Evaluation of early single dose vaccination on swine influenza A virus transmission in piglets: From experimental data to mechanistic modelling

Swine influenza A virus (swIAV) is a major pathogen affecting pigs with a huge economic impact and potentially zoonotic. Epidemiological studies in endemically infected farms permitted to identify critical factors favoring on-farm persistence, among which maternally-derived antibodies (MDAs). Vaccination is commonly practiced in breeding herds and might be used for immunization of growing pigs at weaning. Althoughinterference between MDAs and vaccination was reported in young piglets, its impact on swIAV transmission was not yet quantified. To this aim, this study reports on a transmission experiment in piglets with or without MDAs, vaccinated with a single dose injection at four weeks of age, and challenged 17 days post-vaccination. To transpose small-scale experiments to real-life situation, estimated parameters were used in a simulation tool to assess their influence at the herd level. Based on a thorough follow-up of the infection chain during the experiment, the transmission of the swIAV challenge strain was highly dependent on the MDA status of the pigs when vaccinated. MDA-positive vaccinated animals showed a direct transmission rate 3.6-fold higher than the one obtained in vaccinated animals without MDAs, estimated to 1.2. Vaccination nevertheless reduced significantly the contribution of airborne transmission when compared with previous estimates obtained in unvaccinated animals. The integration of parameter estimates in a large-scale simulation model, representing a typical farrow-to-finish pig herd, evidenced an extended persistence of viral spread when vaccination of sows and single dose vaccination of piglets was hypothesized. When extinction was quasi-systematic at year 5 post-introduction in the absence of sow vaccination but with single dose early vaccination of piglets, the extinction probability fell down to 33% when batch-to-batch vaccination was implemented both in breeding herd and weaned piglets. These results shed light on a potential adverse effect of single dose vaccination in MDA-positive piglets, which might lead to longer persistence of the SwIAV at the herd level.

Improvement in Disease Activity in Refractory Juvenile Dermatomyositis Following Abatacept Therapy

OBJECTIVE

An open-label 24-week study was conducted to evaluate the safety and efficacy of abatacept in patients with refractory juvenile dermatomyositis (JDM).

METHODS

Ten patients >7 years of age with moderate disease activity were enrolled in a 24-week study to examine the safety and treatment response of subcutaneous abatacept. The primary endpoint was the International Myositis Assessment and Clinical Studies Group (IMACS) Definition of Improvement (DOI). Secondary endpoints included safety, change in core set activity measures (CSMs) of IMACS and Pediatric Rheumatology International Trials Organization (PRINTO), and the ACR-EULAR response criteria for JDM. Blinded radiologists assessed thigh magnetic resonance imaging (MRI). Interferon gene score (IFNGS) was performed on whole-blood RNA by NanoString and cytokines were assessed by Luminex.

RESULTS

Five patients achieved DOI at week 12, and nine achieved DOI at week 24, including two with minimal, four moderate, and three with major improvement by ACR-EULAR response criteria using IMACS CSMs. All CSMs improved from baseline at weeks 12 and 24, except muscle enzymes. Daily corticosteroid dose decreased from a mean of 16.7 mg at baseline to 10.2 mg at week 24 (p=0.002). Average MRI muscle edema score decreased from baseline 5.3 to 2.3 at week 24 (p=0.01). Six patients had down-trending IFNGS and galectin-9 at week 24. Decreases in IFNGS, IP-10, galectin-9 and IL-2 correlated with improvement in disease activity and in MRI muscle edema. Eleven Grade 2 or 3 treatment-emergent adverse events were observed.

CONCLUSIONS

This open-label study demonstrated abatacept may be beneficial for treatment-refractory JDM.

Atrial flutter caused by migration of a superior vena cava stent into the right atrium

We describe the case of a patient presenting with an atrial flutter mechanically induced by a stent migration from the superior vena cava to the right atrium.

Regulatory T-cells and GARP expression are decreased in exercise-associated chikungunya viral arthritis flares

Objective

Chikungunya virus (CHIKV) causes persistent arthritis, and our prior study showed that approximately one third of CHIKV arthritis patients had exacerbated arthritis associated with exercise. The underlying mechanism of exercise-associated chikungunya arthritis flare (EACAF) is unknown, and this analysis aimed to examine the regulatory T-cell immune response related to CHIKV arthritis flares.

Methods

In our study, 124 Colombian patients with a history of CHIKV infection four years prior were enrolled and 113 cases with serologically confirmed CHIKV IgG were used in this analysis. Patient information was gathered via questionnaires, and blood samples were taken to identify total live peripheral blood mononuclear cells, CD4+ cells, T regulatory cells, and their immune markers. We compared outcomes in CHIKV patients with (n = 38) vs. without (n = 75) EACAF using t-tests to assess means and the Fisher’s exact test, chi-squared to evaluate categorical variables, and Kruskal-Wallis tests in the setting of skewed distributions (SAS 9.3).

