Copy number variation analysis identifies MIR9-3 and MIR1299 as novel miRNA candidate genes for CAKUT

BACKGROUND

Congenital anomalies of the kidney and urinary tract (CAKUT) represent a frequent cause of pediatric kidney failure. CNVs, as a major class of genomic variations, can also affect miRNA regions. Common CNV corresponding miRNAs (cCNV-miRNAs) are functional variants regulating crucial processes which could affect urinary system development. Thus, we hypothesize that cCNV-miRNAs are associated with CAKUT occurrence and its expressivity.

METHODS

The extraction and filtering of common CNVs, identified in control samples deposited in publicly available databases gnomAD v2.1 and dbVar, were coupled with mapping of miRNA sequences using UCSC Genome Browser. After verification of the mapped miRNAs using referent miRBase V22.1, prioritization of cCNV-miRNA candidates has been performed using bioinformatic annotation and literature research. Genotyping of miRNA gene copy numbers for MIR9-3, MIR511, and MIR1299, was conducted on 221 CAKUT patients and 192 controls using TaqMan™ technology.

RESULTS

We observed significantly different MIR9-3 and MIR1299 gene copy number distribution between CAKUT patients and controls (Chi-square, P = 0.006 and P = 0.0002, respectively), while difference of MIR511 copy number distribution showed nominal significance (Chi-square, P = 0.027). The counts of less and more than two of MIR1299 copy numbers were more frequent within CAKUT patients compared to controls (P = 0.01 and P = 0.008, respectively) and also in cohort of patients with anomalies of the urinary tract compared to controls (P = 0.016 and P = 0.003, respectively).

CONCLUSIONS

Copy number variations of miRNA genes represent a novel avenue in clarification of the inheritance complexity in CAKUT and provide potential evidence about the association of common genetic variation with CAKUT phenotypes.

The MMP-9 promoter genetic variant rs3918242, mRNA and protein expression in advanced carotid plaque tissue

BACKGROUND

The MMP-9 is a known player in atherosclerosis, yet associations of the MMP-9 -1562 C/T variant (rs3918242) with various atherosclerotic phenotypes and tissue mRNA expression are still contradictory. This study aimed to investigate the MMP-9 -1562 C/T variant, its mRNA and protein expression in carotid plaque (CP) tissue, as a risk factor for CP presence and as a marker of different plaque phenotypes (hyperechoic and hypoechoic) in patients undergoing carotid endarterectomy. The MnSOD as an MMP-9 negative regulator was also studied in relation to CP phenotypes.

METHODS AND RESULTS

Genotyping of 770 participants (285 controls/485 patients) was done by tetra-primer ARMS PCR. The MMP-9 mRNA expression in 88 human CP tissues was detected by TaqMan® technology. The protein levels of MMP-9 and MnSOD were assessed by Western blot analysis. The MMP-9 -1562 C/T variant was not recognized as a risk factor for plaque presence or in predisposing MMP-9 mRNA and protein levels in plaque tissue. Patients with hypoechoic plaques had significantly lower MMP-9 mRNA and protein levels than those with hyperechoic plaque (p = 0.008, p = 0.003, respectively). MnSOD protein level was significantly higher in hypoechoic plaque compared to hyperechoic (p = 0.039). MMP-9 protein expression in CP tissue was significantly affected by sex and plaque type interaction (p = 0.009).

CONCLUSIONS

Considering the differences of MMP-9 mRNA and protein expression in CP tissue regarding different plaque phenotypes and the observed sex-specific effect, the role of MMP-9 in human atherosclerotic plaques should be further elucidated.

Targeted RNAseq Revealed the Gene Expression Signature of Ferroptosis-Related Processes Associated with Disease Severity in Patients with Multiple Sclerosis

Detrimental molecular processes in multiple sclerosis (MS) lead to the cellular accumulation of lipid peroxidation products and iron in the CNS, which represents the main driving force for ferroptosis. Ferroptosis is an iron-dependent form of regulated cell death, with proposed roles in neurodegeneration, oligodendrocyte loss and neuroinflammation in the pathogenesis of MS. Ferroptosis-related gene expression signature and molecular markers, which could reflect MS severity and progression, are currently understudied in humans. To tackle these challenges, we have applied a curated approach to create and experimentally analyze a comprehensive panel of ferroptosis-related genes covering a wide range of biological processes associated with ferroptosis. We performed the first ferroptosis-related targeted RNAseq on PBMCs from highly distinctive MS phenotype groups: mild relapsing-remitting (RR) (n = 24) and severe secondary progressive (SP) (n = 24), along with protein detection of GPX4 and products of lipid peroxidation (MDA and 4-HNE). Out of 138 genes, 26 were differentially expressed genes (DEGs), indicating changes in both pro- and anti-ferroptotic genes, representing a molecular signature associated with MS severity. The top three DEGs, as non-core ferroptosis genes, CDKN1A, MAP1B and EGLN2, were replicated by qPCR to validate findings in independent patient groups (16 RR and 16 SP MS). Co-expression and interactions of DEGs were presented as additional valuable assets for deeper understanding of molecular mechanisms and key targets related to MS severity. Our study integrates a wide genetic signature and biochemical markers related to ferroptosis in easily obtainable PBMCs of MS patients with clinical data and disease severity, thus providing novel molecular markers which can complement disease-related changes in the brain and undergo further research as potential therapeutic targets.

A preliminary study of the miRNA restitution effect on CNV-induced miRNA downregulation in CAKUT

BACKGROUND

The majority of CAKUT-associated CNVs overlap at least one miRNA gene, thus affecting the cellular levels of the corresponding miRNA. We aimed to investigate the potency of restitution of CNV-affected miRNA levels to remediate the dysregulated expression of target genes involved in kidney physiology and development in vitro.

METHODS

Heterozygous MIR484 knockout HEK293 and homozygous MIR185 knockout HEK293 cell lines were used as models depicting the deletion of the frequently affected miRNA genes by CAKUT-associated CNVs. After treatment with the corresponding miRNA mimics, the levels of the target genes have been compared to the non-targeting control treatment. For both investigated miRNAs, MDM2 and PKD1 were evaluated as common targets, while additional 3 genes were investigated as targets of each individual miRNA (NOTCH3, FIS1 and APAF1 as hsa-miR-484 targets and RHOA, ATF6 and CDC42 as hsa-miR-185-5p targets).

RESULTS

Restitution of the corresponding miRNA levels in both knockout cell lines has induced a change in the mRNA levels of certain candidate target genes, thus confirming the potential to alleviate the CNV effect on miRNA expression. Intriguingly, HEK293 WT treatment with investigated miRNA mimics has triggered a more pronounced effect, thus suggesting the importance of miRNA interplay in different genomic contexts.

CONCLUSIONS

Dysregulation of multiple mRNA targets mediated by CNV-affected miRNAs could represent the underlying mechanism behind the unresolved CAKUT occurrence and phenotypic variability observed in CAKUT patients. Characterizing miRNAs located in CNVs and their potential to become molecular targets could eventually help in understanding and improving the management of CAKUT.

Genotypic and Haplotypic Association of Catechol-O-Methyltransferase rs4680 and rs4818 Gene Polymorphisms with Particular Clinical Symptoms in Schizophrenia

Catechol-O-methyl transferase (COMT) gene variants are involved in different neuropsychiatric disorders and cognitive impairments, associated with altered dopamine function. This study investigated the genotypic and haplotypic association of COMT rs4680 and rs4618 polymorphisms with the severity of cognitive and other clinical symptoms in 544 male and 385 female subjects with schizophrenia. COMT rs4818 G carriers were more frequent in male patients with mild abstract thinking difficulties, compared to CC homozygotes or C allele carriers. Male carriers of COMT rs4680 A allele had worse abstract thinking (N5) scores than GG carriers, whereas AA homozygotes were more frequent in male subjects with lower scores on the intensity of the somatic concern (G1) item, compared to G carriers. Male carriers of COMT rs4818-rs4680 GA haplotype had the highest scores on the G1 item (somatic concern), whereas GG haplotype carriers had the lowest scores on G2 (anxiety) and G6 (depression) items. COMT GG haplotype was less frequent in female patients with severe disturbance of volition (G13 item) compared to the group with mild symptoms, while CG haplotype was more frequent in female patients with severe then mild symptoms. These findings suggest the sex-specific genotypic and haplotypic association of COMT variants with a severity of cognitive and other clinical symptoms of schizophrenia.

