Establishment of multicenter COVID-19 therapeutics preclinical test system in Republic of Korea

Throughout the recent COVID-19 pandemic, South Korea led national efforts to develop vaccines and therapeutics for SARS-CoV-2. The project proceeded as follows: 1) evaluation system setup (including Animal Biosafety Level 3 (ABSL3) facility alliance, standardized nonclinical evaluation protocol, and laboratory information management system), 2) application (including committee review and selection), and 3) evaluation (including expert judgment and reporting). After receiving 101 applications, the selection committee reviewed pharmacokinetics, toxicity, and efficacy data and selected 32 final candidates. In the nonclinical efficacy test, we used golden Syrian hamsters and human angiotensin-converting enzyme 2 transgenic mice under a cytokeratin 18 promoter to evaluate mortality, clinical signs, body weight, viral titer, neutralizing antibody presence, and histopathology. These data indicated eight new drugs and one repositioned drug having significant efficacy for COVID-19. Three vaccine and four antiviral drugs exerted significant protective activities against SARS-CoV-2 pathogenesis. Additionally, two anti-inflammatory drugs showed therapeutic effects on lung lesions and weight loss through their mechanism of action but did not affect viral replication. Along with systematic verification of COVID-19 animal models through large-scale studies, our findings suggest that ABSL3 multicenter alliance and nonclinical evaluation protocol standardization can promote reliable efficacy testing against COVID-19, thus expediting medical product development.

Collaboration and health promotion for the health care system – evaluation of the WOL healthcare

Background

Health care and social services are industries with special challenges: Constant emotional demands, the shortage of skilled workers is noticeable (in Germany) and special organizational stresses, not only since the Corona pandemic. This study evaluates the Working out Loud (WOL) program for healthcare, which aims to create a learning culture for interdisciplinary collaboration and network-oriented learning and increases growth-oriented thinking at organizational level.

Methods

The sample consists of 51 participants. From 16 persons data could be analyzed in the pre-post-design of the 10-week intervention accompanied by individual coaching. All respondents work in the health care system in Germany. Dependent variables were collected with validated scales for psychological safety, psychological flexibility, cooperative learning, emotional energy, engagement and voice behavior.

Results

Effects of moderate strength were shown for all variables: psychological safety (Mt1= 4.86, Mt2 = 5.45 t(15) =-1.86, p =.083, d = 0.46), psychological flexibility (Mt1= 3.57, Mt2 = 3.82 t(15) = -2.12, p = .051, d = 0.53), cooperative learning (Mt1= 4.63, Mt2 = 4.81 t(15) = -2.18, p =. 045, d = 0.54), emotional energy (Mt1= 2.70, Mt2 = 2.75 t(15) = -0.82, p = .423, d = 0.20), engagement (Mt1= 2.87, Mt2 = 3.05 t(15) = -1.65, p = .119, d = 0.41)and voice behavior (Mt1= 3.84, Mt2 = 4.05 t(15) = -1.64, p = .120, d = 0.41). Correlations are shown for psychological safety with emotional energy (r = .426, p = .012) and job satisfaction (r = .612, p = .000).

Conclusions

The 10-week WOL Healthcare program can strengthen employees in the important area of health promotion and care. The program serves as behavioral prevention and, by empowering individuals, brings about job crafting structural prevention in the workplace. The intervention follows a bottom-up principle, it is an approach for health promotion in the healthcare sector, that can strengthen patient's safety.

Key messages

• Evidence for the effectiveness of a health promotion intervention for health care workers.

• Organizational learning promotes workers health.

Laboratory information management system for COVID-19 non-clinical efficacy trial data

Background

As the number of large-scale studies involving multiple organizations producing data has steadily increased, an integrated system for a common interoperable format is needed. In response to the coronavirus disease 2019 (COVID-19) pandemic, a number of global efforts are underway to develop vaccines and therapeutics. We are therefore observing an explosion in the proliferation of COVID-19 data, and interoperability is highly requested in multiple institutions participating simultaneously in COVID-19 pandemic research.

Results

In this study, a laboratory information management system (LIMS) approach has been adopted to systemically manage various COVID-19 non-clinical trial data, including mortality, clinical signs, body weight, body temperature, organ weights, viral titer (viral replication and viral RNA), and multiorgan histopathology, from multiple institutions based on a web interface. The main aim of the implemented system is to integrate, standardize, and organize data collected from laboratories in multiple institutes for COVID-19 non-clinical efficacy testings. Six animal biosafety level 3 institutions proved the feasibility of our system. Substantial benefits were shown by maximizing collaborative high-quality non-clinical research.

Conclusions

This LIMS platform can be used for future outbreaks, leading to accelerated medical product development through the systematic management of extensive data from non-clinical animal studies.

Pneumonie grave à SARS-Cov2 chez les patients vaccinés : une étude multicentrique

Introduction

La vaccination contre le SARS-Cov2 réduit le risque d’infection, d’hospitalisation et de décès liés à l’infection. Cependant, certains patients peuvent développer une infection après une vaccination. L’objectif était de décrire les caractéristiques des patients vaccinés et qui développaient une infection grave à SARS-Cov2 nécessitant une admission en réanimation.

