Genetic determinants of micronucleus formation in vivo

Genomic instability arising from defective responses to DNA damage1 or mitotic chromosomal imbalances2 can lead to the sequestration of DNA in aberrant extranuclear structures called micronuclei (MN). Although MN are a hallmark of ageing and diseases associated with genomic instability, the catalogue of genetic players that regulate the generation of MN remains to be determined. Here we analyse 997 mouse mutant lines, revealing 145 genes whose loss significantly increases (n = 71) or decreases (n = 74) MN formation, including many genes whose orthologues are linked to human disease. We found that mice null for Dscc1, which showed the most significant increase in MN, also displayed a range of phenotypes characteristic of patients with cohesinopathy disorders. After validating the DSCC1-associated MN instability phenotype in human cells, we used genome-wide CRISPR-Cas9 screening to define synthetic lethal and synthetic rescue interactors. We found that the loss of SIRT1 can rescue phenotypes associated with DSCC1 loss in a manner paralleling restoration of protein acetylation of SMC3. Our study reveals factors involved in maintaining genomic stability and shows how this information can be used to identify mechanisms that are relevant to human disease biology1.

The PERInatal MYocardial Remodeling (PERIMYR) cohort study protocol: A prospective study of cardiac remodeling and "recovery" in pregnancy as a model to understand the impact of comorbidities in cardiac remodeling and reverse remodeling

INTRODUCTION

Heart failure (HF) is among the leading causes of morbidity and mortality worldwide. Several conditions trigger left ventricular chronic pressure or volume overload, hypertrophy, systolic and diastolic dysfunction, leading to cardiac remodeling and a rapid progression toward HF. Therapeutic interventions elicit reverse remodeling (RR), a highly variable myocardial response that ranges from none to total ventricular structural/functional recovery. However, HF patients present several comorbidities and medications that mask a comprehensive molecular knowledge of RR and hinder the identification of potential biomarkers of its progression or prognosis. Therefore, instead of using this heterogeneous population or even animal models to understand myocardial remodeling, we propose studying pregnancy-induced cardiovascular remodeling and postpartum-induced RR.

OBJECTIVES

To assess cardiovascular functional and structural adaptations during pregnancy and in postpartum, characterizing the associated molecular changes; as well as to explore the impact of hypertension, obesity and diabetes on these processes.

METHODS

We will perform echocardiography and assess endothelial function and arterial stiffness (EndoPAT® and pulse wave velocity, respectively) and assess potential markers of remodeling and RR using plasma and urine samples from pregnant women. To translate to a HF context, we will determine the impact of risk factors (hypertension, obesity and diabetes) by studying subgroups of pregnant women with these comorbidities.

RESULTS

Not applicable Conclusion: We are convinced that understanding the impact of these comorbidities in such a homogeneous population, such as pregnant women, provides a valuable model to unveil the most relevant pathologic and often masked signaling pathways underlying cardiac remodeling and incomplete RR in a heterogeneous population, such as HF patients. Moreover, we expect to identify potential novel biomarkers of RR progression/prognosis more easily.

The Use of Radiomic Analysis in Cardiovascular Diseases

A The recent years of the cardiovascular medicine saw a rapid development of advanced imaging modalities. The new era of personalized medicine takes advantage of what can be interpreted from medical images, searching for underlying connections between image phenotyping and biological characteristics to support precise clinical decisions. The application of radiomics in cardiovascular imaging has lagged behind other fields, such as oncology. While the current interpretation of cardiac and vascular images mainly depends on subjective and qualitative analysis, radiomics uses advanced image analysis to extract numerous quantitative features from digital images that are unrecognizable to the naked eye. The goal of this narrative review is to highlight the main findings of the recent use of radiomic analysis in the cardiovascular field. English-language articles published in the database PubMed were used for this review. The keywords used in the search included radiomics, cardiovascular or cardiac or aortic. Radiomics is expected to contribute to a more precise phenotyping of the cardiovascular disease, which can improve diagnostic, prognostic, and therapeutic decision making in the near future.

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.

Tracking Prostate Carcinogenesis over Time through Urine Proteome Profiling in an Animal Model: An Exploratory Approach

Prostate cancer (PCa) is one of the most lethal diseases in men, which justifies the search for new diagnostic tools. The aim of the present study was to gain new insights into the progression of prostate carcinogenesis by analyzing the urine proteome. To this end, urine from healthy animals and animals with prostate adenocarcinoma was analyzed at two time points: 27 and 54 weeks. After 54 weeks, the incidence of pre-neoplastic and neoplastic lesions in the PCa animals was 100%. GeLC-MS/MS and subsequent bioinformatics analyses revealed several proteins involved in prostate carcinogenesis. Increased levels of retinol-binding protein 4 and decreased levels of cadherin-2 appear to be characteristic of early stages of the disease, whereas increased levels of enolase-1 and T-kininogen 2 and decreased levels of isocitrate dehydrogenase 2 describe more advanced stages. With increasing age, urinary levels of clusterin and corticosteroid-binding globulin increased and neprilysin levels decreased, all of which appear to play a role in prostate hyperplasia or carcinogenesis. The present exploratory analysis can be considered as a starting point for studies targeting specific human urine proteins for early detection of age-related maladaptive changes in the prostate that may lead to cancer.

P-104 production and glucose-dependent secretion of insulin by human spermatozoa

Study question

Do human spermatozoa express insulin and the enzymes responsible for the cleavage of proinsulin? Is the secretion of insulin by spermatozoa responsive to glucose stimuli?

Summary answer

Human spermatozoa express insulin and PC1/3 and PC2, enzymes responsible for the cleavage of proinsulin. Spermatozoa produce and release insulin in a glucose concentration-dependent manner.

What is known already

Spermatogenesis is dependent on a finely regulated hormonal and metabolic control. Insulin is considered one of the most important regulators in the metabolic regulation of spermatogenesis, acting directly on the differentiation of spermatogonia into primary spermatocytes or indirectly through the metabolic modulation of both Sertoli and Leydig cells. In addition, insulin is hypothesized to play a major role in human spermatozoa capacitation, although the mechanisms that regulate its production and secretion remain to be disclosed.

Study design, size, duration

The main objective of this study was to estimate the capacity of insulin production by human spermatozoa and if they express PC1/3 and PC2, which are enzymes responsible for the cleavage of proinsulin. In addition, we hypothesized that insulin production could respond to glucose stimuli. Seminal samples of normozoospermic men (n = 15) seeking fertility treatment were collected for these experiments.

Participants/materials, setting, methods

Spermatozoa were submitted to a density gradient centrifugation and two fractions were collected according to their motility (high vs low motility). The expression of insulin, PC1/3 and PC2 mRNA was evaluated by RT-qPCR. The protein expression of insulin, PC1/3 and PC2 was evaluated by immunofluorescence. High motility spermatozoa were incubated in BWW medium with increasing glucose concentrations (0, 5.5, 11, and 22 mM). After 6 h, the concentration of secreted insulin was quantified by ELISA.

Main results and the role of chance

We were able to identify the expression of insulin, PC1/3, and PC2 mRNA, as well as the respective proteins, in human spermatozoa. Through immunofluorescence, we observed that insulin and both enzymes are mainly expressed in the midpiece. Human spermatozoa also express insulin receptor, mainly in the midpiece and tail. The mRNA expression of insulin and PC1/3 was found to be higher in the highly motile spermatozoa. Human spermatozoa produce very small quantities of insulin (pg/mL range), which suggests an autocrine or paracrine action. The release of insulin to the medium was found to occur in a glucose concentration-dependent manner.

Limitations, reasons for caution

This is an in vitro study with relatively small sample size. Future studies are required to further evaluate the role of insulin and its signalling pathway on human spermatozoa capacitation and fertilization capacity.

Wider implications of the findings

This study shows that human spermatozoa express PC1/3 and PC2, enzymes responsible for the cleavage of proinsulin. In addition, human spermatozoa release insulin in a glucose concentration-dependent manner. The study of insulin signalling opens the path for a deeper understanding of human spermatozoa bioenergetics and the development of novel therapies.

Trial registration number

Not applicable

P-064 Clinical outcomes of 127 patients with recurrent implantation failure treated with testicular sperm aspiration (TESA)

Study question

Are the embryological, clinical and newborn outcomes using aspirated testicular sperm improved in cases with recurrent implantation failure previously treated with ejaculated sperm?