Results

33.6% of CHIKV cases reported worsening arthritis with exercise. EACAF patients reported higher global assessments of arthritis disease ranging from 0-100 (71.2 ± 19.7 vs. 59.9 ± 28.0, p=0.03). EACAF patients had lower ratios of T regulatory (Treg)/CD4+ T-cells (1.95 ± 0.73 vs. 2.4 ± 1.29, p = 0.04) and lower percentage of GARP (glycoprotein-A repetitions predominant) expression per Treg (0.13 ± 0.0.33 vs. 0.16 ± 0.24 p= 0.020).

Conclusion

These findings suggest relative decreases in GARP expression may indicate a decreased level of immune suppression. Treg populations in patients with CHIKV arthritis may contribute to arthritis flares during exercise, though current research is conflicting.

Polymicrobial native valve endocarditis due to Bacillus cereus and Cardiobacterium hominis

We present a case of polymicrobial subacute bacterial endocarditis and bacteremia with Bacillus cereus and Cardiobacterium hominis in a 72-year-old man with pre-existing mitral valve disease and prior mitral valve repair who presented with renal failure and glomerulonephritis. Bacillus is often a contaminant in blood cultures but has been rarely implicated in patients with invasive infections such as endocarditis. Intravenous drug use, prosthetic heart valves, valvular heart disease and venous catheters are the most frequently described risk factors for Bacillus bacteremia and endocarditis in the medical literature. Management is challenging as Bacillus is resistant to penicillin and cephalosporin antibiotics due to production of beta-lactamase. Polymicrobial endocarditis is uncommon and when it occurs typically involves Staphylococcal species. To our knowledge, this is the first reported case of polymicrobial endocarditis in which both Bacillus and a HACEK organism are implicated.

Laparoscopic Extraperitoneal Approach to Bilateral Pelvic Lymph Node Dissection in Low Rectal Cancer: Technique with Video and 3D Modeling

BACKGROUND

Lateral pelvic lymph node dissection for rectal cancer is a difficult technique due to the complex pelvic anatomy. Recent series have underlined the importance of lateral lymphadenectomy in selective patients to prevent local recurrence of rectal cancer.

METHODS

A 65-year-old woman was diagnosed with locally advanced rectal adenocarcinoma of the low rectum with right and left lateral pelvic lymph nodes of respectively 9 and 13 mm. After chemotherapy followed by radiotherapy, the size of the right internal iliac lymph nodes remained enlarged to 5 mm. A laparoscopic extraperitoneal approach was used for total mesorectal excision, complete mesocolic excision, and bilateral lateral lymph node dissection. The extraperitoneal space was divided into the subperitoneal space dissected by a transanal approach and the retroperitoneal space dissected by a transabdominal approach.

RESULTS

The operating time was 303 min, and the estimated blood loss was 270 ml. No intraoperative adverse events occurred. Bilateral lymph node dissection was performed with obturator nerve and neurovascular bundle sparing. A postoperative complication classified as Clavien 3a arose with a pelvic infection but no anastomotic leakage. Final pathology disclosed T3N1M0 adenocarcinoma with free surgical margins. The patient never had urinary dysfunction.

CONCLUSIONS

The laparoscopic extraperitoneal approach to lateral pelvic lymph node dissection is feasible. For lateral lymph node dissection, the transanal approach may have some advantages over the standard transabdominal approach, with better visibility of and access to the distal internal iliac area. This video may help oncological surgeons to perform this new and complex procedure.

Recent sexual violence exposure is associated with immune biomarkers of HIV susceptibility in women

PROBLEM

HIV/AIDS and sexual violence act synergistically and compromise women's health. Yet, immuno-biological mechanisms linking sexual violence and increased HIV susceptibility are poorly understood.

METHODS

We conducted a cross-sectional pilot study of HIV-uninfected women, comparing 13 women exposed to forced vaginal penetration within the past 12 weeks (Exposed) with 25 Non-Exposed women. ELISA assays were conducted for 49 biomarkers associated with HIV pathogenesis in plasma and cervicovaginal lavage (CVL). Differences between Exposed and Non-Exposed were analyzed by linear and logistic regression, using propensity score weighting to control for age, race, socioeconomic status, menstrual cycle, and contraceptive use.