Patients et méthodes

Nous avons réalisé une étude de cohorte multicentrique incluant les patients vaccinés avec une infection grave à SARS-CoV2 et admis dans 15 réanimations françaises entre janvier et septembre 2021. Nous avons comparé ces patients à une cohorte publiée de patients non vaccinés avec une pneumonie grave à SARS-Cov2.

Résultats

Cent patients dont 68 (68 %) hommes avec un âge médian de 64 [57–71] ans ont été inclus. Une immunodépression était présente chez 38³8 %) des patients. Parmi les patients ayant eu une sérologie à leur admission, 64 % avait un niveau d’anticorps anti-SARS-Cov2 efficace. À l’admission en réanimation, le score SOFA médian était de 4 [4–6,3] et le rapport PaO2/FiO2 médian de 84 [69–128]mmHg. Une oxygénothérapie humidifiée à haut débit a été initiée chez 79 (79 %) patients et une ventilation non invasive chez 18 (18 %) patients. Au cours de la prise en charge, 48 (48 %) patients ont nécessité le recours à l’intubation oro-trachéale avec une durée de ventilation de 11 [5–19] jours. Sur une durée de séjout médiane de 8 [4–20] jours, 31 patients sont décédés. L’âge (OR pour 5 années supplémentaires 1,38 [1,02–1,85], p = 0,035) et le score SOFA à l’admission (OR 1,40 [1,14–1,72] par point, p = 0,002) étaient indépendamment associés à la mortalité. En comparaison avec les patients non vaccinés, les patients vaccinés présentaient moins souvent du diabète (16 [16 %] vs. 351 [27 %], p = 0,029), étaient plus souvent immunodéprimés (38 [38 %] vs. 109 (8,3 %), p < 0,0001), insuffisants rénaux chroniques (24 [24 %] vs. 89 (6,8 %), p < 0,0001), insuffisants cardiaques chroniques (16 [16 %] vs. 58 [4,4 %], p < 0,0001), and insuffisants hépatiques chroniques chronic liver disease(3 [3 %] vs. 8 [0,6 %], p = 0,037). Malgré une gravit similaire à l’admission, les patients vaccinés nécessitaient moins souvent le recours à la ventilation invasive, que ce soit à l’admission ou au cours de la prise en charge en réanimation (23 [23 %] vs. 785 [59,7 %], p < 0,0001, et 48 [48 %] vs. 930 [70,7 %], p < 0,0001, respectivement). Il n’y avait pas de différence en terme de mortalité (31 [31 %] vs. 379 [28,8 %], p = 0,64).

Conclusion

Les infections sévères à SARS-Cov2 peuvent survenir chez des patients vaccinés, principalement ceux immunodéprimés ou avec des insuffisances rénale, hépatique ou cardiaque. L’âge et la gravité à l’admission sont associés à la mortalité.

Visualizing myocardial injury from elective cardioversion with CMR

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Association of Cardiothoracic Anaesthesiologists Research Grant

Background

Despite everyday use of electrical interventions in cardiovascular care, the extent and type of concomitant myocardial injury is not fully understood. Current literature disagrees about the question whether and how cardioversion or defibrillation damage the myocardium, especially when serologic markers are used. Such markers are not always cardiac-specific, nor diagnostic for type and region of myocardial injury. These limitations may be overcome by parametric T1 and T2 mapping. We aimed to investigate whether the acute and long-term impact of electrical cardioversion on myocardial structure and function is detectable using CMR imaging.

Methods

Patients scheduled for elective cardioversion were enrolled to undergo three CMR exams (3 Tesla): on the morning prior to cardioversion to assess pre-existing injury; two to five hours after cardioversion to assess the acute response; and six to ten weeks later to investigate chronic injury. The CMR exam studied left ventricular (LV) function, T2 mapping to measure edema, and extracellular volume (ECV) from T1 maps to measure diffuse fibrosis. Both the degree of injury and proportion (%) of myocardial area affected were analysed.

Results

Eight patients completed the study, requiring 1-2 shocks (totalling 120-300 J biphasic energy) to achieve sinus rhythm. LV ejection fraction increased after cardioversion from 47 ± 13% to 55 ± 15% (p = 0.020), and was 52 ± 16% at the third exam (p = 0.199). Even prior to intervention, some patients showed edema (baseline T2 &gt; 40ms) afflicting 49 ± 23% of their LV myocardium. Area affected by edema expanded to 72 ± 18% after cardioversion (p = 0.002) and returned to 54 ± 24% by the third exam. T2 rose from baseline (40.4 ± 1.8ms) after cardioversion acutely to 44.1 ± 5.2ms (p = 0.028) and normalized until the late exam (40.8 ± 3.1ms). Myocardial area affected by diffuse fibrosis (ECV &gt; 30%) was 28.3 ± 9.4% at baseline and 38.8 ± 18.9% late after cardioversion (p = 0.018). Pathologic T2 increases (indicative of edema) were not observed in all patients, but individuals with higher baseline ECV also experienced greater T2 increase after cardioversion (r = 0.840, p = 0.036).

