Correction to "Cathepsin-Targeting SARS-CoV-2 Inhibitors: Design, Synthesis, and Biological Activity"

[This corrects the article DOI: 10.1021/acsptsci.3c00313.].

Filamentous fungus-produced human monoclonal antibody provides protection against SARS-CoV-2 in hamster and non-human primate models

Monoclonal antibodies are an increasingly important tool for prophylaxis and treatment of acute virus infections like SARS-CoV-2 infection. However, their use is often restricted due to the time required for development, variable yields and high production costs, as well as the need for adaptation to newly emerging virus variants. Here we use the genetically modified filamentous fungus expression system Thermothelomyces heterothallica (C1), which has a naturally high biosynthesis capacity for secretory enzymes and other proteins, to produce a human monoclonal IgG1 antibody (HuMab 87G7) that neutralises the SARS-CoV-2 variants of concern (VOCs) Alpha, Beta, Gamma, Delta, and Omicron. Both the mammalian cell and C1 produced HuMab 87G7 broadly neutralise SARS-CoV-2 VOCs in vitro and also provide protection against VOC Omicron in hamsters. The C1 produced HuMab 87G7 is also able to protect against the Delta VOC in non-human primates. In summary, these findings show that the C1 expression system is a promising technology platform for the development of HuMabs in preventive and therapeutic medicine.

A tetravalent bispecific antibody outperforms the combination of its parental antibodies and neutralizes diverse SARS-CoV-2 variants

The devastating impact of COVID-19 on global health shows the need to increase our pandemic preparedness. Recombinant therapeutic antibodies were successfully used to treat and protect at-risk patients from COVID-19. However, the currently circulating Omicron subvariants of SARS-CoV-2 are largely resistant to therapeutic antibodies, and novel approaches to generate broadly neutralizing antibodies are urgently needed. Here, we describe a tetravalent bispecific antibody, A7A9 TVB, which actively neutralized many SARS-CoV-2 variants of concern, including early Omicron subvariants. Interestingly, A7A9 TVB neutralized more variants at lower concentration as compared to the combination of its parental monoclonal antibodies, A7K and A9L. A7A9 also reduced the viral load of authentic Omicron BA.1 virus in infected pseudostratified primary human nasal epithelial cells. Overall, A7A9 displayed the characteristics of a potent broadly neutralizing antibody, which may be suitable for prophylactic and therapeutic applications in the clinics, thus highlighting the usefulness of an effective antibody-designing approach.

Cathepsin-Targeting SARS-CoV-2 Inhibitors: Design, Synthesis, and Biological Activity

Cathepsins (Cats) are proteases that mediate the successful entry of SARS-CoV-2 into host cells. We designed and synthesized a tailored series of 21 peptidomimetics and evaluated their inhibitory activity against human cathepsins L, B, and S. Structural diversity was realized by combinations of different C-terminal warhead functions and N-terminal capping groups, while a central Leu-Phe fragment was maintained. Several compounds were identified as promising cathepsin L and S inhibitors with Ki values in the low nanomolar to subnanomolar range, for example, the peptide aldehydes 9a and 9b (9a, 2.67 nM, CatL; 0.455 nM, CatS; 9b, 1.76 nM, CatL; 0.512 nM, CatS). The compounds' inhibitory activity against the main protease of SARS-CoV-2 (Mpro) was additionally investigated. Based on the results at CatL, CatS, and Mpro, selected inhibitors were subjected to investigations of their antiviral activity in cell-based assays. In particular, the peptide nitrile 11e exhibited promising antiviral activity with an EC50 value of 38.4 nM in Calu-3 cells without showing cytotoxicity. High metabolic stability and favorable pharmacokinetic properties make 11e suitable for further preclinical development.

Polyvalent Nano-Lectin Potently Neutralizes SARS-CoV-2 by Targeting Glycans on the Viral Spike Protein

Mutations in spike (S) protein epitopes allow SARS-CoV-2 variants to evade antibody responses induced by infection and/or vaccination. In contrast, mutations in glycosylation sites across SARS-CoV-2 variants are very rare, making glycans a potential robust target for developing antivirals. However, this target has not been adequately exploited for SARS-CoV-2, mostly due to intrinsically weak monovalent protein-glycan interactions. We hypothesize that polyvalent nano-lectins with flexibly linked carbohydrate recognition domains (CRDs) can adjust their relative positions and bind multivalently to S protein glycans, potentially exerting potent antiviral activity. Herein, we displayed the CRDs of DC-SIGN, a dendritic cell lectin known to bind to diverse viruses, polyvalently onto 13 nm gold nanoparticles (named G13-CRD). G13-CRD bound strongly and specifically to target glycan-coated quantum dots with sub-nM K_d. Moreover, G13-CRD neutralized particles pseudotyped with the S proteins of Wuhan Hu-1, B.1, Delta variant and Omicron subvariant BA.1 with low nM EC₅₀. In contrast, natural tetrameric DC-SIGN and its G13 conjugate were ineffective. Further, G13-CRD potently inhibited authentic SARS-CoV-2 B.1 and BA.1, with <10 pM and <10 nM EC₅₀, respectively. These results identify G13-CRD as the 1st polyvalent nano-lectin with broad activity against SARS-CoV-2 variants that merits further exploration as a novel approach to antiviral therapy.

Omicron subvariant BA.5 efficiently infects lung cells

The SARS-CoV-2 Omicron subvariants BA.1 and BA.2 exhibit reduced lung cell infection relative to previously circulating SARS-CoV-2 variants, which may account for their reduced pathogenicity. However, it is unclear whether lung cell infection by BA.5, which displaced these variants, remains attenuated. Here, we show that the spike (S) protein of BA.5 exhibits increased cleavage at the S1/S2 site and drives cell-cell fusion and lung cell entry with higher efficiency than its counterparts from BA.1 and BA.2. Increased lung cell entry depends on mutation H69Δ/V70Δ and is associated with efficient replication of BA.5 in cultured lung cells. Further, BA.5 replicates in the lungs of female Balb/c mice and the nasal cavity of female ferrets with much higher efficiency than BA.1. These results suggest that BA.5 has acquired the ability to efficiently infect lung cells, a prerequisite for causing severe disease, suggesting that evolution of Omicron subvariants can result in partial loss of attenuation.

