Mitochondrial morphology controls fatty acid utilization by changing CPT1 sensitivity to malonyl-CoA

Changes in mitochondrial morphology are associated with nutrient utilization, but the precise causalities and the underlying mechanisms remain unknown. Here, using cellular models representing a wide variety of mitochondrial shapes, we show a strong linear correlation between mitochondrial fragmentation and increased fatty acid oxidation (FAO) rates. Forced mitochondrial elongation following MFN2 over-expression or DRP1 depletion diminishes FAO, while forced fragmentation upon knockdown or knockout of MFN2 augments FAO as evident from respirometry and metabolic tracing. Remarkably, the genetic induction of fragmentation phenocopies distinct cell type-specific biological functions of enhanced FAO. These include stimulation of gluconeogenesis in hepatocytes, induction of insulin secretion in islet β-cells exposed to fatty acids, and survival of FAO-dependent lymphoma subtypes. We find that fragmentation increases long-chain but not short-chain FAO, identifying carnitine O-palmitoyltransferase 1 (CPT1) as the downstream effector of mitochondrial morphology in regulation of FAO. Mechanistically, we determined that fragmentation reduces malonyl-CoA inhibition of CPT1, while elongation increases CPT1 sensitivity to malonyl-CoA inhibition. Overall, these findings underscore a physiologic role for fragmentation as a mechanism whereby cellular fuel preference and FAO capacity are determined.

Obesity and Pancreatic Cancer: Recent Progress in Epidemiology, Mechanisms and Bariatric Surgery

More than 30% of people in the United States (US) are classified as obese, and over 50% are considered significantly overweight. Importantly, obesity is a risk factor not only for the development of metabolic syndrome but also for many cancers, including pancreatic ductal adenocarcinoma (PDAC). PDAC is the third leading cause of cancer-related death, and 5-year survival of PDAC remains around 9% in the U.S. Obesity is a known risk factor for PDAC. Metabolic control and bariatric surgery, which is an effective treatment for severe obesity and allows massive weight loss, have been shown to reduce the risk of PDAC. It is therefore clear that elucidating the connection between obesity and PDAC is important for the identification of a novel marker and/or intervention point for obesity-related PDAC risk. In this review, we discussed recent progress in obesity-related PDAC in epidemiology, mechanisms, and potential cancer prevention effects of interventions, including bariatric surgery with preclinical and clinical studies.

A91 ECONOMIC EVALUATION OF A FECAL MICROBIOTA TRANSPLANTATION PROGRAM FOR RECURRENT CLOSTRIDIOIDES DIFFICILE INFECTION IN ALBERTA

Background

Fecal microbiota transplantation (FMT) is the most effective therapy for recurrent C. difficile infection. Although studies using statistical modeling have shown FMT to be cost-effective, real-world data is lacking.

Aims

To assess the impact of FMT program on the healthcare cost of recurrent C. difficile infections using real-world data from Alberta’s public healthcare system.

Methods

C. difficile infection patients were identified through provincial laboratory database with positive C. difficile results in Edmonton, Alberta between 2009–16. If an initial positive test was followed by ≧2 positive tests within 183 days, an individual was categorized as recurrent C. difficile infection (RCDI). Otherwise, non-recurrent C. difficile infection (non-RCDI) was assigned. Since the Edmonton FMT program was established in 2013, patients were further divided into pre-FMT (2009–12) and post-FMT (2013–16) eras. This divided patients into four study groups as outlined in Table 1. Administrative data, including inpatient stays, ambulatory or emergency room visits, outpatient prescriptions, and physician billings, were extracted. A cost of $389 was assigned to each FMT procedure to account for cost of donor screening and sample preparation. A difference in differences (DID) approach, a tool which estimates the effect of a treatment by comparing outcome difference between treatment group and control group over time, was used to analyze the impact of FMT program on the cost of RCDI. Non-RCDI patients were used as control group to account for changes in treatment costs over time. Ordinary least squares regression, with log-transformed healthcare cost as the dependent variable, was used for the analysis.

Results

4717 non-RCDI and 548 RCDI patients were identified and divided into the 4 groups (Table 1). RCDI patients were significantly older than non-RCDI patients (71.13 vs 62.49; P < 0.001). After adjusting for differences in age, sex, and baseline healthcare utilization, cost for RCDI patients were significantly lower relative to costs for non-RCDI patients in the post-FMT era. Cost of non-RCDI increased by $5,300.08 between the pre- and post-FMT eras, while the cost of RCDI decreased by $7,654.92 in the same time frame (Table 2). FMT program was estimated to have saved $12,954 annually for RCDI patients at mean age, sex, and baseline cost of our overall sample.

