Targeting osteosarcoma with canine B7-H3 CAR T cells and impact of CXCR2 Co-expression on functional activity

The use of large animal spontaneous models of solid cancers, such as dogs with osteosarcoma (OS), can help develop new cancer immunotherapy approaches, including chimeric antigen receptor (CAR) T cells. The goal of the present study was to generate canine CAR T cells targeting the B7-H3 (CD276) co-stimulatory molecule overexpressed by several solid cancers, including OS in both humans and dogs, and to assess their ability to recognize B7-H3 expressed by canine OS cell lines or by canine tumors in xenograft models. A second objective was to determine whether a novel dual CAR that expressed a chemokine receptor together with the B7-H3 CAR improved the activity of the canine CAR T cells. Therefore, in the studies reported here we examined B7-H3 expression by canine OS tumors, evaluated target engagement by canine B7-H3 CAR T cells in vitro, and compared the relative effectiveness of B7-H3 CAR T cells versus B7-H3-CXCR2 dual CAR T cells in canine xenograft models. We found that most canine OS tumors expressed B7-H3; whereas, levels were undetectable on normal dog tissues. Both B7-H3 CAR T cells demonstrated activation and OS-specific target killing in vitro, but there was significantly greater cytokine production by B7-H3-CXCR2 CAR T cells. In canine OS xenograft models, little anti-tumor activity was generated by B7-H3 CAR T cells; whereas, B7-H3-CXCR2 CAR T cells significantly inhibited tumor growth, inducing complete tumor elimination in most treated mice. These findings indicated therefore that addition of a chemokine receptor could significantly improve the anti-tumor activity of canine B7-H3 CAR T cells, and that evaluation of this new dual CAR construct in dogs with primary or metastatic OS is warranted since such studies could provide a critical and realistic validation of the chemokine receptor concept.

Lower Airway Dysbiosis Augments Lung Inflammatory Injury in Mild-to-Moderate Chronic Obstructive Pulmonary Disease

Rationale: Chronic obstructive pulmonary disease (COPD) is associated with high morbidity, mortality, and healthcare costs. Cigarette smoke is a causative factor; however, not all heavy smokers develop COPD. Microbial colonization and infections are contributing factors to disease progression in advanced stages. Objectives: We investigated whether lower airway dysbiosis occurs in mild-to-moderate COPD and analyzed possible mechanistic contributions to COPD pathogenesis. Methods: We recruited 57 patients with a >10 pack-year smoking history: 26 had physiological evidence of COPD, and 31 had normal lung function (smoker control subjects). Bronchoscopy sampled the upper airways, lower airways, and environmental background. Samples were analyzed by 16S rRNA gene sequencing, whole genome, RNA metatranscriptome, and host RNA transcriptome. A preclinical mouse model was used to evaluate the contributions of cigarette smoke and dysbiosis on lower airway inflammatory injury. Measurements and Main Results: Compared with smoker control subjects, microbiome analyses showed that the lower airways of subjects with COPD were enriched with common oral commensals. The lower airway host transcriptomics demonstrated differences in markers of inflammation and tumorigenesis, such as upregulation of IL-17, IL-6, ERK/MAPK, PI3K, MUC1, and MUC4 in mild-to-moderate COPD. Finally, in a preclinical murine model exposed to cigarette smoke, lower airway dysbiosis with common oral commensals augments the inflammatory injury, revealing transcriptomic signatures similar to those observed in human subjects with COPD. Conclusions: Lower airway dysbiosis in the setting of smoke exposure contributes to inflammatory injury early in COPD. Targeting the lower airway microbiome in combination with smoking cessation may be of potential therapeutic relevance.

Machine learning models for estimating contamination across different curbside collection strategies

Contaminated recyclables, which are frequently discarded as waste, pose a significant challenge to the implementation of a circular economy. These contaminated recyclables impede the circulation of resources, resulting in higher processing costs at material recovery facilities (MRFs). Over the past few decades, machine learning (ML) models such as linear regression (LR), support vector machine (SVM), and random forest (RF) have evolved to provide new methods for predicting inbound contamination rates in addition to traditional statistical models. In this study, we applied ML models to predict inbound contamination rates using demographic features from 15 counties in the U.S. with different curbside collection strategies. In general, we found that ML models outperformed linear mixed models. Specifically, SVM models had the highest performance (R² = 0.75; mean absolute error (MAE) = 0.06), which may be due to their ability to model nonlinear relationships between features and inbound contamination rates. The key predictor was population, with poverty rate being positively correlated and median age negatively correlated with inbound contamination rates. To improve the management of contamination and enhance the implementation of a circular economy, better models are needed to understand and estimate inbound contamination rates as well as identify critical factors in the present and future.

The use of microplastics as a reliable chronological marker of the Anthropocene onset in Southeastern South America

Microplastics (MPs) represent an emergent contamination marker. For this reason, we analyzed the vertical distribution of MPs in six sediment cores retrieved from the Patos-Mirim System, the world's largest coastal lagoonal system. The sediment cores span from mid Holocene to present times according to both radiocarbon and lead dating and are located close to both urban/industrial and agricultural regions. We identified a basal pre-disturbance MP-free zone in all cores and an uppermost contaminated 70-cm-zone, where a general increasing trend in MPs content resembling the human anthropization process was recorded. The predominant format of MPs was fiber, followed by fragments. The most commonly identified polymers were rayon, PVC, acrylate, polycarbonate and cellophane. Urban/industrial and agricultural activities were shown as clear sources of MPs, leading to comparable MPs concentration values in the sediment cores. Thus, MPs are collectively a reliable indicator of the Anthropocene onset, and in the Patos-Mirim System the most appropriate chronology can be assigned to the beginning of 1970s, matching the intensification of anthropogenic activities in the area.