Summary answer

Aspirated testicular sperm enabled to obtain significant higher embryological, clinical and newborn outcomes in cases with recurrent implantation failure previously treated with ejaculated sperm.

What is known already

High levels of sperm DNA fragmentation (SDF) were associated to poor clinical outcomes (1-Simon et al., 2017). Testicular sperm display lower SDF than ejaculated sperm (2-Sakas and Alvarez, 2010), improving clinical outcomes in cases with abnormal semen parameters (3-Awaga et al., 2018; 4-Kang et al., 2018), recurrent implantation failure (RIF) and pregnancy loss (RPL) (5-Esteves et al., 2017), and elevated SDF (6-Ambar et al., 2021). As only a few studies are specifically dedicated to RIF, we expanded the number of cases and first provided full demographic, stimulation, embryological, clinical and newborn outcomes.

References

1-(https://doi.org/10.4103/1008-682X.182822);

2-(https://doi.org/10.1016/j.fertnstert.2009.10.046);

3-(https://doi.org/10.1016/j.rbmo.2018.08.017);

4-(https://doi.org/10.1038/s41598-018-26280-0);

5-(https://doi.org/10.1016/j.fertnstert.2017.06.018);

6-(https://doi.org/10.5534/wjmh.200084

Study design, size, duration

We retrospectively evaluated during consecutive years (2010-2020) 63 patients with recurrent implantation failure, which accepted to perform testicular sperm aspiration (TESA) as an alternative treatment. These patients presented a long history of failed treatments (153 cycles) using ejaculated sperm. From these cycles, no pregnancy ensued. The present study compares 127 treatment cycles, 80 with testicular sperm (17 cases repeated TESA) and 47 with ejaculated sperm from the same patients performed at the present IVF clinic.

Participants/materials, setting, methods

Patients were screened for karyotype abnormalities, for Y-chromosome microdeletions (7-Gonçalves et al., 2016), and for SDF with the TUNEL assay (8-Sá et al., 2015). Conventional semen analysis was performed according to World Health Organization guidelines (9-WHO, 2010). Male evaluation and TESA was performed by the same experienced urologist (LF) according to established protocols (10-Madureira et al 2014). The procedure was performed entirely on an outpatient basis, with no complications reported.

References

7-(https://doi.org/10.4103/1008-682X.172827);

8-(https://doi.org/10.1016/j.rbmo.2015.06.019);

9-(https://apps.who.int/iris/handle/10665/44261);

10-(https://doi.org/10.1111/j.2047-2927.2014.00231.x).

Main results and the role of chance

The mean ages were 35.5±3.4 (26-42)-female and 38.1±5.7 (29-59)-male. There were 4 abnormal karyotypes (3-female, 1-male), all without known relevance. Most cases had asthenozoospermia and teratozoospermia (65.1%), or oligoasthenoteratozoospermia (41.8%). Of the 19 cases with <5M/ml, none presented Y-chromosome microdeletions. Although we do not routinely perform SDF testing, 15 patients had previous SDF values (12, >20%; 8, >36%). Female basal characteristics and testicular evaluation were under normal values. The TESA procedure took about 15-20 min, and the time of laboratorial search around 30-60 min. Cases using testicular sperm showed significant higher rates of fertilization (64% vs 73%-p=0.005), blastocyst development (47% vs 62%-p=0.010), implantation (6% vs 27%-p=0.000), clinical pregnancy (10% vs 39%-p=0.001), live birth delivery (5% vs 28%-p=0.005) and newborn (5% vs 32%-p=0.000) than ejaculated sperm. No significant differences were observed regarding the rates of embryo cleavage (95% vs 94.8%) and high quality embryos (89.4% vs 94%), in the mean number of transferred embryos (1.8±0.4 vs 1.9±0.4), or in the abortion rate (2 cases-50% vs 7 cases-25.9%). Cases using testicular sperm had 22 frozen-thawed embryo transfer cycles, enabling per initiated cycle a cumulative pregnancy rate of 45%, live birth delivery rate of 31.3% and newborn rate of 37.5% (32 newborn).

Limitations, reasons for caution

Although presenting the higher number of cycles using TESA in the treatment of RIF, this number needs to be increased for drawing more definitive conclusions, as these women present a diversity of conditions, rendering subgrouping difficult. In the future, it would also be important to evaluate SDF in all cases.

Wider implications of the findings

In conclusion, the present results gave further evidence for the superiority of using testicular sperm instead of ejaculated sperm in cases with recurrent implantation failure. Data also evidences the security of using testicular sperm aspiration, as there were no pregnancy or delivery complications, or congenital anomalies among the 32 newborn.

Trial registration number

Not Applicable

P-536 Common variation in the PIN1 locus increases the genetic risk to suffer from Sertoli Cell Only syndrome

Study question

Are the common genetic variants located in the PIN1 region associated with human male infertility due to severe spermatogenic failure (SPGF)?

Summary answer

PIN1 gene polymorphisms may play a relevant role in the development of Sertoli Cell Only syndrome (SCO), the most extreme form of SPGF.

What is known already

PIN1 is a relevant prolyl isomerase in humans, that catalyzes cis/trans isomerization of peptide bonds. It has a central role in cell cycle progression and cancer, and it has been linked to the immune system promoting inflammation and reactive-oxygen species. Pin1 gene is highly expressed in adult mice testes, particularly in spermatogonia and Sertoli cells, and it is required to control the proliferation of spermatogonial stem cells. Additionally, it controls the integrity of the blood-testis barrier, helping to maintain the immune privilege of the testis. Nevertheless, mutations in PIN1 have not yet been described in human male infertility cases.

Study design, size, duration

A genetic association study was performed including samples from 715 men diagnosed with SPGF and classified as suffering from non-obstructive azoospermia (NOA, n = 505) or severe oligospermia (SO, n = 210), and 1,058 matched unaffected male controls from the Iberian Peninsula (Spain and Portugal). Allelic association on SPGF susceptibility were evaluated by testing three PIN1 single nucleotide polymorphisms (SNPs; rs2287839, rs2233678, and rs62105751), which tagged most of the common genetic variation present in this locus.

Participants/materials, setting, methods

Participants signed an informed written consent approved by the ethical committees of each participating center. SO and NOA were clinically defined according to the guidelines of the World Health Organization. Genomic DNA from blood samples was genotyped using TaqMan assays and statistical analyses were carried out by the means of logistic regression models. An in silico functional prioritization of the associated variants and their linked polymorphisms was also performed.

Main results and the role of chance

A subtype-specific genetic association with the subset of NOA patients classified as suffering from SCO was identified for the three analyzed genetic variants under the additive model (rs2287839: P = 1.94E-02, rs2233678: P = 1.94E-02, rs62105751: P = 1.94E-02). The minor alleles showed strong risk effects for this subset (rs2287839: OR = 1.85 [1.17-2.93], rs2233678: OR = 1.62 [1.11-2.36], rs62105751: OR = 1.43 [1.06-1.93]). Dependence analysis showed that all associated variants tagged the same signal. The variants underlying the identified association signal were prioritized based on their functional impact on the PIN1 locus, being rs3810166 the most likely candidate for functionality. The minor allele of such variant (G) is in linkage disequilibrium with the observed rs2287839-G risk allele and it is predicted to affect both gene expression and isoform balance of PIN1. The rs3810166 SNP likely influences the binding affinity of both HDAC2 and NRSF transcription factors, which are involved in cell cycle progression and transcription, respectively. Moreover, the tagged variants rs28802413 and rs10425775 were also predicted to alter the binding of significant transcription factors of the spermatogenic process, such as SIN3A and NANOG.

Limitations, reasons for caution

Although the overall statistical power of the study cohort was appropriate to detect the expected effects, the sample sizes in the subtype analyses were considerably lower, which may influence the obtained results. Further analyses including a larger SCO cohort should be performed to confirm our findings.

Wider implications of the findings

The obtained results shed light into the genetic contribution of common variation to male infertility, which may contribute to design a future panel of genetic markers to predict the testicular sperm extraction outcome, avoiding surgical interventions in NOA cases in which the probability of spermatozoa finding is much reduced.