Downregulation of fibrosis related hsa-miR-29c-3p in human CAKUT

Congenital anomalies of the kidney and urinary tract (CAKUT) represent structural and functional urinary system malformations and take place as one of the most common congenital malformations with an incidence of 1:500. Ureteral obstruction-induced hydronephrosis is associated with renal fibrosis and chronic kidney diseases in the pediatric CAKUT. We aimed to construct interaction network of previously bioinformatically associated miRNAs with CAKUT differentially expressed genes in order to prioritize those associated with fibrotic process and to experimentally validate the expression of selected miRNAs in CAKUT patients compared to control group. We constructed interaction network of hsa-miR-101-3p, hsa-miR-101-5p and hsa-miR-29c-3p that showed significant association with fibrosis. The top enriched molecular pathway was extracellular matrix-receptor interaction (adjusted p = .0000263). We experimentally confirmed expression of three miRNAs (hsa-miR-29c-3p, hsa-miR-101-3p and hsa-miR-101-5p) in obstructed ureters (ureteropelvic junction obstruction and primary obstructive megaureter) and vesicoureteral reflux. The hsa-miR-29c-3p was shown to have lower expression in both patient groups compared to controls. Relative levels of hsa-miR-101-5p and hsa-miR-101-3p showed significant positive correlations in both groups of patients. Statistically significant correlation was observed between hsa-miR-101 (-3p and -5p) and hsa-miR-29c-3p only in the obstructed group. The significant downregulation of anti-fibrotic hsa-miR-29c-3p in obstructive CAKUT could explain activation of genes involved in fibrotic processes. As miRNAs are promising candidates in therapeutic approaches our results need further measurement of fibrotic markers or assessment of extent of fibrosis and functional evaluation of hsa-miR-29c.

Influence of Multiple Anti-VEGF Injections on Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer Thickness in Patients with Exudative Age-Related Macular Degeneration

Backgrounds and Objectives: To analyze the influence of multiple anti-VEGF intravitreal injections for exudative age-related macular degeneration on the thickness of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC + IPL) using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: A prospective interventional study of consecutive patients treated with intravitreal bevacizumab (IVB) was performed. Average and sectorial values of RNFL and GC + IPL thickness were recorded using Cirrus SD-OCT at 0, 6, 12, and 24 months. Patients suffering from any ocular disease that could affect RNFL or GC + IPL thickness were excluded. Results: A total of 135 patients (70 women and 65 men, aged 65 ± 15 years) were included. The average number of injections per patient was 12.4 ± 2.4. Average RNFL and GC + IPL thickness prior to the first injection (87.6 ± 12.2 and 47.2 ± 15.5 respectively), and after 24-month follow-up (86.2 ± 12.6 and 46.7 ± 11.9 respectively) did not differ significantly (p > 0.05). There was a significant decrease in GC2, GC5 segments, and minimum GC + IPL thickness. Conclusion: Repeated anti-VEGF treatment did not cause significant changes in the thickness of RNFL and GC + IPL layers over a period of 24 months. The detected decrease in GC2 and GC5 sectors, as well as in minimum GC + IPL thickness, could be a sign of ganglion cell damage induced by the treatment or could occur during the natural course of the disease.

Variants Tagging LGALS-3 Haplotype Block in Association with First Myocardial Infarction and Plasma Galectin-3 Six Months after the Acute Event

Galectin-3 is encoded by LGALS-3, located in a unique haplotype block in Caucasians. According to the Tagger server, rs4040064, rs11628437, and rs7159490 cover 82% (r² > 0.8) of the genetic variance of this HapBlock. Our aims were to examine the association of their haplotypes with first myocardial infarction (MI), changes in left ventricular echocardiographic parameters over time, and impact on plasma galectin-3 and LGALS-3 mRNA in peripheral blood mononuclear cells, both 6 months post-MI. The study group consisted of 546 MI patients and 323 controls. Gene expression was assessed in 92 patients and plasma galectin-3 in 189 patients. Rs4040064, rs11628437, rs7159490, and LGALS-3 mRNA expression were detected using TaqMan^® technology. Plasma galectin-3 concentrations were determined by the ELISA method. We found that the TGC haplotype could have a protective effect against MI (adjusted OR 0.19 [0.05-0.72], p = 0.015) and that the GAC haplotype had significantly higher galectin-3 concentrations (48.3 [37.3-59.4] ng/mL vs. 18.9 [14.5-23.4] ng/mL, p < 0.0001), both in males and compared to the referent haplotype GGC. Higher plasma Gal-3 was also associated with higher NYHA class and systolic dysfunction. Our results suggest that variants tagging LGALS-3 HapBlock could reflect plasma Gal-3 levels 6 months post-MI and may have a potential protective effect against MI in men. Further replication, validation, and functional studies are needed.

Identification and functional interpretation of miRNAs affected by rare CNVs in CAKUT

Rare copy number variants (CNVs) are among the most common genomic disorders underlying CAKUT. miRNAs located in rare CNVs represent well-founded functional variants for human CAKUT research. The study aimed to identify and functionally interpret miRNAs most frequently affected by rare CNVs in CAKUT and to estimate the overall burden of rare CNVs on miRNA genes in CAKUT. The additional aim of this study was to experimentally confirm the effect of a rare CNV in CAKUT on candidate miRNA's expression and the subsequent change in mRNA levels of selected target genes. A database of CAKUT-associated rare CNV regions, created by literature mining, was used for mapping of the miRNA precursors. miRNAs and miRNA families, most frequently affected by rare CAKUT-associated CNVs, have been subjected to bioinformatic analysis. CNV burden analysis was performed to identify chromosomes with over/underrepresentation of miRNA genes in rare CNVs associated with CAKUT. A functional study was performed on HEK293 MIR484^+/- KO and HEK293 WT cell lines, followed by the analysis of relative miRNA and mRNA target gene levels. 80% of CAKUT patients with underlying rare CNV had at least one miRNA gene overlapping the identified CNV. Network analysis of the most frequently affected miRNAs has revealed the dominant regulation of the two miRNAs, hsa-miR-484 and hsa-miR-185-5p. Additionally, miR-548 family members have shown substantial enrichment in rare CNVs in CAKUT. An over/underrepresentation of miRNA genes in rare CNVs associated with CAKUT was observed in multiple chromosomes, such as chr16, chr20, and chr21. A significant 0.37 fold downregulation of hsa-miR-484, followed by a notable upregulation of MDM2 and APAF1 and downregulation of NOTCH3 was detected in HEK293 MIR484^+/- KO compared to HEK293 WT cell lines, supporting the study hypothesis. miRNA genes are frequently affected by rare CNVs in CAKUT patients. Understanding the potential of CNV-affected miRNAs to participate in CAKUT as genetic drivers represent a crucial implication for the development of novel therapeutic approaches.

Sex related difference in heart failure development in patients after first myocardial infarction; role of galectine-3

 

Cardiac remodeling after the first myocardial infarction (MI) appears to be more successful in women than in men, but more frequently associated with heart failure (HF) development. Galectin-3 expression is upregulated in remodeling and failing myocardium and circulatory level is activated in hypertrophy, fibrosis and inflammation.

This study aimed to investigate the potential role of sex differences in the following: risk factors, structural and functional left ventricle (LV) changes, coronary angiography, expression of Galectin-3 and it's circulating level for HF occurrence during 6 months in patients after first MI.

Material and methods

The prospective study included patients with the first MI treated with the primary percutaneous coronary intervention (p PCI) who underwent Doppler echocardiography within 2±1 days of MI and after 6 months. Relative LGALS-3 mRNA expression in peripheral blood were detected by TaqMan® technology. Expression and concentration of Galectin-3 was obtained by ELISA method. Presence of HF was confirmed by clinical examination and Doppler echocardiography. Assessment of p PCI and description of coronary angiography was performed at the patient's admission time.

Results

The study included 137 men and 44 women, who were significantly older (57.8 vs. 54.4, p=0.034), with higher LDL cholesterol (3.54±0.93 vs. 4.03±1.27, p=0.027) without differences among angiographic characteristics and medications. In the acute phase of MI, the significantly lower indexed LV volumes were found in women compared to men (EDLVI: 58.3 vs. 49.6, p&lt;0.001, ESLVI: 33.84 vs. 26.83, p&lt;0.001), but the grade of LV remodeling (delta LVDVI, delta LVESVI) during 6 months and changes in LV ejection fraction (deltaLVEF) were similar (p=ns). Incidence of LV hypertrophy and HF development was significantly higher in women 70% vs. 44.6%, p=0.034, 37.5% vs.19.3%, p=0.02). Females have had a higher degree of LV diastolic dysfunction (DD) in the early and late phase after MI (p=0.038, p=0.027). There were significant correlations between grade of DD and level of Gal-3 expression (p=0.001). The relative expression of LGALS-3 mRNA in peripheral blood was higher in females (p=0.007) with upregulation of circulating Gal-3 in females (44.66 vs. 16.30, p&lt;0.001) and in HF patients (31.1 vs. 21.2, p=0.025).