Repeat cryoablation as a redo procedure for atrial fibrillation ablation: Is it a good choice?

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Medtronic Inc.

Introduction

Catheter ablation of atrial fibrillation, both cryoablation and radiofrequency pulmonary vein isolation, have demonstrated to be safe and effective techniques for treating symptomatic atrial fibrillation as a first procedure. However, about one in three patients may face a redo procedure due to AF recurrence. The most suitable technique for redo is unknown.

Purpose

The aim of this study is to assess the efficacy of cryoballoon AF ablation as a redo technique in patients with prior cryoballoon or radiofrequency AF ablation.

Methods

We analyzed a nation-wide real-world cryoablation registry (RECABA) and compared patients who were referred for a first cryoballoon AF ablation procedure with those who had previously undergone cryoballoon or radiofrequency pulmonary vein isolation. The primary endpoint was AF recurrence during the first year after a 3-month blanking period. We performed survival analysis and built univariate and multivariate cox regression models.

Results

From 1742 patients, 1625 had a 12-month follow-up visit. 1551 (95.45%) underwent a first cryoballoon ablation, whereas 33 (2.03%) had a previous CB ablation performed and 41 (2.52%) a previous RF ablation.

Mean age was 58.6 ±10.4 years and 511 (31.5%) were women. 463 (28.5%) had persistent atrial fibrillation and there were no major clinical differences between groups.

Prior-CB group had a higher share of veins without electrogram visualization, with a median of 100% (IQR 75%-100%), compared to prior-RF group (median 67%, IQR 25%-75%) and first procedure group (median 25%, IQR 0%-50%). Kruskal-Wallis test Chi2=54.35, p<0.0001.

12-month Kaplan–Meier estimate of freedom from AF recurrence after the blanking period was 78.5% (95% CI 76.2% - 80.7%) in the first procedure group, 61.0% (95% CI 41.4% - 75.8%) in the prior-CB and 89.2% (95% CI 73.6% - 95.9%) in the prior-RF group. Log-rank test Chi2=17.49, p<0.0001.

Multivariate cox regression analysis pointed female sex, persistent AF, and prior-CB ablation as independent predictors of AF recurrence. The adjusted HR for AF recurrence of prior-CB ablation vs first-CB ablation was 3.13 (95% CI 1.82 -5.40) and for prior-RF vs first CB-ablation was 1.01 (95% CI 0.51 – 1.97).

Conclusion

Repeat cryoballoon AF ablation shows higher rates of AF recurrences compared to first CB procedures or after prior RF ablation. These data suggest that patients with AF recurrence after CB-ablation have worse arrhythmic outcomes and may benefit from other ablation techniques after a recurrence.

The effect of agricultural intensification and water-locking on the world's largest coastal lagoonal system

The palaeolimnological conditions of Mirim Lagoon, a large coastal shallow lagoon under the influence of historical human impacts related to the development of the primary sector of the economy were reconstructed. The first significant human impact consisted of locking the estuarine system to induce the transition from brackish to freshwater conditions. During this transition, the sedimentation rate consistently increased from pre-disturbance values of 0.25 cm yr^-1 to >1 cm yr^-1. A concomitant increase in nitrogen and carbon values was recorded indicating a related eutrophication process. The highest nutrient levels were achieved during the 1990s after the incorporation of cutting-edge technologies for agricultural production such as high-yielding varieties of rice resistant to climate variability and pests, and the use of inorganic fertilisers, pesticides and water supply controlled by irrigation. After 2011, the soybean production boosted and the area cultivated with this oilseed equalled the area of rice paddies, i.e., 2 × 10⁵ ha. A sharp decrease in δ¹³C from -19 to -24‰ and in δ¹⁵N from 6 to 2‰ were observed in the sedimentary record, indicating a major shift in the composition of the organic matter after the agricultural intensification. Trace elements Cr, Cu, Ni and Zn showed a high positive correlation with Al and Fe, and enrichment factors near 1, indicating a natural and terrigenous source of these elements and also unpolluted conditions. However, the increase of As after 1990 and the positive correlation with Pb was associated with agricultural practices. All elemental ratios (K/Al, Ti/Al and V/Cr) showed constant pre-disturbance trends and a turning point ca. the 1990s. Microplastics were detected from the beginning of the 1990s and increased towards recent sediments, thus corroborating an anthropogenically impacted scenario. Therefore, the development of the primary sector of the economy exerted clear impacts on the environmental quality of the system.