Discovery of Polyphenolic Natural Products as SARS-CoV-2 Mpro Inhibitors for COVID-19

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has forced the development of direct-acting antiviral drugs due to the coronavirus disease 2019 (COVID-19) pandemic. The main protease of SARS-CoV-2 is a crucial enzyme that breaks down polyproteins synthesized from the viral RNA, making it a validated target for the development of SARS-CoV-2 therapeutics. New chemical phenotypes are frequently discovered in natural goods. In the current study, we used a fluorogenic assay to test a variety of natural products for their ability to inhibit SARS-CoV-2 Mpro. Several compounds were discovered to inhibit Mpro at low micromolar concentrations. It was possible to crystallize robinetin together with SARS-CoV-2 Mpro, and the X-ray structure revealed covalent interaction with the protease's catalytic Cys145 site. Selected potent molecules also exhibited antiviral properties without cytotoxicity. Some of these powerful inhibitors might be utilized as lead compounds for future COVID-19 research.

Single-cell transcriptomics reveal extracellular vesicles secretion with a cardiomyocyte proteostasis signature during pathological remodeling

Aberrant Wnt activation has been reported in failing cardiomyocytes. Here we present single cell transcriptome profiling of hearts with inducible cardiomyocyte-specific Wnt activation (β-catΔex3) as well as with compensatory and failing hypertrophic remodeling. We show that functional enrichment analysis points to an involvement of extracellular vesicles (EVs) related processes in hearts of β-catΔex3 mice. A proteomic analysis of in vivo cardiac derived EVs from β-catΔex3 hearts has identified differentially enriched proteins involving 20 S proteasome constitutes, protein quality control (PQC), chaperones and associated cardiac proteins including α-Crystallin B (CRYAB) and sarcomeric components. The hypertrophic model confirms that cardiomyocytes reacted with an acute early transcriptional upregulation of exosome biogenesis processes and chaperones transcripts including CRYAB, which is ameliorated in advanced remodeling. Finally, human induced pluripotent stem cells (iPSC)-derived cardiomyocytes subjected to pharmacological Wnt activation recapitulated the increased expression of exosomal markers, CRYAB accumulation and increased PQC signaling. These findings reveal that secretion of EVs with a proteostasis signature contributes to early patho-physiological adaptation of cardiomyocytes, which may serve as a read-out of disease progression and can be used for monitoring cellular remodeling in vivo with a possible diagnostic and prognostic role in the future.

In vivo evaluation of the potential protective effects of prolactin against damage caused by methylmercury

Non-biodegradable metals such as mercury accumulate in living organisms during life (bioaccumulation) and also within trophic webs (biomagnification) and may reach high concentrations in humans. The contamination of humans by mercury in drinking water and food may be common, in particular in riverside communities that have a diet rich in fish. In vitro studies of human cell lines exposed to the cytotoxic and mutagenic effects of methylmercury have shown that prolactin has potential cytoprotective properties and may act as a co-mitogenic factor and inhibitor of apoptosis. The present in vivo study investigated the protective potential of prolactin against the toxic effects of methylmercury in the mammal Mus musculus. Histological and biochemical analyses, together with biomarker of genotoxicity, were used to verify the protective potential of prolactin in mice exposed to methylmercury. The reduction in kidney and liver tissue damage was not significant. However, results of biochemical and genotoxic analyses were excellent. After prolactin treatment, a significant reduction was observed in biochemical parameters and mutagenic effects of methylmercury. The study results therefore indicated that prolactin has protective effects against the toxicity of methylmercury and allowed us to suggest the continuation of research to propose prolactin in the future, as an alternative to prevent the damage caused by mercury, especially in populations that are more exposed.

Small-Molecule Thioesters as SARS-CoV-2 Main Protease Inhibitors: Enzyme Inhibition, Structure-Activity Relationships, Antiviral Activity, and X-ray Structure Determination

The main protease (Mpro, 3CLpro) of SARS-CoV-2 is an attractive target in coronaviruses because of its crucial involvement in viral replication and transcription. Here, we report on the design, synthesis, and structure-activity relationships of novel small-molecule thioesters as SARS-CoV-2 Mpro inhibitors. Compounds 3w and 3x exhibited excellent SARS-CoV-2 Mpro inhibition with kinac/Ki of 58,700 M-1 s-1 (Ki = 0.0141 μM) and 27,200 M-1 s-1 (Ki = 0.0332 μM), respectively. In Calu-3 and Vero76 cells, compounds 3h, 3i, 3l, 3r, 3v, 3w, and 3x displayed antiviral activity in the nanomolar range without host cell toxicity. Co-crystallization of 3w and 3af with SARS-CoV-2 Mpro was accomplished, and the X-ray structures showed covalent binding with the catalytic Cys145 residue of the protease. The potent SARS-CoV-2 Mpro inhibitors also inhibited the Mpro of other beta-coronaviruses, including SARS-CoV-1 and MERS-CoV, indicating that they might be useful to treat a broader range of coronaviral infections.