Trial registration number

Not applicable

Pharmacological Targeting of Senescence with ABT-263 in Experimental Heart Failure with Preserved Ejection Fraction

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fundação Ciência e Tecnlogia

HFpEF is the most common form of heart disease in the elderly and is associated with high morbidity and mortality. Our understanding of HFpEF pathophysiology is limited and development of efficient therapies that alter the clinical course of the disease has proved greatly challenging. Although aging is a risk factor of HFpEF1, the involvement of aging hallmarks such as cell senescent and immunosenescence is unclear. Recently, a link between endothelial senescence and HFpEF development was demonstrated in mice with accelerated aging [1], endorsing anti-aging pharmacologic as potential new therapeutic alternatives for HFpEF. In fact, the senolytic (drugs that selectively promote apoptosis of senescent cells) ABT-263 has already proven efficacy in the context of cardiovascular diseases. Further studies are needed to clarify the relevance of aging and of anti-aging therapies in the context of HFpEF.

Using ZSF1 obese rats (ZSF1-Ob) as model of HFpEF we showed from 18 weeks signs of immunosenescence compared to ZSF1-Ln, namely an increased frequency of circulating myeloid cells and decreased frequency of T and B cells. Concomitantly, expression of pro-inflammatory factors (IL-6, IL-1, TGF-β, TNF-α) was upregulated in peripheral blood mononuclear cells (PBMCs) of ZSF1-Ob which also displayed characteristic features of cell senescence (p21 expression, lysosomal endogenous Beta-galactosidase (SA-B-Gal) senescence-associated secretory phenotype (SASP) and up-regulation of BCL-XL. Importantly, no signs of cellular senescence (SA-B-gal, pH2AX and senescence associated pathways) were found in the main hematopoietic organs (spleen and bone marrow). Alongside, these systemic alterations, an upsurge of cellular senescence was observed in myocardium of ZSF1-Ob rats, particularly in endothelial and hematopoietic cells. Serum of ZSF1-Ob rat was able to induce activation and cellular senescence of cardiac microvascular endothelial cells, indicating that systemic circulating factors may be the upstream mechanism of cellular senescence and dysfunction in HFpEF. Analysis of HFpEF patients and a control cohort adjusted to main co-morbidities further demonstrated accumulation of senescent monocytes in HFpEF patients. In these patients, the senescence marker SA-B-Gal correlated with plasmatic brain natriuretic peptide (BNP) levels and pulmonary artery systolic pressure. Targeting aging hallmarks through the treatment of ZSF1-Ob rat with ABT-263 resulted in a reduction in circulating senescent cells, decreased systemic and local inflammation, re-established immune proportions, restore the levels of circulating BNP and attenuated myocardial remodeling, particularly endothelial dysfunction and fibrosis.

Collectively these findings support that premature cellular senescence contributes to the establishment of a deleterious pro-inflammatory environment in HFpEF and that senolytic agents hold promise for the treatment of this syndrome.

Role of epicardial adipose tissue volume as predictor of atrial fibrillation recurrence

Funding Acknowledgements

Type of funding sources: None.

Background

Several studies have demonstrated the relation between general obesity and atrial fibrillation (AF). Epicardial adipose tissue (EAT), due to its local paracrine effect and the intimate relation with the atrium, could influence AF recurrence rates, but very few studies have explored this association.

Purpose

In this study we aimed to evaluate if EAT could be a predictor of AF recurrence after an AF ablation procedure.

Methods

We included all consecutive patients submitted to AF ablation (2017-2019) who performed a computed tomography scan prior to the procedure. EAT volume was semi-automatically reconstructed by manually tracing the pericardium. Adipose tissue was defined in the range between -150 and -50 Hounsfield units. Recurrence was defined as any documented (ECG/Holter) episode of AF, atrial flutter or atrial tachycardia after 3 months of the procedure. Logistic regression with a restricted cubic polynomial transformation was used to model the non-linear relationship between recurrence and EAT volumes. Inspection of the partial effect curves suggested that a cutoff for EAT volume ≥80mL could stratify patients at risk of recurrence and a Time-to-event analysis was carried.

Results

A total of 354 patients (66% male, median age 57 years [IQR 48–65] and 21% persistent AF) were included. During a median follow-up of 34 months [IQR 24-43], 117 patients (33%) had AF recurrence. These patients had a significantly greater EAT volume (76 mL [IQR 55-111] vs 72 mL [IQR 48-95], p=0.03) when compared to those without recurrence. Also, patients with higher EAT volume (≥ 80mL) had a higher risk of recurrence compared to patients with lower volume (Figure 1, log-rank test p=0.007). After adjusting for clinical risk factors (age, gender, hypertension, diabetes mellitus, obesity, thyroid disease, AF type and left atrial enlargement), higher EAT volume did not remain an independent predictor of AF recurrence (Figure 2, HR 1.25 [95% CI, 0.83-1.86] p=0.3).

Conclusion

In this cohort of patients with AF submitted to catheter ablation, EAT volume ≥80mL was associated with increased risk of AF recurrence. However, it was not an independent predictor of AF recurrence after adjustment to clinical risk factors.

Higher coronary calcium score is associated with increased risk of atrial fibrillation recurrence

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients with atrial fibrillation (AF) referred for catheter ablation routinely undergo cardiac computed tomography (CCT) for procedure planning. An opportunistic evaluation of coronary artery calcium score (CACS) can be an important tool to improve clinical care. It is already known that CACS is associated with a high risk of AF development, particularly if values are above 100, but few data are available regarding the impact of CACS in AF recurrence after ablation.

Purpose

To assess the impact of CACS on atrial fibrillation recurrence following catheter ablation.

Methods

Retrospective, single-centre cohort study of consecutive patients with AF undergoing CCT for ablation procedure planning, from 2017 to 2019. Baseline clinical and demographical data were collected. Patients with known history of coronary artery disease (CAD) and moderate to severe valvular heart disease were excluded. CACS was assessed using the Agatston method. Recurrence was defined as any documented episode of AF, atrial flutter or atrial tachycardia after 3 months from procedure. Patients were stratified in CACS<100 and CACS≥100. Explorative analysis incorporated Kaplan-Meier survival curves and Cox regression.

Results

A total of 354 patients were included, with a mean age of 56 ± 12 years, 66% male and 21% with persistent AF. More than half of the patients had a CACS>0 (n=185, 52%) and 63 patients (18%) had a CACS≥100. Patients with CACS≥100 were older (63 ± 7 vs 54 ± 12 years, p<0.001), had higher prevalence of hypertension (68% vs 43%, p<0.001) and diabetes mellitus (21% vs 10%, p=0.012) and higher left atrial volume (39 ± 9 vs 35 ± 9 ml/m2, p=0.018). After a median observation time of 34 months (IQR 24-43), 117 patients (33%) had AF recurrence.

CACS≥100 was associated with increased risk of AF recurrence (unadjusted Cox regression: hazard ratio [HR] 1.85; 95% confidence interval [CI], 1.23-2.79, p=0.003) (Fig. 1). After covariate adjustment (age, gender, hypertension, diabetes mellitus, obesity, thyroid disease, AF type and left atria enlargement) CACS≥100 remained an independent predictor of the risk of AF recurrence (HR, 1.68; 95% CI, 1.05-2.70, p=0.03) as well as persistent AF (HR, 1.91; 95% CI, 1.23-3.00, p=0.004) (Fig. 2).

Conclusion

In patients with AF undergoing catheter ablation, without previous history of CAD, a CACS≥100 was independently associated with a 68% increase in the risk of AF recurrence.

Association of epicardial adipose tissue and coronary artery calcium score in patients with atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

Introduction

Both coronary artery calcium (CAC) and epicardial adipose tissue (EAT) had been implicated in coronary artery disease (CAD) and risk of future adverse cardiovascular events. There are scarce data regarding the assessment and association of EAT volume and CAC score (CACS) in atrial fibrillation (AF) patients.

Purpose

To assess the association between EAT volume and the presence and severity of CAC in patients with AF.