Episodic Aspiration with Oral Commensals Induces a MyD88-dependent, Pulmonary T-Helper Cell Type 17 Response that Mitigates Susceptibility to Streptococcus pneumoniae

Rationale: Cross-sectional human data suggest that enrichment of oral anaerobic bacteria in the lung is associated with an increased T-helper cell type 17 (Th17) inflammatory phenotype.Objectives: In this study, we evaluated the microbial and host immune-response dynamics after aspiration with oral commensals using a preclinical mouse model.Methods: Aspiration with a mixture of human oral commensals (MOC; Prevotella melaninogenica, Veillonella parvula, and Streptococcus mitis) was modeled in mice followed by variable time of killing. The genetic backgrounds of mice included wild-type, MyD88-knockout, and STAT3C backgrounds.Measurements and Main Results: 16S-rRNA gene sequencing characterized changes in microbiota. Flow cytometry, cytokine measurement via Luminex and RNA host-transcriptome sequencing was used to characterize the host immune phenotype. Although MOC aspiration correlated with lower-airway dysbiosis that resolved within 5 days, it induced an extended inflammatory response associated with IL-17-producing T cells lasting at least 14 days. MyD88 expression was required for the IL-17 response to MOC aspiration, but not for T-cell activation or IFN-γ expression. MOC aspiration before a respiratory challenge with S. pneumoniae led to a decrease in hosts' susceptibility to this pathogen.Conclusions: Thus, in otherwise healthy mice, a single aspiration event with oral commensals is rapidly cleared from the lower airways but induces a prolonged Th17 response that secondarily decreases susceptibility to S. pneumoniae. Translationally, these data implicate an immunoprotective role of episodic microaspiration of oral microbes in the regulation of the lung immune phenotype and mitigation of host susceptibility to infection with lower-airway pathogens.

POS0006 NX-5948, A SELECTIVE DEGRADER OF BTK, SIGNIFICANTLY REDUCES INFLAMMATION IN A MODEL OF AUTOIMMUNE DISEASE

Background:

Aberrant activation of B cells and autoantibody mediated tissue damage are hallmarks of autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Therefore, novel treatments that prevent autoantibody generation or antibody-mediated end organ tissue damage are of high interest. Bruton’s tyrosine kinase (BTK) transduces signals downstream of the B cell receptor (BCR), toll-like receptors, and Fc receptors in B cells and myeloid cells [1]. Overexpression of BTK in B cells leads to hyperactive BCR signaling, plasma cell generation, autoantibody secretion, and an SLE-like disease in mice [2]. Conversely, reducing BTK expression in B cells can ameliorate disease in Lyn-deficient mice.[3] BTK inhibitors, such as evobrutinib, have entered clinical studies for the treatment of autoimmune diseases.[4]

Objectives:

Small molecule-induced protein degradation offers a unique approach to target BTK; this approach simultaneously eliminates both BTK kinase activity and BTK-mediated scaffolding interactions in the signalosome. Chimeric Targeting Molecules (CTMs) are small molecules that catalyze ubiquitylation and proteasomal degradation of target proteins and are comprised of a ubiquitin ligase binding element (“harness”), a linker, and a target binding element (“hook”). NX-5948 is a CTM that contains a BTK hook linked to a cereblon (CRBN) harness. We examined the activity of NX-5948 in a collagen-induced arthritis model as part of an assessment of its potential as a drug candidate for autoimmune disease.

Methods:

Cellular degradation of BTK, Aiolos and Ikaros as well as induction of CD69 and CD86 was determined using flow cytometry. Degradation of BTK in CD-1 mice or cynomolgus monkey was determined using flow cytometry analysis. In a collagen-induced arthritis (CIA) model, mice were vaccinated with type II collagen and treated before the onset of symptoms. Serum cytokine and anti-type II collagen antibody levels were determined using Luminex and ELISA, respectively.

Results:

In human PBMCs, NX-5948 degrades BTK at sub-nanomolar concentrations and inhibits BCR signaling as measured by CD69 and CD86 induction in anti-IgM-stimulated B cells with similar potency. Oral administration of NX-5948 in mice leads to BTK degradation to <10% of baseline levels in circulating and splenic B cells. NX-5948 also promotes potent BTK degradation in cynomolgus monkeys, and it can suppress BTK levels to <10% of baseline levels after a single oral dose as low as 10 mg/kg.

Unlike IMiD drugs such as lenalidomide, the CRBN harness of NX-5948 was designed to avoid the degradation of known CRBN neo-substrates Aiolos (IKZF3) and Ikaros (IKZF1). In primary human T cells, NX-5948 induces minimal degradation of Aiolos and Ikaros and does not promote IL-2 secretion suggesting that NX-5948 does not convey IMiD activity associated with agents such as lenalidomide.

We examined the activity of NX-5948 in a mouse CIA model compared to that of the BTK inhibitor ibrutinib or dexamethasone as a positive control. In mice treated with NX-5948, symptoms of arthritis were resolved, and a significant reduction in arthritis clinical score was observed. Treatment with NX-5948 resulted in a reduction in anti-type II collagen titer and serum levels of the pro-inflammatory cytokine IL-6. Treatment with NX-5948 yielded superior anti-inflammatory activity relative to ibrutinib and similar activity to dexamethasone. Treatment with NX-5948 was well-tolerated and, unlike dexamethasone, did not promote body weight loss.

Conclusion:

Degradation of BTK by NX-5948 shows robust activity in a CIA model compared to existing agents tested as controls. These findings provide support for further investigation of NX-5948 in additional models of autoimmune disease to inform plans for clinical development.

References:

[1]Crofford et al. 2016. Expert Rev Clin Immunol 12: 763–773.

[2]Kil et al. 2012. Blood 119: 3744-3756.

[3]Whyburn et al. 2003. J Immunol 171: 1850-1858.

[4]Haselmayer, et. Al. 2019. J Immunol 202: 2888-2906.