Alternatives to animal models and their application in the discovery of species susceptibility to SARS-CoV-2 and other respiratory infectious pathogens: A review

The emergence of the coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) inspired rapid research efforts targeting the host range, pathogenesis and transmission mechanisms, and the development of antiviral strategies. Genetically modified mice, rhesus macaques, ferrets, and Syrian golden hamsters have been frequently used in studies of pathogenesis and efficacy of antiviral compounds and vaccines. However, alternatives to in vivo experiments, such as immortalized cell lines, primary respiratory epithelial cells cultured at an air-liquid interface, stem/progenitor cell-derived organoids, or tissue explants, have also been used for isolation of SARS-CoV-2, investigation of cytopathic effects, and pathogen-host interactions. Moreover, initial proof-of-concept studies for testing therapeutic agents can be performed with these tools, showing that animal-sparing cell culture methods could significantly reduce the need for animal models in the future, following the 3R principles of replace, reduce, and refine. So far, only few studies using animal-derived primary cells or tissues have been conducted in SARS-CoV-2 research, although natural infection has been shown to occur in several animal species. Therefore, the need for in-depth investigations on possible interspecies transmission routes and differences in susceptibility to SARS-CoV-2 is urgent. This review gives an overview of studies employing alternative culture systems like primary cell cultures, tissue explants, or organoids for investigations of the pathophysiology and reverse zoonotic potential of SARS-CoV-2 in animals. In addition, future possibilities of SARS-CoV-2 research in animals, including previously neglected methods like the use of precision-cut lung slices, will be outlined.

SARS-CoV-2 Omicron sublineages show comparable cell entry but differential neutralization by therapeutic antibodies

The Omicron variant of SARS-CoV-2 evades antibody-mediated neutralization with unprecedented efficiency. At least three Omicron sublineages have been identified—BA.1, BA.2, and BA.3—and BA.2 exhibits increased transmissibility. However, it is currently unknown whether BA.2 differs from the other sublineages regarding cell entry and antibody-mediated inhibition. Here, we show that BA.1, BA.2, and BA.3 enter and fuse target cells with similar efficiency and in an ACE2-dependent manner. However, BA.2 was not efficiently neutralized by seven of eight antibodies used for COVID-19 therapy, including Sotrovimab, which robustly neutralized BA.1. In contrast, BA.2 and BA.3 (but not BA.1) were appreciably neutralized by Cilgavimab, which could constitute a treatment option. Finally, all sublineages were comparably and efficiently neutralized by antibodies induced by BNT162b2 booster vaccination after previous two-dose homologous or heterologous vaccination. Collectively, the Omicron sublineages show comparable cell entry and neutralization by vaccine-induced antibodies but differ in susceptibility to therapeutic antibodies.

Investigations on SARS-CoV-2 Susceptibility of Domestic and Wild Animals Using Primary Cell Culture Models Derived from the Upper and Lower Respiratory Tract

Several animal species are susceptible to SARS-CoV-2 infection, as documented by case reports and serological and in vivo infection studies. However, the susceptibility of many animal species remains unknown. Furthermore, the expression patterns of SARS-CoV-2 entry factors, such as the receptor angiotensin-converting enzyme 2 (ACE2), as well as transmembrane protease serine subtype 2 (TMPRSS2) and cathepsin L (CTSL), cellular proteases involved in SARS-CoV-2 spike protein activation, are largely unexplored in most species. Here, we generated primary cell cultures from the respiratory tract of domestic and wildlife animals to assess their susceptibility to SARS-CoV-2 infection. Additionally, the presence of ACE2, TMPRSS2 and CTSL within respiratory tract compartments was investigated in a range of animals, some with unknown susceptibility to SARS-CoV-2. Productive viral replication was observed in the nasal mucosa explants and precision-cut lung slices from dogs and hamsters, whereas culture models from ferrets and multiple ungulate species were non-permissive to infection. Overall, whereas TMPRSS2 and CTSL were equally expressed in the respiratory tract, the expression levels of ACE2 were more variable, suggesting that a restricted availability of ACE2 may contribute to reduced susceptibility. Summarized, the experimental infection of primary respiratory tract cell cultures, as well as an analysis of entry-factor distribution, enable screening for SARS-CoV-2 animal reservoirs.

Chemical vapor deposition (DLI-CVD) and characterization of multiphasic molybdate-based catalysts for propene oxidation

Deposition by DLI-CVD of a multi-element BiFeCoMo catalyst in the millimetric channels of a monolithic reactor has been achieved. When tested for the oxidation of propene to acrolein the reactors with various coatings are efficient but need to be optimized.

The effect of osteochondral lesion size and ankle joint position on cartilage behavior - numerical and in vitro experimental results

Osteochondral lesion of the talus is defined as damage in the cartilage that covers the talus bone, compromising the integrity of the joint in the long term. Due to the low incidence of this pathology, there are few studies to understand the importance of lesion size and position in cartilage strains. The purpose of this study is then to analyze the influence of the lesion size in joint behavior. A 3D virtual and in vitro model of a patient's injured ankle joint was developed. The models were built using CT scan and MRI images, to obtain the CAD models of intact and with 10 mm lesion size for 3D print models using additive manufacturing. The physical model was tested with 685N applied vertically to determine experimentally the principal strains and contact pressures in the cartilage. Five finite element models were developed with lesion dimensions (5 to 20 mm) and with 3 ankle joint positions. The numerical and experimental results were correlated with an R² = 0.86 justified by the complexity of the model geometry. The maximum principal strain was 2566µε in the plantar flexion position without lesion. The experimental contact area between cartilages increased by 1.2% in the 10 mm lesion size for 431 mm². The maximum stress in the cartilage was observed for a 20 mm lesion size with 2.5 MPa. The 5 and 10 mm sizes present similar results; the 15 mm lesion size presents a stress increase of 13% comparatively with 10 mm. Plantar flexion seems to be the most critical configuration; stress increases with an increase of lesion size around the cartilage.

Risk communication during COVID-19: a comparative analysis of four countries

Background

Risk communication (RC) is fundamental to ensuring public engagement in public health emergencies. Existing studies describe the mechanisms that integrate RC into emergency responses, but knowledge about which governing structures and policies are needed to ensure effective RC in public health emergencies is lacking. We compare RC across four epidemiological, socio-political, and geo-economic settings and identify key structural factors that can lead to effective RC in public health emergencies.

