Preoperative diagnosis and safe surgical approach in gallbladder amyloidosis: a case report

BACKGROUND

Preoperative diagnosis of gallbladder amyloidosis is usually difficult. In our case, the patient exhibited gallbladder dyskinesia, which led us to suspect cholecystic amyloidosis. We were able to safely perform surgery before cholecystitis onset.

CASE PRESENTATION

A 59-year-old male patient with a history of multiple myeloma and cardiac amyloidosis presented to our hospital with a chief complaint of epicardial pain. Abdominal ultrasonography and computed tomography revealed an enlarged gallbladder and biliary sludge without any specific imaging findings of cholecystitis. After percutaneous transhepatic gallbladder aspiration (PTGBA), the patient experienced recurrent bile retention and right upper quadrant pain. Flopropione was effective in relieving these symptoms. Based on his symptoms and laboratory findings, we diagnosed the patient with dyskinesia of the gallbladder. Considering his medical history, we suspected that it was caused by amyloidosis of the gallbladder. A laparoscopic cholecystectomy was performed. The histopathological examination showed amyloid deposits in the gallbladder mucosa, from the intrinsic layer to the submucosa, and in the peripheral nerves of the gallbladder neck. The patient was discharged on postoperative day 5 and has had no recurrence of abdominal pain since then.

CONCLUSION

In our case, gallbladder dyskinesia symptoms led us to suspect gallbladder amyloidosis. We safely surgically treated the patient before cholecystitis onset.

Tumor endothelial cell-derived Sfrp1 supports the maintenance of cancer stem cells via Wnt signaling

Cancer stem cells (CSCs), which are critical targets for cancer therapy as they are involved in drug resistance to anticancer drugs, and metastasis, are maintained by angiocrine factors produced by particular niches that form within tumor tissue. Secreted frizzled-related protein 1 (Sfrp1) is an extracellular protein that modulates Wnt signaling. However, the cells that produce Sfrp1 in the tumor environment and its function remain unclear. We aimed to elucidate angiocrine factors related to CSC maintenance, focusing on Sfrp1. Although Sfrp1 is a Wnt pathway-related factor, its impact on tumor tissues remains unknown. We investigated the localization of Sfrp1 in tumors and found that it is expressed in some tumor vessels. Analysis of mice lacking Sfrp1 showed that tumor growth was suppressed in Sfrp1-deficient tumor tissues. Flow cytometry analysis indicated that CSCs were maintained in the early tumor growth phase in the Sfrp1 knockout (KO) mouse model of tumor-bearing cancer. However, tumor growth was inhibited in the late tumor growth phase because of the inability to maintain CSCs. Real-time PCR results from tumors of Sfrp1 KO mice showed that the expression of Wnt signaling target genes significantly decreased in the late stage of tumor growth. This suggests that Sfrp1, an angiocrine factor produced by the tumor vascular niche, is involved in Wnt signaling-mediated mechanisms in tumor tissues.

The efficacy and safety of pure laparoscopic liver resection for hepatocellular carcinoma in super-elderly patients over 80 years: A multicenter propensity analysis

BACKGROUND

Very few reports have evaluated the safety of laparoscopic liver resection in super-elderly patients. We assessed the short-term outcomes of laparoscopic liver resection in patients with hepatocellular carcinoma aged ≥80 years, using propensity score matching.

METHODS

We retrospectively analyzed the data of 287 patients (aged ≥80 years) who underwent liver resection for hepatocellular carcinoma at eight hospitals belonging to Hiroshima Surgical study group of Clinical Oncology, between January 2012 and December 2021. The perioperative outcomes were compared between laparoscopic and open liver resection, using propensity score matching.

RESULTS

Of the 287 patients, 83 and 204 were included in the laparoscopic and open liver resection groups, respectively. Propensity score matching was performed, and 52 patients were included in each group. The operation (p = .68) and pringle maneuver (p = .11) time were not different between the groups. There were no significant differences in the incidences of bile leakage or organ failure. The laparoscopic liver resection group had significantly less intraoperative bleeding and a lower incidence of cardiopulmonary complications (both p < .01).

CONCLUSIONS

Laparoscopic liver resection can be safely performed in elderly patients aged ≥80 years.