Methods

Retrospective and single-centre study including consecutive patients with AF undergoing contrast-enhanced cardiac computed tomography for catheter ablation planning, from 2017 to 2019. Patients with known history of CAD and moderate to severe valvular heart disease were excluded. Baseline clinical and demographical data were collected, as well as their cardiovascular risk, based on the SCORE (Systematic Coronary Risk Evaluation) system and cardiovascular risk categories. We assessed CACS (Agatston method) and EAT volume and analysed their association. EAT was defined as the adipose tissue accumulated between the visceral pericardium and the myocardium and was semi-automatically reconstructed by manually tracing the pericardium. Patients were split into three groups according to CACS: 0, 1-99 and ≥100. A logistic regression (LR) analysis was performed to explore the relationship between EAT volume and the presence of CAC (CACS>0), adjusted for age, gender, obesity, diabetes mellitus and hypertension.

Results

A total of 354 patients were included, with a mean age of 56 ± 12 years, 66% male and 21% with persistent AF. A CHA2DS2-VASc score ≥2 was present in 130 (37%) patients and most patients had low to moderate cardiovascular risk (n=213, 82%). More than half of the patients had a CACS>0 (n=185, 52%), of which 63 patients (18%) had a CACS≥100. The mean EAT volume was 79 ± 39 ml. There was a significant association between EAT volume and the presence of CAC: CACS=0 69 ± 34 ml vs CACS 1-99 84 ± 38 ml vs CACS ≥100 95 ± 45 ml (p<0.001) (Fig. 1). After covariate adjustment (LR model R2 = 0.373, p <0.0001), the presence of CAC was not associated with EAT volume (OR 1.00, 95%CI 1.00 - 1.01, p=0.2) or obesity, and only with higher age, male gender, hypertension and diabetes mellitus (Fig. 2).

Conclusion

In our cohort of patients with AF undergoing catheter ablation we observed an association between EAT and CACS. Nevertheless, EAT volume was not an independent predictor of CACS and only the classical cardiovascular risk factors remained significant.

Histological and haemodynamic characterization of right ventricle in sedentary and trained rats with heart failure with preserved ejection fraction

NEW FINDINGS

What is the central question of this study? Right ventricle (RV) dysfunction is highly prevalent in heart failure with preserved ejection fraction (HFpEF), nearly doubling the risk of death: what are the RV functional and structural changes in HFpEF and how does aerobic exercise impact them? What is the main finding and its importance? The HFpEF ZSF1 rat model presents RV structural and functional changes mimicking the human condition. Aerobic exercise prevented the decline in V ̇ O 2 max , lowered surrogate markers of RV overload (e.g., higher mean and maximum systolic pressure) and improved diastolic dysfunction (e.g., end-diastolic pressure and relaxation time constant). This emphasizes the importance of using exercise to manage HFpEF.

ABSTRACT

Right ventricle (RV) dysfunction is highly prevalent in heart failure with preserved ejection fraction (HFpEF) and is a marker of poor prognosis. We assessed the obese ZSF1 rat model of HFpEF to ascertain if these animals also develop RV dysfunction and evaluated whether aerobic exercise could prevent this. Obese ZSF1 rats were randomly allocated to an aerobic exercise training group (n = 7; treadmill running, 5 days/week, 60 min/day, 15 m/min for 5 weeks) or to a sedentary group (n = 7). We used lean ZSF1 rats (n = 7) as the control group. After 5 weeks, rats were submitted to an exercise tolerance test and invasive haemodynamic evaluation, killed and samples from the RV collected for histological analysis. Obese sedentary ZSF1 rats showed lower V ̇ O 2 max , RV pressure overload (e.g., higher mean and maximum systolic pressure) and diastolic dysfunction (e.g., higher minimum and end-diastolic pressure and relaxation time constant), paralleled by RV cardiomyocyte hypertrophy. Except for cardiomyocyte hypertrophy, aerobic exercise prevented these functional changes. Our data support that this model of HFpEF shows functional and structural changes in the RV that resemble the human HFpEF phenotype, reinforcing its utility to understand this pathophysiology and to adress novel therapeutic targets to manage HFpEF. In addition, we showed that aerobic exercise is cardioprotective for the RV. A deeper knowledge of the mechanisms underlying the benefits of aerobic exercise could also lead to the identification of therapeutic targets to be further explored.

P–038 Clinical outcomes of 77 testicular sperm extraction treatment cycles in non-mosaic Klinefelter syndrome patients

Study question

What are the clinical results of patients with azoospermia and nonmosaic Klinefelter syndrome, using fresh and cryopreserved sperm?

Summary answer

The results showed a recovery rate of testicular sperm in the order of 40% and a life newborn rate of 52% when using fresh sperm

What is known already

In Klinefelter syndrome (KS), the rates of successful testicular sperm retrieval were shown to be similar either using conventional TESE or micro-TESE (Corona et al., 2017), which highlights that the variability observed between studies is due to differences in patient characteristics. There are a few works with a large number of KS patients elucidating the clinical outcomes using fresh and cryopreserved testicular sperm. However, these studies revealed contradictory outcomes, either revealing better (Greco et al., 2013; Vicdan et al., 2016) or worst (Madureira et al., 2014) results with cryopreserved testicular sperm, or finding no differences (Chen et al, 2019).

Study design, size, duration

This study includes all patients up to 2019 presenting azoospermia due to non-mosaic Klinefelter syndrome (n = 76) that went for infertility consultations in a private fertility clinic. Patients were evaluated by the same Urologist. The genetic analysis of the patients was performed at an academic institution. At examination patients did not refer other complaints besides infertility, and referred to have not received any hormone replacement therapy in the past.

Participants/materials, setting, methods

The 76 azoospermic patients with non-mosaic Klinefelter syndrome (KS) were treated by testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI), using fresh and cryopreserved testicular sperm. Most patients used fresh testicular sperm, where others preferred to postpone ICSI treatment cycles and used cryopreserved testicular sperm. Aneuploidy screening in children was performed by prenatal diagnosis and MLPA (Multiplex ligation-dependent probe amplification). Full embryological, clinical and newborn outcomes are provided.

Main results and the role of chance

Of the 76 patients with non-mosaic Klinefelter syndrome, one repeated the testicular sperm extraction (TESE) procedure. Testicular sperm were recovered in 31/77 (40.3%) of the cases. Comparisons between the 31 cases with successful sperm recover (group–1) and the 46 cases without a successful TESE (group–2) revealed no significant differences regarding age, time of infertility, testicular volume, serum levels of FSH, LH and testosterone, total number of testicular fragments analyzed, and time of search in samples. The mean male age was 34 years. In most of the cases, the testicular volume was reduced (96.1%), the levels of FSH (98.3%) and LH (94.1%) were increased, and the levels of testosterone were normal (77.6%). There were 25 intracytoplasmic sperm injection (ICSI) treatment cycles using fresh testicular sperm and 22 ICSI treatment cycles using frozen testicular sperm. The rates of fertilization (63.5% fresh sperm vs 41.6% frozen sperm), implantation (37% fresh sperm vs 13.2% frozen sperm), clinical pregnancy (60.9% fresh sperm vs 19% frozen sperm), live birth delivery (52.2% fresh sperm vs 19% frozen sperm) and newborn (65.2% fresh sperm vs 23.8% frozen sperm) were higher in the group using fresh testicular sperm. Chromosome analysis of the 21 newborn was normal.

Limitations, reasons for caution

Although presenting a high number of cases with azoospermic non-mosaic Klinefelter syndrome treated with testicular sperm extraction and intracytoplasmic sperm injection, future studies are needed with a higher number of cycles using frozen testicular sperm, in order to confirm or rebut that the freezing methodology affects negatively the clinical outcomes.

Wider implications of the findings: Data adds further information regarding testicular sperm retrieval rates and use of fresh or frozen testicular sperm in Klinefelter syndrome (KS) patients. High newborn rates were obtained only with fresh testicular sperm. Results also reassure KS patients about the safety relative to any abnormal chromosomal transmission to the born children.

Trial registration number

Not applicable

O-188 Participation in a video-based fertility awareness program advances the desire to have children sooner

Study question

Participating in a fertility awareness program accelerates the intention to have children 6 to 12 months after video- fertility awareness?