Methods

A multisite international study was implemented using qualitative research methods in Germany, Guinea, Nigeria, and Singapore. We mapped and assessed RC governing structures, drawing on a document review and semi-structured key informant interviews with 155 stakeholders involved in the design and implementation of RC strategies at national and sub-national levels.

Results

A comparative analysis of the content, process, actors, and context of the distinct RC structures in the four countries as well as related strengths and weaknesses are presented. Early integration of RC into preparedness and response plans alongside the use of previous experiences and structures are key to effective implementation of RC during public health emergencies. A lack of coordination increases the risk of parallel structures, missed opportunities, duplication of resources, and public confusion due to a cacophony of messages. Building on previous experiences of outbreaks and on existing structures and relationships can help governments to more quickly mobilise effective RC strategies during pandemics.

Conclusions

RC is key to effective pandemic responses and can help to reduce infection and transmission. Yet, considerable potential exists for countries to improve RC in public health emergencies. Learning from mistakes and successes during COVID-19 can help improve RC strategies and governing structures and prepare for future pandemics.

Key messages

Strengthening RC preparedness and response enables governments to more effectively implement the International Health Regulations. COVID-19 provides ample learning opportunities to improve communication in public health emergencies.

The Upper Respiratory Tract of Felids Is Highly Susceptible to SARS-CoV-2 Infection

Natural or experimental infection of domestic cats and virus transmission from humans to captive predatory cats suggest that felids are highly susceptible to SARS-CoV-2 infection. However, it is unclear which cells and compartments of the respiratory tract are infected. To address this question, primary cell cultures derived from the nose, trachea, and lungs of cat and lion were inoculated with SARS-CoV-2. Strong viral replication was observed for nasal mucosa explants and tracheal air-liquid interface cultures, whereas replication in lung slices was less efficient. Infection was mainly restricted to epithelial cells and did not cause major pathological changes. Detection of high ACE2 levels in the nose and trachea but not lung further suggests that susceptibility of feline tissues to SARS-CoV-2 correlates with ACE2 expression. Collectively, this study demonstrates that SARS-CoV-2 can efficiently replicate in the feline upper respiratory tract ex vivo and thus highlights the risk of SARS-CoV-2 spillover from humans to felids.

Abstract MP217: Nuclease-deficient Cas9 Transcription Factors Restore Krueppel-like Factor 15 Expression In Stressed Mouse And Human Cardiomyocytes

Transcriptional changes in cardiomyocytes drive heart failure progression, however, precise control over endogenous gene expression remains challenging. The expression of Krueppel-like factor 15 ( KLF15 ), an evolutionary conserved nuclear and cardiomyocyte specific inhibitor of WNT/CTNNB1 signalling in the heart, is lost upon cardiac remodelling, and accompanied by aberrantly active WNT/CTNNB1 resulting in heart failure progression. We investigated KLF15 expression dynamics employing CRISPR/Cas9-based tools in mouse cardiomyocytes in vivo and in human induced pluripotent stem cell derived cardiomyocytes (hiPSC-CM) under the hypothesis that re-establishment of KLF15 levels in myocardial stress conditions prevents heart failure progression. Using a mouse model expressing enzymatically inactive Cas9 (dCas9) fused to transcriptional activators (VPR) under Myh6 -promoter control, we activated Klf15 in a murine pressure overload model by transverse aortic constriction. Delivery of Klf15 gRNAs targeted to the Klf15 promoter region via AAV9 induced Klf15 expression sufficiently to re-normalize Klf15 expression to transcript levels comparable to sham surgery hearts. This was accompanied by reduced decrease of fractional shortening as well as reduced cardiomyocyte hypertrophy in stressed Klf15 re-activated hearts compared to non-trageted (NT) gRNA hearts (n=3-8 per group, echo data from 4 and 8 weeks post-surgery). We achieved titratable KLF15 activation in dCas9VPR transgenic hiPSC-CM by selection of single and multiple gRNAs (n=3-4 replicates) and used these cells to generate human engineered myocardium by combining hiPSC-CM and fibroblasts which we subjected to isometric contractions in order to induce mechanical stress, which resulted in KLF15 expressional decrease in line with our in vivo data. This transcriptional loss was rescued in CRISPR/dCas9VPR hiPSC-CM targeted to the KLF15 locus compared to controls (n=6-9/2/4 tissues per group/casting sessions/differentiations). Additionally, TGFB1 induced cardiomyocyte stress resulted in decreased KLF15 expression levels in 2D hiPSC-CM cultures which were rescued by dCas9VPR- KLF15 targeting (n=3 experiments). In conclusion, we report controllable gene activity by CRISPR/dCas9VPR to restore the loss of KLF15 in stressed mouse and human cardiomyocytes. We furthermore evaluate the potential to gain full control over gene dose titratability with these models to validate and define novel therapeutic targets for the prevention of heart failure progression.

Gynaecological cytology in women under the age of 30—the impact of P16/KI67 dual-staining cytology

Background

The HPV detection test is not recommended as a primary screening of cervical lesions, before the age of 30, because the high rate of HPV infections with a high rate of spontaneous resolution in this age group. This study aims to evaluate the performance of p16/Ki67 dual staining in detecting high-grade squamous cervical lesions in these women.

Methods

Cervical-vaginal samples from 67 women HPV positives under the age of 30 and cervical biopsies of 41 of these women. Results of p16/Ki67 dual staining, cytology and histology were analysed. In 53 of the women, 159 results of p16/Ki67 dual staining, HPV test and cytology, obtained in 3 follow-up medical visit, were compared.