RESULTS

In CVL, Exposed women had significantly reduced chemokines MIP-3α (p < .01), MCP-1 (p < .01), and anti-HIV/wound-healing thrombospondin-1 (p = .03). They also had significantly increased inflammatory cytokine IL-1α (p < 0.01) and were more likely to have detectable wound-healing PDGF (p = .02). In plasma, Exposed women had reduced chemokines MIP-3α (p < .01) and IL-8 (p < .01), anti-inflammatory cytokine TGF-β (p = .02), anti-HIV/antimicrobial HBD-2 (p = .02), and wound-healing MMP-1 (p = 0.02). They also had increased thrombospondin-1 (p < .01) and Cathepsin B (p = .01). After applying the stringent method of false discovery rate adjustment, differences for IL-1α (p = .05) and MCP-1 (p = .03) in CVL and MIP-3α (p = .03) in plasma remained significant.

CONCLUSIONS

We report systemic and mucosal immune dysregulation in women exposed to sexual violence. As these biomarkers have been associated with HIV pathogenesis, dysregulation may increase HIV susceptibility.

Sleep Disturbances are a Significant Predictor of Chikungunya Arthritis Flare Severity

OBJECTIVE

The primary objective of this research was to explore the link between sleep and flare pain associated with chikungunya virus (CHIKV) infection. The secondary objective was to investigate if cytokines and T regulatory (Treg) cells have an influence on this relationship.

METHODS

A cross-sectional study was performed using data collected in Barranquilla, Colombia, which enrolled patients with and without chronic arthritis with a history of chikungunya infection. Flare severity was measured by a version of the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) flare questionnaire adapted for CHIKV arthritis, including metrics for pain, difficulty with physical activity, fatigue, stiffness and difficulty maintaining social activities due to arthritis that contribute to flare severity. In addition, four sleep disturbance items, five inflammatory cytokine levels, four anti-inflammatory cytokine levels, and six Treg levels were measured. Then, multivariable linear regression models were used to test the direct and indirect effects of flare-pain on sleep disturbance, and to determine whether this relationship was mediated by cytokines or Tregs. Finally, the SAS CALIS procedure was used to test path models showing possible causal effects with mediators and confounds.

RESULTS

The analysis showed that sleep disturbance is positively correlated with CHIKV arthritis flare pain, and that it is a significant predictor of flare severity after adjusting for demographic variables, cytokine, and T cell levels. Further, neither T cells nor cytokines mediate the pain/sleep relationship in CHIKV arthritis.

CONCLUSION

There is a strong association between sleep disturbance and arthritis flare pain and severity; however, this relationship is not mediated by cytokines or T cells. Since this study is unable to determine causation, further research is needed to determine the mechanism underlying the relationship between sleep disturbances and CHIKV arthritis flares.

Enhanced structural and magnetic properties of fcc colloidal crystals of cobalt nanoparticles

We report the elaboration of supercrystals made up of dodecanoic acid-coated 8.1 nm-Co nanocrystals with controlled supercrystallinity, morphology and magnetic properties. Supercrystal growth is controlled using a solvent-mediated ligand-ligand interaction strategy. Either face-centered cubic supercrystalline films or single colloidal crystals composed of cobalt nanocrystals are obtained. The change in supercrystal morphology is explained by Flory-type solvation theory using Hansen solubility colloidal parameters. The use of the same batch of Co nanocrystals for the fabrication of supercrystalline films and colloidal crystals enables accurate comparative structural and magnetic studies using (high-resolution) transmission electron microscopy, field emission gun scanning electron microscopy, grazing incidence small-angle X-ray scattering and vibrating sample magnetometry. The nearest neighbor distance between nanoparticles is interpreted using theoretical models proposed in the literature. We evidence the increase in both geometric anisotropy and magnetic dipolar interactions for colloidal crystals compared to supercrystalline films.

A new agarose-based microsystem to investigate cell response to prolonged confinement

Emerging evidence suggests the importance of mechanical stimuli in normal and pathological situations for the control of many critical cellular functions. While the effect of matrix stiffness has been and is still extensively studied, few studies have focused on the role of mechanical stresses. The main limitation of such analyses is the lack of standard in vitro assays enabling extended mechanical stimulation compatible with dynamic biological and biophysical cell characterization. We have developed an agarose-based microsystem, the soft cell confiner, which enables the precise control of confinement for single or mixed cell populations. The rigidity of the confiner matches physiological conditions and its porosity enables passive medium renewal. It is compatible with time-lapse microscopy, in situ immunostaining, and standard molecular analyses, and can be used with both adherent and non-adherent cell lines. Cell proliferation of various cell lines (hematopoietic cells, MCF10A epithelial breast cells and HS27A stromal cells) was followed for several days up to confluence using video-microscopy and further documented by Western blot and immunostaining. Interestingly, even though the nuclear projected area was much larger upon confinement, with many highly deformed nuclei (non-circular shape), cell viability, assessed by live and dead cell staining, was unaffected for up to 8 days in the confiner. However, there was a decrease in cell proliferation upon confinement for all cell lines tested. The soft cell confiner is thus a valuable tool to decipher the effects of long-term confinement and deformation on the biology of cell populations. This tool will be instrumental in deciphering the impact of nuclear and cytoskeletal mechanosensitivity in normal and pathological conditions involving highly confined situations, such as those reported upon aging with fibrosis or during cancer.