Conclusions

Our data suggest that the healthcare cost of RCDI has decreased with the introduction of an FMT program.

Funding Agencies

Alberta Health Services, University of Alberta Hospital Foundation

A265 SERIAL FECAL MICROBIOTA TRANSPLANT PLUS FIDAXOMICIN IN THE TREATMENT OF SEVERE OR FULMINANT CLOSTRIDIOIDES DIFFICILE INFECTION

Background

Severe and fulminant Clostridioides Difficile infection(CDI) is associated with increased mortality and morbidity. Current guidelines recommend high dose vancomycin with metronidazole for treatment. Surgery is a high risk for patients failing medical therapy partly due to multiple comorbidities. Emerging evidence suggests efficacy of sequential fecal microbiota transplantation(FMT) by colonoscopy combined with vancomycin in patients failing maximal medical therapy. Fidaxomicin is non-inferior to vancomycin in treating CDI; however, it has not been studied in severe/fulminant cases. It is not known if FMT by enema combined with fidaxomicin is efficacious and safe in this patient population.

Aims

This single center, prospective, open-label pilot study aimed to determine the efficacy and safety of combined sequential FMT by enema plus fidaxomicin in severe or fulminant CDI not responding to maximal medical therapy. Primary outcome was resolution of diarrhea 2 weeks following final FMT. Secondary outcomes were resolution of diarrhea 8 weeks following final FMT, safety of proposed treatment protocol and colectomy rate.

Methods

Consecutive patients with severe or fulminant CDI, who fulfilled study inclusion criteria were recruited. Sequential cycles of FMT, administered by enema daily over three days(720cc followed by 360cc and 180cc), plus fidaxomicin 200mg PO BID were given. Clinical symptoms and inflammatory markers were monitored during the study and subsequent cycles of FMT were administered when clinical or biochemical improvement plateaued. A final FMT was administered with CDI resolution.

Results

A total of three patients were enrolled between Jan 22 to Aug 8, 2019, shown in Table 1. One patient had fulminant CDI due to shock, and the others had severe CDI. All had severe pseudomembranous colitis seen on endoscopy at enrollment. Two of three patients reached both primary and secondary outcomes with 2 FMT cycles. The only patient who did not reach the primary was successfully managed with long term vancomycin suppression. This patient had failed multiple FMTs prior to enrollment. There were no adverse events noted and no colectomy was required during this study.

Conclusions

This pilot study is the first to demonstrate efficacy and safety of combined sequential FMT by enema and fidaxomicin in treating severe or fulminant CDI patients. An adequately powered study is required to validate these findings.

Funding Agencies

CIHRAlberta Health Services, University of Alberta Hospital Foundation

A rodent model of human organophosphate exposure producing status epilepticus and neuropathology

Exposure to organophosphates (OPs) often results in seizures and/or status epilepticus (SE) that produce neural damage within the central nervous system (CNS). Early control of SE is imperative for minimizing seizure-related CNS neuropathology. Although standard therapies exist, more effective agents are needed to reduce OP-induced SE and neuronal loss, particularly therapies with efficacy when administered 10's of minutes after the onset of SE. To evaluate novel antiseizure compounds, animal models should simulate the CNS effects of OP exposure observed in humans. We characterized in rats the effects of the OP, diisopropyl flourophosphate (DFP) as a function of dose and route of administration of supporting agents (pyridostigmine, 2-PAM, atropine); outcome measures were mortality, electrographic seizure activity during SE, and subsequent CNS neuropathology. Doses of DFP between 3 and 7mg/kg consistently caused SE, and the latency to behavioral tremors and to subsequent initiation of SE were dose related. In distinction, all doses of DFP that resulted in electrographic SE (3-7mg/kg) produced seizures of similar intensity and duration, and similar CNS neuropathology (i.e., the effects were all-or-none). Although SE was similar across doses, mortality progressively increased with higher doses of DFP. Mortality was significantly lower when the route of administration of therapeutic agents was intramuscular compared to intraperitoneal. This rodent model of OP poisoning demonstrates pathological characteristics similar to those observed in humans, and thus begins to validate this model for investigating potential new therapeutic approaches.