Results

The p16/ki67 dual staining was positive in 23.9% and negative in 76.1% of all 67 women. All women with high squamous intraepithelial lesion cytology, 39.1% with low squamous intraepithelial lesion cytology, 17.4% with negative for intraepithelial lesion cytology and 10% with atypical squamous cells cytology, were p16/Ki-67 dual staining positives. In the 41 women with histological diagnosis, p16/ki67 dual staining showed a sensitivity of 87.5% and a specificity of 96% to detect HSIL. When comparing, the tests differ significantly (P &lt; 0.001), p16/ki67 dual staining was positive in 24% of positive cytology and in 19.5% of positive HPV tests.

Conclusions

Our results demonstrate that p16/Ki67 dual stain has good sensitivity and specificity to detect HSIL and can be useful on women under the age of 30, avoiding excessive diagnosis and reducing colposcopy referrals. Further studies are required in a large number of women.

Social networks, depressive symptoms and quality of life in the elderly: Results of an intergenerational program

Introduction

Intergenerational programs involving children and the elderly promote intergenerational interactions and can positively affect physical and mental health, and the quality of life of the elderly.

Objectives

To test the effects of an intergenerational intervention in social isolation, depressive symptoms and quality of life of the elderly.

Methods

This study employed a pretest-posttest design. Measures: Portuguese versions of Geriatric Depression Scale, Lubben Social Networks Scale and WHOQOL-OLD. Participants: 12 elderly, 75% females, with mean age of 80.8 years (sd=8.8) and 20 kindergarten children (65% female) with mean age of 4,1 years (sd=0.79). The intervention ran for 6 weeks, with 11 intergenerational group sessions, each range between 30 and 120 minutes. A nonparametric paired samples tests was conducted to evaluate the impact of the intervention.

Results

After the intervention, when comparing elderly with and without depressive symptoms, results showed significant differences in the total value of quality of life (p=.048) and in the facets: 1) Sensory functioning, 2) Autonomy, 3) Past, present and future activities (p=.003; p=.018; p=.030, respectively). 12,5% of de elderly with depressive symptoms before the intervention no longer have depressive symptoms after the intervention. Regarding social networks, there were no significant differences (p=.576) between the mean values of the two assessments.

Conclusions

The implemented intergenerational program was effective in promoting quality of live and minimized depressive symptoms. After the intervention, the number of the elderly without depressive symptoms have increased and these presented a higher quality of life. Finally, longitudinal studies with a large sample are needed to consolidate results.

Abstract 498: Krueppel-like Factor 15 Modulation: A Crispr-based Re-establishment of Homeostatic Transcription in Diseased Mouse and Human Cardiomyocytes

An altered transcriptomic profile of cardiomyocytes is a hallmark of cardiac remodelling and heart failure. Re-activation of gene programs necessary for myocardial homeostasis and inhibition of deleterious signalling pathways, such as Wnt/beta-catenin signalling, is therefore therapeutically desirable, however challenging to achieve tissue-specifically. We identified Krueppel-like factor 15 (KLF15) as a cardiac specific inhibitor of Wnt/beta-catenin signalling, lost during heart failure progression in the mouse and human heart. To re-establish endogenous Klf15 expression, we designed a cardiomyocyte specific CRISPR activation mouse model expressing enzymatically inactive Cas9 (dCas9) fused to a transcriptional activator (VPR) under Myh6 promoter control. The dCas9VPR protein is directed by guide RNAs (gRNA), delivered by AAV9, to the promoter region of Klf15 and induces gene expression. We tested activation of Klf15 in the adult myocardium by injecting 15 weeks old Myh6-dCas9VPR mice systemically with AAV9 carrying Klf15 gRNAs and increasing Klf15 transcript levels 8 weeks later up to 1.6 fold compared to controls. Since we found a 0.5 fold change of Klf15 expression upon transverse aortic constriction compared to sham operated mice, we expect the CRISPR activation induced Klf15 activation to be sufficient to re-establish Klf15 expression. As a translational approach and since we demonstrated KLF15-WNT regulation in human cardiomyocytes, we integrated dCas9VPR into human induced pluripotent stem cells (hIPSC) by targeted genome editing at the AAVS1 safe harbour locus and confirmed dCas9VPR expression in hIPSC and in hIPSC-derived cardiomyocytes (hIPSC-CM). We tested KLF15 gRNAs in HEK293 cells and selected the most efficient candidate gRNAs to test Klf15 activation in dCas9VPR-IPSC resulting in an up to 1.7 fold activation compared to controls. For gene activation in dCas9VPR hIPSC-CM, we are currently testing lentivirus constructs to deliver up to 3 gRNAs simultaneously to tailor KLF15 expression. With these prerequisites, we aim to re-activate master regulators of normal cardiomyocyte function in failing cardiomyocytes at physiologically relevant levels, such as KLF15, to test potential therapeutic targets for the prevention of heart failure progression.

Prevalence of self-medication in adolescents

Introduction Self-medication by definition is the use of over-the-counter medications, in which the patient or his / her caregiver decides which drug to use, in order to treat or relieve symptoms. Self-medication is considered one of the health risk behaviours found among adolescents.

Objectives The main objective of this study was to determine the prevalence of self-medication for adolescents enrolled in the 10th and 12th year of the High School/3 Dra Maria Cândida - Mira and the Lima-de-Faria High School – Cantanhede in the 2018/2019 school year.

Methodology A questionnaire was handled and processed with statistical program, version 24.0 SPSS. This study is based on the correlational descriptive type with cross cohort. The study took place on the school year of 2018/2019 and the data acquisition took place over the course of 2 months.