Protocol to evaluate the efficacy and safety of tolvaptan in patients with refractory ascites after liver resection: an open-label, single-arm phase I/II study

Background

In patients with chronic liver diseases such as cirrhosis, massive ascites after hepatic resection is the cause of prolonged hospitalization and worsening prognosis. Recently, the efficacy of tolvaptan in refractory ascites has been reported; however, there are no reports on the efficacy or safety of tolvaptan for refractory ascites after hepatic resection. This study aims to evaluate the efficacy of early administration of tolvaptan in patients with refractory ascites after hepatic resection.

Materials and methods

This is an open-label, single-arm phase I/II study. This study subject will comprise patients scheduled for hepatic resection of a liver tumor. Patients with refractory ascites after hepatic resection (drainage volume on postoperative day 1 ≥5 ml/body weight 1 kg/day) will be treated with tolvaptan. The primary endpoint will include the maximum change in body weight after hepatic resection relative to the preoperative baseline. The secondary endpoints will include drainage volume, abdominal circumference, urine output, postoperative complication rate (heart failure and respiratory failure), number of days required for postoperative weight gain because of ascites to decrease to preoperative weight, change in improvement of postoperative pleural effusion, total amount of albumin or fresh frozen plasma transfusion, type and amount of diuretics used, and postoperative hospitalization days.

Conclusion

This trial will evaluate the efficacy and safety of tolvaptan prophylaxis for refractory ascites after hepatic resection. As there are no reports demonstrating the efficacy of tolvaptan prophylaxis for refractory ascites after hepatic resection, the authors expect that these findings will lead to future phase III trials and provide valuable indications for the selection of treatments for refractory postoperative ascites.

Peritoneal dissemination of appendiceal goblet cell adenocarcinoma mimicking white pus caused by peritonitis following appendicitis: an instructive case report

BACKGROUND

Goblet cell adenocarcinoma is an extremely rare tumor in which the same cells exhibit both mucinous and neuroendocrine differentiation. It is considered more aggressive compared to conventional carcinoids and more likely to cause metastasis.

CASE PRESENTATION

We report a case of goblet cell adenocarcinoma with peritoneal metastases. A 62-year-old man underwent appendectomy for acute appendicitis. Intraoperatively, inflammatory white pus and a small amount of dirty ascites were observed in the lower abdomen with severely inflamed appendix. Histopathological examination of the specimen collected during appendectomy revealed goblet cell adenocarcinoma with a positive surgical margin. One month later, additional ileal resection was planned. Laparoscopic examination revealed disseminated nodules throughout the abdominal cavity. Therefore, the patient underwent resection of the peritoneal nodules. The peritoneal specimens confirmed the histopathological findings. Thus we diagnosed the patient with peritoneal dissemination of appendiceal goblet cell adenocarcinoma.

CONCLUSIONS

In cases wherein white pus is observed during surgery for acute appendicitis, considering the possibility of dissemination, collecting samples for histopathological examination, and initiating early treatment are crucial.

Prognostic impact of pre- and postoperative tumor markers in patients with intrahepatic cholangiocarcinoma

PURPOSE

The present study assessed the impact of pre- and postoperative tumor markers on the survival of patients with intrahepatic cholangiocarcinoma.

METHODS

Medical records of 73 patients with intrahepatic cholangiocarcinoma were reviewed retrospectively. The pre- and postoperative carcinoembryonic antigen and carbohydrate antigen 19-9 levels were assessed. Patient characteristics, clinicopathological factors, and prognostic factors were analyzed.

RESULTS

The median recurrence-free survival and overall survival were 30.0 and 90.9 months, respectively. A multivariate survival analysis revealed that elevated postoperative carbohydrate antigen 19-9 (p = 0.023) was the only independent poor prognostic factor. The median overall survival of patients with normal and elevated postoperative carbohydrate antigen 19-9 levels was 101.4 and 15.7 months (p < 0.001), respectively. Multivariate logistic regression identified elevated preoperative carbohydrate antigen 19-9 as an independent preoperative risk factor for elevated postoperative carbohydrate antigen 19-9. The optimal cutoff value of preoperative carbohydrate antigen 19-9 for predicting elevated postoperative carbohydrate antigen 19-9 was 40 U/mL, with a sensitivity and specificity of 92% and 87%, respectively (area under curve = 0.915).