Conclusion

Elective cardioversion improves LV systolic function, but also aggravates myocardial edema and possibly adds to diffuse fibrosis during several weeks thereafter. Such sequelae of cardioversion were observed mainly in patients with a greater burden of pre-existing myocardial injury. More data is needed to corroborate these preliminary findings and to study whether this type of myocardial injury predicts worse outcome. Moreover, changes in CMR markers caused by electrical interventions including defibrillation, may have the potential to confound diagnostic assessments of the underlying cardiac injury.

Abstract Figure

Changes in right ventricular deformation during hyperoxia versus normoxaemia in patients with stable coronary artery disease and healthy controls

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Local research funds of the Department of Anaesthesiology and Pain medicine, Bern University Hospital, Inselspital

Background

During anaesthesia, emergency and critical care treatment, patients with coronary artery disease (CAD) are often exposed to supraphysiologic arterial oxygen tensions. The balance between benefits and risks of hyperoxia (HO) in patients with stable CAD is controversial, with reports about reduced left ventricular contractility or increased morbidity and mortality. Effects of HO on right ventricular (RV) function in CAD are less well described. Advanced cardiovascular magnetic resonance (CMR) feature tracking software allows assessment of myocardial deformation, which may serve as early marker of ventricular dysfunction. In a CMR study we quantified the effect of HO on RV function and deformation in awake healthy participants and CAD patients.

Methods

Ten healthy participants and 26 patients with stable one- or two-vessel obstructive CAD were included. In a CMR study, a short-axis function stack of both ventricles was obtained first at room air (RA), then during HO induced by breathing oxygen at 10L/min for 5 minutes via a non-rebreathing facemask. RV strain was analysed by a blinded reader who manually traced epicardial and endocardial contours of the RV for determining peak global circumferential strain (RVGCS), time to peak strain, systolic and diastolic strain rate parameters.

Results

RV ejection fraction did not change with O2 breathing in the healthy control group (RA, 56 ± 12% vs. HO, 55 ± 10%, p = 0.999) nor in the CAD group (RA, 60 ± 8% vs. HO, 60 ± 9%, p = 0.609). RV cardiac index decreased significantly in CAD patients from RA (2.62 ± 0.88 L/min/m2) to HO (2.42 ± 0.77L/min/m2, p = 0.002). The decrease in the control group was not significant (RVCI: RA 3.28 ± 1.29 vs HO 3.04 ± 1.27L/min/m2 p = 0.068).

In the healthy control group, RVGCS, time to peak strain, and systolic strain rate did not change significantly with HO (RVGCS: RA, -14.6 ± 3.9% vs. HO, -13.1 ± 4.5%, p = 0.353; time to peak strain: 282 ± 45ms vs. 286 ± 29ms, p = 0.540; and systolic strain rate: -0.85 ± 0.27/s vs. -0.67 ± 0.28, p = 0.055).

In CAD patients RVGCS worsened from -14.8 ± 3.3% on RA to -13.9 ± 3.6% at HO (p = 0.040). Time to peak strain became significantly prolonged from 319 ± 40ms on RA to 329 ± 49ms at HO (p = 0.046). This was accompanied by a reduction of systolic strain rate from -0.79 ± 0.27/s to -0.75 ± 0.22/s (p = 0.037). Diastolic strain parameters did not differ significantly between RA and HO in either group.

Conclusion

In our cohort of CAD patients HO significantly reduced RV cardiac index and impaired systolic deformation as determined by CMR feature tracking. Studies are required in a larger patient cohort with regional analysis and assessment of longitudinal and radial deformation to assess the role of hyperoxia in CAD.

Abstract Figure. Change in RV Peak Circumferential Strain

[Successful rituximab treatment of recurrent glomerulonephritis associated with antibodies against the glomerular basement membrane]

This article presents a case of recurrent anti-GBM disease (with antibodies against the glomerular basement membrane [GBM]) in a 17-year-old patient successfully treated with rituximab. Kidney biopsy with detection of linear deposition of immunoglobulin G (IgG) along the basement membrane is the diagnostic gold standard, which should be accompanied by serological testing. However, standard assays for the detection of anti-GBM antibodies have a high rate of false-negative results. In this particular case, an increase in proteinuria despite standard therapy (plasmapheresis, steroids, cyclophosphamide) was the clinical correlate of relapsing disease. The use of rituximab completely resolved the recurrent anti-GBM disease.

Effects of lysophospholipid supplementation to reduced energy, crude protein, and amino acid diets on growth performance, nutrient digestibility, and blood profiles in broiler chickens