Results The sample comprised 421 adolescents, of whom 344 (81.7%) already tried self-medication in some way or form and 278 (66.0%) did that in the last 6 months. The main health problems that motivated self-medication were headache (62.5%), the flu (57.5%), sore throat (45.6%) and fever (44.4%). Analgesics/antipyretics were the most consumed drugs (71%) followed by non-steroidal anti-inflammatory drugs (66.0%). The Pharmacy (71.7%) was the preferred place to purchase drugs; however, 222 adolescents (52.7%) reported having medicines at home. Of the adolescents who resort to self-medication, 59.6% sought additional information or clarification of the drug, referring to the package leaflet as the main source (43.2%). Of these, 59.9% revealed that they are aware of the risks that the drugs taking may cause.

Conclusion It was observed that self-medication is very common in adolescents, making it important to carry out more studies in Portugal and its population, on this practice, due to studies scarcity. These data can be used to define strategies for the dissemination of the rational use of the drug in adolescent population.

Evaluation of Health Literacy and Therapy Adherence Levels in the Mealhada Municipality Population

Introduction In order to ensure self-care, the individual must be able to decide, for example, on the lifestyle to adopt. These capacities and the capacities to take their share of responsibility in public health issues are called health literacy. In the same way, your attitude towards the treatments imposed on you is also crucial to the successful treatment and / or prevention of pathologies. In this case we talk about adherence to therapy.

Objectives To clarify the concepts Health Literacy and Therapy Adherence and identify measurement measures of each concept. In addition to measuring these variables, the study also aimed at investigating the existence of a relationship between health literacy levels and levels of adherence to therapy.

Methodology Through the application of a measurement tool, consisting of three validated instruments, in a pharmacy in the municipality of Mealhada, to 377 individuals residing there. To evaluate the levels of Health Literacy, two tests were applied: HLS-EU-PT (European Health Literacy Survey Questionnaire - Portugal) and METER (Medical Term Recognition Test). The first, quite comprehensive and previously applied at European level, of self-perception, and the second more objective. The third measurement instrument used was the MAT (Treatment Adherence Measure) to assess adherence to therapy.

Results 59.2% of individuals from Mealhada County have a problematic or inadequate index of health literacy. Compliance rates correspond to 67.9%. In the sample studied, as regards non-adherents, it is the individuals with limited literacy that present the highest non-adherence rate (HLS-EU-PT 71.1%; METER 61.2%). In each of the three domains assessed by the HLS-EU-PT, in the individuals with adequate levels of literacy, the percentage of adherents is always higher than non-adherents.

Conclusion There is a correlation between health literacy levels and adherence levels. Low levels of health literacy had a negative impact on treatment adherence.

Forssman Prevalence in a Portuguese Donor Population

Introduction Discovered in 1911 by Frederick Forssman, the Forssman (Fs) antigen (Ag) expression varies among species, being rarely present on human red blood cells (RBC). In 1987 three unrelated English families were identified with a phenotype designed Apae which was later classified as the 31st blood group: FORS. Since antibodies (Ab) anti-Fs has natural occurrence and the expression of the Ag occurs on the surface of the RBC, body fluids and organs, raises a potential role for this antigen in transfusion and transplantation implications.

Objectives Our main goals were to evaluate the prevalence of anti-Fs Ab and clarify its impact in transfusional medicine by classifying the type of immunoglobulin (Ig) involved.

Methodology 3-5% sheep RBC suspension with positive expression for Fs Ag was used to evaluate the presence of Ab anti-Fs in plasma samples from a Portuguese population of blood donor and classify the immunoglobulin involved. Standard tube technique was used in all the experiments.

Results From a total of 11877 donors, 117 (0,99%) showed weak reactions (between 0 and 1 in a scale from 0 to 4). All these samples would be further studied to evaluate the presence of the Arg296Gln in the GBGT1 gene. Also, from the 192 samples studied to classify the Ab involved, 52% revealed to be only IgM, being the rest a mixture between IgG and IgM.

Conclusion The population studied revealed few samples with negative reaction against the sheep RBC confirm the low-prevalence of this blood group. The majority from the Ab to be IgM was also corroborated although the presence of an IgG portion can be clinically significant once it can cross the placental barrier.

Self-medication practice in different contexts: higher education students vs. users of an interior pharmacy

Introduction Self-medication is a common practice these days and is influenced by many factors, such as education, family, society, availability of medications and exposure to advertisements. This practice should be done responsibly for relief and treatment of brief and non-serious health conditions. Its irresponsible use can create risks to the individual’s health.

Objectives This work aims to evaluate the knowledge about self-medication on higher education students, and on a village population located at the interior of the Portugal central region, in order to verify if health education and school level influence the behaviours how self-medication is done.

Methodology An observational study was carried out at the Coimbra Health School (ESTeSC), and at a Pharmacy in a rural village, with a questionnaire done between March and May 2019. In this study 430 individuals contributed, of which 223 were enrolled in ESTeSC and 207 were Pharmacy’s customers.

Results At the sample, female students (88.8%) predominated, with an average age of 20 years old. From the results collected at the Pharmacy’s customers, female individuals predominated (65.7%). From the overall, 75.8% indicated that they self-medicated in the last 6 months (170 individuals from ESTeSC and 156 from pharmacy) mainly for Flu/Cold symptoms (38.8%). Analgesics and antipyretics predominates self-medication with 36.3% and 41.06% (ESTeSC and Pharmacy, respectively). They further stated that self-medication is acceptable in some circumstances.

Conclusion We can conclude that regarding to self-medication practice, individuals increasingly look out to treat their symptoms without seeking medical advice, as it is faster and cheaper. Therefore, pharmacy professionals must educate population about benefits and risks of self-medication. These professionals have an important role at the self-medication risks prevention, sharing information, therapeutic guidance and population education.

Non-adhesion to therapy in the elderly, in Tábua

Introduction Most medicines are taken by the elderly because they suffer natural changes, which lead to chronic and degenerative diseases. Older people often have increasingly complex medication regimens, which may lead to errors with dosing and administration and to non-adherence to therapy. Non-adherence to therapy leads to a decrease in therapeutic efficacy, an increase in morbidity, suffering, and health costs. It is influenced by several factors that can and should be driven to improve health status.

