This study aims to understand the possible reasons for vaccine hesitancy in patients with autoimmune rheumatic diseases and the effectiveness of Specialist counselling on vaccine-hesitant patients willingness to take the vaccine.

Objectives

1. To assess causes of Vaccine hesitancy against COVID-19 vaccines in patients with autoimmune rheumatic diseases.

2. To study the effect of specialist counselling on vaccine-hesitant patients willingness to take vaccine.

Methods

Study design: We conducted an observational survey-based in person cross-sectional study. Patients attending a tertiary care hospital’s outpatient department were asked about their vaccination status. Those unvaccinated were asked reasons for vaccine hesitancy The vaccine-hesitant patients were counselled by the treating rheumatologist and asked regarding their willingness to take the vaccine after the counselling. The patient responses were recorded.

Sample: Convenience sampling was used, so the sample size was not calculated.

Inclusion and exclusion criteria: All adults(>18yrs) with AIRD coming to the rheumatology OPD. Those vaccinated, recently infected(within 6 weeks), and non-AIRD patients were excluded.

Data collection: The questionnaire included patients’ demographic details, Diagnosis, medication details, and response to the reason for vaccine hesitancy.

Statistical analysis: Descriptive statistics were performed by calculating measures of central tendency for quantitative variables and using counts and percentages for qualitative and nominal variables.

Results

A total of 322 patients participated in the study with a mean age of 40 years(18-76), with 73%(234) females and 27%(88) males. Most patients had Rheumatoid Arthritis(40%) followed by SPA (27%), SLE(13%) and others and may were on immunosuppressive medications(95%). A significant proportion of patients(60%) had more than one reason for vaccine hesitancy. Almost 60% of the respondents feared their disease might flare post-vaccination, while almost half(44.4%) were hesitant to take the vaccine due to the fear of vaccine side effects and more than one third (35%) feared vaccine may not be effective on them as they were on immunosuppressive medications. Other major causes of vaccine hesitancy were the inability to get a chance to get vaccinated (18%), doubts about vaccine efficacy (15%), and fear of injections (10%).Most patients(91%) were willing to take the vaccine after specialist counselling and only 28 of the 322 (9%) were unwilling even after specialist counselling.

Conclusion

Vaccine hesitancy can be multifactorial. Major reasons for vaccine hesitancy in patients with autoimmune rheumatic diseases were fear of flare of disease post-vaccination, fear of vaccine side effects and doubts whether the vaccine would work in patients taking immunosuppressive medications. Most patients were willing to take vaccine after counselling by a rheumatologist.

Disclosure of Interests

None declared

IL-27 modulates T cell cytokines in the T cell-osteoclast crosstalk during HIV infection

In People with HIV (PWH), chronic immune activation and systemic inflammation are associated with increased risk to develop comorbidities including bone loss. IL-27 has been shown to modulate osteoclastogenesis and T cell function, however, the roles of IL-27 and T cell activation in the setting of HIV infection are largely unknown. In the present study, we evaluated the effects of IL-27 in modulating T cell function during T cells:Osteoclasts (OCs) crosstalk in PWH and healthy controls. We developed an in vitro coculture system of T cells with OCs from PWH and healthy controls. T cells and autologous OCs were isolated from frozen PBMCs of PWH (n= 26) and healthy controls (n= 10). We found that the stimulation of T cells from PWH and healthy controls cultured in the presence of OCs significantly enhanced T cell secretion of pro- (IFN-γ, TNF-α, IL-17) and anti-inflammatory (IL-10) cytokines. IL-27 down-regulated secretion of IL-17 (p&lt; 0.001) and IL-10 (p= 0.003) from PWH but not in healthy controls and had a weak effect reducing RANKL surface expression in CD4 T cells (p= 0.047) when T cells were cultured with OCs. In addition, the level of IFN-γ secreted by stimulated T cells cultured alone was negatively associated with T score in absence (R= −0.59, p= 0.013) or in presence of IL-27 (R= −0.64, p= 0.007). All together these results suggest that in the context of HIV infection IL-27 may promote a dominant Th1 response (IFN-γ and TNF-α secretion) generating a “pro-osteoclastic” environment.