Conclusion

Sex specific actions such as LV hypertrophy, diastolic dysfunction, upregulation of Galectin-3 expression and higher circulating level may explain more incidence of HF in female. Difference in model and determinants of HF between men and women can be important for further therapy including Gelectin-3 inhibition.

Funding Acknowledgement

Type of funding sources: None.

Association of MMP1 and MMP3 haplotypes with myocardial infarction and echocardiographic parameters of the left ventricle

BACKGROUND

Myocardial infarction (MI) leads to ischemia and afterward to left ventricular (LV) remodeling. Matrix metalloproteinase-1 (MMP1) and -3 (MMP3) belong to the family of endopeptidases and together they can dissolve most of the components of the extracellular matrix. MMP1 and MMP3 variants have been investigated solely in association with ischemic heart disease and LV dysfunction, but not in haplotype. The aims of this study were to investigate the association of haplotypes inferred from MMP1 rs1799750 (-1607 1G/2G; NC_000011.9:g.102670497del) and MMP3 rs35068180 (-1612 5A/6A; NC_000011.9:g.102715952dup) with MI and their effect on the change in echocardiographic parameters of LV structure and function in patients within 6 months after MI.

METHODS

The study included 325 patients with the first MI and 283 healthy controls. Gene variants were detected by PCR-RFLP method. Parameters of LV structure and function were assessed by conventional 2D echocardiography, 3-5 days and 6 months after the first MI, on a subgroup of 160 patients. Haplotype analysis was performed with Thesias software.

RESULTS

Haplotypes 2G-5A and 1G-6A were significantly and independently associated with MI compared with the reference haplotype 2G-6A (adjusted, p = 0.009 and p = 0.026, respectively). After Bonferroni correction for multiple testing, MMP1 and MMP3 haplotypes lost their association with the change in LV long diameter and stroke volume within 6 months after MI.

CONCLUSION

MMP1 and MMP3 haplotypes are strongly associated with MI. Further studies are needed to validate this result and to examine their association with echocardiographic parameters of LV structure and function after MI.

Tinnitus as a comorbidity to depression and transcranial magnetic stimulation as a treatment for both - case report

Introduction

Depressive symptoms are common in individuals with tinnitus, however, the mechanisms of their interaction are not fully understood. There is neurobiological evidence that might help understanding the interplay between tinnitus and depression which, in turn, helps in making the right choice for treating both conditions.

Objectives

This case report describes a 70-year old female patient that presented with tinnitus and depressive symptoms lasting for the past 5 years.

Methods

The patient showed limited treatment results with different antidepressants. The otorhinolaryngologist ruled out any possible somatic causes of her tinnitus. Tinnitus was causing her sleep disturbances, which worsened her everyday functioning that was already quite poor even further.

Results

After being administered with 30 rounds of TMS, her symptoms either completely resolved or at least reached a level that was adequate for her to start functioning normally on a day-to-day basis.

Conclusions

TMS is a technique that provides non-invasive cortical stimulation, more specifically, when used for depression treatment it stimulates the left dorsolateral prefrontal cortex, a brain region synaptically connected to the limbic system involved in mood regulation that is proven to be hypoactive in depression. The limbic system is where tinnitus-related brain networks and regions involved in the pathophysiology of depression overlap. Further research is needed to deepen the understanding of this topic.

Disclosure

No significant relationships.

Should we implant cardioverter defibrillators in asymptomatic patients with Brugada syndrome?

Funding Acknowledgements

Type of funding sources: None.

Background

Implantable cardiverter defibrillators (ICD) represent the only effective treatment in prevention of sudden cardiac death (SCD) in patients with Brugada syndrome (BrS). However, according to current ESC Guidelines, ICD implantation is recommended only in secondary prevention, while it should be considered in patients with a spontaneous diagnostic type I ECG pattern and history of syncope.

Purpose

We aimed to determine the frequency of ventricular tachyarrhythmias during the long-term follow-up among patients with BrS and ICDs implanted in primary or secondary prevention.

Methods

This retrospective, observational study was conducted in a tertiary center among adult patients with BrS that underwent single or dual chamber ICD implantation from January 2008 to December 2017. The study group was devided into subgroups depending on weather the patients at the time of ICD implantation had documented sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) regardless of the ECG type of BrS (group I), had BrS type I and history of syncope (group II) or had BrS type I and were asymptomatic but assessed as in high risk of SCD due to non-sustained VT episodes, younger age or history of SCD in close family members (group III). We used patients medical records for collecting the data about VT and VF episodes during the follow-up period.

Results

In the course of ten-year period, ICDs were implanted in 21 adult patients with BrS (66.7% were male). Mean age at the ICD implantation time was 40.3 ± 14.9 years. We analyzed 8 patients from group I, 7 patients from group II, and 6 patients from group III. Mean follow-up period was 82.5 ± 33.3 months. During the obsereved period, VT/VF episodes were appropriately detected in 7 patients from group I (87.5%), in 3 patients from group II (42.86%) and in one patient from group III (16.67%). Kruskal-Wallis test showed that there was a statistically significant difference in the occurrence of ventricular tachyarrhythmias among at least one pair of observed groups (p = 0.031). Using Dunn-Bonferroni post hoc analysis we found statistically significant difference between the patients with malignant arrhythmias and asymptomatic patients (p = 0.03), but not between the other pairs.

Conclusion

Although asymptomatic patients with BrS are at significantly lower risk of SCD, it is important to identify high-risk patients in the low-risk group. Therefore, creating a tool for calculating the risk of SCD among these patients might be helpfull in everyday clinical practice.

The association between BDNF C270T genetic variants and smoking in patients with mental disorders and in healthy controls

Studies investigating the association between smoking and the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism have reported inconclusive results, while the studies on the association of smoking status with BDNF C270T polymorphism are missing. We aimed to determine the association of smoking and BDNF Val66Met and C270T genetic variants in control subjects and patients with mental disorders. This study included 3502 Caucasian subjects: 918 healthy controls and 2584 patients with mental disorders (519 individuals with posttraumatic stress disorder (PTSD), 419 patients with depression, 996 patients with schizophrenia, and 650 patients with alcohol dependence). The frequency of the BDNF Val66Met and C270T variants were presented in codominant, dominant and recessive models. BDNF C270T, but not BDNF Val66Met polymorphism, was significantly associated with smoking in all groups, since the presence of the C270T T allele was more frequently found in smokers compared to non-smokers. Significant predictors of smoking were sex, age and BDNF C270T genetic variants. However, after detailed analysis of the separate diagnostic entities, the significant association of BDNF C270T polymorphism was confirmed only in healthy subjects, but not in patients with mental disorders; and was not related to number of cigarettes smoked per day. In patients with alcohol dependence, the severity of smoking was significantly associated with BDNF Val66Met variants. This is a first report of the significant association between the BDNF C270T polymorphism and smoking status in the large groups of Caucasian cases/controls.

Non-coding RNA and cholesteatoma

OBJECTIVE

Cholesteatoma is a challenging chronic pathology of the middle ear for which pharmacologic therapies have not been developed yet. Cholesteatoma occurrence depends on the interplay between genetic and environmental factors while master regulators orchestrating disease progression are still unknown. Therefore, in this review, we will discuss the diagnostic and therapeutic potential of non-coding RNAs (ncRNA) as a new class of regulatory molecules.

METHODS

We have comprehensively reviewed all articles investigating ncRNAs, specifically micro RNAs (miRNAs) and long ncRNAs (lncRNA/circRNA) in cholesteatoma tissue.

RESULTS

Candidate miRNA approaches indicated that miR-21 and let-7a are the major miRNAs involved in cholesteatoma growth, migration, proliferation, bone destruction, and apoptosis. Regulatory potential for the same biological processes was also observed for miR-203a. The NF-kB/miR-802/PTEN regulatory network was in relation to observed miR-21 activity in cholesteatoma as well. High throughput approaches revealed additional ncRNAs implicated in cholesteatoma pathology. Competitive endogenous RNA (ceRNA) analysis highlighted lncRNA/circRNA that could be "endogenous sponge" for miR-21 and let-7a based on the hypothesis that RNA transcripts can communicate with and regulate each other by using shared miRNA response elements.