Objectives The objective of this study was to determine and evaluate the medication regimen complexity in an elderly population, in Tábua, and verify its relation with adherence to therapy.

Methodology Surveys were applied to elderly people in order to collect the medication data. The study lasted for 5 months and took place at a pharmacy (n = 337). Only people with ≥65 years were included. Medication regimen complexity was assessed using the Brazilian translation for the Medication Regimen Complexity Index (MRCI) and adhesion to therapy was measured by MAT scale. Data was analysed with SPSS statistical program, version 24.0.

Results Our study showed a high percentage of adhesion to therapy (65%) and also of polypharmacy among the elderly (84,9%). Most medication that elderly take belong to the cardiovascular system pharmaceutical group (94,1%). Still, people described some difficulties to adhesion to therapy, mainly forgetfulness (73,66%). Data also revealed that individuals with more literacy and those who are not under polypharmacy showed more adherence to therapy (p = 0.000 and p = 0.012). The most significant result from our study was that MRCI and non-adherence are correlated statistically, that is, a higher MRCI leads to an increase in non-adherence to therapy (p = 0.001).

Conclusion Healthcare professionals should be aware that high levels of medication regimen complexity suggest bad outcomes and non-adherence to therapy. They should assist the elderly, help avoid errors, and find solutions to improve adherence to therapy, whenever possible.

Assessment of Health Literacy Levels: HLS-EU-PT versus METER

Introduction The definition of this concept and its domains, as well as its measurement, will allow to identify health inequalities. And therefore focus the focus of professional intervention to ensure equitable access to health. The health literacy assessment tool should be based on the defined literacy concept and address the domains of the underlying theory, considering public health behaviours and outcomes. According to the European Consortium for Health Literacy, three dimensions of literacy are distinguished: functional literacy, interactive literacy and critical literacy.

Objectives To compare the health literacy levels obtained by applying two different measurement tools.

Methodology To assess Health Literacy levels were applied two tests: HLS-EU-PT (European Health Literacy Survey Questionnaire - Portugal) and METER (Medical Term Recognition Test). The first, quite comprehensive and previously used at European level, of self-perception, and the second more objective. These validated instruments were applied in a pharmacy in the municipality of Mealhada, to 377 individuals resident there.

Results HLS-EU-PT presents 40.8% of individuals with adequate literacy, while METER classifies 49.1% of the sample. There is a difference of 8.3% in the results. However, there is a statistically significant relationship between them (p = 0.001). METER is limited to the assessment of functional literacy levels. Too narrow a perspective for a concept as broad as health literacy. In this context, when measuring literacy is based on word recognition, limited levels of health literacy are found in 50.9% of individuals.

Conclusion Statistically, the two tests used present a significant correlation. Although METER misclassifies some individuals with adequate literacy who actually have inadequate literacy, this happens more often when the scores obtained are reduced. When the score on one test is high, on the other test, it also happens.

Impact of adverse effects to oral antidiabetics on adherence and quality of life in patients with type 2 diabetes

Introduction Diabetes is a metabolic disorder with many comorbidities, microvascular and macrovascular complications. In Portugal the prevalence was 13,3% which corresponds to 1 million Portuguese diagnosed, but the forecasts are for a big increase. The various therapeutic options currently available have been shown to be effective in controlling glycaemia and HbA1 levels. Adherence with this therapeutic is essential for optimization and control of chronic conditions. However, they present side effects that may compromise adherence to therapy and the quality of life of the patients.

Objectives The objective of this study is to evaluate the impact of the adverse effects of oral antidiabetic medicines on patient’s quality of life and adherence to therapy.

Methodology We developed a cross-sectional study in a sample of 65 patients with type 2 diabetes recruited in several Portuguese pharmacies. Data collected through a questionnaire previously validated with MAT Scale and EQ-5D-3L questionnaire.

Results In total, 36 men (55,4%) and 29 women (44,6%) participated in the study, the mean age was 65 years. 73,8 % take oral medication and 92,30% of people have high adherence. The adverse events with more impact in the patients’ perception are "Discomfort in the genital area", "Dry mouth" and gastrointestinal events such as "Abdominal distention", "Flatulence" and "Constipation". The number of adverse events have a negative impact on patients’ quality of life (rs=-0,479; p≤0,01). The satisfaction with the therapeutic regime is significantly associated with adherence (rs = 0,348; p≤0,01)and their quality of life (rs = 0,316; p=0,01).

Conclusion We concluded that the adverse events have a negative impact on adherence and quality of life. The presence of adverse events, the type of medication and the therapeutic regimen are factors that negatively influence the patients’ quality of life, especially in the polymedicated elderly people.

Glycerol inoculation in eggs of young broiler breeders at different embryonic periods

Small eggs have lesser amounts of nutrients to be used by the embryo, and the yolk glycerol is the main substrate for glycogen production, which is the main energy source in the last days of incubation. Thus, the present study aimed to assess the effect of a glycerol injection in light weight eggs at 2 different days of incubation. To this end, 336 light eggs (55.6 to 58.6 g) from 32-wk-old broiler breeders were incubated. The eggs were divided into 3 treatment groups: 1 group inoculated with saline solution on the 17th d of embryonic development (E17) (control group), the second group injected with a 6 mg glycerol/mL solution at E17, and the third group injected with 6 mg glycerol/mL on the 18th d of incubation (E18). Incubation parameters, liver and muscle glycogen, and broilers performance at 7 d of age were evaluated. Glycerol administration in ovo did not influence hatchability, period of embryonic death or early hatching. Chicks exposed to glycerol in ovo feeding (IOF) used more yolk than birds inoculated with saline solution. Glycerol inoculation at E18 enhanced liver glycogen deposition (P = 0.001) and also improved broilers performance at 7 d, although this improvement in performance and glycogen reserves was not observed when eggs were inoculated at 17 d of incubation. Birds receiving glycerol IOF at E18 showed higher feed intake and body weight gain when compared to the control group and the group inoculated at E17. It was found that glycerol inoculation in light eggs at the 18th d of incubation contributed to raise liver glycerol levels and also to improve broilers performance at 7 d.