Disclosure of Interests:

DANIEL ROBBINS Shareholder of: Nurix therapeutics, Employee of: Nurix therapeutics, Mark Noviski Shareholder of: Nurix Therapeutics, Employee of: Nurix Therapeutics, May Tan Shareholder of: Nurix Therapeutics, Employee of: Nurix Therapeutics, Cristiana Guiducci Shareholder of: Nurix Therapeutics, Employee of: Nurix Therapeutics, Timothy Ingallinera Shareholder of: Nurix Therapeutics, Employee of: Nurix Therapeutics, Dane Karr Shareholder of: Nurix Therapeutics, Employee of: Nurix Therapeutics, Aileen Kelly Shareholder of: Nurix Therapeutics, Employee of: Nurix Therapeutics, Zef Konst Shareholder of: Nurix Therapeutics, Employee of: Nurix Therapeutics, Austin Tenn-McClellan Shareholder of: Nurix Therapeutics, Employee of: Nurix Therapeutics, Jenny McKinnell Shareholder of: Nurix Therapeutics, Employee of: Nurix Therapeutics, Luz Perez Employee of: Nurix Therapeutics, Gwenn Hansen Shareholder of: Nurix Therapeutics, Employee of: Nurix Therapeutics, Ryan Rountree Shareholder of: Nurix Therapeutics, Employee of: Nurix Therapeutics

Exposure of Teramnus labialis (L.F.) Spreng Seeds to Liquid Nitrogen Does Not Affect Nutritional Status of Field Grown Adult Plants

BACKGROUND

Teramnus labialis (L.f.) Spreng is a potentially important legume species, and can be used as an animal feed and to enhance soil physicochemical characteristics. Despite the biological and agricultural importance, the low availability of seeds, their small size and the low percentage germination limit their large-scale use by farmers. We previously reported a method to cryopreserve seeds of T. labialis which also allowed for the breaking of seed dormancy.

OBJECTIVE

The current study reports on the nutritional status of 5 month old field grown plants regenerated from cryostored and control seeds.

MATERIALS AND METHODS

Biomass (fresh and dry mass of leaves and stems) and contents of ash, neutral detergent fiber, acid detergent fiber, lignin, cellulose, crude protein, P, Ca, Mg and K were measured.

RESULTS

Seeds germinated and emerged faster following immersion in liquid nitrogen (LN) which was supported by quantitative evaluations of fresh and dry weights per m². However, the ratio of leaf:stem mass were not altered by seed exposure to LN.

CONCLUSION

The results showed that exposure of seeds to cryogenic temperatures did not alter the nutritional composition of regenerated plants.

Intraparotid mucous retention cyst in an infant: a rare case report

Mucocoeles can be defined as benign lesions that have resulted from extravasation or retention of saliva in the extraglandular spaces, and commonly affect the minor salivary glands. This case details a mucous retention cyst within the parotid gland of an infant, and its management.

AB1007 SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS: ARE DIFFERENT CLINICAL PATTERNS ASSOCIATED WITH S100A8/S100A9 SERUM LEVELS?

Background:

Systemic juvenile idiopathic arthritis (SJIA) is a category of Juvenile Idiopathic Arthritis (JIA). Different clinical patterns (articular/systemic/both of them combined) have been recognized, possibly identifying distinct subpopulations. Serum biomarkers that reflect disease activity include S100A8/S100A9 (S100A8/9), however to date patterns of SJIA and their association with S100A8/9 has not been tested.

Objectives:

To evaluate S100A8/9 levels in a cohort of patients with SJIA. To determinate S100A8/9 inactive vs inactive visits. To distinguish patterns on SJIA and their association with S100A8/9. To compare serum levels of S100A8/9 with other JIA categories and autoinflammatory diseases.

Methods:

An unicenter, observational, cross sectional study was conduced. Patients with SJIA according ILAR whom S100A8/9 was measured as part of standard care were enrolled. Consecutive visits were included. Variables recorded were: clinical (systemic: fever, serositis, adenopathy, hepatomegaly, splenomegaly and arthritis); biochemical (S100A8/9, hemoglobin, platelet, erythrosedimentation, c-reactive protein, ferritin). Activity measures: Juvenile Arthritis Disease Activity Score (JADAS -10) and physician visual analogue scale (phy VAS).Visits were divided into active/inactive. Active visit was defined as at least one clinical feature.(systemjc and/or arthritis). Inactive visit no clinical symptoms neither JADAS-10> 1 and phy VAS: 0. SJIA patterns were defined as: “articular pattern”: those patients with arthritis without systemic features, “systemic pattern”: any systemic feature without arthritis, “mixed pattern”: both articular and systemic. Levels of S100A8/9 were tested using Calprotectin Elisa Kit. For comparisons others JIA: enthesitis related arthritis (ERA), polyarticular and autoinflammatory diseases who had at least one S100A8/9 determination were included. Descriptive statistics, Mann- Whitney U test and ANOVA were used as appropiate.

Results:

Forty-two patients with SJIA were included (25 F). Age at evaluation 13 (1-16.5) years. Clinical features at study baseline: arthritis 57 %, rash 19%, fever 15 %, adenopathies 6%, splenomegaly 4%, hepatomegaly 1.5%. Laboratory features (median): hemoglobin 12.2 gr/dl, platelet 314000 cel/mm3, erythrosedimentation 12.5 mm/h, c-reactive protein 0.7 mg/dl, ferritin 235 ng/ml. JADAS -10 ≥ 1: 62%. Number of active patients were 29 (69%). Scheduled Medical visits were 129 (active 65%, inactive 35%). Active visits were divided according patterns into: articular 54%, mixed 35%, systemic 11%.