CONCLUSIONS

Elevated postoperative carbohydrate antigen 19-9 was an independent poor prognostic factor. Preoperative predictors, such as elevated preoperative carbohydrate antigen 19-9, may indicate the need for neoadjuvant therapies to improve the survival.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Comparison of postoperative outcomes in cases achieving sustained virological response with direct-acting antiviral and interferon therapy

BACKGROUND/PURPOSE

The effect of direct-acting antiviral agents (DAAs) on hepatocellular carcinoma (HCC) recurrence after curative hepatectomy remains uncertain. This retrospective study aimed to evaluate the effect of sustained virological response (SVR) with DAAs or interferon (IFN) therapy on recurrence and overall survival (OS) after hepatectomy.

METHODS

We enrolled 593 patients who underwent curative resections between January 2010 and December 2017. Among them, 186 achieved SVR before hepatectomy: a total of 51 (27.4%) in the DAA-SVR group and 132 (72.6%) in the IFN-based SVR group.

RESULTS

SVR before hepatectomy was an independent predictor of OS, and the 5-year OS rate was significantly higher in the SVR group than that in the non-SVR group (82.2% vs. 63.9%). There were no significant differences in the recurrence rates or OS between DAA and IFN treatments in achieving SVR before hepatectomy, regardless of poor hepatic function in the DAA therapy group.

CONCLUSIONS

There was no significant difference in OS and recurrence-free survival (RFS) between the preoperative SVR achieved with DAA and IFN groups in this study, although liver function was significantly worse at the time of surgery in the DAA group compared to the IFN group.

AB0653 The association of autoantibodies with morbidity and mortality of scleroderma renal crisis in Japan

Background

The morbidity of scleroderma renal crisis (SRC) and autoantibodies in systemic sclerosis (SSc) vary by races and regions. Anti-RNA polymerase III is associated with SRC in America and European countries. However, the association of autoantibodies with SRC had not been elucidated in Japan.

Objectives

We aimed to investigate the association of autoantibodies with morbidity and mortality of SRC in Japan.

Methods

The clinical characteristics and mortality of 330 patients with systemic sclerosis (SSc) at Kyoto University Hospital were retrospectively analyzed, focusing on anti-centromere, anti-RNA polymerase III, anti-topoisomerase I, and anti-U1-RNP. Logistic regression analyses were performed to examine the association of autoantibodies with the development and mortality of SRC. Kaplan-Meier survival analysis was performed comparing the groups classified by autoantibodies.

Results

Anti-centromere (n = 177/318, 56%), anti-topoisomerase I (n = 80/311, 26%), anti-RNA polymerase III (n = 27/204, 13%), and anti-U1-RNP (n = 24/305, 8%) were found in SSc patients (n = 330). SRC was observed in 24 out of 330 SSc patients, including anti-topoisomerase I (n = 12/24, 50%), anti-RNA polymerase III (n = 7/24, 29%), anti-U1-RNP (n = 5/24, 21%), and anti-centromere (n = 3/24, 13%). Anti-U1-RNP (odds ratio [95% confidence interval], 3.63 [1.11–10.2]), anti-RNA polymerase III (3.29 [1.16–8.70]), and anti-topoisomerase I (3.22 [1.37–7.57]) were associated with the development of SRC. All patients with SRC were treated with ACE inhibitors and the 1-year survival rate was 54%. Anti-topoisomerase I was associated with the 1-year mortality of SRC (6.00 [1.11–41.1]). When the survival rate was compared between the patients positive for anti-topoisomerase I (n=12) and negative for anti-topoisomerase I (n=12), the 1-year survival rate was 33% vs 75% (p=0.041), respectively (Figure 1A). Furthermore, the 1-year survival of anti-centromere (100%), anti-RNA polymerase III (83%), and others/not detected (50%) were shown in patients negative for anti-topoisomerase I (Figure 1B).

Figure 1.

Overall survival of patients with SRC according to the type of autoantibodies.