Summary answer

In combination with positive childbearing motivation, those in the video condition anticipated their intentions to have children at 6-12 months follow-up

What is known already

Fertility awareness education and initiatives have been focused on increasing fertility awareness and knowledge. However, the role of fertility awareness on reproductive decisions is less explored in literature. There are few studies showing that participating in fertility awareness education is related to higher intentions to have children or decreased time until trying to conceive regarding beforehand planned. Since intentions seem to be a good predictor of behaviour, we were interested in exploring the variables which might predict higher intentions to have children after participating in a fertility awareness education study based on a video intervention

Study design, size, duration

This study is part of a randomised controlled trial initiated in October 2016. Participants were randomly allocated into the intervention (IG) and control group (CG) at baseline (TO). The follow-up was evaluated 6 to 12 months later. IG participants were exposed to a 5-min video delivering information on age-related fertility decline, infertility risk factors, and pregnancy chances after having filled-in the T0 questionnaire: Participants in CG received no stimulus.

Participants/materials, setting, methods

Three hundred sixty-five individuals (65% women) were recruited through social media, gynaecology clinics, and religious pre-marital courses. From those, 128 responded to follow-up (between 6 and 12 months). Childbearing Motivation Scale (positive and negative) and a question about childbearing timing intentions were used. Regression analysis was conducted to explore the role of video intervention and childbearing motivation on childbearing timing intention.

Main results and the role of chance

Participants were, on average, 29.5 years old (SD = 5.13). From baseline to 6-12 months later, participants significantly anticipated their desire to have children (p<.005). Correlations showed that childbearing timing intention was positively and significantly associated with the following subscales of the positive motivations: personal fulfilment, continuity, and couple relationship; negative motivations were not associated with the childbearing timing intention. The regression analysis revealed that only the childbearing motivation regarding couple relationship (having a child would strengthening partnership ties, fulfilling partner’s project, growing as a couple, fulfilling a shared project) and the visualization of the educational video significantly contributed to predicting at follow-up the increased desire to have children sooner at follow-up.

Limitations, reasons for caution

Other factors, not considered, might contribute to the prediction of childbearing motivation timing. Although we had randomly allocated people to CG and IG, the high attrition rate may limit the generalization of our results.

Wider implications of the findings

This study seems to indicate that watching an educational video about fertility awareness might contribute to a significant change in childbearing timing. In addition, the importance of the couple relationship is highlighted. These findings reinforce the importance to assist people with informed reproductive decisions in social and healthcare settings. 

Trial registration number

NCT02813993

P–473 Should couples be educated on how to try to conceive (TTC) before an infertility diagnosis? A comparative study of fertile, subfertile and infertile couples

Study question

What sexual strategies do individuals TTC with different fertility status use?; What are the predictors of sexual dysfunction(SD) and frequency of intercourse(IF) when TTC? Summary answer: TTC strategies with no evidence of effectiveness are the most used. Poor marital quality predicted SD, and female SD was a significant predictor of IF.

What is known already

It is well known that couples TTC have low fecundity knowledge. Previous evidence showed that after 12 months the frequency of intercourse decreases. After seeing a fertility specialist couples report a feeling of waiting time by attempting natural conception, which can be associated to evidence of an overestimation and excessive confidence in the success of fertility treatments. Existing guidelines recommend intercourse every other day, but no comparative studies exist up to date on what sexual strategies are used in different fertility status and what are the predictors of sexual frequency and sexual dysfunction when trying to conceive.

Study design, size, duration

This study is part of a randomized controlled trial on the effects of timed intercourse in psychosocial outcomes. Data was collected between July 2016 and November 2019 via an advertising strategy and obstetrics/gynecology centers. Inclusion criteria were: i) adult in a marital/cohabitation heterosexual relationship >1 year; ii) not knowing of any condition that can prevent pregnancy; iii) being actively TTC; iv) female age >22<42 years old; v) no previous children. Measurements were carried out online.

Participants/materials, setting, methods

Our final sample had 399 subjects (252 women). Participants rated the use of the following strategies: intercourse every other day (EOD), fertile week (FW), basal temperature, cervical mucus monitoring (CMM), ovulation predictor kits (OPK), and keeping legs elevated afterwards (EL). We also accessed psychological adjustment, relationship quality, SD and IF. Comparisons between groups were made by analysis of variance (ANOVA) and Chi-square tests, and logistic regression was used to determine predictors of SD and IF.

Main results and the role of chance

Participants were highly educated (72,8%), in the relationship for 9 years (±5.2), cohabitating for 5 (±3.6), and TTC for 2,5 years (range 0–16). Women were 33 years old (±4.4) and men 36 (±5.5). Regarding fertility status, 22.6% of participants were TTC <12 months, 22.8% >12 months but not diagnosed, 23.6% had a diagnosis but no treatment, and 31.1% had ART. The most reported female strategy in all groups was EL, and the most never used was OPK. Differences were found in EOD, with significantly more women TTC <12 months that never used it, and more women with previous ART using it. Women who had ART are the ones who more frequently use FW and CMM comparing to other women (P>.05). In all groups, the majority reported IF once or twice/week. SD was found in 17.5% of women and 10,9% of men. Age (OR 0.91, 95%CI 0.85–0.97) and SD (OR 2.47, 95%CI 1.02–6.02) were the only predictors of low IF for women, with no significant findings for men. Poor relationship quality increased the risk of SD for both men (OR 0.11, 95%CI 0.03–0.40) and women (OR 0.46, 95%CI 0.03–0.40), and depression increased the risk of female SD (OR 1.24, 95%CI 1.06–0.46).

Limitations, reasons for caution

The cross-sectional nature of this study does not allow causal relationships to be determined. Further cohort studies allowing to assess differences as couples cross different fertility status are warranted. There are important predictors of SD that were not considered, specifically the comorbidity of diseases and pain.

Wider implications of the findings: Findings indicate that individuals TTC are misinformed, and that those using evidence-based sexual strategies are fertility patients. SD should be screened in patients TTC given that it might be an important predictor of IF. Couples might benefit from counselling to improve marital quality and consequently sexual functioning.

Trial registration number

NCT028140069

P-473 Should couples be educated on how to try to conceive (TTC) before an infertility diagnosis? A comparative study of fertile, subfertile and infertile couples

Study question

What sexual strategies do individuals TTC with different fertility status use?; What are the predictors of sexual dysfunction(SD) and frequency of intercourse(IF) when TTC? 

Summary answer

TTC strategies with no evidence of effectiveness are the most used. Poor marital quality predicted SD, and female SD was a significant predictor of IF.

What is known already

It is well known that couples TTC have low fecundity knowledge. Previous evidence showed that after 12 months the frequency of intercourse decreases. After seeing a fertility specialist couples report a feeling of waiting time by attempting natural conception, which can be associated to evidence of an overestimation and excessive confidence in the success of fertility treatments. Existing guidelines recommend intercourse every other day, but no comparative studies exist up to date on what sexual strategies are used in different fertility status and what are the predictors of sexual frequency and sexual dysfunction when trying to conceive.

Study design, size, duration

This study is part of a randomized controlled trial on the effects of timed intercourse in psychosocial outcomes. Data was collected between July 2016 and November 2019 via an advertising strategy and obstetrics/gynecology centers. Inclusion criteria were: i) adult in a marital/cohabitation heterosexual relationship >1 year; ii) not knowing of any condition that can prevent pregnancy; iii) being actively TTC; iv) female age >22<42 years old; v) no previous children. Measurements were carried out online.

Participants/materials, setting, methods

Our final sample had 399 subjects (252 women). Participants rated the use of the following strategies: intercourse every other day (EOD), fertile week (FW), basal temperature, cervical mucus monitoring (CMM), ovulation predictor kits (OPK), and keeping legs elevated afterwards (EL). We also accessed psychological adjustment, relationship quality, SD and IF. Comparisons between groups were made by analysis of variance (ANOVA) and Chi-square tests, and logistic regression was used to determine predictors of SD and IF.

Main results and the role of chance

Participants were highly educated (72,8%), in the relationship for 9 years (±5.2), cohabitating for 5 (±3.6), and TTC for 2,5 years (range 0-16). Women were 33 years old (±4.4) and men 36 (±5.5). Regarding fertility status, 22.6% of participants were TTC <12 months, 22.8% >12 months but not diagnosed, 23.6% had a diagnosis but no treatment, and 31.1% had ART. 