CONCLUSION

In this review, we summarize the discoveries and role of ncRNA in major pathways in cholesteatoma and highlight the potential of miRNA-based therapeutics in the treatment of cholesteatoma.

Level of Evidence: NA.

QSAR modeling of corneal permeability of drugs – the application of Monte Carlo optimization method

Direct implementation into the eye is the most commonly used method of the application of the most commonly used drugs for the treatment of most ocular diseases. The improvement of...

Tag Variants of LGALS-3 Containing Haplotype Block in Advanced Carotid Atherosclerosis

OBJECTIVES

Galectin-3 affects a variety of biological processes. It is encoded by LGALS-3, located in unique haplotype block in Caucasians. Most of the studies regarding the gal-3 role in atherosclerosis are focused exclusively on protein/mRNA levels. Genetic analyses of LGALS-3 are scarce. We sought to thoroughly examine the genetic background of gal-3 and to analyze tag variants that cover more than 80% variability of the LGALS-3 containing hap-block in association with carotid plaque presence (CPP). According to Tagger server, rs4040064 G/T, rs11628437 G/A and rs7159490 C/T cover 82% (r² > 0.8) of the genetic variance of this hap-block. Our aims were to investigate possible association of rs4040064, rs11628437 and rs7159490 haplotypes with CPP in patients with advanced carotid atherosclerosis (CA) and to analyze their possible effect on LGALS-3 mRNA expression in carotid plaques.

MATERIALS AND METHODS

Study group consisted of 468 patients and 296 controls. Rs4040064, rs11628437, rs7159490 and LGALS-3 mRNA expression were detected by TaqMan® technology.

RESULTS

We have found that haplotype TAC was associated with the cerebrovascular insult (CVI) occurrence (OR = 1.68, 95% CI = 1.09-2.58, p = 0.02), compared to the referent haplotype. OR was adjusted for hypertension, age and BMI. TAC also showed higher, but not statistically significant, LGALS-3 expression in carotid plaques.

CONCLUSIONS

Our results suggest that rs4040064, rs11628437 and rs7159490 bear no association with CPP, neither they affect LGALS-3 mRNA in carotid plaques. However, we showed a significant association of haplotype TAC with the CVI occurrence in CA patients from Serbia. Replication and validation of our results are required.

Voxel model of a rabbit: assessment of absorbed doses in organs after CT examination performed by two different protocols

The objective of this work was to assess absorbed doses in organs and tissues of a rabbit, following computed tomography (CT) examinations, using a dedicated 3D voxel model. Absorbed doses in relevant organs were calculated using the MCNP5 Monte Carlo software. Calculations were perfomed for two standard CT protocols, using tube voltages of 110 kVp and 130 kVp. Absorbed doses were calculated in 11 organs and tissues, i.e., skin, bones, brain, muscles, heart, lungs, liver, spleen, kidney, testicles, and fat tissue. The doses ranged from 15.3 to 28.3 mGy, and from 40.2 to 74.3 mGy, in the two investigated protocols. The organs that received the highest dose were bones and kidneys. In contrast, brain and spleen were organs that received the smallest doses. Doses in organs which are stretched along the body did not change significantly with distance. On the other hand, doses in organs which are localized in the body showed maximums and minimums. Using the voxel model, it is possible to calculate the dose distribution in the rabbit's body after CT scans, and study the potential biological effects of CT doses in certain organs. The voxel model presented in this work can be used to calculated doses in all radiation experiments in which rabbits are used as experimental animals.

Changes of neurocognitive status in patients with the first-episode psychosis after 18 months of treatment-A prospective cohort study

Neurocognitive symptoms exert the most influence on treatment outcomes over the course of schizophrenia, starting from the first-episode of psychosis (FEP) onwards. Our aim was to analyze the neurocognitive status of FEP compared to healthy controls (HC), and its change after 18 months of treatment. We performed a study in a sample of 159 patients with FEP and 100 HC. We followed the patients up for 18 months after initial assessment with a battery of neurocognitive tests. We observed statistically significant improvement in the majority of neurocognitive tests after 18 months, but several tests of specific neurocognitive domains (verbal memory, language functions, executive functions) did not show significant differences between the two assessments. The results for the majority of tests obtained from patients with FEP after 18 months of treatment showed significant deterioration compared with HC. Although our study showed significant improvement of baseline neurocognitive deficits in FEP with treatment, this varied across domains and overall performance remained below that of HC. Thus, while it seems that treatment of FEP may help to delay or restore neurocognitive deterioration, it is unclear whether specific areas of neurocognitive deterioration (e.g. verbal domain) would benefit from more time or specific treatment approaches.

Polyphenol-Rich Aronia melanocarpa Juice Consumption Affects LINE-1 DNA Methylation in Peripheral Blood Leukocytes in Dyslipidemic Women

Cardiovascular disease (CVD) is associated with alterations in DNA methylation and polyunsaturated fatty acid (PUFA) profile, both modulated by dietary polyphenols. The present parallel, placebo-controlled study (part of the original clinical study registered as NCT02800967 at www.clinicaltrials.gov) aimed to determine the impact of 4-week daily consumption of polyphenol-rich Aronia melanocarpa juice (AMJ) treatment on Long Interspersed Nucleotide Element-1 (LINE-1) methylation in peripheral blood leukocytes and on plasma PUFAs, in subjects (n = 54, age range of 40.2 ± 6.7 years) at moderate CVD risk, including an increased body mass index, central obesity, high normal blood pressure, and/or dyslipidemia. The goal was also to examine whether factors known to affect DNA methylation (folate intake levels, MTHFR C677T gene variant, anthropometric and metabolic parameters) modulated the LINE-1 methylation levels upon the consumption of polyphenol-rich aronia juice. Experimental analysis of LINE-1 methylation was done by MethyLight method. MTHFR C677T genotypes were determined by the polymerase chain reaction–restriction fragment length polymorphism method, and folate intake was assessed by processing the data from the food frequency questionnaire. PUFAs were measured by gas–liquid chromatography, and serum lipid profile was determined by using Roche Diagnostics kits. The statistical analyses were performed using Statistica software package. In the comparison after vs. before the treatment period, in dyslipidemic women (n = 22), we observed significant decreases in LINE-1 methylation levels (97.54 ± 1.50 vs. 98.39 ± 0.86%, respectively; P = 0.01) and arachidonic acid/eicosapentaenoic acid ratio [29.17 ± 15.21 vs. 38.42 (25.96–89.58), respectively; P = 0.02]. The change (after vs. before treatment) in LINE-1 methylation directly correlated with the presence of MTHFR 677T allele, average daily folate intake, and the change in serum low-density lipoprotein cholesterol but inversely correlated with the change in serum triacylglycerols (R = 0.72, R² = 0.52, adjusted R² = 0.36, P = 0.03). The current results imply potential cardioprotective effects of habitual polyphenol-rich aronia juice consumption achieved through the modifications of DNA methylation pattern and PUFAs in subjects at CVD risk, which should be further confirmed. Hence, the precision nutrition-driven modulations of both DNA methylation and PUFA profile may become targets for new approaches in the prevention of CVD.

The association of glutathione S-transferase T1 and M1 deletions with myocardial infarction

Glutathione S-transferases (GSTs) are the family of enzymes involved in the second line of defense against oxidative stress (OS). The lack of GSTT1/GSTM1 enzyme quantity or activity, due to the presence of homozygous deletion compromises antioxidative defense resulting in OS. OS is the critical mechanism in the pathophysiology of atherosclerosis, coronary artery disease, and myocardial infarction (MI). The increase in reactive oxygen species together with the process of apoptosis plays a role in left ventricular remodeling (LVR) after MI. The associations of GSTT1 and GSTM1 gene polymorphisms with the risk of MI are inconsistent. The aim was to analyze the association of GSTT1/GSTM1 null genotypes with first MI and LVR 8 months after the MI. The study involved 330 controls and 438 consecutive patients with symptoms and signs of first MI. The subgroup of 150 MI patients was prospectively followed up for 6 months. Evidence of maladaptive LVR was obtained by 2D Doppler echocardiography 3-5 days and 6 months after the MI. A multiplex polymerase chain reaction was used to detect the deletion in GSTT1 and GSTM1 genes. GSTM1 null genotype was significantly and independently associated with first MI (adjusted OR = 1.45 95% CI 1.03-2.03, p = 0.03). Association of double null genotypes with maladaptive LVR in patients 6 months after the first MI was no longer significant after adjustment for factors that differed significantly between patients with and without maladaptive LVR. This study demonstrated the association of GSTM1 null genotypes with the risk of MI in the Serbian population.