(A) The survival rates in SRC patients who were positive for anti-topoisomerase I (solid line, n = 12) and those who were negative for anti-topoisomerase I (dotted line, n = 12).

(B) SRC patients negative for anti-topoisomerase I were classified as patients with anti-RNA polymerase III (dotted line, n = 6), anti-centromere (broken line, n = 2), and others/not detected (chain line, n = 4).

Conclusion

Specific SSc-related autoantibodies were associated with the morbidity and mortality in SRC.

References

[1]Nihtyanova SI, et al. Arthritis Rheumatol 2020;72(3):465-76.

[2]Hamaguchi Y, et al. Arthritis Rheumatol 2015;67(4):1045-52.

Table 1.

Univariate logistic regression analysis for mortality in SRC (n = 24).

VariablesOdds ratio (95% CI)P valueAge1.07 (0.99, 1.16)0.08Female sex3.00 (0.32, 66.6)0.38Diffuse/limited (diffuse %)0.25 (0.04, 1.36)0.12BMI0.67 (0.41, 0.93)0.049Modified Rodnan skin score0.95 (0.88, 1.02)0.15Digital ulcer0.52 (0.10, 2.63)0.43Reflux esophagitis0.60 (0.02, 17.1)0.73Pulmonary hypertension7.50 (1.17, 69.2)0.046Pleural effusion7.20 (1.23, 62.0)0.04Glucocorticoid use3.86 (0.65, 32.4)0.16Hemoglobin0.55 (0.25, 1.01)0.09Platelet1.00 (0.98, 1.01)0.44Total protein0.17 (0.02, 0.69)0.04Creatinine0.95 (0.67, 1.24)0.69CRP0.90 (0.67, 1.17)0.46Anti-topoisomerase I6.00 (1.11, 41.1)0.048Anti-centromere7.4x10-9 (--, 0.93)1.00Anti-RNA polymerase III0.36 (0.04, 2.18)0.29Anti-U1-RNP0.74 (0.08, 5.49)0.77

Disclosure of Interests

None declared

POS0532 DRUG RETENTION OF BIOLOGICS OR JAK INHIBITORS IN PATIENTS WITH DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS: RESULTS FROM THE ANSWER COHORT

Background

Difficult-to-treat rheumatoid arthritis (D2T RA) is defined as RA in which disease activity is uncontrolled despite the use of two or more biologics or Janus kinase inhibitors (JAKi) with different mechanisms of action (MOA).

Objectives

To explore the optimal treatment strategy for D2T RA, we evaluated the drug retention, efficacy, and reasons for discontinuation of biologics or JAKi used for patients with D2T RA in a longitudinal multicenter cohort.

Methods

RA patients with clinical disease activity index (CDAI) >10 despite the use of at least two biologics or JAKi with different MOA and further treated with biologics or JAKi were included. The drug retention rates of biologics (TNFi, IL-6Ri, and CTLA4-Ig) or JAKi were estimated at 12 months using the Kaplan-Meier method and adjusted for potential confounders (age, sex, disease duration, concomitant MTX and PSL use, and the number of switched biologics or JAKi) using Cox proportional hazards models.

Results

A total of 251 treatment courses (TCs) from 167 patients were included (TNFi: 97 TCs, IL-6Ri: 67 TCs, CTLA4-Ig: 27 TCs, JAKi: 60 TCs). Baseline characteristics showed no difference in age, sex, disease duration, ACPA positivity, CDAI, and concomitant MTX and PSL use between the four groups. Drug retention excluding non-toxic reasons and remission was significantly higher in patients treated with JAKi or IL-6Ri than in patients treated with TNFi or CTLA4-Ig (P=0.00172). Multivariate analysis using Cox proportional hazards models demonstrated that discontinuation of the drug was associated with the use of TNFi or CTLA4-Ig (HR: 3.29, 95%CI: 1.15-9.42, P=0.027) and concomitant PSL use (HR: 1.14, 95%CI: 1.04-1.26, P=0.0084). In terms of disease activity evaluated with CDAI, no difference was observed between the four groups at 3 months (P=0.90), at 6 months (P=0.77), and at 12 months (P=0.75).