The most reported female strategy in all groups was EL, and the most never used was OPK. Differences were found in EOD, with significantly more women TTC <12 months that never used it, and more women with previous ART using it. Women who had ART are the ones who more frequently use FW and CMM comparing to other women (P>.05). In all groups, the majority reported IF once or twice/week. SD was found in 17.5% of women and 10,9% of men. Age (OR 0.91, 95%CI 0.85-0.97) and SD (OR 2.47, 95%CI 1.02-6.02) were the only predictors of low IF for women, with no significant findings for men. Poor relationship quality increased the risk of SD for both men (OR 0.11, 95%CI 0.03-0.40) and women (OR 0.46, 95%CI 0.03-0.40), and depression increased the risk of female SD (OR 1.24, 95%CI 1.06-0.46).

Limitations, reasons for caution

The cross-sectional nature of this study does not allow causal relationships to be determined. Further cohort studies allowing to assess differences as couples cross different fertility status are warranted. There are important predictors of SD that were not considered, specifically the comorbidity of diseases and pain.

Wider implications of the findings

Findings indicate that individuals TTC are misinformed, and that those using evidence-based sexual strategies are fertility patients. SD should be screened in patients TTC given that it might be an important predictor of IF. Couples might benefit from counselling to improve marital quality and consequently sexual functioning.

Trial registration number

NCT028140069

Gastric microbiome profile throughout gastric carcinogenesis: beyond helicobacter

BACKGROUND

Gastric dysbiosis has been hinted as a potential cause of gastric cancer. However, changes in microbiome throughout the major stages of gastric carcinogenesis remain mostly unknown.

OBJECTIVE

To describe gastric microbiome at different stages, analysing for the first time dysbiosis specifically in patients with early gastric cancer (EGC).

METHODS

Cross-sectional study including patients (n = 77) with endoscopically and histologically confirmed normal stomachs (controls; n = 25), advanced atrophic gastritis with intestinal metaplasia (IM; n = 18) and EGC (n = 34). Endoscopic biopsies from antrum and corpus (n = 154) were analyzed. Next-generation sequencing was performed characterizing microbial communities down to the species level based on full-length 16SrRNA gene profiling.

RESULTS

Significant differences were found in the microbiome profile between the groups. Firmicutes were more frequent (p = .012) and Proteobacteria were less frequent (p = .04) both in the IM and EGC when comparing to controls. Relative frequency of Helicobacter pylori, when present, was much higher in the controls (83%) when comparing to the other groups (IM 1%, EGC 27%; p = .006), being the dominant bacteria only in the controls. Dysbiosis was present already and more significantly at the IM stage, with two bacteria progressively increasing from controls to IM then to cancer: Gemella from 1.48 to 3.9% (p = .014); and Streptococcus from 19.3 to 33.7% (p = .04), being the EGC dominant bacteria.

CONCLUSIONS

Our results confirm Helicobacter pylori dominancy in non-atrophic stomachs and progressive dysbiosis throughout gastric carcinogenesis. Gemella but particularly Streptococcus is significantly increased in patients with EGC. Specific modulation of these bacteria may change gastric cancer risk.

Serum microRNAs and antifibrotic response to eplerenone in acute myocardial infarction complicated by systolic dysfunction

BACKGROUND

After myocardial infarction (MI) complicated by heart failure (HF), eplerenone reduced serum concentrations of amino-terminal propeptide of type III collagen (PIIINP) and carboxy-terminal propeptide of type I collagen (PICP). Determining a subgroup who are more prone to decrease their collagen content and to respond better to the antifibrotic effects of mineralocorticoid receptor antagonists (MRA) may be relevant for a personalized treatment approach. Whether circulating microRNAs may identify a subgroup that have experienced a more pronounced antifibrotic effect of eplerenone as measured by a PICP and PIIINP decrease is unclear.

METHODS

A set of circulating microRNAs linked to cardiac fibrosis (mir-1, mir-21, mir-29a, mir-29b, mir-101, mir-122, mir-133a) were measured at baseline in 198 patients in the biomarker substudy of Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Associations between baseline microRNA levels and changes in both PIIINP and PICP from baseline to month 9 were studied using multivariable analysis of covariance, adjusting for age, sex, history of hypertension and diabetes mellitus, prescription of ACE-inhibitors or angiotensin receptor blockers, baseline PIIINP or PICP, and eplerenone treatment. Furthermore, a treatment-by-microRNA interaction was studied.

RESULTS

From the selected microRNAs, only mir-133a was associated with a PICP decrease (ß-6.43, 95%CI-12.71 to -0.15,p = 0.045). None of the microRNAs was associated with a PIIINP change. The microRNAs did not predict an effect of eplerenone on PICP and PIIINP changes.

CONCLUSION

Although serum mir-133a was associated with PICP change, none of the microRNAs previously linked to cardiac fibrosis predicted an antifibrotic response to eplerenone. Further study is needed to identify other suitable targets for a personalized treatment approach.

Coverage and inequalities in health interventions in Ecuador 1994- 2012

Several Latin American countries have reported significant reductions in inequalities and increases in coverage of essential health interventions across the continuum of reproductive, maternal, newborn and child health (RMNCH) care. Although Ecuador has had significant political and economic progress, few studies have evaluated the magnitude and trend of inequalities in RMNCH coverage interventions, a critical step in defining priorities for future health policies and strategies. This cross-sectional study used data from four national representative, standardized health surveys (1994, 1999, 2004 and 2012), analyzing coverage of seven interventions, stratifying by wealth quintile, urban-rural residence and geographic location. We used a variance-weighted least squares regression to calculate the average annual absolute change in coverage across interventions and mapped the results. Using the latest round of the survey, simple and complex measures of inequality were computed. Between 1994 and 2012, in almost all analyzed interventions the differences between rich and poor decreased, especially from 2004 to 2012, period in which primary health care policies were strengthened. In 2012, nevertheless, the most unequal intervention was improved sanitary facilities with 2.4-fold difference between rich and poor (ratio quintile 5:1; concentration index 15.4% 95% CI; 15.0-15.9%); and antenatal care, institutional delivery and improved drinking water kept significant inequality by economic status. While interventions related to the provision of health services showed reduction in inequality gaps, basic sanitation and drinking water had high gaps. Several provinces failed to improve coverage interventions over time, gaps which are masked by national averages and need additional intersectoral approaches to be addressed. Further analysis should focus on other dimensions of inequality such as ethnic group to identify gaps and generate strategies adapted to local realities.

Key messages

In Ecuador from 1994 to 2012 inequality gaps between rich and poor in most RMNCH coverage interventions declined, mainly from 2004 to 2012, but national means mask inequalities at the provincial level. Interventions related to the provision of health services showed reduction in socio-economic inequalities, while inequalities in basic sanitation and drinking water intervention coverage remained high.

Risk Factors for Recoarctation and Mortality in Infants Submitted to Aortic Coarctation Repair: A Systematic Review

Aortic coarctation is a common congenital heart defect that often requires correction at a young age. Currently, success is defined by the achievement of a durable repair with low morbidity and mortality. We sought to systematically review the literature on risk factors for recoarctation and mortality in infants submitted to aortic arch coarctation repair under 1 year of age. PubMed and Scopus were searched for studies reporting risk factors for recoarctation and mortality from January 1989 to August 2019. Among the 1038 retrieved articles, 18 met the inclusion criteria, with a total of 2891 patients. The extracted risk factors for recoarctation were comprehensively summarized in the following categories: demographic variables, associated anomalies, clinical and repair variables, and morphometric variables. Younger age and lower weight were weak determinants of need for reintervention, while smaller aortic arch was a strong predictor of recoarctation. While balloon angioplasty is a clear risk factor for arch restenosis, the chosen surgical technique is not a strong risk factor. Associated minor cardiac anomalies and lower weight at surgery were important risk factors for death. Younger and smaller infants are at increased risk for adverse outcomes when submitted to aortic arch coarctation repair. This is particularly important when associated with smaller arch morphology. Strategies to improve the management of these patients may play a key role in improving their outcomes. Notably, surgical technique was not a strong predictor of recoarctation and mortality, suggesting that the choice of one over the other should be tailored.