Frequency of ventricular tachyarrhythmias in patients with different risk scores for sudden cardiac death in hypertrophic cardiomyopathy and cardioverter defibrilators implanted in primary prevention

Funding Acknowledgements

Type of funding sources: None.

Background

The European Society of Cardiology’s (ESC) risk calculator for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathies (HCM) is currently a tool that facilitates the decision to implant a cardioverter defibrillator (ICD) in primary prevention, but doubts still exist in everyday clinical practice.

Purpose

We aimed to determine the incidence of life-threatening ventricular arrhythmias

during long-term follow-up in patients with different ESC HCM risk scores for SCD

calculated on ICD implantation in primary prevention.

Methods

This retrospective, observational study was conducted in a tertiary center among

adult patients with HCM and ICD devices (ICD-VR, ICD-DR and CRT-ICD) implanted in

primary prevention from January 2008 to December 2019. The patients followed up for less than one year were excluded from the analysis. Study group was divided into three subgroups, according to the ESC 5 years risk score of SCD and based on it the estimated need for ICD implantation: group A

with risk &lt; 4%, where ICD is generally not indicated; group B with risk 4-6%, where ICD

may be considered; group C with risk ≥6%, where ICD should be considered. Regularly, ICD

was interrogated twice a year, while emergency controls were performed after delivering of

ICD therapy. Follow-up data including information about sustained ventricular tachicardia

(VT) and ventricular fibrillation (VF) episodes were collected from patients medical records.

Results

In the observed period, ICD devices were implanted in 60 adult patients with HCM.

Ten of them had history of sustained ventricular arrhythmias and 3 were lost to follow-up. Therefore, we analysed 47 patients (55.3% male, mean age 51.0 ± 15.7 years), 13 from group

A, 12 from group B and 22 from group C. Mean follow-up period was 80.6 ± 37.9 months.

During the follow-up period ventricular tachyarrhythmias (VT and VF, either in monitoring or

therapy zone) were recorded in one patient from group A (7.7%), in two patients from group

B (16.7%) and in 7 patients from group C (31.8%). Using Kruskal-Wallis analysis of

variance, we did not find a statistically significant difference in the occurrence of ventricular

tachyarrhythmias among the observed groups (p = 0.225).

Conclusions

Patients with HCM and a 5-year risk of SCD ≥ 6% calculated on ICD

implantation had more frequent life-threatening ventricular arrhythmias during long-term

follow-up, but not statistically significant. There should be an individual

approach when deciding on the need for device implantation in all patients with HCM.

Incidence of pocket infection during long- term follow- up

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Cardiac implantable electronic devices (CIEDs) are being implanted worldwide in increasing numbers, so the incidence of hospitalizations due to their infections is also increasing. 

Purpose

The aim of this study was to analyze the incidence of pocket infection related to the CIED procedure, as well as clinical presentation, diagnostic approach and methods of treatment during long-term follow- up on large cohort of patients. Methods: This was a retrospective, observational, single-center study. We enrolled patients who underwent CIED procedure between January 2011 and December 2015. The CIED procedure included implantation and replacement of the device. Pocket infection is defined as an infection limited to the generator pocket and can be presented from redness, swelling, pain to the skin erosion with exposure of the generator and/or leads. It may also be associated with lead infections and systemic CIED infections and/or infective endocarditis. All patients with CIED infection underwent the same diagnostics: complete blood count and inflammatory markers, pocket swab, three sets of blood cultures and echocardiography. Results: During the observed period 5 969 CIED procedures were performed (anti-bradycardia pacemakers 68.6%; ICD 21.4%; CRT-P/D 10.0%; CIED replacement 26.1%). CIED infection was registered in 41 patients (0.68%), most often after the ICD procedure (59.0%). In 22 patients (53.6%) the infection occurred after primo-implantation. The average time from intervention to infection was 17 ± 7.3 months. The mean follow-up was 52.2 ± 13.4 months. The most common manifestations of infection were redness (68.1%) and swelling (56.0%), then the protrusion of the generator or electrode (41.5%). Pacemaker pocket swabs and wound swabs were positive in 61.1% of samples and coagulase negative staphylococcus was found to be the most prevalent cause of infection (64.2%). The hemoculture test was positive in 10 patients, and the isolated causative agent matched the swab finding. The valvular vegetation was found in 4 patients. Pacemaker removal and surgical wound treatment were performed in all patients. Complete removal of all leads was achieved in 32 patients. In all pacemaker dependent patients and patients with ICD implanted in the secondary prevention of sudden cardiac death, reimplantation of the new device was performed in the same hospitalization on the opposite side. The remaining patients were operated on 3 to 4 weeks after the end of treatment.  Conclusions: It has been shown that the risk of pocket infection was low in a large number of patients, during long-term follow-up. The risk was higher in patients with ICD devices, and slightly higher after primo-implantation.

Cut-Off Values of Foveal Vascular Indices in Exfoliation Glaucoma

PURPOSE

To compare the vascular measurements obtained from fovea including foveal avascular zone (FAZ) with optical coherence tomography angiography (OCTA) between patients with exfoliation glaucoma (XFG) and healthy controls.

METHODS

This cross-sectional comparative study included 54 XFG patients and 94 healthy subjects. All subjects were given a complete ophthalmological examination including visual field testing, retinal nerve fiber layer and macular ganglion cell complex analysis. OCTA was performed to evaluate the vascular features of fovea including FAZ. The measurements of vessel density (VD), perfusion density (PD) and FAZ values were segmented and calculated using the inbuilt software on OCTA. Receiver operating characteristic (ROC) analyses were performed to determine the best cut-off values to detect the disease.

RESULTS

In the XFG group, decreased VD, PD and FAZ values were observed. ROC analysis showed an obvious separation, differentiating the patients with XFG from the healthy controls at cut-off value of 19.55 with a sensitivity (sen) of 92.3% and a specificity (spe) of 81.9%) for VD total and 21.20 (sen:100 and spe:78.7) for VD parafoveal; 0.36 (sen:98.1and spe:76.6) for PDtotal and 0.378 (sen:96.2and spe:84) for PDparafoveal; 0.635 (sen: 79.3 and spe:72) for FAZ circulatory index.

CONCLUSION

The results support the findings of decreased microvascular density on foveal region in XFG. The cut off values of the changes in the foveal parameters in patients with exfoliation may be useful in evaluation of future glaucoma management to show how far a particular exfoliative eye is positioned from an healthy eye and how close to XFG.

The role of zinc, albumin, c reactive protein, and interleukin-6 in differentiation of unipolar depression and depression in bipolar disorder

Introduction

There is no clinical difference between depressive episodes in bipolar disorder compared to major depressive disorder, which is why bipolar disorder remains unrecognized. Correctly distinguishing these disorders is of great importance because the therapeutic approach differs significantly. According to previous research, zinc, albumin, C reactive protein (CRP), and interleukin-6(IL-6) seem to play a role in differentiating these two types of depressive episodes.

Objectives

To determine zinc, albumin, CRP and IL-6 serum concentrations in patients with major depressive disorder and depressive episode of bipolar disorder.

Methods

Research involved 60 participants. Participants signed informed consent prior to inclusion in the study. Sociodemographic data have been collected using a previously structured questionnaire. The severity of depressive symptoms has been measured by the Montgomery Asberg Depression Rating Scale (MADRS) and the Hamilton Depression Scale (HAM-D-17). Blood samples were obtained from each study participant’s brachial vein, to determine zinc, albumin, C reactive protein and interleukin-6 serum concentrations.

Results

Statistically significant difference was found in zinc serum levels between the two analysed groups. In the overall sample, there is a significant positive correlation between the results on the rating scales and the serum level of CRP.

Conclusions

We confirmed an association between serum levels of CRP and the severity of the illness. Regardless, these are preliminary results of the research. Sufficient final conclusion cannot yet be drawn because it is being limited by the sample size and further investigation is needed.

Association of PHACTR1 intronic variants with the first myocardial infarction and their effect on PHACTR1 mRNA expression in PBMCs

BACKGROUND

Myocardial infarction (MI) and underlining atherosclerosis are the main causes of death worldwide. Phosphatase and actin regulator 1 (PHACTR1) variants have been associated with early onset MI, coronary artery disease and carotid dissection. PHACTR1 mRNA expression has been detected in tissues and cells related to atherosclerosis. Nonetheless, the true effect of PHACTR1 on vascular diseases is still unknown. Our aim was to examine the association of PHACTR1 intronic variants, rs9349379, rs2026458 and rs2876300, with MI and multi-vessel disease (MVD) and to assess their effect on PHACTR1 and EDN1 mRNA expression in PBMCs of patients six months after MI.