Serum Levels of S100A8/9 according to SJIA’ patterns.

SJIAOverallActiveArticularSystemicMixedInactiveVisits129844692945S100A8/9 ng/mlMedian (range)7590(300-2625)16788(300-26250)10750(300-26250)5200(850-12250)25000(3290-2625)3103(1140-1010)

S100A8/9 analysis revealed significant differences among active vs inactive medical visits (p: 0,00001). ANOVA test among SJIA`patterns showed, F:86.48, (p:0.00001). Mixed pattern was distinctive to others. S100A8/9 (medians ng/ml) in comparable diseases were: ERA: 4320, polyarticular: 4120, autoinflammatory: 6532. SJIA had the higher S100A8/9. SJIA was different than others comparable diseases (F: 11,62,p: 0.00001). Comparisons among SJIA`patternss and others disease found that systemic and articular pattern did not show differences (F.2.78, p:0.067)

Conclusion:

S100A8/9 was higher in SJIA compared to others diseases. It reflected disease activity. Mixed pattern evidenced to be different to others (systemic/articular). Mixed pattern was the unique that showed significative difference compared to other diseases. SJIA is probably not a single disease, but not only clinical patterns and biomarkers as S100A8/9, if not, genetic variants and their expression would be able to identify homogeneous groups towards tailored treatments.

Disclosure of Interests:

None declared

P906 Are all severe Tricuspid Regurgitation the same?

Introduction

Tricuspid regurgitation (TR) importance is growing in the last years. Its presence is associated with a worse prognosis. A new severity classification has been published, adding massive and torrential to the classical TR classification. However, both clinical profile of the patients as well as right chambers morphologic and functional changes have not been described compared to the severe TR patients.

Methods

Consecutive patients undergoing an echocardiographic study in 9 Spanish hospitals within a three-month period with at least moderate TR were prospectively included. All studies with severe TR were selected for analysis. TR assessment was performed as recommended by the European Association of Cardiovascular Imaging. TR severity grades was performed according to Hanh & Zamorano new published classification. Two cohorts were made: patients with severe TR and patients with massive or torrential TR.

Results

A total of 644 patients with severe or bigger TR were analysed. Severe TR was present in 540 (84%), massive was present in 83 (13%) and torrential in 21 (3%) Baseline characteristics of the study population are shown in table 1.

No differences were found in NYHA class or atrial fibrillation incidence between groups. Pacemaker was more frequent in massive/torrential group (30% vs 19%; 0,014).

Patients with massive/torrential TR presented worst RV remodelling data:

-RV was dilated (RV telediastolic basal diameter &gt;42mm) in 84.2% of patients with massive/torrential TR vs 57% of patients with severe TR (p &lt; 0.001).

-Right atrium was bigger in patients with massive/torrential TR (21 ± 0.8 cm2/m2 vs 17.2 ± 0,3 cm2/m2; p &lt; 0.001)

-Tricuspid annulus diameter was bigger between massive/torrential TR patients (26.7 ± 0.6 cm/m2 vs 23.6 ± 0.3 cm/m2; p &gt; 0.001).

No significant differences in prevalence of RV function (TAPSE &lt; 17 mm) were noted 39% vs 33%, p = 0,273.

Conclusions

In this large multicentre cohort of patients, the presence of massive/torrential TR seems to be associated with a differential RV and RA remodelling, reflecting the greater volume overload seen in these patients. Further studies are needed to define prognosis implication of our findings and its role in clinical decision making.

Table 1 Variable Severe (n = 540) Massive/Torrential (n = 104) Body mass index 26,6 (±0,3) 26.4(±0,6) 0.350 Woman 336 (62%) 69 (66%) 0.438 Atrial firilation 298(55%) 61(59%) 0.514 Age (years) 76,5 (±0,5) 77,5(±1,1) 0.209

39 Overview of tricuspid regurgitation (tr). new classification of tr. when severe tr is too severe?

Introduction

Tricuspid regurgitation (TR) importance is growing in the last years. Its presence is associated with a worse prognosis. A new severity classification has been published, adding massive and torrential to the classical TR classification. However, it is not know how many of the patients classified as severe TR, corresponds to the new Torrential or massive classification that for sure will lead to different treatment strategies. Also few published studies have addressed the aetiologies, mechanisms and severity in large cohorts.

Purpose

To evaluate the burden of TR in a large cohort of patients referred for an echocardiography.

Methods

Prospective study where consecutive patients undergoing an echocardiographic study in 10 Spanish hospitals within a three-month period were included. All studies with at least moderate TR were selected for analysis. The evaluation was conduced according to the usual practice of the laboratory. TR assessment was performed as recommended by the European Association of Cardiovascular Imaging. TR was quantified according to Hanh & Zamorano new published classification.

Results

A total of 35088 consecutive echocardiographic studies were performed in the participant hospitals during the recruitment period. TR of at least moderate degree was detected in 2124 studies (6,05%). Mean age was 77,1 years and 62.8% were women.