Exposure of pregnant women to organophosphate insecticides and child motor inhibition at the age of 10-12 years evaluated by fMRI

BACKGROUND

Organophosphate pesticides (OP) are widely used for both agricultural and domestic purposes. Epidemiological studies suggest neurotoxicity in children after exposure to organophosphates pesticides (OP) at low levels but possible mechanism is still unclear.

OBJECTIVES

We aimed at investigating the effects of prenatal exposure to OPs on inhibitory control of 10-12 year-old-children assessed by a motor inhibition task during functional magnetic resonance imaging (fMRI).

METHODS

Ninety-five children from the PELAGIE cohort (Brittany-France, from 2002) underwent a fMRI examination during which inhibition was assessed by a Go/No-Go task. Task performance was assessed by average response latency, commission rate and composite performance score (PS). Whole brain activation was estimated by modeling the hemodynamic response related to inhibition demand and successful inhibition. OP exposure was assessed by measuring six dialkylphosphate (DAP) metabolites in the urine of women in early pregnancy (<19 WG). Concentrations were summed to obtain overall levels of diethylphosphate (DE), dimethylphosphate (DM) and total non-specific metabolites (DAP), standardized to homogenize sampling conditions and categorized into levels of exposure: low (reference), moderate or high. Regression models were adjusted for potential cofounders considered by restriction and statistical criteria.

RESULTS

Moderate levels of DAP were associated with a decreased commission rate (β = -6.65%, p = 0.04), indicating improved performance. Increasing levels of DM and DE were associated with decreased brain activity in the left inferior and bilateral superior frontal regions during successful inhibition. We did not observe any differential activation related to inhibitory demands.

DISCUSSION

These results suggest that prenatal OPs may be associated with altered pattern of brain activity in regions related to inhibition among children and need to be confirmed by additional studies.

Chronic Joint Pain 3 Years after Chikungunya Virus Infection Largely Characterized by Relapsing-remitting Symptoms

OBJECTIVE

To determine the frequency of chronic joint pain and stiffness 3 years after infection with chikungunya virus (CHIKV) in a Latin American cohort.

METHODS

A cross-sectional followup of 120 patients from an initial cohort of 500 patients who reported joint pain 2 years after infection from the Atlántico Department, Colombia. Patients were clinically diagnosed as having CHIKV during the 2014-2015 epidemic, and baseline and followup symptoms at 40 months were evaluated in serologically confirmed cases.

RESULTS

Of the initial 500 patients enrolled in the study, 482 had serologically confirmed chikungunya infection. From this group, 123 patients reported joint pain 20 months after infection, and 54% of those patients reported continued joint pain 40 months after infection. Therefore, 1 out of every 8 people who tested serologically positive for CHIKV infection had persistent joint pain 3 years after infection. Participants who followed up in person were predominantly adult (mean ± SD age 51 ± 14 yrs) and female (86%). The most common type of pain reported in these patients at 40 months post-infection was pain with periods of relief and subsequent reoccurrence, and over 75% reported stiffness after immobility, with 39% experiencing morning stiffness.

CONCLUSION

To our knowledge, this is the first report to describe persistent joint pain and stiffness 40 months after viral infection. The high frequency of chronic disease highlights the need to develop prevention and treatment methods. Further studies should be conducted to understand the similarities between post-chikungunya joint pain and rheumatoid arthritis.

FRI0450 MEASURES OF DISEASE SEVERITY PREDICT DISABILITY AND QUALITY OF LIFE DIFFERENTLY IN RHEUMATOID ARTHRITIS AND CHRONIC CHIKUNGUNYA DISEASE

Background:

Chronic rheumatological manifestations similar to those of rheumatoid arthritis (RA) have been described after chikungunya virus infection. However, the clinical significance of the symptoms and disease severity in the two conditions has not been directly compared.

Objectives:

To compare, using identical measures of disease severity and patient outcomes, the impact of disease severity measures and symptoms on outcomes in RA and chronic chikungunya disease.

Methods:

Forty patients with chronic chikungunya arthralgia two years post-infection and 40 matched patients with RA were enrolled in Roraima, Brazil. Twenty-eight joints were assessed for tenderness and swelling, a pain intensity visual analogue scale, musculoskeletal stiffness questionnaire, modified Health Assessment Questionnaire and the EuroQol EQ5D-5L quality of life assessment were completed. The importance of the various measures of disease severity were analysed using Spearman’s rank correlation and regression analysis.