Supported by NIH R01AI145549-02

SARS-CoV-2 infection reduces the frequencies of angiogenic CD4 and CD8 T cells (Tang)

SARS-CoV-2 is one of the leading causes of mortality worldwide with rising death toll over 5.4 million. The severe presentation of the disease is associated with systemic inflammation, activation of the coagulation cascade and immunological dysfunction. Numerous studies implicate endothelial activation and dysfunction as playing an important role; however, the pathways involved are not well-understood. Endothelial injury and damage trigger a mechanism of vascular repair mediated by bone marrow derived endothelial progenitor cells and recently discovered a type of T cells with angiogenic properties. In this study, we hypothesize that SARS-COV-2 alters this pathway. To address this hypothesis, we determined changes in the frequency and phenotype of these two cell types, the circulating endothelial progenitor (EPC) (LIN4−CD45−CD34+) and Tang cells (CXCR4+CD31+) using PBMCs from hospitalized COVID-19 positive (n = 10) and healthy (n = 11) donors. Our results indicate a decrease in the frequency of CD4 and CD8 Tang cells compared with healthy controls (p=0.003; p=0.01). In addition, Tang cells showed a significant increase in the expression of progenitor marker (CD49f) (p&lt;0.001; p=0.016), and no changes were observed in the frequency and phenotype of the LIN4−CD45−CD34+. Moreover, a negative association was observed between Tang cells and plasma levels of the procoagulant PAI-1 biomarker (r=−0.806, p=0.007; r=−0.818, p=0.006), and CD8 Tang cells were inversely correlated with the levels of MMP9 and TNFa, (r=−0.879, p=0.002; r=−0.709, p=0.027). Altogether these data suggest that SARS-CoV-2 infection reduces the frequency of Tang cells and promote activation and may interfere with their vascular repair function.

Bamlanivimab and etesevimab improve symptoms and associated outcomes in ambulatory patients at increased risk for severe COVID-19: results from the placebo-controlled double-blind Phase 3 BLAZE-1 trial

Background

In the Phase 2/3 BLAZE-1 trial, bamlanivimab and etesevimab together reduced COVID-19–related hospitalizations and any-cause mortality in ambulatory patients. Herein, we assess the impact of bamlanivimab and etesevimab treatment on the severity and length of symptoms and health outcomes among patients at increased risk for severe COVID-19.

Methods

In the Phase 3 portion of BLAZE-1 (NCT04427501), symptomatic patients with increased risk for severe COVID-19 were randomized (2:1) to a single infusion of 700 mg bamlanivimab and 1400 mg etesevimab or placebo. Hospitalization events, vital signs, and symptomatology were monitored throughout the trial.

Results

Overall, 769 patients were randomized to bamlanivimab and etesevimab together (N=511) or placebo (N=258). The time to sustained symptom resolution was significantly shorter among patients who received bamlanivimab and etesevimab compared with placebo (8 vs 10 days; p&lt;0.01). The median time to first sustained symptom resolution of body aches and pain, chills, fatigue, feeling feverish, headache, and shortness of breath was significantly different in patients receiving bamlanivimab and etesevimab compared to placebo (p&lt;0.05). The proportion of patients who experienced COVID-19–related hospitalization by day 29 was significantly reduced among the bamlanivimab and etesevimab group compared with placebo (0.8% vs 5.4%; p&lt;0.01). The mean duration of hospital stay was numerically shorter among patients who received bamlanivimab and etesevimab (7.3 vs 13.5 days; p=0.16), with fewer intensive care admissions.

Conclusions

Patients receiving bamlanivimab and etesevimab together resolved their symptoms more rapidly than those receiving placebo. Bamlanivimab and etesevimab treatment was associated with reduced rates of hospitalizations and shorter hospital stays.