Mitral or aortic valvulopthy was the most common cause, present in almost half of cases (48.4%). The second cause of TR was idiopathic with 22.2% of cases. Primary TR was found in 7.2% of patients, the most frequent aetiology in these group was cardiac implantable devices with 4.2% of total of TR. Aetiology and severity according to the new classification can be seen in the figures

Atrial fibrillation was present in 47.6% of cases. 56.4% of patients had symptoms at the time of the study (NYHA≥2 at the time of study).

Right ventricle (RV) was dilated (telediastolic basal diameter &gt;42mm) in 39.4% of patients). RV function was impared (TAPSE &lt;17mm) in 30.6% of patients.

Conclusions

In these larger multicentre study, significant TR may is present in up to 6% of the echocardiographic studies and is often symptomatic[m1] . 4,91% of patients had a massive or torrential grade. Most TR are secondary to mitral or aortic valvulopathy. Idiopathic TR has taken the second place.

Abstract 39 Figure. Severity and aetiology of TR

A Case of a Monolingual Spanish-Speaking Latina with Semantic Variant Primary Progressive Aphasia (svPPA)

Objective

Often, individuals with lower educational attainment and limited proficiency in the English language get misdiagnosed and/or undertreated, which can impact their quality of life and other outcomes. The present case study intends to review and discuss the presentation of a monolingual, Spanish-speaking woman with Semantic Variant Primary Progressive Aphasia (svPPA), who was originally referred for a neuropsychological evaluation to determine the severity of her existing Alzheimer’s Disease (AD) diagnosis.

Case Description

Ms. X, is a 64-year-old, right-handed Hispanic woman with 6 years of education. Symptoms included forgetfulness, restlessness, and insomnia. Her family reported that she was repeating her ideas frequently during conversations and failing to recognize previously acquainted people, including her own relatives. A recent MRI of the brain showed anterior temporal lobe atrophy.

Diagnostic Impressions and Outcomes

Overall, she showed naming deficits (anomia), impaired verbal fluency, surface dyslexia, and significant problems with comprehension. Executive functioning, sentence repetition, working memory, and attention were generally intact. Qualitatively, her speech was apparently fluent and automatic, yet clearly empty in meaning. In Ms. X’s case, collateral reports of word-finding difficulties, tendency to repeat her thoughts incessantly, associative agnosia and prosopagnosia, and spared repetition and motor speech are strongly indicative of svPPA.

Discussion

svPPA primarily impacts language production and comprehension, and is characterized by severe anomia, word-finding difficulties, impaired single word comprehension, and in some cases, defective recognition of familiar faces. On testing, impairments can be observed in confrontation naming, with motor speech and repetition, working memory, episodic memory, visuospatial skills, and problem-solving skills relatively intact. Language symptoms are thought to stem from deficits of the semantic system.

Host transcriptomic signatures associated with dysbiosis in a preclinical model of lung cancer

3107

Background: Enrichment of the lower airway microbiota with oral commensals has been associated with transcriptomic changes affecting several inflammatory pathways associated with non-small cell lung cancer (NSCLC) development and progression. Using a mouse model of NSCLC, we evaluated the effects of lower airway dysbiosis on tumor progression and host transcriptomics. Methods: Preclinical model of lung cancer was constructed by introducing luminescence-tagged Kras mutated cells into C57/B6 mice, causing lung cancer to develop. Lower airway dysbiosis was induced by weekly intratracheal challenge with either PBS or Veillonella parvula in wild type and lung cancer mice. Experiments were repeated twice to evaluate for survival as well as lower airway host response using flow cytometry and RNA sequencing (HiSeq). Sequence data was processed using a validated mouse gene expression signature matrix with cibersort from https://cibersort.stanford.edu and DESeq using FDR correction. Results: In wild type mice, lower airway dysbiosis with Veillonella did not affect the survival, weight gain or airway lumen diameter. Among lung cancer mice, dysbiosis led to increased mortality, weight loss, and tumor burden. Multiple transcriptomic signatures were identified among the dysbiosis groups (both in WT and lung cancer mice). Unsupervised hierarchical clustering of immune cell profiles using cibersort on whole transcriptome showed near perfect separation between the four experimental conditions. Amongst the most differentially enriched immune cell subsets, we identified that lung dysbiosis upregulates genes annotated to Th1 and Th2 cells (p < 0.01, q < 0.2). Using flow cytometry, we identified that PD-1, IL-17, and ROR-gamma are differentially expressed in CD4+ cells in dysbiosis conditions, and these patterns are consistent in whole RNA transcriptome. Conclusions: Transcriptomic signatures reveal immune profiles associated with dysbiosis, an experimental condition associated with worse outcomes in lung cancer. This investigation provides novel insights into how disruption of the lower airway microbiome may contribute to the pathogenesis of NSCLC.

The Solubility of Octacalcium Phosphate at 37°C in the System Ca(OH)2-H 3PO4-KNO3-H2O

The solubility product of octacalcium phosphate [Ca4H(PO4)3 · 2.5H 2O] has been determined in the system Ca(OH)2-H3PO 4KNO3-H2O at 37°C in experiments involving a range of hydrodynamics, ionic strength, and equilibration time. A value of pK so= 49.3 ± 0.2 was obtained for three different solid preparations by considering activity coefficients and ion-pair corrections.