METHODS

The study enrolled 537 patients with the first MI and 310 controls. Gene expression was assessed in 74 patients six months after MI and 37 healthy controls. Rs9349379, rs2026458, rs2876300 and relative mRNA expressions were detected by TaqMan® technology.

RESULTS

The significant association between PHACTR1 variants and MI was not found, either individually or in haplotype. A higher frequency of rs2876300G-allele in MVD was rendered not significant after Bonferroni correction. PHACTR1 mRNA was significantly increased in PBMCs of patients six months after MI compared to controls (p = 0.02). Patients that carry ACG haplotype have increased PHACTR1 mRNA expression in PBMCs (p = 0.04). There was no effect of PHACTR1 variants on EDN1 mRNA expression.

CONCLUSION

Our findings suggest that PHACTR1 intronic variants may have a role in severity and progression of coronary atherosclerosis. Future research is needed to clarify the mechanism underlying the role of PHACTR1 in coronary atherosclerosis and MI.

Association study of rs7799039, rs1137101 and rs8192678 gene variants with disease susceptibility/severity and corresponding LEP, LEPR and PGC1A gene expression in multiple sclerosis

BACKGROUND

Leptin (LEP), leptin receptor (LEPR) and peroxisome proliferator-activated receptor gamma co-activator 1-alpha (PGC1A) are involved in the pathogenesis of multiple sclerosis (MS) by affecting the inflammatory response and reactive oxygen species production. LEP rs7799039 and LEPR rs1137101 genetic variants modify the serum LEP levels and PGC1A rs8192678 alters the PGC1A activity. The study objective was to explore the associations of these variants with susceptibility to MS, disease course/clinical parameters and also with peripheral blood mononuclear cell expression of the target genes and plasma LEP concentrations, in the study subjects.

METHODS

The study groups included 528 patients with MS and 429 controls. TaqMan® assays were used for genotyping and gene expression quantification. The Chi-square, parametric and nonparametric tests and simple/multiple logistic regression were performed for the statistical analysis of data.

RESULTS

A multiple logistic regression model including all three investigated variants, applied to patients (RRMS + SPMS) and controls, showed that PGC1A rs8192678 minor allele had an increased risk for the occurrence of disease, with OR (95%CI) = 1,32 (1,01-1,73), P = 0,04. Between-effect of gender and LEPR variant on the multiple sclerosis severity score (MSSS) was identified (P = 0,005). In male patients (relapsing-remitting and secondary progressive), LEPR minor allele carriers had increased MSSS (GG + AG vs AA, median (minimum-maximum) = 5,38 (0,64-9,88) vs 4,27 (0,78-9,63); P = 0,01, P_adj = 0,03). In relapsing-remitting patients LEP rs7799039 affected the LEP gene expression (P = 0,006; P_adj = 0,04).

CONCLUSION

The current findings implicate an impact of investigated genetic variants on the pathogenesis of MS.

A two year echocardiographic follow-up of patients with chronic total occlusion treated with percutaneous coronary intervention or receiving only medical therapy

Background

Percutaneous coronary intervention of chronic total occlusion (PCI CTO) can reduce angina and the need for bypass surgery, however, it is still not clear how it effects the myocardial function. Conventional echocardiography is subjective and experience-dependent while tissue Doppler imaging together with strain imaging provides a more objective assessment of myocardial contractility.

Purpose

Our aim was to access the effectiveness of percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) on myocardial function.

Methods

We compared two groups of patients. The first group of patients underwent PCI CTO with OMT while the second group of patients only received OMT (control group). The echocardiographic exam was performed before randomization and after 24 months of follow-up. Doppler time intervals- isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT) and ejection time (ET) were measured from mitral inflow and left ventricular outflow Doppler tracings. Myocardial performance index (MPI) is equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral filling wave (E) was measured and divided by average peak early diastolic annular velocity (e'). Peak longitudinal strain was assessed in 17 left ventricular segments. Time intervals from start Q/R on electrocardiogram to peak negative strain during the cardiac cycle were assessed. Mechanical dispersion was defined as the standard deviation of this time interval from 17 left ventricular segments, reflecting myocardial contraction heterogeneity

Results

Comparing the groups at follow up, there was no significant change in ejection fraction (EF), diastolic function, and mechanical dispersion, however, there was improvement in GLS and MPI (Table 1).

Conclusion

Global longitudinal strain as a parameter of systolic function and Myocardial performance index as a parametar of global systolic and diastolic function are sensitive markers that can detect subtle improvement in myocardial function after recanalisation of CTO.

Funding Acknowledgement

Type of funding source: None

FADS2 polymorphisms are associated with plasma arachidonic acid and estimated desaturase-5 activity in a cross-sectional study

Polymorphisms in FADS genes are associated with plasma long-chain polyunsaturated fatty acids (LC-PUFA) and modulate omega-6/omega-3 balance. We hypothesized that the FADS2 gene variants will be associated with lower product-to-precursor ratio in the fatty acid metabolic pathways. Thus, we explored FADS2 rs174593, rs174616, and rs174576 effects on plasma phospholipid fatty acid profile, markers of desaturase activities, and risk factors in a sample of apparently healthy Serbian adults. Food and nutrient intake data were compiled through 24 h recalls. Plasma phospholipid fatty acid content was assessed by gas-chromatography. Estimated desaturase activities were calculated as conversion rates towards LC-PUFA in omega-6 pathway. During the selection of FADS2 polymorphisms, we accounted for their positional and functional aspect. Genotyping was performed by Real-Time PCR. Multivariable-adjusted general linear and hierarchical regression models were applied. Study subjects (mean age = 40 ± 7 years, 70% who were overweight) had a median dietary omega-6/omega-3 ratio of 16.29. Alternative allele frequencies were 33%, 36%, and 51% for rs174593, rs174576, and rs174616, respectively. Addition of FADS2 alternative alleles was associated with lower plasma arachidonic acid (AA, C20:4 n-6, P < .001) and estimated desaturase-5 activity (P < .001), irrespective of gender, age, daily polyunsaturated/saturated fatty acid intake, and obesity. The rs174576 association with AA withstood multiple testing and additional adjustments for other variants (multivariable-adjusted β = -1.14 [95% CI: -2.25, -0.43]). None of the variants was associated with dietary intake, serum lipids, or obesity. We observed inverse associations between FADS2 variants and plasma AA but not omega-3 fatty acids in Serbian subjects, with rs174576 exhibiting the strongest relation.

Catechol-O-methyltransferase rs4680 and rs4818 haplotype association with treatment response to olanzapine in patients with schizophrenia

Antipsychotic drugs target primarily dopaminergic system which makes catechol-O-methyltransferase (COMT) an interesting target in studies searching for treatment response predictors in schizophrenia. The study assessed the association of the COMT rs4680 and rs4818 polymorphisms with therapeutic response to olanzapine, risperidone, clozapine or other antipsychotic medication after 8 weeks of monotherapy in patients with schizophrenia. 521 Caucasian patients with schizophrenia received a monotherapy with olanzapine (10–20 mg/day; N = 190), risperidone (3–6 mg/day; N = 99), or clozapine (100–500 mg/day; N = 102). The fourth group (N = 130) consisted of patients receiving haloperidol (3–15 mg/day), fluphenazine (4–25 mg/day) or quetiapine (50–800 mg/day). Treatment response was defined as a 50% reduction from the baseline positive and negative syndrome scale (PANSS) total and subscale scores, but also as an observed percentage reduction from the initial PANSS_0–6 total and subscale scores. Carriers of the COMT rs4680 A allele and carriers of the COMT rs4680–rs4818 C-A haplotype block had greater reduction in the PANSS total scores following olanzapine treatment, compared to carriers of the COMT rs4680 GG genotype and other COMT rs4680–rs4818 haplotypes. The COMT rs4680 A allele, and COMT rs4680–rs4818 C-A haplotype, were significantly associated with therapeutic response in patients treated with olanzapine, but not in patients treated with other antipsychotics.

THU0573 YOGA LEADS TO SUSTAINED IMPROVEMENT IN FATIGUE AND MOOD IN RHEUMATOID ARTHRITIS: PRELIMINARY RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Background:

Rheumatoid arthritis (RA) patients experience reduced health-related quality of life (HRQOL). Previous studies suggest that yoga, a mind-body practice, can improve physical and mental health but it has not been extensively studied in RA.