IL-27 Modulates the Cytokine Secretion in the T Cell-Osteoclast Crosstalk During HIV Infection

In People with HIV (PWH), chronic immune activation and systemic inflammation are associated with increased risk to develop comorbidities including bone loss. Numerous cells of the immune system, namely, T cells are involved in the regulation of the bone homeostasis and osteoclasts (OCs) activity. IL-27, a cytokine that belongs to the IL-12 family can regulate the secretion of pro- and anti-inflammatory cytokines by T cells, however its role in the setting of HIV is largely unknown. In the present study, we determined the impact of OCs in T cell secretion of cytokines and whether IL-27 can regulate this function. We found that the presence of OCs in the T cell cultures significantly enhanced secretion of IFNγ, TNFα, IL-17, RANKL, and IL-10 in both PWH and healthy controls. In PWH, IL-27 inhibited IL-17 secretion and downregulated surface expression of RANKL in CD4 T cells. All together these results suggest that in the context of HIV infection IL-27 may favor IFNγ and TNFα secretion at the sites of bone remodeling.

The impacts of HIV infection, age, and education on functional brain networks in adults with HIV

HIV-associated neurocognitive disorders (HAND) remain highly prevalent in people with HIV (PWH). Studies suggested that certain sociodemographic factors are associated with the risk of HAND in PWH. Here we investigated the impact of HIV infection and demographics on functional brain networks. One run of 8.5 min resting state functional MRI (fMRI) data was collected from 101 PWH (41-70 years old) and 40 demographically comparable controls. Functional connectivity (FC) was calculated using average wavelet coherence. The impact of demographic factors on FCs was investigated using canonical correlation analysis (CCA). Wavelet coherence analysis revealed a reduced within-network connectivity in the dorsal somatomotor network (dSMN), along with a reduced between-network connectivity between dSMN and medial temporal lobe (MTL) in PWH (compared to controls). Across all participants, CCA revealed that older age and HIV infection had negative impacts on network connectivity measures (mainly reduced within- and between-network FCs), whereas education had an opposite effect. In addition, being female at birth or a member of a minority ethnic/racial group was also associated with network disruptions. Our data suggested that advanced age and HIV infection are risk factors for functional brain network disruptions, whereas higher educational attainment was linked to better preserved functional network connectivity.

Long-term effects of evolocumab in participants with HIV and dyslipidemia: results from the open-label extension period

OBJECTIVES

People with HIV (PWH) are at an increased risk of atherosclerotic cardiovascular disease. Suboptimal responses to statin therapy in PWH may result from antiretroviral therapies (ARTs). This open-label extension study aimed to evaluate the long-term safety and efficacy of evolocumab up to 52 weeks in PWH.

DESIGN

This final analysis of a multinational, placebo-controlled, double-blind, randomized phase 3 trial evaluated the effect of monthly subcutaneous evolocumab 420 mg on low-density lipoprotein cholesterol (LDL-C) during the open-label period (OLP) following 24 weeks of double-blind period in PWH with hypercholesterolemia/mixed dyslipidemia. All participants enrolled had elevated LDL-C or nonhigh-density lipoprotein cholesterol (non-HDL-C) and were on stable maximally tolerated statin and stable ART.

METHODS

Efficacy was assessed by percentage change from baseline in LDL-C, triglycerides, and atherogenic lipoproteins. Treatment-emergent adverse events (TEAEs) were examined.

RESULTS

Of the 467 participants randomized in the double-blind period, 451 (96.6%) received at least one dose of evolocumab during the OLP (mean age of 56.4 years, 82.5% male, mean duration with HIV of 17.4 years). By the end of the 52-week OLP, the overall mean (SD) percentage change in LDL-C from baseline was -57.8% (22.8%). Evolocumab also reduced triglycerides, atherogenic lipid parameters (non-HDL-C, apolipoprotein B, total cholesterol, very-low-density lipoprotein cholesterol, and lipoprotein[a]), and increased HDL-C. TEAEs were similar between placebo and evolocumab during the OLP.

CONCLUSION

Long-term administration of evolocumab lowered LDL-C and non-HDL-C, allowing more PWH to achieve recommended lipid goals with no serious adverse events.