Two experiments investigated the effects of lysophospholipid (LPL) supplementation on low-energy and low-nitrogenous diets for broilers. A total of 300 one-day-old male chicks (Ross 308) was allotted to 5 treatments in a completely randomized design. Each group consisted of 6 replicates with 10 birds each. Experimental diet I included positive control (PC) having 3,025 (starter), 3,150 (grower), and 3,200 kcal/kg (finisher) of ME; negative control (NC) was 150 kcal/kg of ME lower than PC, and LPL-05, LPL-10, and LPL-15 treatments were NC + 0.05%, 0.10%, and 0.15% of LPL supplementation, respectively. Experimental diet II included positive control (PC) having a formulated amount of crude protein including Lys and Met + Cys that met the Ross 308 standards; negative control (NC) was 4% lower CP and AA than PC; other treatments were supplemented with LPL at 0.05% (LPL-05), 0.10% (LPL-10), and 0.15% (LPL-15) into the NC, respectively. Experiment I showed that growth performance linearly increased as the LPL inclusion increased (P < 0.001). Broilers fed LPL-10 and LPL-15 increased digestibility of DM (P < 0.05), crude protein (P < 0.01), and total amino acids (P < 0.01) compared to NC. Serum glucose (P < 0.01) and high-density lipoprotein (P < 0.05) concentrations were greater in groups fed LPL-10 than those fed PC. Furthermore, leg muscle increased in birds fed LPL-10 compared with NC (P < 0.05). Experiment II observed a linear response to LPL supplementation in the whole period, in terms of body weight gain (P = 0.015) and feed conversion ratio (P = 0.027). Feeding of 0.15% LPL had promising effects on digestibility of crude protein and ether extract compared with NC (P < 0.01 and P < 0.05, respectively). Overall, LPL could be considered as a feed additive to reduced energy (−150 kcal/kg) or nitrogenous diets (−5%) in order to improve growth performance and nutrient digestibility without adverse effects on lymphoid organs and hepatic enzyme of broilers.

Co-delivery of antigens and immunostimulants via a polymersome for improvement of antigen-specific immune response

Bilayer spherical polymersome based adjuvants promote the antigen cellular uptake into antigen-presenting cells. The administration of polymersome loading OVA and MPLA induce the secretion of cytokines by macrophage activation and elicit potent antigen-specific antibody responses.

Abstract A114: Quantitative mass spectrometry imaging: A game changer in the pharmaceutical industry

Developing a drug requires to demonstrate its efficacy in preclinical and clinical studies but also to characterize its pharmacokinetics properties. If Quantitative Whole-Body Autoradiography (QWBA) is still a gold standard to support the design of radiolabelled clinical studies, its lack of molecular specificity limits the understanding of the distribution of the drug and its metabolites, with no establishing of separate quantitative results for each target tissue of interest. On the contrary, the use of high resolution mass spectrometers such as FT-ICR MS allows a quantitative characterization of the metabolic profile of the drug at the tissue level in order to further understand its behaviour in the organism. A comparative analysis between QWBA and QMSI was applied as a complementary approach to follow chloroquine and one of its metabolites (desethyl-chloroquine) at different time-points after a single administration of a radiolabeled dose to Long-Evans male rats (30 mg/kg). 1H-Chloroquine and 1H-desethyl chloroquine were well detected by MALDI-FTICR in the eye including; the uveal tract, the vitreous humor, the lens and the Harderian gland. In the mid whole-body region, both compounds were also detected in various organs from the unique prepared T4h sections. Interestingly the two compounds were co-localized into the tissue sections and their distributions matched the zones obtained by QWBA. In QWBA additional regions containing the radiolabeled moiety could be clearly identified because of the high sensitivity of the technique. The advantage brought by MALDI QMSI was the ability to discriminate between parent drug 1H-choloroquine and its metabolite 1H-desethyl chloroquine so that each compound had its own distribution image and thus its own quantification data directly in one tissue section. The used labeled forms of both compounds during the matrix deposit allowed normalizing the data for each position targeted with the MALDI onto the section of interest and the calibration range of both 1H-choloroquine and 1H-desethyl chloroquine and quantifying each compound into the organs of interest with the ILC approach. Finally the QMSI was able to demonstrate the disappearance of the drug and its metabolite with time to better understand differential pharmacokinetics analysis demonstrating the additional input of the technology compared to QWBA.

Citation Format: Rima Ait-Belkacem, Guillaume Hochart, Joseph Marini, Aurore Tomezyk, p Mantefeul, B. Jung, David Bonnel, Don Mc Kenzie, Jonathan Stauber. Quantitative mass spectrometry imaging: A game changer in the pharmaceutical industry [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr A114. doi:10.1158/1535-7163.TARG-19-A114

Effects of lysophospholipid on growth performance, carcass yield, intestinal development, and bone quality in broilers

A study was conducted to evaluate the effects of supplementing different levels of lysophospholipid (LPL) to normal or reduced energy diets on growth performance, carcass yield, intestinal morphology, and skeletal development in broilers. A total of 960 one-day-old Cobb 500 male birds were allocated using a 2 × 4 factorial arrangement with 2 energy levels (NE: normal and RE: 100 kcal/kg metabolizable energy reduction) and 4 LPL supplement levels (0, 0.025, 0.050, and 0.075%). Three diet phases were fed throughout the trial: starter (days 0 to 7), grower (days 8 to 21), and finisher (days 22 to 42) phases. Body weight (BW), feed intake (FI), and feed conversion ratio were calculated at the end of each phase. At day 7 and 21, duodenum and jejunum samples were collected for intestinal morphology and claudin-3 expression analyses, and tibia were sampled for bone quality analyses. At day 42, 4 birds per replicate were selected to measure carcass yield. The results showed low metabolizable energy diets impaired bird's growth performance, intestine development, and bone quality. The 0.075% LPL supplement in NE improved BW, BW gain, and FI in the finisher and overall period compared with no LPL supplement in NE (P < 0.05). In RE, the 0.025% LPL supplement significantly improved growth performance compared to the other treatments in RE (P < 0.05). The interactions on processing parameters were detected with LPL supplement in NE diets; 0.025, 0.05, and 0.075% LPL supplements significantly increased pectoral major percentages compared to the one without LPL supplement in NE (P < 0.05). The 0.075% LPL supplement increased dressing percentage (cold carcass weight/live BW) compared with the others (P < 0.05). The intestine morphology results showed LPL had positive effects on intestine development mainly during the early age (day 7) and claudin-3 expression at both day 7 and 21. Furthermore, LPL supplement significantly increased the total Ca and P deposition and positively affected the bone structure development. In summary, dietary LPL supplementation promoted growth performance, carcass yield, intestinal development, intestinal health, and bone quality.