Effect of Blanching and Vacuum Pulse Application on Osmotic Dehydration of Pear

Osmotic dehydration of pear cylinders (var. blanquilla) was studied by analysing the effect of blanching pre-treatment and the application of a vacuum pulse on the kinetics and yield of the process and on product quality (colour and mechanical behaviour). Fresh and stem-blanched samples were treated with 65 Brix sucrose at atmospheric pressure and by applying a vacuum pulse (50 mbar for 5 min). The influence of the sugar gain and water loss fluxes, and the tissue structural response to the vacuum pulse, on the total mass and volume losses of the samples has been discussed. Blanching implied an increase in the mass transfer rate in pear tissue. Vacuum pulse in blanched samples resulted in more volume compression than sample impregnation with the external solution due to the sample softening by thermal effect and to the partial gas release during its thermal expansion. This provoked the greatest volume losses and a reductionof the ratio of sugar gain to water loss, where the highest values reached were for non-blanched samples submitted to vacuum pulse. Mechanical changes induced by treatments were similar inall cases, but colour hue and chrome were better preserved in samples treated by PVOD. Nevertheless, this treatment implied a transparency gain due to the sample gas release and so, samples become darker.

Sexual side effects in patients treated with desvenlafaxine: An observational study in daily practice

Introduction

Sexual function is important for patients’ well-being but it is a common side effect of SSRI and SNRI, included desvenlafaxine.

Objectives and aims

Evaluate incidence and characteristics of sexual dysfunction caused by desvenlafaxine in the clinical practice.

Methods

One hundred and thirty-three patients with recently introduced desvenlafaxine treatment are recruited from Barakldo and Uribe-Kosta Mental Health Centres in Biscay, Spain. UKU scale is administered to measure sexual side effects. Statistical analysis is performed using SPSS v.22.

Results

Sexual dysfunction is observed in 5 patients (3.7%) at 50 and 100 mg/d (2 and 3 patients, respectively) desvenlafaxine doses. Two patients (1.5%) have experimented more than one sexual side effect. Regarding gender differences, the most frequent sexual dysfunctions are diminished sexual desire (5.5%) and erectile dysfunction (5.5%) in men and orgasmic dysfunction (1.2%) in women (P-values are 0.034; 0.034 and 0.408, respectively). Discontinuation is decided in 60% of patients.

Conclusions

Desvenlafaxine has a well-tolerated sexual side effect profile in general population. There are some gender-related differences both in presentation and perception, as it has been described with other drugs, and this should be taken into account by prescriptors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Abstract P2-08-31: Tumor and axillar downstaging as a prognostic factor and evaluation of effectiveness to primary chemotherapy in breast cancer: A retrospective analysis

Introduction: Evaluation of the benefit of primary chemotherapy (PC) is not easy to establish. Pathologic complete response (pCR) has been considered the main surrogate prognostic factor of patient's survival. However, patients achieving a pCR are not the only ones who benefit from PC. The purpose of our study is to find a measure of response that includes the maximum of patients that benefit from PC in terms of survival.

Patients and methods: 224 breast cancer patients were treated in Breast Cancer Unit from Institut Català d'Oncologia (ICO) L'Hospitalet with taxans and antracyclines-based PC +/- trastuzumab between 2009 and 2011. pCR was defined as no invasive carcinoma found in the tumor and in the axillary lymph nodes (ypT0/ypTis ypN0). Tumor and nodal downstaging (TNDS) was calculated according to the "neoadjuvant response index" (NRI) from Rodenhuis and also as a dichotomic variable: Positive includes those patients achieving dowstaging of both T and N plus T downstaging N0 and negatives those patients without downstaging in any of both variables. Those parameters were related to patient's overall survival (OS). Statistical analysis was performed with SPSS version 15.

Results: Median age 45.5 years (24-83). Main tumor characteristics: T2 (62.6%); N1 (50%); ductal infiltrating carcinoma (95.5%) and grade III (57.1%). Biological sub-type according to the last St Gallen classification: luminal A: 28 patients (pts); luminal B/Her2-: 61 pts; luminal B/HER2+: 34 pts; HER2+: 33 pts and triple negative: 69 pts. Pathologic complete response was achieved in 49 pts (22.5%). TNDS was evaluated in 181 patients and of those 90 was positive. According to NRI 74 patients presented cut-off&gt; 0.5 and 52 pts &gt; 0.7. Parameters related to OS were: biological subtype (P: 0.007); achieving a pCR (p: 0.007); NRI cut-off 0.5 (P: 0.001) and TNDS (p:0.000). In the multivariate analysis only TNDS and biological subtype remained statistically significant. When comparing those patients with positive vs. negative TNDS, the HR for recurrence was of 10.05 (IC 2.33 -43.57). The median OS of the series has not been reached. OS at 5y was 82.7% (IC: 77.1%-88%) and specific breast cancer OS at 5 y was 85% (IC:79.5%-90%). The number of events (breast cancer deaths) for each biological subtype according to positive vs. negative TNDS was: luminal A: 0/5 vs. 0/18; luminal B Her2-: 0/10 vs. 8/43; luminal B HER2+:0/23 vs. 2/9; HER2+: 0/22 vs. 0/2 and TN: 2/30 vs. 8/18. Survival data per subtypes and TNDS is immature due to the scarce number of events. Estimated 5y OS for TNDS positive vs. negative in luminal A: 100% vs. 100%; luminal B Her2-: 100% vs. 82%; luminal B HER2+:100 vs.77.7%; HER2+: 100% vs. 100% and TN: 93% vs. 55%, respectively.