TRAIL REGISTRATION

NCT02833844.

VIDEO ABSTRACT

http://links.lww.com/QAD/C441.

Airway Complications After Lung Transplant for Post Coronaviral Disease (COVID-19) Acute Respiratory Distress Syndrome (ARDS) Related End Stage Lung Disease: Single Centre Experience

Purpose

Severe COVID-19 ARDS related end stage lung fibrosis with irreversible changes is a newer indication for lung transplantation with acceptable survival rate. Airway complication post lung transplant is a major source of morbidity and mortality with incidence as high as 25 to 49 percent. Patients with end stage COVID-19 fibrosis are likely to be clinically deconditioned with long duration of extracorporeal oxygenator (ECMO) support, high burden of sepsis and prolonged respiratory support which may affect the airways post lung transplantation.

Methods

This is a retrospective observational study after obtaining institutional ethical clearance. We reviewed electronic medical data of patients who underwent lung transplantation for post COVID-19 ARDS related fibrosis. We evaluated the incidence and type of airway complications and the various therapeutic interventions applied for its management.

Results

Between May 2020 and September 2021 our centre performed 23 bilateral lung transplants for end stage COVID-19 ARDS related fibrosis. 22 patients were on ECMO support with mean duration of 50.9 days before transplantation. All patients underwent lung transplantation with central Veno-Arterial ECMO support with mean organ ischaemia time of 360±154 minutes. The incidence of airway complication in our study group was 56%. We observed anastomotic narrowing in 3(13%), distal airway narrowing in 4(17%) and sloughing/coating of anastomotic site in 5(22%) patients. Nonspecific inflammatory polypi around the bronchial anastomotic site were noticed in 4(17%) and mild airway anastomotic dehiscence in 2 subjects. 8(34%) patients required serial bronchoscopy and balloon dilatation; 2 among them mandated additional cautery usage. 2 cases underwent polypectomy, further 4 subjects needed bronchial stent placement. 5 (21%) recipients were discharged with Tracheostomy while rest were successfully decannulated in the ward.

Conclusion

We observed a high incidence of airway complications in post lung transplant for COVID-19 ARDS related fibrosis. Early detection, timely management and serial follow up is of paramount importance in this subset of patients.

Causal discovery of drivers of surface ozone variability in Antarctica using a deep learning algorithm

The discovery of causal structures behind a phenomenon under investigation has been at the heart of scientific inquiry since the beginning. Randomized control trials, the gold standard for causal analysis, may not always be feasible, such as in the domain of climate sciences. In the absence of interventional data, we are forced to depend only on observational data. This study demonstrates the application of one such causal discovery algorithm using a neural network for identifying the drivers of surface ozone variability in Antarctica. The analyses reveal the overarching influence of the stratosphere on the surface ozone variability in Antarctica, buttressed by the southern annular mode and tropospheric wave forcing in mid-latitudes. We find no significant and robust evidence for the influence of tropical teleconnection on the ground-level ozone in Antarctica. As the field of atmospheric science is now replete with a massive stock of observational data, both satellite and ground-based, this tool for automated causal structure discovery might prove to be invaluable for scientific investigation and flawless decision making.

Activation of Complement Components on Circulating Blood Monocytes From COVID-19 Patients

The coronavirus disease-2019 (COVID-19) caused by the SARS-CoV-2 virus may vary from asymptomatic to severe infection with multi-organ failure and death. Increased levels of circulating complement biomarkers have been implicated in COVID-19-related hyperinflammation and coagulopathy. We characterized systemic complement activation at a cellular level in 49-patients with COVID-19. We found increases of the classical complement sentinel C1q and the downstream C3 component on circulating blood monocytes from COVID-19 patients when compared to healthy controls (HCs). Interestingly, the cell surface-bound complement inhibitor CD55 was also upregulated in COVID-19 patient monocytes in comparison with HC cells. Monocyte membrane-bound C1q, C3 and CD55 levels were associated with plasma inflammatory markers such as CRP and serum amyloid A during acute infection. Membrane-bounds C1q and C3 remained elevated even after a short recovery period. These results highlight systemic monocyte-associated complement activation over a broad range of COVID-19 disease severities, with a compensatory upregulation of CD55. Further evaluation of complement and its interaction with myeloid cells at the membrane level could improve understanding of its role in COVID-19 pathogenesis.