Diagnostic et Prise en Charge de l’Acidose Métabolique Recommandations formalisées d’experts communes Société de réanimation de langue française (SRLF) – Société française de médecine d’urgence (SFMU)

L’acidose métabolique est un trouble fréquemment rencontré en médecine d’urgence et en médecine intensive réanimation. La littérature s’étant enrichie de nouvelles données concernant la prise en charge de l’acidose métabolique, la Société de Réanimation de Langue Française (SRLF) et la Société Française de Médecine d’Urgence (SFMU) ont élaboré des recommandations formalisées d’experts selon la méthodologie GRADE. Les champs de la stratégie diagnostique, de l’orientation et de la prise en charge thérapeutique ont été traités et vingt-neuf recommandations ont été formulées : quatre recommandations fortes (Grade 1), dix recommandations faibles (Grade 2) et quinze avis d’experts. Toutes ont obtenu un accord fort. L’application des méthodes d’Henderson-Hasselbalch et de Stewart pour le diagnostic du mécanisme de l’acidose métabolique est discutée et un algorithme diagnostique est proposé. L’utilisation de la cétonémie et des lactatémies veineuse et capillaire est également traitée. L’intérêt du pH, de la lactatémie et de sa cinétique pour l’orientation des patients en pré-hospitalier et aux urgences est envisagé. Enfin, les modalités de l’insulinothérapie au cours de l’acidocétose diabétique, les indications de la perfusion de bicarbonate de sodium et de l’épuration extra-rénale ainsi que les modalités de la ventilation mécanique au cours des acidoses métaboliques sévères sont traitées dans la prise en charge thérapeutique.

Adgrf5 contributes to patterning of the endothelial deep layer in retina

Neovascularization of the inner retinal space is a major cause of vision loss. In retinal angiomatous proliferation (RAP) syndrome, newly formed vessels originate from the retinal plexus and invade the inner retinal space. However, the molecular pathways preventing subretinal vascularization remain largely unknown. In most murine models of RAP, pathological neovascularization occurs concomitantly with the development of the retinal vasculature. Here, we demonstrate that disturbing the sequence of morphogenetic events that shape the three-layered retinal vascular network leads to subretinal vascularization. Sprouts emerging from the perivenous region after the first postnatal week extended toward the retinal space where they merged into the deep layer. The small GTPase Rac1 was required for the formation of these vascular extensions and the vascular inner plexus is formed coaxially to the overarching veins. The adhesion receptor Adgrf5 was highly expressed in the endothelium of the central nervous system, where it regulates blood–brain barrier formation. The vascular superficial plexus of Adgrf5 mutant mouse retinae exhibited an increased vascular density in the perivenous areas with increased projections toward the inner plexus where they subsequently created hyper-dense endothelial cells (EC) clusters. Disturbing the perivenous pool of EC thus significantly altered the inner plexus formation. These abnormalities culminated in transient vascular protrusions in the inner retinal space. Taken together, these results reveal a previously unobserved vascular morphogenetic defect in Adgrf5 knockout mice, implicating a role for ADGRF5 in the initiation of subretinal vascularization. Our findings also illustrate how vein-derived EC shape the inner retinal layer formation and could control the appearance of angiomatous malformations.

Ultra-deep next-generation sequencing of plasma cell-free DNA in patients with advanced lung cancers: results from the Actionable Genome Consortium

BACKGROUND

Noninvasive genotyping using plasma cell-free DNA (cfDNA) has the potential to obviate the need for some invasive biopsies in cancer patients while also elucidating disease heterogeneity. We sought to develop an ultra-deep plasma next-generation sequencing (NGS) assay for patients with non-small-cell lung cancers (NSCLC) that could detect targetable oncogenic drivers and resistance mutations in patients where tissue biopsy failed to identify an actionable alteration.

PATIENTS AND METHODS

Plasma was prospectively collected from patients with advanced, progressive NSCLC. We carried out ultra-deep NGS using cfDNA extracted from plasma and matched white blood cells using a hybrid capture panel covering 37 lung cancer-related genes sequenced to 50 000× raw target coverage filtering somatic mutations attributable to clonal hematopoiesis. Clinical sensitivity and specificity for plasma detection of known oncogenic drivers were calculated and compared with tissue genotyping results. Orthogonal ddPCR validation was carried out in a subset of cases.