Heterotrophy as a tool to overcome the long and costly autotrophic scale-up process for large scale production of microalgae

Industrial scale-up of microalgal cultures is often a protracted step prone to culture collapse and the occurrence of unwanted contaminants. To solve this problem, a two-stage scale-up process was developed – heterotrophically Chlorella vulgaris cells grown in fermenters (1^st stage) were used to directly inoculate an outdoor industrial autotrophic microalgal production unit (2^nd stage). A preliminary pilot-scale trial revealed that C. vulgaris cells grown heterotrophically adapted readily to outdoor autotrophic growth conditions (1-m³ photobioreactors) without any measurable difference as compared to conventional autotrophic inocula. Biomass concentration of 174.5 g L⁻¹, the highest value ever reported for this microalga, was achieved in a 5-L fermenter during scale-up using the heterotrophic route. Inocula grown in 0.2- and 5-m³ industrial fermenters with mean productivity of 27.54 ± 5.07 and 31.86 ± 2.87 g L⁻¹ d⁻¹, respectively, were later used to seed several outdoor 100-m³ tubular photobioreactors. Overall, all photobioreactor cultures seeded from the heterotrophic route reached standard protein and chlorophyll contents of 52.18 ± 1.30% of DW and 23.98 ± 1.57 mg g⁻¹ DW, respectively. In addition to providing reproducible, high-quality inocula, this two-stage approach led to a 5-fold and 12-fold decrease in scale-up time and occupancy area used for industrial scale-up, respectively.

Characterization of CCDC103 expression profiles: further insights in primary ciliary dyskinesia and in human reproduction

PROPOSE

To study CCDC103 expression profiles and understand how pathogenic variants in CCDC103 affect its expression profile at mRNA and protein level.

METHODS

To increase the knowledge about the CCDC103, we attempted genotype-phenotype correlations in two patients carrying novel homozygous (missense and frameshift) CCDC103 variants. Whole-exome sequencing, quantitative PCR, Western blot, electron microscopy, immunohistochemistry, immunocytochemistry, and immunogold labelling were performed to characterize CCDC103 expression profiles in reproductive and somatic cells.

RESULTS

Our data demonstrate that pathogenic variants in CCDC103 gene negatively affect gene and protein expression in both patients who presented absence of DA on their axonemes. Further, we firstly report that CCDC103 is expressed at different levels in reproductive tissues and somatic cells and described that CCDC103 protein forms oligomers with tissue-specific sizes, which suggests that CCDC103 possibly undergoes post-translational modifications. Moreover, we reported that CCDC103 was restricted to the midpiece of sperm and is present at the cytoplasm of the other cells.

CONCLUSIONS

Overall, our data support the CCDC103 involvement in PCD and suggest that CCDC103 may have different assemblies and roles in cilia and sperm flagella biology that are still unexplored.

Clinical and molecular characterization of Y microdeletions and X-linked CNV67 implications in male fertility: a 20-year experience

BACKGROUND

Approximately 15% of couples worldwide are affected with infertility, attributed to a male co-factor in about half of the cases. Y chromosome microdeletions are the second most common genetic cause for male infertility, with a global prevalence of 2-10% in infertile men. Recently, CNV67, localized in X chromosome, has emerged as potential contributor to male infertility, with a described frequency of 1.1% in the oligo/azoospermic men.

OBJECTIVES

To investigate the prevalence of Y-linked CNVs in a cohort of Portuguese infertile men and correlate the patients' phenotypes with a genetic alteration; to investigate the CNV67 deletion in a subset of patients and corroborate the role of this CNV in male infertility.

MATERIALS AND METHODS

We retrospectively analysed a database of 4000 Portuguese infertile men for karyotype anomalies and Y microdeletions and selected a cohort of 400 for CNV67 screening analysis by quantitative PCR or single PCR plus/minus.

RESULTS

Karyotype anomalies were present in 263 patients (6.6%), with Klinefelter syndrome representing the most frequent karyotype anomaly (2.8%). Among the 4000 patients, the prevalence of Yq microdeletions was 4.6%. Ninety microdeletions (10.0%) were found in the azoospermic group, 44 deletions (4.5%) in the severe oligozoospermic group, 1 AZFc partial deletion (0.3%) in the mild-moderate oligozoospermic group and 2 partial AZFc deletions (0.4%) in the normozoospermic group. Complete AZFc deletions represented 56.8% of the Yq microdeletions. The CNV67 deletion frequency was 1.2% in the studied sample.

CONCLUSIONS

This study presents one of the largest samples of infertile men worldwide with the main purpose of correlating the Yq microdeletions with sperm count. Our findings are supported by previous reviews with large data and provide a reliable estimation of the prevalence of these anomalies in a Portuguese population. CNV67 was exclusively deleted in patients with spermatogenic impairment, showing a consistent genotype-phenotype correlation and a significant prevalence.

Semen quality is affected by HLA class I alleles together with sexually transmitted diseases

BACKGROUND

The human leukocyte antigen (HLA) locus includes several genes with key roles in antigen presentation and immune response, some of them inclusively found to be associated with non-obstructive azoospermia. Still, HLA connections to other infertility phenotypes such as semen hyperviscosity (SHV), asthenozoospermia (AST), and oligozoospermia (OLI) have been often neglected.

OBJECTIVES

In this work, we aimed to evaluate the association of HLA class I and II genes with SHV, AST, and OLI phenotypes while exploring a possible role in an adaptive immune response to sexually transmitted diseases (STD).

MATERIALS AND METHODS

Whole-exome sequencing was performed in a Portuguese cohort of 71 infertility cases and 68 controls, followed by HLA typing using a specific software-HLA*PRG:LA tool. Molecular screenings of seven STD were carried out in a subset of 72 samples (30 cases and 42 controls).

RESULTS

Statistical tests uncovered three protective alleles: HLA-A*11:01, associated with all forms of male infertility (p = 0.0006); HLA-DQB1*03:02 with SHV and OLI (P_SHV   = 0.0303, P_OLI   = 0.0153); and HLA-A*29:02 with OLI (p = 0.0355), which was found to interfere in sperm number together with HPV (p = 0.0313). Five risk alleles were also identified: two linked with SHV (HLA-B*50:01, p = 0.0278; and HLA-C*06:02, p = 0.0461), another one with both SHV and OLI (HLA-DQA1*05:01, P_SHV   = 0.0444 and P_OLI =0.0265), and two with OLI (HLA-C*03:03, p = 0.0480; and HLA-DQB1*03:01, p = 0.0499). Here, HLA-C*03:03 carriers tend to be HPV infected.

CONCLUSIONS

The application of HLA*PRG:LA tool to the study of male infertility provided novel insights for an HLA correlation with semen quality, namely among SHV and OLI phenotypes. The discovery of an HLA-A*29:02/HPV crosstalk, together with former reports of HLA alleles conferring resistance-susceptibility to diverse human pathogens, raises the hypothesis of a mechanistic link between male infertility, HLA polymorphism, and host response to STD.

FGF2 induces breast cancer growth through ligand-independent activation and recruitment of ERα and PRBΔ4 isoform to MYC regulatory sequences

Progression to hormone-independent growth leading to endocrine therapy resistance occurs in a high proportion of patients with estrogen receptor alpha (ERα) and progesterone receptors (PR) positive breast cancer. We and others have previously shown that estrogen- and progestin-induced tumor growth requires ERα and PR interaction at their target genes. Here, we show that fibroblast growth factor 2 (FGF2)-induces cell proliferation and tumor growth through hormone-independent ERα and PR activation and their interaction at the MYC enhancer and proximal promoter. MYC inhibitors, antiestrogens or antiprogestins reverted FGF2-induced effects. LC-MS/MS identified 700 canonical proteins recruited to MYC regulatory sequences after FGF2 stimulation, 397 of which required active ERα (ERα-dependent). We identified ERα-dependent proteins regulating transcription that, after FGF2 treatment, were recruited to the enhancer as well as proteins involved in transcription initiation that were recruited to the proximal promoter. Also, among the ERα-dependent and independent proteins detected at both sites, PR isoforms A and B as well as the novel protein product PRBΔ4 were found. PRBΔ4 lacks the hormone-binding domain and was able to induce reporter gene expression from estrogen-regulated elements and to increase cell proliferation when cells were stimulated with FGF2 but not by progestins. Analysis of the Cancer Genome Atlas data set revealed that PRBΔ4 expression is associated with worse overall survival in luminal breast cancer patients. This discovery provides a new mechanism by which growth factor signaling can engage nonclassical hormone receptor isoforms such as PRBΔ4, which interacts with growth-factor activated ERα and PR to stimulate MYC gene expression and hence progression to endocrine resistance.