Results:

Tender and swollen joint counts, pain and stiffness were all predictive of the HAQ disability index in RA, but only stiffness was significantly associated with disability in chikungunya patients (Table 1). Tender and swollen joint counts, pain and stiffness were predictive for all EQ5D quality of life domains (except anxiety/depression) in RA patients. In contrast, in chikungunya disease, tender joint counts were predictive only of usual daily activities; pain was predictive of impaired mobility, self-care and discomfort, while stiffness was predictive for the mobility and anxiety/depression domains (Figure 1). Swollen joint counts were not associated with any of the patient outcomes in chikungunya disease. Linear regression analysis confirmed (p=0.003) that the effect of swollen joint count on the HAQ disability index depends on the underlying disease.

Table 1.

Association of disease severity with HAQ disability index in rheumatoid and CHIKV+ arthritis

Severity measureRheumatoid arthritisCHIKV+ arthritisr (p)r (p)Tender joint count0.56 (0.0002)0.24 (0.14)Swollen joint count0.60 (<0.0001)0.002 (0.99)Joint pain (VAS)0.55 (0.0002)0.29 (0.07)Stiffness severity0.57 (0.0001)0.38 (0.02)Figure 1.

Association of disease severity with quality of life domains in rheumatoid and CHIKV+ arthritis

Conclusion:

The value of all the disease severity measures tested in RA were confirmed, but tender joint counts may have more limited value in the assessment of chronic chikungunya disease. Joint swelling appears to have little impact for chikungunya patients, while stiffness appears to be an important metric to quantify chikungunya arthritis disease severity.

Disclosure of Interests:

Hugh Watson Shareholder of: Sanofi, Employee of: Sanofi, Ramão Luciano Nogueira-Hayd: None declared, Maony Rodrigues-Moreno: None declared, Felipe Naveca: None declared, Giulia Calusi: None declared, Richard Amdur: None declared, Karol Suchowiecki: None declared, Gary S. Firestein: None declared, Gary Simon: None declared, Aileen Chang: None declared

Persistent chikungunya arthritis in Roraima, Brazil

BACKGROUND

The Amazon region of Brazil experienced a large epidemic of East Central South African (ECSA) chikungunya virus (CHIKV) in 2017 and continuous transmission of CHIKV persists. The impact of chronic arthritis caused by ECSA CHIKV is unknown.

OBJECTIVE

The study aim was to describe the duration, severity, and characteristics of CHIKV arthritis in Roraima, Brazil, in comparison with local controls to further understand the long-term rheumatologic impact of ECSA CHIKV infection.

METHODS

We performed a cross-sectional analysis comparing clinical arthritis outcomes among 40 cases with chronic (> 3 months) arthritis attributed to their CHIKV disease (n = 40) with control participants who were exposed to CHIKV but did not develop chronic arthritis (n = 40), rheumatoid arthritis controls (n = 40), and healthy controls lacking CHIKV exposure and arthritis (n = 40).

FINDINGS

Our primary finding is that over 2 years post-infection, patients report moderate arthritis disease severity comparable with rheumatoid arthritis with the most significant impact on decreased quality of life from pain.

MAIN CONCLUSIONS

These findings suggest that chronic arthritis caused by ECSA CHIKV infection has had a moderate impact in the Americas. Key Points • Chikungunya infection is responsible for moderate arthritis disease severity. • The East Central South African (ECSA) strain of CHIKV is a cause of persistent arthritis in Roraima, Brazil.

DNA dependent protein kinase (DNA-PK) enhances HIV transcription by promoting RNA polymerase II activity and recruitment of transcription machinery at HIV LTR

Despite reductions in mortality from the use of highly active antiretroviral therapy (HAART), the presence of latent or transcriptionally silent proviruses prevents HIV cure/eradication. We have previously reported that DNA-dependent protein kinase (DNA-PK) facilitates HIV transcription by interacting with the RNA polymerase II (RNAP II) complex recruited at HIV LTR. In this study, using different cell lines and peripheral blood mononuclear cells (PBMCs) of HIV-infected patients, we found that DNA-PK stimulates HIV transcription at several stages, including initiation, pause-release and elongation. We are reporting for the first time that DNA-PK increases phosphorylation of RNAP II C-terminal domain (CTD) at serine 5 (Ser5) and serine 2 (Ser2) by directly catalyzing phosphorylation and by augmenting the recruitment of the positive transcription elongation factor (P-TEFb) at HIV LTR. Our findings suggest that DNA-PK expedites the establishment of euchromatin structure at HIV LTR. DNA-PK inhibition/knockdown leads to the severe impairment of HIV replication and reactivation of latent HIV provirus. DNA-PK promotes the recruitment of Tripartite motif-containing 28 (TRIM28) at LTR and assists the release of paused RNAP II through TRIM28 phosphorylation. These results provide the mechanisms through which DNA-PK controls the HIV gene expression and, likely, can be extended to cellular gene expression, including during cell malignancy, where the role of DNA-PK has been well-established.