RESULTS

In 127 assessable patients, plasma NGS detected driver mutations with variant allele fractions ranging from 0.14% to 52%. Plasma ddPCR for EGFR or KRAS mutations revealed findings nearly identical to those of plasma NGS in 21 of 22 patients, with high concordance of variant allele fraction (r = 0.98). Blinded to tissue genotype, plasma NGS sensitivity for de novo plasma detection of known oncogenic drivers was 75% (68/91). Specificity of plasma NGS in those who were driver-negative by tissue NGS was 100% (19/19). In 17 patients with tumor tissue deemed insufficient for genotyping, plasma NGS identified four KRAS mutations. In 23 EGFR mutant cases with acquired resistance to targeted therapy, plasma NGS detected potential resistance mechanisms, including EGFR T790M and C797S mutations and ERBB2 amplification.

CONCLUSIONS

Ultra-deep plasma NGS with clonal hematopoiesis filtering resulted in de novo detection of targetable oncogenic drivers and resistance mechanisms in patients with NSCLC, including when tissue biopsy was inadequate for genotyping.

Insuffisances rénales aiguës : actes du 5e Séminaire de recherche translationnelle de la Société de réanimation de langue française (Paris, 4 décembre 2018)

Le séminaire annuel de la commission de recherche translationnelle de la SRLF a eu lieu à Paris le 4 décembre 2018. Ce séminaire a pour but de réunir des cliniciens et scientifiques autour de grandes thématiques de recherche en médecine intensive et réanimation. La cinquième édition a porté sur l’insuffisance rénale aiguë, problématique quotidienne importante des réanimateurs. Les interventions se sont intéressées à la physiopathologie des diverses formes d’insuffisance rénale aiguë, à la récupération rénale, aux modèles expérimentaux, à l’hémodynamique régionale ou encore aux innovations technologiques en épuration extrarénale.

Prise en charge du transplanté rénal en réanimation

La transplantation rénale est la thérapeutique de choix de l’insuffisance rénale chronique au stade ultime, son usage est de plus en plus large. Les progrès réalisés dans les traitements immunosuppresseurs ont permis une amélioration de la durée de vie du greffon, mais au prix d’une augmentation des complications cardiovasculaires et infectieuses. Environ 5 % des transplantés rénaux présentent des complications sévères qui nécessitent une prise en charge intensive. Elles sont principalement de cause infectieuse et dominées par la défaillance respiratoire aiguë. L’insuffisance rénale aiguë est commune, elle affecte la fonction du greffon à court et long termes. La prise en charge en réanimation de ces complications doit prendre en compte le terrain particulier du transplanté rénal et les effets délétères de l’immunosuppression, condition nécessaire à une amélioration de la mortalité qui reste à plus de 30 %.

Faire face à la menace infectieuse en réanimation : de la veille épidémiologique à l’innovation. Actes du séminaire de recherche translationnelle de la Société de réanimation de langue française (5 décembre 2017)

Le séminaire annuel de la Commission de recherche translationnelle de la SRLF a pour but de réunir des cliniciens et scientifiques autour de grandes thématiques de recherche en médecine intensive et réanimation. La quatrième édition du séminaire a porté sur l’infectiologie, thématique au centre des préoccupations des réanimateurs. Les interventions se sont ainsi focalisées sur des aspects aussi divers que les relations hôtes–pathogènes, la contribution de pathogènes dans des pathologies habituellement considérées comme non infectieuses, l’émergence de nouveaux risques infectieux, les avancées technologiques du diagnostic moléculaire des infections et le développement de stratégies antibactériennes alternatives à l’antibiothérapie classique.

Risk factors for anastomotic leakage following ileosigmoid or ileorectal anastomosis

AIM

Reconstruction with an ileosigmoidal anastomosis (ISA) or ileorectal anastomosis (IRA) is a surgical option after a subtotal colectomy. Anastomotic leakage (AL) is a problematic complication and high rates have been reported, but there is limited understanding of the risk factors involved. The aim of this study was to assess the established and potential predictors of AL following ISA and IRA.

METHOD

This was a retrospective cohort study including all patients who had undergone ISA or IRA at three Swedish referral centres for colorectal surgery between January 2007 and March 2015. Data regarding clinical characteristics, treatment and outcome were collected from medical records. Univariate and multivariate logistic regression models were used to determine the association between patient and treatment related factors and the cumulative incidence of AL.

RESULTS

In total, 227 patients were included. Overall, AL was detected amongst 30 patients (13.2%). Amongst patients undergoing colectomy with synchronous ISA or IRA (one-stage procedure), AL occurred in 23 out of 120 (19.2%) compared with seven out of 107 (6.5%) after stoma reversal with ISA or IRA (two-stage procedure) (P = 0.004). In addition, the multivariate analyses revealed a statistically significantly lower odds ratio for AL following a two-stage procedure (OR 0.10, 95% CI 0.03-0.41, P = 0.001).

CONCLUSIONS

This study confirms high rates of AL following ISA and IRA. In particular, a synchronous procedure with colectomy and ISA/IRA carries a high risk of AL.