Correction to: The Cancer, Educate to Prevent Model-the Potential of School Environment for Primary Prevention of Cancer

The affiliation address of Dr. Helena Santos should be Faculty of Economics, University of Porto, Portugal and Dr. Luís Moreira's should be Research Unit in Education and Community Intervention - RECI & Health School of Vila Nova de Gaia - Piaget Institute.

Spectrum of CFTR gene sequence variants in a northern Portugal population

In Portugal, the spectrum of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene variants is not known. The main objective of this work was to determine the type and frequency of CFTR variants in a sample from northern Portugal by the complete analysis of the CFTR coding sequencing performed in 512 Portuguese children. A total of 30 different CFTR sequence variants, already reported as cystic fibrosis (CF) or CFTR related disorders variants, were detected. Ninety-two children (18.0%; 95%CI: 14.7-21.6) were found to be carriers of one sequence variant and 8 (1.6%; 95%CI: 0.7-3.1) had two sequence variants. Taking into consideration only variants that may cause CF when combined with a pathogenic CF variant, the CF pathogenic variant carrier frequency was 3.3% (95%CI: 1.9-5.3). One (0.2%; 95%CI: 0.01-0.7) child presented two CF pathogenic variants.

CONCLUSIONS

The majority of CFTR variants detected have been associated with a less severe CF phenotype. A wide spectrum of CFTR variants was identified, confirming the highest CFTR allelic heterogeneity previously reported in Mediterranean country. Additionally, better knowledge about the CFTR sequence variation spectrum may contribute to more efficient genetic testing in the Portuguese population.

Independent Component Analysis and Neural Networks Applied for Classification of Malignant, Benign and Normal Tissue in Digital Mammography

Objectives : This paper proposes an efficient method for the discrimination and classification of mammograms with benign, malignant and normal tissues.

Methods : The proposed method consists of selection of tissues, feature extraction using independent component analysis, feature selection by the foiward- selection technique and classification of the tissue by the multilayer perceptron.

Results : The method is tested for a mammogram set of the MIAS database, resulting in a 97.83% success rate, with 98.0% specificity and 97.5% sensitivity.

Conclusion : The proposed method showed a good classification rate. The method will be useful for early cancer diagnosis.

Survival After Bilateral Internal Mammary Artery In Coronary Artery Bypass Grafting: Are Women at Risk?

INTRODUCTION

To compare survival and safety of BIMA versus SIMA CABG between males and females at our tertiary care center.

METHODS

Single-center retrospective cohort including consecutive patients with at least 2 left coronary system (LCS) vessel disease who underwent isolated CABG with at least 1 IMA conduit and a minimum of 2 conduits targeting the LCS between 2004 and 2013. All-cause mortality was the primary outcome, secondary outcomes were in-hospital mortality and reoperation due to sternal wound complications (SWC). Kaplan-Meier analysis after inverse probability weighting using propensity score (IPW) was used to compare BIMA and SIMA CABG amongst genders. Results were confirmed by subgroup analysis.

RESULTS

BIMA CABG was performed in 39% out of 2424 eligible procedures and in 27% of 460 females. No differences were found in survival after BIMA and SIMA CABG (median and maximum follow-up of 5.5 and 12 years, respectively) but a statistical interaction was observed with gender (P<0.001). Females who underwent BIMA CABG showed higher mortality (weighted HR in females subset: 3.16; 95%CI: 1.56-6.29, P=0.001). BIMA CABG showed a higher incidence of reoperations due to SWC (IPW adjusted model OR: 1.74; 95% CI: 1.16-2.60) that were mostly ascribable to males (weighted OR in males: 3.10; 95%CI: 1.74-5.51, P<0.001).

CONCLUSION

Females may experience higher mortality after BIMA CABG which should be further explored.

DNA methylation imprinting errors in spermatogenic cells from maturation arrest azoospermic patients

Imprinting errors have been described in spermatozoa from infertile patients with oligozoospermia and azoospermia. However, little is known about methylation of imprinted genes in other spermatogenic cells from azoospermic patients. Therefore, we aimed to evaluate the methylation status of single CpGs located in the differentially methylated regions (DMRs) of two imprinted genes, one paternally (H19) and one maternally (MEST) methylated, in primary spermatocytes of azoospermic patients presenting complete (MAc, n = 7) and incomplete (MAi, n = 8) maturation arrest, as well as in other spermatogenic cells from MAi patients that presented focus of complete spermatogenesis in some seminiferous tubules. We observed H19 imprinting errors in primary spermatocytes from one MAi patient and MEST imprinting errors in one MAi and two MAc patients. Additionally, H19 imprinting errors were observed in elongated spermatids/spermatozoa from one MAi patient. Nevertheless, no statistical differences were found for H19 and MEST global methylation levels (percentage of methylated and unmethylated CpGs, respectively) between patients with complete and incomplete MA and also between MA groups and a control group. These results provide further evidence that imprinting errors occur in spermatogenic cells from patients presenting impaired spermatogenesis, as we and others have previously described in ejaculated and testicular spermatozoa. As paternal imprinting errors can be transmitted to the embryo by the sperm cell, they can provide a possible explanation for poor embryo development and/or low pregnancy rates as correct expression of imprinted genes is crucial for embryo and placental development and function. Therefore, in cases with male factor infertility where unsuccessful in vitro fertilization (IVF) treatments are recurrent, analysis of imprinting marks in spermatozoa might be a useful diagnostic tool.

The Cancer, Educate to Prevent Model-the Potential of School Environment for Primary Prevention of Cancer

Cancer represents one of the main causes of death worldwide; consequently, preventive interventions are of utmost importance in public health education. The leading model of cancer prevention campaigns is based on general and undifferentiated actions mediated by health professionals, focusing on the technical and scientific information but rather ineffective in changing the symbolic, cognitive and practical relationship with the disease. New intervention models are thus required to address cancer literacy, being early interventions targeted to specific groups an elective counterpoint to contribute to positive and durable changes in cancer prevention. Our aim is to evaluate the feasibility and impact of cancer prevention programmes planned as focused interventions in restricted targets and mediated by non-healthcare professionals to increase cancer literacy and promote preventive behaviours. This pilot study evaluates schools' potential as a vehicle for cancer prevention education in a reality shaped by traditional health prevention campaigns. We developed a protocol of systematic surveying in order to review and, in the future, optimize and replicate this ecological model of intervention to other groups and contexts. The implementation of this model has been successful in which concerns to the effectiveness of the training programme for teachers. This led to the development of impactful cancer prevention education projects by trainees targeted to their students, allowing us to argue that it contributes to knowledge and practice in this complex as consensual priority area of intervention.

Ghrelin acts as energy status sensor of male reproduction by modulating Sertoli cells glycolytic metabolism and mitochondrial bioenergetics

Ghrelin is a growth hormone-releasing peptide that has been suggested to interfere with spermatogenesis, though the underling mechanisms remain unknown. We studied the effect of ghrelin in human Sertoli cells (hSCs) metabolic phenotype. For that, hSCs were exposed to increasing concentrations of ghrelin (20, 100 and 500 pM) mimicking the levels reported in obese, normal weight, and severely undernourished individuals. The metabolite production/consumption was determined. The protein levels of key glycolysis-related transporters and enzymes were assessed. The lactate dehydrogenase (LDH) activity was measured. Mitochondrial complexes protein levels and mitochondria membrane potential were also measured. We showed that hSCs express the growth hormone secretagogue receptor. At the concentration present in the plasma of normal weight men, ghrelin caused a decrease of glucose consumption and mitochondrial membrane potential in hSCs, though LDH activity and lactate production remained unchanged, illustrating an alteration of glycolytic flux efficiency. Exposure of hSCs to levels of ghrelin found in the plasma of severely undernourished individuals decreased pyruvate consumption and mitochondrial complex III protein expression. All concentrations of ghrelin decreased alanine and acetate production by hSCs. Notably, the effects of ghrelin levels found in severely undernourished individuals were more pronounced in hSCs metabolic phenotype highlighting the importance of a proper eating behavior to maintain male reproductive potential. In conclusion, ghrelin acts as an energy status sensor for hSCs in a dose-dependent manner, showing an inverse association with the production of lactate, thus controlling the nutritional support of spermatogenesis.