Conclusion

In patients with D2T RA, JAKi or IL-6Ri may have treatment advantages compared with TNFi or CTLA4-Ig.

References

[1] EULAR definition of difficult-to-treat rheumatoid arthritis.

Nagy G, Roodenrijs NMT, Welsing PM, Kedves M, Hamar A, van der Goes MC, Kent A, Bakkers M, Blaas E, Senolt L, Szekanecz Z, Choy E, Dougados M, Jacobs JW, Geenen R, Bijlsma HW, Zink A, Aletaha D, Schoneveld L, van Riel P, Gutermann L, Prior Y, Nikiphorou E, Ferraccioli G, Schett G, Hyrich KL, Mueller-Ladner U, Buch MH, McInnes IB, van der Heijde D, van Laar JM.

Ann Rheum Dis. 2021 Jan;80(1):31-35.

[2] Prevalence and predictive factors of difficult-to-treat rheumatoid arthritis: the KURAMA cohort.

Watanabe R, Hashimoto M, Murata K, Murakami K, Tanaka M, Ohmura K, Ito H, Matsuda S.

Immunol Med. 2021 May 25:1-10.

Disclosure of Interests

Ryu Watanabe Speakers bureau: Eli Lilly, Mitsubishi Tanabe, Pfizer, Sanofi, AbbVie, Asahi Kasei, Eisai, Bristol-Myers Squibb, UCB Japan, Chugai, Janssen, Astellas, Nippon Shinyaku, Daiichi Sankyo, Gilead Sciences Japan, and Boehringer ingelheim., Tadashi Okano Speakers bureau: Asahi Kasei, Astellas, Abbvie, Amgen, Ayumi, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead Sciences, Janssen, Kyowa Kirin, Mitsubishi Tanabe, Novartis, Ono, Pfizer, Sanofi, Takeda, UCB, Grant/research support from: Asahi Kasei, Abbvie, Chugai, Eisai, Mitsubishi Tanabe, Shinsuke Yamada: None declared, Wataru Yamamoto: None declared, Koichi Murata Speakers bureau: Eisai Co., Ltd., Chugai Pharmaceutical Co., Ltd.; Asahi Kasei Pharma Corp.; and Mitsubishi Tanabe Pharma Co., and Daiichi Sankyo Co. Ltd., Kosaku Murakami: None declared, Kosuke Ebina Speakers bureau: AbbVie, Amgen, Asahi-Kasei, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Janssen, Mitsubishi-Tanabe, Ono Pharmaceutical, Pfizer, Sanofi, and UCB Japan., Grant/research support from: AbbVie, Amgen, Asahi-Kasei, Astellas, Chugai, Eisai, Mitsubishi-Tanabe, Ono Pharmaceutical, Teijin Pharma, and UCB Japan, Yuichi Maeda Speakers bureau: Eli Lilly Japan K.K., Chugai Pharmaceutical Co. Ltd., Pfizer Inc., Bristol Myers Squibb, and Mitsubishi Tanabe Pharma Corporation., Sadao Jinno Speakers bureau: AbbVie G.K., Asahi Kasei Pharma., Bristol-Myers Squibb., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., and Mitsubishi Tanabe Pharma, and Ono Pharmaceutical Co, Iku Shirasugi: None declared, Yonsu Son: None declared, Hideki Amuro Speakers bureau: Chugai Pharmaceutical Co.,Ltd, Masaki Katayama: None declared, Ryota Hara: None declared, Kenichiro Hata Speakers bureau: AbbVie, Asahi-Kasei, Chugai, Janssen, Mitsubishi-Tanabe, Eisai, Ayaka Yoshikawa: None declared, Motomu Hashimoto Grant/research support from: Abbvie, Asahi-Kasei, Brystol-Meyers, Eisai, Eli Lilly, Novartis Pharma.