Extensions to the HISA Standard – the SynEx Computing Environment

Objectives: This paper reports on the integration work required to support the delivery of healthcare. Specifically, four elements are included being: the DHE (a standards based distributed healthcare environment), Synapses which is a patient record server, XML as a technology to deliver records, and finally two client applications that facilitate structured data entry (SDE) and the remote booking of specialist services. Methods: A general motivation for the work is presented and augmented on hand of a clinical scenario. Additionally, the adoption of a middleware approach is reviewed. The role of computerised patient records is described followed by an account of a federated record server. The approach favoured by standards bodies in utilising XML is covered and the tailoring to suit the needs of the integration is explained. The main practical challenges in achieving integration are presented, one of these being the mapping between the DHE data model and the Synapses server record architecture.

Results: The described environment has been demonstrated to provide the functionality that is required and in addition it has been shown that the engineering challenges can be met in a controlled and orderly manner.

Conclusions: The role of the DHE middleware component acting as an ‘anchor’ has been shown to be a valid one onto which other specialised components can be added to provide a richer service environment. Additionally, it has been demonstrated that XML is a good candidate technology that facilitates connectivity to client applications over an extranet. The demands inherent in both the clinical scenario and the computerised patient record can be met by the computing environment described in the paper.

Pharmacokinetic study of anidulafungin in ICU patients with intra-abdominal candidiasis

Background

Only limited pharmacokinetic data are available for anidulafungin in ICU patients, especially in patients treated for severe intra-abdominal infection (IAI).

Methods

This was a prospective multicentre observational study in ICU patients with suspected yeast IAI. All patients received an intravenous loading dose of 200 mg of anidulafungin, followed by 100 mg/day. Thirteen blood samples were drawn between day 1 and day 5 for pharmacokinetic analysis. Samples were analysed by an HPLC-tandem MS method. Demographics and SAPS2 and SOFA scores were recorded.

Results

Fourteen patients with a median age (IQR) of 62 years (48-70) and with a mean BMI of 30.5 kg/m 2 were included from three centres; 57.1% were women. Their median (IQR) SAPS2 score was 54 (45-67) and their median (IQR) SOFA score was 8 (7-12). Six patients with community-acquired IAI and eight patients with nosocomial-acquired IAI were included. Twelve yeasts were isolated: six Candida albicans , two Candida glabrata , two Candida tropicalis , one Candida parapsilosis and one Candida krusei . Pharmacokinetic parameters were as follows [mean (% coefficient of variation)]: C max (mg/L) = 6.0 (29%); T max (h) = 1.6 (25.8%); C min (mg/L) = 3.2 (36.8%); AUC 0-24 (mg·h/L) = 88.9 (38.6%); t 1/2 (h) = 42.1 (68.2%); CL (L/h) = 1.2 (42.3%); and V (L) = 72.8 (87.8%). A two-compartment model best described the anidulafungin concentrations in the population pharmacokinetic study.

Conclusions

The pharmacokinetic parameters of anidulafungin in critically ill ICU patients with complicated IAI are similar to those observed in the literature. However, an increased V and a longer t 1/2 were observed in this study. (EudraCT No. 2010-018695-25).

B-cell activating factor BAFF reflects patients' immunological risk profile after kidney transplantation

The B-cell activating factor BAFF plays an important role in the development and maturation of B-lymphocytes, which can contribute to the generation of donor-specific antibodies and thus may influence graft function and graft survival. Inconsistent data on the role of BAFF levels after renal transplantation for the formation of donor-specific antibodies and the contribution for allograft rejection exist. The aim of the current study was to determine to what extent the degree of pre-immunization is reflected by each patient's BAFF levels before transplantation and in the follow-up. Furthermore, the impact of BAFF on allograft rejection frequency as well as severity and resulting allograft function over time was analyzed. Additionally, the impact of viral infections on BAFF levels after transplantation - as a potential confounder - was examined. For this purpose, a group of pre-sensitized patients (PRA>0%, (52±24% on average), n=40) was compared with non-sensitized patients (PRA=0%, n=62) and in a subsequent analysis stratification in accordance to the detected BAFF level was performed. Pre-sensitized patients had significantly higher BAFF levels before transplantation and suffered significantly more often from early steroid-resistant, mainly antibody-mediated rejections. A result which was confirmed also in highly sensitized patients with PRA levels >50%. Additionally, in the follow-up patients with either rising BAFF levels over time or BAFF levels above the median also had significantly more often antibody mediated rejections. Additionally, patients with BAFF levels above detected median even displayed impaired creatinine values as well as an induced eGFR slope up to month 48 after transplantation. The occurrence of viral infections (CMV, BKV) was only an additional influencing factor in the absence of concomitant allograft rejections. Therefore, the B-cell proliferation factor BAFF appears not only to reflect the immunological risk profile of patients in the context of kidney transplantation, it may possibly be further developed as a predictor of patients with an increased risk profile for subsequent allograft rejection and impaired allograft function.

A diaper-embedded disposable nitrite sensor with integrated on-board urine-activated battery for UTI screening

This paper reports a low-cost solution to the early detection of urinary nitrite, a common surrogate for urinary tract infection (UTI). We present a facile method to fabricate a disposable and flexible colorimetric [1] nitrite sensor and its urine-activated power source [2] on a hydrophobic (wax) paper through laser-assisted patterning and lamination. Such device, integrated with interface circuitry and a Bluetooth low energy (BLE) module can be embedded onto a diaper, and transmit semi-quantitative UTI monitoring information in a point-of-care and autonomous fashion. The proposed nitrite sensing platform achieves a sensitivity of 1.35 ms/(mg/L) and a detection limit of 4 mg/L.