647. Diagnoses Associated with Temperature ≥104°F in Adults

Background

Temperature ≥104°F (T ≥ 104) is uncommon in adults. The diagnoses and clinical characteristics were reviewed for patients with T ≥ 104.

Methods

Infectious disease physicians reviewed charts of patients with T ≥ 104 seen at the Washington DC Veterans Affairs Medical Center from 2009 to 2018. The following was collected: demographics, past medical history, medications, WBC, maximum temperature, time to defervescence, etiology of T ≥ 104, and death.

Results

Less than 0.01% of all patient encounters were associated with T ≥ 104. Of the 60 most recent patients with T ≥ 104 (from 2014 to 2018), the median age was 63.5 years (range 23–97), 65% were African American, 88% were male. 82% of those with T ≥ 104 were hospitalized; 76% of those had the T ≥ 104 on or within 72 hours of admission. 25% of the 60 patients had underlying cancer, 10% HIV, 30% DM, 13% CKD, and 13% were on steroids/immunosuppressants/biologics. The median peak temperature was 104.3°F (interquartile range 104.0 – 104.7); maximum was 106.8°F. 82% had T ≥ 104 for only 1 day and the median time to defervescence was 2 days. There were 55 diagnoses amongst 48 patients; 12 had no identifiable etiology of T ≥ 104. Of the identifiable diagnoses, there were 45 (81.8%) infections, 4 (7.3%) metastatic malignancies (1 Hodgkin’s lymphoma, 1 small cell carcinoma, 1 squamous cell carcinoma, 1 unknown primary), 2 (3.6%) intracranial bleeds, 2 (3.6%) GI bleeds, 1 (1.8%) mixed collagen vascular disease, and 1 (1.8%) neuroleptic malignant syndrome. The most common infections were 15 cases of pneumonia including 2 Legionella, 8 complicated UTI/pyelonephritis, 3 primary bacteremia, 2 West Nile virus, 2 influenza, and 2 cholangitis with bacteremia. The median WBC of infectious diagnoses (9.8) was significantly higher than noninfectious diagnoses (5.8, P = 0.006, T-test). Of the 60 patients, 20% died within 30 days of T ≥ 104 including 2 patients who died of sepsis. 67% of those who died were receiving hospice care.

Conclusion

T ≥ 104 is rare in adults and is usually associated with bacterial infections such as pneumonia (including Legionella), complicated UTIs/pyelonephritis, and primary bacteremia but may also be seen with viral infections such as West Nile virus and influenza. Mortality is high.

Disclosures

All authors: No reported disclosures.

CinéBreast-factors influencing the time to first metastatic recurrence in breast cancer: Analysis of real-life data from the French ESME MBC database

Purpose

The Time to First Metastatic Recurrence (TFMR) could be considered as an indirect reflection of the tumour growth kinetics which plays an important role in cancer. Molecular subtypes such as expression of estrogen receptor are known predictive factors of TFMR. The CinéBreast study aimed to identify predictive factors of the time to TFMR.

Methods

The French Epidemiological Strategy and Medical Economics (ESME) Metastatic Breast Cancer (MBC) Database (NCT03275311) was used, which contains data from a cohort of metastatic breast cancer patients from 2008 to 2016 using retrospective data collection. It is a national multi-centre database. The impact of TFMR on overall survival (OS) since first metastasis was also evaluated.

Results

Among 16 702 patients recorded in the ESME MBC database, 10 595 had an initially localised breast cancer with hormone receptor (HR) and HER2 status available, with a metastatic recurrence. Median follow up was 56 months. Median TFMR was 59 months (<24: 20%, 24–60: 31%, 60–120: 25%, >120: 24%). HER2+ and TNBC were respectively 4 times and 12 times (p < 0.0001) more likely to have a recurrence within 2 years when compared to the luminal subgroup. Short TFMR and HR-/HER2-subtype significantly correlated with a poor OS in multivariate analysis.

Some patients with MBC (20% in HER2+, 10% in ER+/HER2-and <5% in the ER-/HER2-) were long-term survivors in all 3 subgroups.

Conclusions

In this large-scale real-life data study, patients with a TNBC metastatic recurrence had a shorter TFMR. Short TFMR significantly correlated with worse overall survival.

•

ESME is a large-scale real-life database of 16 702 metastatic breast cancer patients.

•

A short time to first metastatic recurrence is associated with poor overall survival.

•

Triple-negative tumours were more likely to recur early than HR+ and HER2+ tumours.