Early embryonic mutations reveal dynamics of somatic and germ cell lineages in mice

De novo mutations accumulate with zygotic cell divisions. However, the occurrence of these mutations and the way they are inherited by somatic cells and germ cells remain unclear. Here, we present a novel method to reconstruct cell lineages. We identified mosaic mutations in mice using deep whole-genome sequencing and reconstructed embryonic cell lineages based on the variant allele frequencies of the mutations. The reconstructed trees were confirmed using nuclear transfer experiments and the genotyping of approximately 50 offspring of each tree. The most detailed tree had 32 terminal nodes and showed cell divisions from the fertilized egg to germ cell- and somatic cell-specific lineages, indicating at least five independent cell lineages that would be selected as founders of the primordial germ cells. The contributions of each lineage to germ cells and offspring varied widely. At the emergence of the germ cell-specific lineages, 10-15 embryonic mutations had accumulated, suggesting that the pregastrulation mutation rate is 1.0 mutation per mitosis. Subsequent mutation rates were 0.7 for germ cells and 13.2 for tail fibroblasts. Our results show a new framework to assess embryonic lineages; further, we suggest an evolutionary strategy for preserving heterogeneity owing to postzygotic mutations in offspring.

Effects of a Watercress Extract Fraction on R-spondin 1-Mediated Growth of Human Hair

OBJECTIVE

Hair loss and greying affect men and women of all ages, often causing psychosocial difficulties. Dickkopf-1 (DKK1), a major hair loss factor secreted from dermal papilla (DP) cells in response to the secretion of dihydrotestosterone (DHT), has been reported to induce and accelerate androgenetic alopecia (AGA). In addition, DKK1 acts as a potent suppressor of melanogenesis and is closely related to hair colour. R-spondin 1 (RSPO1) is a secretory agonist of Wnt signalling known to antagonize the effects of DKK1, including DKK1-mediated hair follicle suppression. In this study, we investigated the effect of watercress extract (WCE) on the secretion of RSPO1 and DKK1 from DP cells as well as its anti-hair loss effect in human hair follicles and patients.

METHODS

The in vitro secretion of RSPO1 and DKK1 was measured by ELISA. Human hair follicles were collected from the scalp of a female donor and used for ex vivo organ culture to investigate the effects of WCE on human hair loss. Finally, a 6-month human clinical trial was conducted to examine the effect of WCE-containing lotion on hair growth in a male panel.

RESULTS

WCE significantly upregulated RSPO1 secretion and suppressed DKK1 secretion in a dose-dependent manner, even in the presence of DHT. WCE-treated hair follicles elongated 1.6-fold compared to the control, and the level of RSPO1 production in DP as well as RSPO1 bound to the outer root sheath (ORS) increased. In the clinical trial, the hair lotion containing 2% WCE increased hair thickness and density to improve against hair loss symptoms.

CONCLUSION

WCE exhibited a strong anti-androgenic effect through its ability to suppress DKK1 secretion and antagonize DKK1 via RSPO1. These findings highlighted the potential use of WCE for the treatment of hair loss. These results also showed that WCE might have an effect on hair colour since DKK1 is a suppressor of melanogenesis.

Targeting the IGF-Axis Potentiates Immunotherapy for Pancreatic Ductal Adenocarcinoma Liver Metastases by Altering the Immunosuppressive Microenvironment

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy, resistant to chemotherapy and associated with high incidence of liver metastases and poor prognosis. Using murine models of aggressive PDAC, we show here that in mice bearing hepatic metastases, treatment with the IGF-Trap, an inhibitor of type I insulin-like growth factor receptor (IGF-IR) signaling, profoundly altered the local, immunosuppressive tumor microenvironment in the liver, curtailing the recruitment of myeloid-derived suppressor cells, reversing innate immune cell polarization and inhibiting metastatic expansion. Significantly, we found that immunotherapy with anti-PD-1 antibodies also reduced the growth of experimental PDAC liver metastases, and this effect was enhanced when combined with IGF-Trap treatment, resulting in further potentiation of a T-cell response. Our results show that a combinatorial immunotherapy based on dual targeting of the prometastatic immune microenvironment of the liver via IGF blockade, on one hand, and reversing T-cell exhaustion on the other, can provide a significant therapeutic benefit in the management of PDAC metastases.