Functional characterisation and cell specificity of BvSUT1, the transporter that loads sucrose into the phloem of sugar beet (Beta vulgaris L.) source leaves

Sugar beet (Beta vulgaris L.) is one of the most important sugar-producing plants worldwide and provides about one third of the sugar consumed by humans. Here we report on molecular characterisation of the BvSUT1 gene and on the functional characterisation of the encoded transporter. In contrast to the recently identified tonoplast-localised sucrose transporter BvTST2.1 from sugar beet taproots, which evolved within the monosaccharide transporter (MST) superfamily, BvSUT1 represents a classical sucrose transporter and is a typical member of the disaccharide transporter (DST) superfamily. Transgenic Arabidopsis plants expressing the β-GLUCURONIDASE (GUS) reporter gene under control of the BvSUT1-promoter showed GUS histochemical staining of their phloem; an anti-BvSUT1-antiserum identified the BvSUT1 transporter specifically in phloem companion cells. After expression of BvSUT1 cDNA in bakers' yeasts (Saccharomyces cerevisiae) uptake characteristics of the BvSUT1 protein were studied. Moreover, the sugar beet transporter was characterised as a proton-coupled sucrose symporter in Xenopus laevis oocytes. Our findings indicate that BvSUT1 is the sucrose transporter that is responsible for loading of sucrose into the phloem of sugar beet source leaves delivering sucrose to the storage tissue in sugar beet taproot sinks.

TGFβ engages MEK/ERK to differentially regulate benign and malignant pancreas cell function

While TGFβ signals are anti-proliferative in benign and well-differentiated pancreatic cells, TGFβ appears to promote the progression of advanced cancers. To better understand dysregulation of the TGFβ pathway, we first generated mouse models of neoplastic disease with TGFβ receptor deficiencies. These models displayed reduced levels of pERK irrespective of KRAS mutation. Furthermore, exogenous TGFβ led to rapid and sustained TGFBR1-dependent ERK phosphorylation in benign pancreatic duct cells. Similar to results that our group has published in colon cancer cells, inhibition of ERK phosphorylation in duct cells mitigated TGFβ-induced upregulation of growth suppressive pSMAD2 and p21, prevented downregulation of the pro-growth signal CDK2 and ablated TGFβ-induced EMT. These observations suggest that ERK is a key factor in growth suppressive TGFβ signals, yet may also contribute to detrimental TGFβ signaling such as EMT. In neoplastic PanIN cells, pERK was not necessary for either TGFβ-induced pSMAD2 phosphorylation or CDK2 repression, but was required for upregulation of p21 and EMT indicating a partial divergence between TGFβ and MEK/ERK in early carcinogenesis. In cancer cells, pERK had no effect on TGFβ-induced upregulation of pSMAD2 and p21, suggesting the two pathways have completely diverged with respect to the cell cycle. Furthermore, inhibition of pERK both reduced levels of CDK2 and prevented EMT independent of exogenous TGFβ, consistent with most observations identifying pERK as a tumor promoter. Combined, these data suggest that during carcinogenesis pERK initially facilitates and later antagonizes TGFβ-mediated cell cycle arrest, yet remains critical for the pathological, EMT-inducing arm of TGFβ signaling.

Effects of lysophospholipid supplementation to lower nutrient diets on growth performance, intestinal morphology, and blood metabolites in broiler chickens

The purpose of this research was to investigate the effects of dietary lysophospholipid (LPL) supplementation on low-energy, crude protein, and selected amino acids on growth performance, intestinal morphology, blood metabolites, inflammatory response, and carcass traits in broiler chickens. A total of 300 one-day-old male chicks (Ross 308) were assigned to 5 treatments, with 6 replications of 10 birds each in a completely randomized design. The 5 treatments were: positive control (PC) without LPL supplementation and adequate in all nutrients, negative control (NC) without LPL, and reduced 150 kcal/kg of metabolizable energy and reduced 5 to 6% of crude protein and selected amino acids including Lys, Met, Thr, and Trp in a calculated amount relative to the PC, NC + 0.05% LPL (LPL05), NC + 0.10% LPL (LPL10), and NC + 0.15% LPL (LPL15). Feeding LPL linearly improved growth performance, feed conversion ratio, ether extract, and protein digestibility. LPL supplementation on low-energy and nitrogenous diets showed significant enhancements in metabolic profiles of blood glucose, protein utilization, and immune system functions. These improvements influenced carcass composition, especially in relative weights of pancreas and breast muscle. In contrast, LPL addition showed no significant effects on relative weights of immune organs, gizzard, and abdominal fat. The NC birds were more susceptible to inflammation via modulating the secretion of interleukin-1 (IL-1) and increasing crypt depth in the jejunal and duodenal segments. However, the inclusion of 0.05% LPL to the NC diet could alleviate inflammation with increased jejunal villi height, ratio of villi height to crypt depth, and decreased IL-1 level. Overall, LPL promotes growth performance, nutrient utilization, gut health, anti-inflammation, and muscle yields when applied to diets of broiler chickens with lower levels of energy, crude protein, and selected amino acids.