Objectives:

To investigate the effect of yoga on HRQOL and secondary on fatigue, anxiety, depression and disease activity in RA patients

Methods:

43 RA patients (mean (SD) age 55 (10) years, median (IQR) disease duration 5 (3,8) years, 93% female), stable on standard pharmacological treatment and DAS28CRP < 5.1 were randomly assigned to 12 weeks yoga intervention (2x/week 90 min; n=22) or arthritis-related educational lectures control (1x/week 60 min; n=21). Yoga based on „Yoga in daily life system“ included asanas, relaxation, pranayama and meditation. Study evaluations at baseline, post-intervention and 3-month follow-up included The Short Form-36 (SF-36) scores for Physical Component Summary (PCS) and Mental Component Summary (MCS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Hospital Anxiety and Depression scale (HADS) and Disease Activity Score-28CRP (DAS28CRP) questionnaires. Data were presented as change from baseline to each time point. Between group differences were analyzed using the t-test for normally and Mann-Whitney U test for non-normally distributed variables. P values <0.05 were considered statistically significant.

Results:

35 patients (17 = intervention, 18 = control group) completed the trial period. Significant improvement in FACIT-F (p=0.013), HADS anxiety (p=0.047) and HADS depression (p=0.004) was found in yoga group compared to control at post-intervention and maintained at follow-up (p=0.025, p=0.02 and p=0.045, respectively). There was no significant difference found between groups for SF-36 MCS, PCS and DAS28CRP at all time points (all p>0.05). No serious adverse events were observed during trial period.

Conclusion:

Although no change in SF-36 scores and disease activity was observed, yoga practice produced significant and sustained improvement in fatigue and mood which strongly account for decreased life quality in RA. Despite limitations our findings suggest that yoga may be of benefit in management of RA patients.

Table.

Changes in outcomes

N= 37 (postintervention)N= 35 (follow-up)VariablesBaseline mean (SD)Change from baseline (95%CI)Difference between groups(95%CI, p-value)Change from baseline (95%CI)Difference between groups(95%CI, p-value)FACIT-F(0-52)Yoga 33.89 (10.77)Control 35.37 (9.3)4.18(-0.26,8.61)-2.17(-5.58,1.25)6.66(1.53,11.78)p= 0.0133.29(-1.23,7.82)-3.33(-7.27,0.61)6.63(0.85,12.4)p=0.025HADS-A(0-21)Yoga 7.39 (3.72)Control 6.89 (2.86)-1.94(-3.28,-0.6)0.056(-1.39,1.51)-1.83(-3.64,-0.024)p= 0.047-2.24(-3.63,-0.84)0.17(-1.38,1.71)-2.4(-4.4,-0.04)p=0.02HADS-D(0-21)Yoga 5.11 (3.03)Control 5.0 (1.82)-1.06(-1.92,-0.2)0.83(-0.06,1.72)-1.73(-2.88,-0.58)p= 0.004-0.2(-1.1,0.63)0.94(0.12,1.77)-1.18(-2.33,-0.03)p=0.045SF-36:MCS(0-100)Yoga 49.49 (11.99)Control 49.71 (8.99)2.97(-4.15,10.09)-1.59(-7.51,4.33)3.86(-4.66,12.33)p= 0.3661.25(-3.62,6.12)-0.45(-5.56,4.65)1.7(-5.09,8.49)p=0.618SF-36:PCS(0-100)Yoga 52.57 (10.11)Control 48.30 (9.76)0.44(-3.13,4.02)-1.16(-4.81,2.48)1.61(-3.31,6.53)p= 0.511-1.54(-5.44,2.35)0.35(-3.21,3.92)-1.9(-6.98,3.18)p=0.453DAS28CRPYoga 2.32 (0.81)Control 2.91 (0.84)-0.0024(-0.42,0.42)-0.096(-0.45,0.26)0.093(-0.44,0.63)p=0.7240.11(-0.43,0.66)-0.54(-0.92,-0.17)0.66(0.02,1.3)p=0.092

Disclosure of Interests:

Silva Puksic: None declared, Josko Mitrovic: None declared, Melanie-Ivana Culo: None declared, Marcela Zivkovic: None declared, Biserka Orehovec: None declared, Marko Lucijanic: None declared, Dubravka Bobek: None declared, Jadranka Morovic-Vergles Speakers bureau: Abbvie., Roche, MSD, Eli Lilly, Pfizer, Mylan, Amgen, Fresenius Kabi

Remission Is not Associated with DRD2 rs1800497 and DAT1 rs28363170 Genetic Variants in Male Schizophrenic Patients after 6-months Monotherapy with Olanzapine

BACKGROUND

Symptomatic remission is an achievable goal in the treatment of schizophrenia. The type of antipsychotic medication and particular genetic variants of the dopaminergic system might be associated with remission. Potential pharmacogenetic markers of the treatment response to antipsychotic medication are missing. This study assessed the possible association between dopamine receptor type 2 (DRD2 rs1800497) and dopamine transporter (DAT1 rs28363170) gene variants with symptomatic remission in schizophrenia.

SUBJECTS AND METHODS

Olanzapine (5-20 mg/d) monotherapy was administered for 6 months to 150 male Caucasian subjects with schizophrenia. Remission was evaluated according to "Remission in Schizophrenia Working Group" criteria. Genotyping was performed by PCR-RFLP.

RESULTS

Symptomatic remission was found in 31% of patients. DRD2 rs1800497 and DAT1 rs28363170 gene variants were not significantly associated with symptomatic remission. The limitations are a relatively small sample size of patients with schizophrenia (N=150), especially of group with symptomatic remission (N=45). However, the study had moderate but adequate sample sizes for most of the comparisons. Only two dopaminergic polymorphisms were analyzed, and plasma concentration of olanzapine was not determined.

CONCLUSION

These results revealed a lack of association between DRD2 rs1800497 and DAT1 rs28363170 genetic variants and symptomatic remission in male patients treated with olanzapine, suggesting that these genetic variants could not be used to predict symptomatic remission to olanzapine monotherapy. Negative results should be further confirmed or rejected in the larger samples, including haplotype analyses, to detect clinically useful and easy obtainable pharmacogenetic markers that might predict therapeutic response or remission in schizophrenia.

HTR1A, HTR1B, HTR2A, HTR2C and HTR6 Gene Polymorphisms and Extrapyramidal Side Effects in Haloperidol-Treated Patients with Schizophrenia

Schizophrenia is a serious, chronic psychiatric disorder requiring lifelong treatment. Extrapyramidal side effects (EPS) are common adverse reactions to antipsychotic medications. In addition to the dopaminergic system, serotonergic mechanisms, including serotonin (5-HT) receptors, might be involved in EPS development. This study aimed to examine molecular associations of HTR1A, HTR1B, HTR2A, HTR2C and HTR6 gene polymorphisms with acute EPS in 229 male schizophrenia patients, following two weeks of haloperidol monotherapy. The Simpson-Angus Rating Scale for Extrapyramidal Side Effects (SAS), Barnes Akathisia Rating Scale (BARS) and Extrapyramidal Symptom Rating Scale (ESRS) were used to evaluate EPS severity. Genotyping was performed using real-time PCR, following extraction of blood DNA. Significant acute EPS appeared in 48.03% of schizophrenia patients. For the rs13212041 HTR1B gene polymorphism, affecting microRNA regulation of HTR1B gene expression, a higher frequency of TT carriers was found among haloperidol-treated patients with akathisia when compared to the group without akathisia symptoms. In comparison to C-allele carriers, patients carrying the TT genotype had higher akathisia severity, as determined by the SAS, BARS and ESRS scales. These molecular findings suggest potential involvement of 5-HT_1B receptors in akathisia development following haloperidol treatment, as well as possible epigenetic mechanisms of serotonergic modulation associated with antipsychotic-induced EPS.

Development of novel therapeutics for the treatment of glaucoma based on actin-binding kinase inhibition – in silico approach

QSAR modeling with computer-aided drug design were used for the in silico development of novel therapeutics for glaucoma treatment.

P284 Patients with reduced systolic function benefit most from recanalisation of chronic total occlusion

Background

Percutaneous coronary intervention of chronic total coronary occlusion (PCI of CTO) is proved to reduce symptoms of angina and long term survival.

Purpose

This study aimed to assess systolic and diastolic left ventricular function with standard echocardiographic indices.