A comparative electrographic analysis of the effect of sec-butyl-propylacetamide on pharmacoresistant status epilepticus

Better treatment of status epilepticus (SE), which typically becomes refractory after about 30 min, will require new pharmacotherapies. The effect of sec-butyl-propylacetamide (SPD), an amide derivative of valproic acid (VPA), on electrographic status epilepticus (ESE) was compared quantitatively to other standard-of-care compounds. Cortical electroencephalograms (EEGs) were recorded from rats during ESE induced with lithium-pilocarpine. Using a previously-published algorithm, the effects of SPD on ESE were compared quantitatively to other relevant compounds. To confirm benzodiazepine resistance, diazepam (DZP) was shown to suppress ESE when administered 15 min after the first motor seizure, but not after 30 min (100mg/kg). VPA (300 mg/kg) also lacked efficacy at 30 min. SPD (130 mg/kg) strongly suppressed ESE at 30 min, less after 45 min, and not at 60 min. At a higher dose (180 mg/kg), SPD profoundly suppressed ESE at 60 min, similar to propofol (100mg/kg) and pentobarbital (30 mg/kg). After 4-6h of SPD-induced suppression, EEG activity often overshot control levels at 7-12h. Valnoctamide (VCD, 180 mg/kg), an SPD homolog, was also efficacious at 30 min. SPD blocks pilocarpine-induced electrographic seizures when administered at 1h after the first motor seizure. SPD has a faster onset and greater efficacy than DZP and VPA, and is similar to propofol and pentobarbital. SPD and structurally similar compounds may be useful for the treatment of refractory ESE. Further development and use of automated analyses of ESE may facilitate drug discovery for refractory SE.

A low-cost approach to public health education using multimedia packages

The effect of health education programmes depends on the number of people exposed to the messages, as well as the method and style in which the information is transmitted. We conducted a pilot project to encourage healthier lifestyles by presenting culturally sensitive information using a variety of media. Material intended to provoke discussion was shared with a range of audiences in Barbados and Montserrat in the West Indies by a series of lecture discussions, which were videorecorded for local television and sound recorded for local radio. The lecture was also disseminated by newspaper articles, a special magazine and by publication on the Internet. The aim of the project was to achieve maximum effect for minimum effort, thus making optimum use of resources. The feedback obtained at the lecture discussions and in response to the radio broadcasts and newspaper articles provided a needs assessment on which to base a definitive programme, and confirmed that radio and television are the most effective media for health education.

Chemical basis of courtship in a beetle (Neopyrochroa flabellata): Cantharidin as "nuptial gift"

The amount of cantharidin (Spanish fly) that the Neopyrochroa flabellata male presents to the female as a glandular offering during courtship represents only a small fraction of the total cantharidin the male accumulates systemically following ingestion of the compound. A major fraction of the acquired cantharidin is stored by the male in the large accessory glands of the reproductive system. At mating, the male transfers this supply, presumably as part of the sperm package, to the spermatheca of the female. The female in turn allocates the gift to the eggs. Eggs endowed with cantharidin proved relatively invulnerable to attack by a predaceous beetle larva (Coleomegilla maculata).

Chemical basis of courtship in a beetle (Neopyrochroa flabellata): cantharidin as precopulatory "enticing" agent

Male Neopyrochroa flabellata have a natural affinity for cantharidin (Spanish fly). They are attracted to cantharidin baits in the field and feed on the compound if it is offered to them in the laboratory. Males that ingest cantharidin secrete cantharidin from a cephalic gland. Females sample secretion from this gland during courtship and mate preferentially with males that had fed on cantharidin. Cantharidin-unfed males can be rendered acceptable to females if cantharidin is added to their cephalic gland.

Psychiatric disorder and disability in New Zealand long-stay psychiatric patients

A study was undertaken of the prevalence of physical disease, psychiatric disorder and deviant behaviour in a sample of 137 long stay psychiatric patients at Porirua Hospital near Wellington, New Zealand. Patients were in the main male, single, middle-aged to elderly and of European descent. Schizophrenia was the most common diagnosis. Psychiatric symptoms were moderately severe, the most common being unusual mannerisms and posturing, anxiety, blunted affect, tension, unusual thought content and somatic concerns. Known physical disorders were present in 66 patients. Levels of neuroleptic medication were high and tardive dyskinesia was observed in almost 60% of patients. Frequency of deviant behaviour was low in absolute terms but nonetheless problematic. The frequency of deviant behaviour was similar to those reported for British patients.