HIV-Specific T Cells Can Be Generated against Non-escaped T Cell Epitopes with a GMP-Compliant Manufacturing Platform

Although anti-retroviral therapy (ART) is successful in suppressing HIV-1 replication, HIV latently infected reservoirs are not eliminated, representing a major hurdle in efforts to eradicate the virus. Current strategies to eradicate HIV involve two steps: (1) the reactivation of latently infected cells with latency reversing agents (LRAs) to expose persisting HIV, and (2) the elimination of these cells with immune effectors while continuing ART to prevent reinfection. HIV-specific T cells (HSTs) can kill reactivated HIV-infected cells and are currently being evaluated in early-stage immunotherapy trials. HIV can mutate sequences in T cell epitopes and evade T cell-mediated killing of HIV-infected cells. However, by directing T cells to target multiple conserved, non-escaped HIV epitopes, the opportunity for viral escape can be reduced. Using a good manufacturing practice (GMP)-compliant platform, we manufactured HSTs against non-escape epitope targets (HST-NEETs) from HIV⁺ and HIV-seronegative donors. HST-NEETs expanded to clinically relevant numbers, lysed autologous antigen-pulsed targets, and showed a polyfunctional pro-inflammatory cytokine response. Notably, HST-NEETs recognized multiple conserved, non-escaped HIV epitopes and their common variants. We propose that HST-NEETs could be used to eliminate reactivated virus from latently infected cells in HIV⁺ individuals following LRA treatment. Additionally, HST-NEETs derived from HIV-negative individuals could be used post-transplant for HIV⁺ individuals with hematologic malignancies to augment anti-viral immunity and destroy residual infected cells.

Continuously Sheared Granular Matter Reproduces in Detail Seismicity Laws

We introduce a shear experiment that quantitatively reproduces the main laws of seismicity. By continuously and slowly shearing a compressed monolayer of disks in a ringlike geometry, our system delivers events of frictional failures with energies following a Gutenberg-Richter law. Moreover, foreshocks and aftershocks are described by Omori laws and interevent times also follow exactly the same distribution as real earthquakes, showing the existence of memory of past events. Other features of real earthquakes qualitatively reproduced in our system are both the existence of a quiescence preceding some main shocks, as well as magnitude correlations linked to large quakes. The key ingredient of the dynamics is the nature of the force network, governing the distribution of frictional thresholds.

HIV disease, metabolic dysfunction and atherosclerosis: A three year prospective study

HIV infection is known to be associated with cardiometabolic abnormalities; here we investigated the progression and causes of these abnormalities. Three groups of participants were recruited: HIV-negative subjects and two groups of treatment-naïve HIV-positive subjects, one group initiating antiretroviral treatment, the other remaining untreated. Intima-media thickness (cIMT) increased in HIV-positive untreated group compared to HIV-negative group, but treatment mitigated the difference. We found no increase in diabetes-related metabolic markers or in the level of inflammation in any of the groups. Total cholesterol, low density lipoprotein cholesterol and apoB levels were lower in HIV-positive groups, while triglyceride and Lp(a) levels did not differ between the groups. We found a statistically significant negative association between viral load and plasma levels of total cholesterol, LDL cholesterol, HDL cholesterol, apoA-I and apoB. HIV-positive patients had hypoalphalipoproteinemia at baseline, and we found a redistribution of sub-populations of high density lipoprotein (HDL) particles with increased proportion of smaller HDL in HIV-positive untreated patients, which may result from increased levels of plasma cholesteryl ester transfer protein in this group. HDL functionality declined in the HIV-negative and HIV-positive untreated groups, but not in HIV-positive treated group. We also found differences between HIV-positive and negative groups in plasma abundance of several microRNAs involved in lipid metabolism. Our data support a hypothesis that cardiometabolic abnormalities in HIV infection are caused by HIV and that antiretroviral treatment itself does not influence key cardiometabolic parameters, but mitigates those affected by HIV.

Abstract P5-17-04: Metastatic inflammatory breast cancer: Clinical features and outcomes in the national, multicentric, real-life ESME cohort

Background:Primary inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer. Survival of IBC patients has been improved by multimodal therapy. However 5-year overall survival (OS) still remains close to 50-60%, due to high risk of disseminated disease. Given the low incidence, prognosis of metastatic cases stages is poorly described.

Methods:This study aimed to describe OS of IBC (T4d AJCC TNM classification) with upfront or recurrent metastatic disease compared with non-IBC patients in the ESME database (N=16,702 patients). OS was calculated from the diagnosis of metastasis to the date of death (from any cause), or censored to date of latest news. Secondary objectives included progression-free survival (PFS).