Methods

We analyzed total of 46 CTO patients (age 58 ± 9, 73% male). Measures were obtained with the transducer in the apical four-chamber view. Doppler time intervals were measured from mitral inflow and left ventricular outflow Doppler tracings by pulsed wave Doppler. The isovolumetric relaxation time (IVRT) was measured from closure of the aortic valve to opening of the mitral valve. The isovolumetric contraction time (IVCT) was measured from closure of the mitral valve to opening of the aortic valve. Ejection time (ET) was measured from the opening to the closure of the aortic valve on the LV outflow velocity profile. Myocardial performance index (MPI) is simple method for evaluation of overall cardiac function and is independent of heart rate and blood pressure. MPI was equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral filling wave (E) was measured and divided by average peak early diastolic annular velocity (e") which was measured as average value between septal and lateral side of the mitral annulus using Doppler tissue imaging. The E/e’ ratio was calculated to estimate the LV filling pressures

Results

Six months after PCI of CTO patients showed no change in ejection fraction (EF) (55.69 ± 8.56% vs. 54.83 ± 8.44%, p = 0.10). MPI was significantly decreased (0.676 ± 0.99 vs. 0.632 ± 0.96 p &lt; 0.01), E/e" was significantly reduced, (13,10 ± 6.90 vs. 12.05 ± 5.1 p &lt; 0.05), and when we analyzed only patients with baseline EF &lt; 50% (n = 9) improvement of diastolic function (reduction of E/e") was even greater (22.53 ± 5.52 vs. 15.65 ± 4.8 p &lt; 0.01).

Conclusion

PCI of CTO improves overall cardiac function, particularly diastolic function in patients with reduced ejection fraction.

Effects of cinchonine, a Cinchona bark alkaloid, on spontaneous and induced rat ileum contractions

AIM

Quinine, a frequently used anti-malaria alkaloid isolated from the Cinchona bark, possesses numerous toxic properties, the majority of which arrive from a dysfunction of the gastrointestinal tract. Similarly, cinchonine, another alkaloid from the Cinchona bark, displays a great potential for treating malaria (especially the resistant forms).

METHODS

In this work, we aimed to evaluate the effects of cinchonine on spontaneous and induced Wistar rat ileum contractions in order to uncover potential side effects that might arise after its application.

RESULTS

Cinchonine produced a concentration-dependent spasmolytic activity, which was found to be reversible (i.e. disappeared after tissue wash-up), with an IC50 value of 273 µM. Furthermore, the mechanism of action of cinchonine at IC50 elucidated through experiments with acetylcholine and Ca2+-induced ileum contractions. The applied IC50 concentration of cinchonine statistically significantly prevented the occurrence of contractions after the application of specific agonist. The obtained results are in a range with the effects seen with standard receptor antagonists, i.e. atropine and verapamil.

CONCLUSIONS

The obtained results showed that cinchonine inhibited both types of induced contractions, suggesting a Ca2+-channels mediated modus operandi (Fig. 4, Ref. 19).

P845Comparison of the performance of the five validated risk scores in acute myocardial infarction patients undergoing primary PCI

Background

Several risk scores have been developed to predict mortality of patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (pPCI), with limited data on the comparative prognostic value of these models.

Purpose

We aimed to compare the prognostic value of five validated risk scores for in-hospital and one-year mortality of patients with AMI undergoing pPCI.

ume catheterization laboratory in a period from January 2009 to December 2017, a total of 3868 consecutive patients who underwent pPCI were available for analysis. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications (CADILLAC), ACTION Registry-GWTG in-hospital mortality risk score (ACTION), Age, Creatinine, and Ejection Fraction (ACEF), and ZWOLLE risk scores were calculated using required clinical and angiographic characteristics. In-hospital and one-year mortality were assessed (follow-up available for 92% of pts). Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow (H-L) goodness-of-fit test and C-statistic, respectively.

Results

Mortality rates for in-hospital and one-year mortality were 1.8% and 6.9% respectively. All five scores showed good model calibration as assessed by the H-L test and very good discriminative power for in-hospital and one-year mortality as assessed by C-statistics (Table 1 & Figure 1):

Table 1 Risk score H-L H-L p AUC in-hospital 95% CI Significant p AUC one-year 95% CI Significant p ZWOLLE 1.3 0.7 0.90 0.89–0.91 vs. CADILLAC <0.05 0.75 0.74–0.77 vs. TIMI <0.005 ACTION 13.1 0.1 0.87 0.86–0.88 vs. TIMI <0.005 0.79 0.77–0.80 CADILLAC 5.5 0.2 0.85 0.84–0.86 vs. TIMI <0.01 0.81 0.80–0.83 vs. ZWOLLE <0.000 vs. TIMI <0.000 ACEF 9.9 0.3 0.814 0.83–0.85 0.80 0.78–0.81 vs. ZWOLLE <0.000 vs. TIMI <0.05 TIMI 7.1 0.3 0.79 0.78–0.80 0.76 0.75–0.78

Figure 1

Conclusion

Risk stratification of patients with AMI undergoing pPCI using the ZWOLLE, ACTION, CADILLAC, ACEF or TIMI risk scores enables accurate identification of high-risk patients for in-hospital and one-year mortality in an all-comers population. Among evaluated scores, ZWOLLE model was better fitted for prediction of in-hospital mortality while CADILLAC and ACEF better predicted late events.

Perimatrix of middle ear cholesteatoma: A granulation tissue with a specific transcriptomic signature

OBJECTIVES/HYPOTHESIS

To establish comprehensive transcriptomic profiles of cholesteatoma perimatrix tissue and granulation tissue from chronic otitis media (COM) that did not develop cholesteatoma, which can indicate molecular pathways involved in the cholesteatoma perimatrix pathology and invasiveness.

STUDY DESIGN

Retrospective Case Series.

METHODS

Transcriptome data were obtained from cholesteatoma perimatrix tissue and COM granulation tissue by an Illumina iScan microarray. Differentially expressed genes (DEGs) were subsequently analyzed using both bioinformatical functional annotation and network analysis. Expression of candidate genes (MMP9 and LCN2) was validated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) on a larger group of samples.

RESULTS

Analysis of the transcriptome led to the identification of 169 differentially expressed genes between investigated tissues. Bioinformatic analysis suggested that most significant biological processes involving DEGs were previously described in cholesteatoma pathology. Network analysis identified ERBB2, TFAP2A, and TP63 as major hubs of the DEGs molecular network. Furthermore, it was observed that the cellular component most significantly enriched in DEGs was extracellular space containing 47 DEGs. Using qRT-PCR, it was confirmed that mRNA levels of the major extracellular hub (MMP9) are increased, whereas its interacting molecule (LCN2) mRNA levels were decreased in cholesteatoma perimatrix tissue compared to COM granulation tissue.

CONCLUSIONS

The current study approach offers an overall look at molecular mechanisms that describe the cholesteatoma entity by focusing exclusively on the perimatrix processes in comparison to COM granulation tissue. The observed differences in gene expression between cholesteatoma perimatrix and COM granulation tissue could suggest novel markers potentially influenced by the perimatrix-matrix molecular interplay, which is not present in COM without cholesteatoma.

LEVEL OF EVIDENCE

NA Laryngoscope, 130:E220-E227, 2020.

Development of novel therapeutics for glaucoma filtration surgery based on transforming growth factor-β receptor 1 inhibition

QSAR modeling with computer-aided drug design was used for the in silico development of novel therapeutics for glaucoma filtration surgery.

Ethical Approach to Prevention of Schizophrenia - Concepts and Challenges

Patients with schizophrenia, nowadays chronic, frequently disabling mental disorder, get initial treatment after detection of a psychotic episode, seemingly late, potentially preventable stage of illness. As our knowledge about the nature of schizophrenia and other diseases of the spectrum is growing, so are the early interventions becoming more possible, and it is important to conceptualize the clinical, legal and moral issues emerging with new preventive treatments. Every intervention, especially in pre-clinical population, demands a careful risk-benefit assessment and having basic bioethical principles - primacy of patient's welfare, beneficience/non-maleficience, autonomy and justice - in mind. We believe that pharmacological treatments, considering today's drugs safety and effectiveness profiles, should stay reserved for cases with higly probable negative outcomes to patient's wellbeing, and that all other low-risk interventions, like psychosocial treatments, should be considered for reducing the conversion to disorder, if possible, or relieving the distress in vulnerable persons, when such vulnerability gets detected. How to recognize persons at risk before the start of the disorder, without missing the majority of cases or burdening healthy persons with stigma, is another challenge and not only mental health professionals should be included in finding the solutions. The broadest public, and especially the experts that will build the safety-net for the at-risk individuals, should get best possible appropriate education about the schizophrenia in order to stigmatize less and help more.