A human IgM M-protein in a patient with unknown bleeding disorder binds to beta-galactosyl and beta-glucosyl residues

In a patient with an unknown bleeding disorder and an IgM lambda paraproteinemia, we demonstrated by thin-layer chromatography immunostaining and enzyme-linked immunosorbent assay that this protein specifically bound to a number of glycolipids and glycoproteins which have terminal beta-galactosyl or beta-glucosyl residues. Binding to galactosylceramide or glucosylceramide was inhibited by both galactosylceramide and glucosylceramide. From these studies, it is apparent that the M-protein recognized both beta-galactosyl and beta-glucosyl residues. This M-protein was also shown to prolong the partial thromboplastin time of normal plasma. Thus, this case represents an example of anti-carbohydrate specificity of an IgM M-protein in association with a spontaneous bleeding disorder.

Defensive steroids from a carrion beetle (Silpha americana)

The defensive anal effluent discharged by Silpha americana in response to disturbance contains a mixture of steroids stemming from a glandular annex of the rectum. The compounds have been characterized as 15 beta-hydroxyprogesterone (1, principal component), 5 beta-pregnan-15 beta-ol-3,20-dione (2), 5 beta-pregnan-3 alpha, 15 beta-diol-20-one (3), 5 beta-pregnan-7 beta, 15 beta-diol-3,20-dione (4), 5 beta-pregnan-3 alpha, 7 beta, 15 beta-triol-20-one (5), 5 beta-pregnan-16 alpha-ol-3,20-dione (6), and 5 beta-pregnan-3 alpha, 16 alpha-diol-20-one (7), none previously found in insects. Bioassays with jumping spiders showed compounds 1 and 6 to be feeding deterrents at the 1 microgram level.

An immunohistological study of benign and malignant skin tumours: epithelial aspects

Biopsies of normal skin and benign and malignant skin tumours were studied immunohistologically with nine monoclonal antibodies. The study showed that monoclonal antibodies can clearly delineate antigens expressed in different regions of normal skin and that, in general, tumours retain the antigenic pattern characteristic of the region from which they have arisen. These findings indicate the potential value of analysing these patterns of antigenic expression with a panel of monoclonal antibodies both for understanding the pathogenesis of skin tumours (e.g. basal cell carcinomas) and in their differential diagnosis (e.g. squamous cell carcinoma versus keratoacanthoma).

Langerhans' cells and T cells in human skin tumours: an immunohistological study

In this study normal skin and a range of skin tumours, both benign and malignant, have been examined using monoclonal antibodies to identify the distribution and morphology of Langerhans' cells and T cells, the distribution of T lymphocytes and their subsets have been analysed using monoclonal anti-T cell antibodies. The results indicated that Langerhans' cells can be reliably identified in both normal and malignant skin biopsies using monoclonal antibodies. A striking finding to emerge was that in benign skin lesions Langerhans' cells were increased, whereas in malignant tumours they were not only markedly depleted or absent but also grossly stunted and deformed in outline. The majority of lymphocytes surrounding these skin tumours were shown to be T cells with helper cells outnumbering suppressor cells by a ratio from 2 to 5:1. This study shows the usefulness of immunohistological techniques using monoclonal antibodies for examining the morphology and distribution of Langerhans' cells in skin pathology. In addition they are particularly appropriate for identifying their topographical relationships with other immunologically important cells such as T cells.

Influence of age and sex on serum complement components in children

Concentrations of eight complement components were determined on sera from 419 healthy children (198 boys and 221 girls) aged from 1 to 19 years. A significant correlation between concentration and age for all complement components (C1q, C1s, C4, C3, C5, factor B, properdin, and C1 inhibitor) was observed for girls; in the male population, a significant correlation was present only for C1q, C4, C3, C5, and properdin. The presence of a significant relationship to age suggests that this variable must be considered in establishing normal values of serum complement for children.

The binding of haloperidol to human blood platelets and interactions with 5-hydroxytryptamine and dopamine

1 The binding of [3H]-5-hydroxytryptamine ([3H]-5-HT), [3H]-haloperidol and [3H]-dopamine to human blood platelets was investigated and the effects of unlabelled haloperidol on [3H]-5-HT binding and (+)- and (-)-butaclamol on [3H]-haloperidol were studied. 2 Scatchard analysis did not show any specific binding of [3H]-haloperidol or [3H]-dopamine to platelets, but two binding sites were identified for binding of [3H]-5-HT. 3 Unlabelled haloperidol reduced the binding of 5-HT in concentrations comparable to those inhibigint 5-HT-induced platelet aggregation; (+)- and (-)-butaclamol did not affect the binding of [3H]-haloperidol. 4 It is concluded that haloperidol binding represents saturation of the platelet membrane, and that the platelet is not a suitable model for investigation of dopamine-drug interactions.