Effectiveness of Decision Aid in Men with Localized Prostate Cancer: a Multicenter Randomized Controlled Trial at Tertiary Referral Hospitals in an Asia Pacific Country

There are several treatment options for localized prostate cancer with very similar outcome but vary in terms of technique and side effect profiles and risks. Considering the potential difficulty in choosing the best treatment, a patient decision aid (PDA) is used to help patients in their decision-making process. However, the use and applicability of PDA in a country in Asia Pacific region like Malaysia is still unknown. This study aims to evaluate the effectiveness of a PDA modified to the local context in improving patients' knowledge, decisional conflict, and preparation for decision making among men with localized prostate cancer. Sixty patients with localized prostate cancer were randomly assigned to control and intervention groups. A self-administered questionnaire, which evaluate the knowledge on prostate cancer (23 items), decisional conflict (10 items) and preparation for decision-making (10 items), was given to all participants at pre- and post-intervention. Data were analyzed using independent T test and paired T test. The intervention group showed significant improvement in knowledge (p = 0.02) and decisional conflict (p = 0.01) from baseline. However, when compared between the control and intervention groups, there were no significant differences at baseline and post-intervention on knowledge, decisional conflict and preparation for decision-making. A PDA on treatment options of localized prostate cancer modified to the local context in an Asia Pacific country improved patients' knowledge and decisional conflict but did not have significant impact on the preparation for decision-making. The study was also registered under the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12614000668606 registered on 25/06/2014.

IL-27 induces IFN/STAT1-dependent genes and enhances function of TIGIT+ HIVGag-specific T cells

HIV-specific T cells have diminished effector function and fail to control/eliminate the virus. IL-27, a member of the IL-6/IL-12 cytokine superfamily has been shown to inhibit HIV replication. However, whether or not IL-27 can enhance HIV-specific T cell function is largely unknown. In the present manuscript, we investigated the role of IL-27 signaling in human T cells by evaluating the global transcriptional changes related to the function of HIV-specific T cells. We found that T cells from people living with HIV (PLWH), expressed higher levels of STAT1 leading to enhanced STAT1 activation upon IL-27 stimulation. Observed IL-27 induced transcriptional changes were associated with IFN/STAT1-dependent pathways in CD4 and CD8 T cells. Importantly, IL-27 dependent modulation of T-bet expression promoted IFNγ secretion by TIGIT+HIVGag-specific T cells. This new immunomodulatory effect of IL-27 on HIV-specific T cell function suggests its potential therapeutic use in cure strategies.

Persistent Oxidative Stress and Inflammasome Activation in CD14highCD16- Monocytes From COVID-19 Patients

The poor outcome of the coronavirus disease-2019 (COVID-19), caused by SARS-CoV-2, is associated with systemic hyperinflammatory response and immunopathology. Although inflammasome and oxidative stress have independently been implicated in COVID-19, it is poorly understood whether these two pathways cooperatively contribute to disease severity. Herein, we found an enrichment of CD14highCD16- monocytes displaying inflammasome activation evidenced by caspase-1/ASC-speck formation in severe COVID-19 patients when compared to mild ones and healthy controls, respectively. Those cells also showed aberrant levels of mitochondrial superoxide and lipid peroxidation, both hallmarks of the oxidative stress response, which strongly correlated with caspase-1 activity. In addition, we found that NLRP3 inflammasome-derived IL-1β secretion by SARS-CoV-2-exposed monocytes in vitro was partially dependent on lipid peroxidation. Importantly, altered inflammasome and stress responses persisted after short-term patient recovery. Collectively, our findings suggest oxidative stress/NLRP3 signaling pathway as a potential target for host-directed therapy to mitigate early COVID-19 hyperinflammation and also its long-term outcomes.