Increasing phenolic and aromatic compounds extraction and maximizing liking of lemon verbena (Aloysia triphylla) infusions through the optimization of steeping temperature and time

Herbal infusions are a new emerging trend among consumers, appearing in the market in many different forms. Due to intense competition, the commercial success of herbal infusions largely depends on flavour. The identification of the best combinations of steeping time and water temperature for the preparation of Aloysia triphylla infusions using a central composite design and response surface methodology was performed. The procedure aimed to maximize its antioxidant activity, phenolic and aromatic compounds, and consumers' liking of the infusions. The antioxidant activity and phenolic content were evaluated using the 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid radical cation) method and the Folin-Ciocalteu procedure. The analysis of aromatic compounds was performed based on the method of terpenic compounds. Sensory evaluation encompassed overall liking using a 9-point hedonic scale. Antioxidant activity and extraction of most phenolic compounds was higher for longer steeping times and higher temperatures, with some presenting a contrasting effect due to degradation at higher temperatures for longer steeping times. Results for terpenic compounds showed similar contrasting patterns. Based on the quadratic response surface, it was possible to predict the maximum overall liking for lemon verbena infusions prepared by brewing for 6 min at 96 ℃. Under such conditions, extraction of bioactive compounds was kept at a high level, close to the maximum attainable, while reducing the extraction of bitter compounds. These results are considered of great importance for the development of premium infusions from organic lemon verbena leaves.

Microwave-dried or air-dried? Consumers' stated preferences and attitudes for organic dried strawberries. A multi-country investigation in Europe

Non-thermal food processing technologies are becoming more important in the organic food sector because, beyond preserving the organic feature, they could offer organic products with additional benefits in terms of enhanced nutritional content and healthiness as well as better sensory properties that could satisfy the more complex demands of organic consumers. Berries have a well-known health benefits and show increasing market shares in European markets while dehydration can increase the food convenience in terms of extended shelf-life. This study investigates for the first time organic consumers' stated preferences, attitudes and individual differences for a non-thermal organic processing technology. Specifically, we investigated consumers' preferences for organic dried strawberries varying in drying technology used, such as the most conventional (i.e. thermal) air drying and the most innovative (i.e. non-thermal) microwave drying, origin, price levels, and nutrient contents in three European countries: Norway, Romania and Turkey. Data from a total of 614 consumers were collected through an online choice experiment. Results show that on average consumers prefer organic dried strawberries produced with air drying technology that have national origin, with natural nutrient content and at low price, but country and individual differences are identified. Consumers who showed least rejection for microwave dried products are young, mostly from Norway and have higher positive attitudes towards new food technologies. Consumers who showed most rejection for microwave dried products are older, mostly from Turkey and have higher positive attitudes for organic, natural and ecological products. Organic producers who adopt microwave drying might better inform consumers about the characteristics, the process and highlight the nutritional benefits of such technology. Finally, this research informs policy makers about the need to define and regulate more clearly microwave drying as an organic technology, as well as to regulate labelling to ensure that consumers are not misled and correctly informed about the new technology.

The performance of Remicade®-optimized quantification assays in the assessment of Flixabi® levels

BACKGROUND

The advent of Remicade® biosimilars, Remsima®, Inflectra® and, more recently, Flixabi®, has brought along the potential to decrease the costs associated with this therapy, therefore increasing its access to a larger group of patients. However, and in order to assure a soft transition, one must make sure the assays and algorithms previously developed and optimized for Remicade perform equally well with its biosimilars. This study aimed to: (a) validate the utilization of Remicade-optimized therapeutic drug monitoring assays for the quantification of Flixabi; and (b) determine the existence of Remicade, Remsima and Flixabi cross-immunogenicity.

METHODS

Healthy donors' sera spiked with Remicade, Remsima and Flixabi were quantified using three different Remicade-quantification assays, and the reactivity of anti-Remicade and anti-Remsima sera to Remicade and to its biosimilars was assessed.

RESULTS

The results show that all tested Remicade-infliximab-optimized assays measure Flixabi as accurately as they measure Remicade and Remsima: the intraclass correlation coefficients between theoretical and measured concentrations varied from 0.920 to 0.990. Moreover, the interassay agreement values for the same compounds were high (intraclass correlation coefficients varied from 0.936 to 0.995). Finally, the anti-Remicade and anti-Remsima sera reacted to the different drugs in a similar fashion.

CONCLUSIONS

The tested assays can be used to monitor Flixabi levels. Moreover, Remicade, Remsima and Flixabi were shown to have a high cross-immunogenicity, which supports their high similarity but prevents their switching in nonresponders with antidrug antibodies.

miRNA profiling of human naive CD4 T cells links miR-34c-5p to cell activation and HIV replication

Cell activation is a vital step for T-cell memory/effector differentiation as well as for productive HIV infection. To identify novel regulators of this process, we used next-generation sequencing to profile changes in microRNA expression occurring in purified human naive CD4 T cells in response to TCR stimulation and/or HIV infection. Our results demonstrate, for the first time, the transcriptional up-regulation of miR-34c-5p in response to TCR stimulation in naive CD4 T cells. The induction of this miR was further consistently found to be reduced by both HIV-1 and HIV-2 infections. Overexpression of miR-34c-5p led to changes in the expression of several genes involved in TCR signaling and cell activation, confirming its role as a novel regulator of naive CD4 T-cell activation. We additionally show that miR-34c-5p promotes HIV-1 replication, suggesting that its down-regulation during HIV infection may be part of an anti-viral host response.