Conclusion: In our series, TNDS measured either with the NRI from Rodenhuis or as a dichotomic variable was the best parameter to evaluate response to PC in terms of OS. OS of luminal A and luminal B/Her2 negative is less influenced by PC than the rest of subgroups. In fact both subgroups have good prognosis despite their poor sensitivity to chemotherapy. Those tumors that benefit most from PC were luminal B/ Her2+; Her2+ and triple negative patients who achieved a positive TNDS.

Citation Format: Falo C, Ventura LM, Petit A, Perez J, Cañellas J, Perez L, Loayza C, Gil M, Varela M, Garcia A, Pla MJ, Lopez A, Guma A, Pernas S. Tumor and axillar downstaging as a prognostic factor and evaluation of effectiveness to primary chemotherapy in breast cancer: A retrospective analysis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-31.

Transport-related measures to mitigate climate change in Basel, Switzerland: A health-effectiveness comparison study

BACKGROUND

Local strategies to reduce green-house gases (GHG) imply changes of non-climatic exposure patterns.

OBJECTIVE

To assess the health impacts of locally relevant transport-related climate change policies in Basel, Switzerland.

METHODS

We modelled change in mortality and morbidity for the year 2020 based on several locally relevant transport scenarios including all decided transport policies up to 2020, additional realistic and hypothesized traffic reductions, as well as ambitious diffusion levels of electric cars. The scenarios were compared to the reference condition in 2010 assumed as status quo. The changes in non-climatic population exposure included ambient air pollution, physical activity, and noise. As secondary outcome, changes in Disability-Adjusted Life Years (DALYs) were put into perspective with predicted changes of CO2 emissions and fuel consumption.

RESULTS

Under the scenario that assumed a strict particle emissions standard in diesel cars and all planned transport measures, 3% of premature deaths could be prevented from projected PM2.5 exposure reduction. A traffic reduction scenario assuming more active trips provided only minor added health benefits for any of the changes in exposure considered. A hypothetical strong support to electric vehicles diffusion would have the largest health effectiveness given that the energy production in Basel comes from renewable sources.

CONCLUSION

The planned local transport related GHG emission reduction policies in Basel are sensible for mitigating climate change and improving public health. In this context, the most effective policy remains increasing zero-emission vehicles.

Basiliximab treatment for autoimmune bowel disease in a pediatric heart transplant patient

Autoimmune-mediated bowel disease has been reported after pediatric heart transplantation. Recognition and treatment of these patients has been difficult. We describe a patient who responded to steroids and basiliximab therapy after an inflammatory process secondary to abnormal T-cell activation. Our patient is a 28-month-old female who received a heart transplant at five wk of age. At 24 months post-transplant, she developed fever and bloody stools. Initial investigations were significant for an elevated ESR (>120) and CRP (15.2). Symptoms persisted despite bowel rest and mycophenolate discontinuation. Endoscopic evaluation revealed discontinuous ulcerative disease involving esophagus, terminal ileum, right and left colon, necessitating extensive bowel resection. She had additional airway inflammation leading to a TEF at the site of esophageal ulceration, requiring tracheostomy. Immune evaluation revealed autoimmune dysregulation that responded to parenteral methylprednisolone. Chronic basiliximab therapy allowed for successful weaning of steroids with sustained remission. She has been transitioned to sirolimus and tacrolimus maintenance immunosuppression with plans to discontinue basiliximab once off steroids. In conclusion, bowel disease in the setting of pediatric heart transplantation can be severe and refractory to traditional treatment methods. Tailoring immune therapy to activated T cells can result in remission. Basiliximab therapy was used in our patient to maintain steroid-induced remission, but long-term complications of this disease process are unknown.

Profile of skin barrier proteins (filaggrin, claudins 1 and 4) and Th1/Th2/Th17 cytokines in adults with atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) in adults and profile of skin barrier proteins and inflammatory cytokines.

OBJECTIVE

Evaluation of the expression of skin barrier proteins such as filaggrin, claudins 1 and 4 and of circulating inflammatory cytokines (Th1/Th2/Th17) in adults with AD.

METHODS

Thirty-three adult patients with AD diagnosed according to the Hanifin & Rajkacriteria, and 25 healthy controls were enrolled in the study. AD severity was measured by Eczema Area and Severity Index (EASI). Laboratory assays included immunohistochemistry analysis of skin barrier proteins, such as filaggrin, claudins 1 and 4 and interleukin-17 (IL-17) from skin samples and determination of circulating cytokine levels (IL-2, 4, 5, 6, 10, 17A, TNF and IFN-γ) by flow cytometry (Cytometric Bead Array).

RESULTS

We observed a reduced expression of filaggrin and claudin 1 in lesional skin of AD patients, when compared to controls. There was an inverse correlation of filaggrin expression and disease severity. In addition, IL-17 expression was enhanced in AD patients. Similarly, higher levels of inflammatory cytokines (IL-2, 5, 6, 10, 17A and IFN-γ) were found in AD patients.

CONCLUSION

Our data reinforce the role of an altered skin barrier in the pathogenesis of AD. Our results show not only reduced expression of filaggrin and claudin 1 in lesional atopic skin but also inverse correlation of filaggrin expression and disease severity. Moreover, elevation of in situ IL-17 and of circulating interleukin levels in AD emphasize the systemic, inflammatory profile of this defective skin barrier dermatosis.