Results:From 2008 to 2014, 7,465 patients with diagnosis of MBC and known clinical status of their primary tumor (T) were identified, including 582 IBC (T4d) and 6,883 non-IBC. As expected, metastatic IBC was associated with pejorative features compared to non-IBC, with less hormonal receptors-positive tumors (44% vs 65.6%), more HER2-positive (30% vs 18.6%) or triple-negative (25.9% vs 15.8%) cases (p&lt;0.001), more frequent upfront M1 stage (53.3% vs 27.7%; p&lt;0.001), and shorter median disease-free interval (2.02 years vs. 4.9 years; p&lt;0.001). With a median follow-up of 50.2 months (0-104), median OS was 28.4 [95%CI 24-33.8] versus 37.2 months [95%CI 36.1-38.5] in metastatic IBC and non-IBC cases respectively (p&lt;0.0001, log-rank test). By multivariate Cox model with adjustment for major prognostic factors [including age, disease-free interval, type of relapse, visceral metastases, molecular subtype, grade], OS was significantly shorter in the metastatic IBC group compared with non-IBC group (HR 1.25 [95%CI 1.1-1.4], p=0.0002). Of note, survival of metastatic IBC patients improved over the last years: median OS 24 months [95%CI 20-31.9], 29 months [95%CI 21.7-39.9] and 36 months [95%CI 27.9-NE] if diagnosed before 2011, between 2011 and 2012, or after 2012 respectively (p=0.003). Such improvement was not observed in non-IBC patients. IBC was associated with shorter median PFS under first line systemic treatment compared with non-IBC (7.2 months [95%CI 6.6-8.3] vs 9.5 months [95%CI 9.1-9.8] respectively, p=0.0136). This was maintained in a multivariate Cox model adjusting for same factors as for OS (HR 1.15 [95%CI 1-1.3], p=0.0050).

Compared with non-IBC, synchronous metastatic IBC showed worse median OS and PFS (39.9 months [95%CI 34.2-45.3] vs 48.4 months [95%CI 46.3-50.8], p=0.0035; 10 months [95%CI 8.8-12.7] vs 14.5 months [95%CI 13.6-15.7], p=0.0027, respectively. Similar results were obtained in metachronous metastatic cases (20.01 months [95%CI 17.1-21.2] vs 32.8 months [95%CI 31.5-34.3], p&lt;0.0001; 5.1 months [95%CI 4.1-6] vs 7.9 months [95%CI 7.6-8.3], p&lt;0.0001, respectively).

Conclusion:In this large national and multicentric study, IBC is a major and independent factor associated with adverse outcome in metastatic setting. Of note, the independent adverse impact on PFS identified in this study may suggest a lower sensitivity of metastatic IBC to available therapeutics. However, results seem to improve in the last years. Detailed analysis according to phenotype will be available.

Citation Format: Monneur A, Bertucci F, Lardy-Cleaud A, Augereau P, Debled M, Levy C, Mouret-Reynier MA, Coudert B, Mailliez A, Bachelot T, Ferrero J-M, Guiu S, Uwer L, Campone M, Cottu P, Jouannaud C, De la Motte Rouge T, Leheurteur M, Petit T, Pistilli B, Dalenc F, Simon G, Robain M, Viens P, Lerebours F, Gonçalves A. Metastatic inflammatory breast cancer: Clinical features and outcomes in the national, multicentric, real-life ESME cohort [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-17-04.

Vergleich zwischen szintigraphischen und neurochirurgischen Befunden bei Hirntumoren

Bei einem selektiven Krankengut von 120 operierten Hirntumoren wurde der neurochirurgische Befund den Ergebnissen der Hirn-Szintigraphie gegenübergestellt. Die Auswahl der Fälle wurde auf die häufigen Tumor-Arten beschränkt, wie Meningeome, Astrozytome, Glioblastome, Oligodendrogliome, Neurinome und Metastasen. Aus dem Operationsbefund wurden die Lokalisation, die Tumorgröße, das Ausmaß der Vaskularisation sowie das Vorhandensein von Zysten und Nekrosen ausgewertet. Diese Daten wurden in Beziehung gesetzt zum Verhalten in der Radioangiographie und dem Grad der Aktivitätsanreicherung in den szintigraphischen Spätbildern.

Von den Hirntumoren waren 105 Fälle szintigraphisch nachweisbar.

In der Artdiagnostik war die Radioangiographie den szintigraphischen Spätbildern deutlich überlegen. Die Tumorgröße wurde szintigraphisch bei den Meningeomen etwas zu groß ermittelt, bei den übrigen Tumoren war die szintigraphische Tumorgröße kleiner als die im Operationsbefund angegebene.

Der Grad der Anreicherung in den Spätbildern zeigte eine Korrelation zur Vaskularisation. Dagegen bestand keine Korrelation zwischen der Vaskularisation und dem radioangiographischen Verhalten bei den Glioblastomen. Dieser Befund bedarf der weiteren Überprüfung. In der Hälfte der Fälle mit Zysten und Nekrosen waren Inhomogeneitäten in der Aktivitätsanreicherung des Tumors auf den Spätbildern erkennbar.