Favorable clinical response and drug retention of anti-IL-6 receptor inhibitor in rheumatoid arthritis with high CRP levels: the ANSWER cohort study

OBJECTIVE

Currently, biological disease-modifying anti-rheumatic drugs (bDMARDs) with different modes of action [tumour necrosis factor inhibitor (TNFi), interleukin-6 receptor inhibitor (IL-6Ri), or cytotoxic T-lymphocyte antigen 4-immunoglobulin (CTLA4-Ig)] are used in clinical practice to treat rheumatoid arthritis (RA). However, it is unclear which type of bDMARD is the most efficacious for a specific clinical situation. C-reactive protein (CRP) is an acute-phase reactant driven by IL-6 signalling. Here, we aimed to establish whether therapeutic efficacy differs between IL-6Ri and other bDMARDs with alternative modes of action in RA patients according to their CRP level.

METHOD

RA patients treated with bDMARDs were enrolled from an observational multicentre registry in Japan. Patients were classified into three groups according to baseline CRP tertiles. The overall 3 year retention rates of each bDMARD category were assessed. The Clinical Disease Activity Index (CDAI) was also assessed before and 3, 6, and 12 months after bDMARD initiation.

RESULTS

A total of 1438 RA patients were included and classified into three groups according to tertiles of baseline CRP levels (CRP¹, 0-0.3; CRP², 0.3-1.8; CRP³, 1.8-18.4 mg/dL). In CRP³, the overall 3 year drug retention rates were significantly higher for IL-6Ri than for TNFi and CTLA4-Ig (77.5 vs 48.2 vs 67.3, respectively). No significant difference was evident in terms of CDAI 12 months after bDMARD initiation in CRP¹-CRP³.

CONCLUSION

IL-6Ri may be a favourable therapeutic option over TNFi and CTLA4-Ig in RA patients with high CRP levels.

Radiomics analysis of myocardial perfusion SPECT images in patients with cardiomyopathy and heart failure

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI Grants

Background

Although myocardial perfusion heterogeneity due to focally damaged cardiomyocytes is observed in single−photon emission computed tomography (SPECT) imaging, a current perfusion defect scoring system does not allow us to provide sufficient diagnostic information for heterogeneity.

Purpose

The aim of this study was to perform radiomics analysis of myocardial perfusion SPECT (MPS) images to investigate the potential to detect myocardial perfusion heterogeneity.

Methods

Patients with hypertrophic cardiomyopathy (n = 3), heart failure (n = 9), and with a low likelihood of coronary artery disease (n =15) (Figure 1), who underwent a rest 99mTc-MIBI myocardial perfusion SPECT, were assessed using a LIFEx software. Four shape−based features, 6 histogram−based features, and 32 textural features were computed. The relevant features for the classification of the patients were selected using the Boruta algorithm, and hierarchical clustering of the selected features using the Spearman correlation coefficient was also performed for the feature reduction. The receiver operating characteristics (ROC) analysis was performed by the support vector machine to calculate the area under the ROC curve (AUC) for the selected features.

Results

Of 40 features, 17 were selected by the classification analysis, and these features were classified into 7 classes by the correlation analysis (Figure 2). The ROC AUCs for 7 features extracted from each class were 0.99, 0.97, 0.96, 0.92, 0.90, 0.86, and 0.83 for the contrast of NDGLDM, the entropy of histogram, ZLNU of GLZLM, the energy of GLCM, the energy of histogram, SZLGE of GLZLM, and the correlation of GLCM, respectively, as compared to 0.39 for a summed rest score.

Conclusions

Radiomics analysis successfully determined the myocardial perfusion heterogeneity in patients with cardiomyopathy and heart failure. It might be promising for the evaluation of myocardial damages that cannot be analyzed by the conventional scoring method.

Usefulness and safety of midline incision for right-sided hepatectomy: Cohort study

Background

While the adoption rates of laparoscopic hepatectomy are increasing, most patients still undergo open hepatectomy. Open hepatectomies use inverted L-shaped or Mercedes incisions for right-sided liver tumor. To decrease procedural invasiveness, we performed midline incisions in such cases, excluding those of laparoscopic hepatectomy. This retrospective study examined the effects of this change in treatment policy on overall patient surgical outcomes.

Materials and methods

From 2012 to 2018, 374 patients who underwent hepatectomy for right-sided hepatocellular carcinoma were enrolled, and short-term patient outcomes were compared following stratification into the 1st (n = 157) or 2nd (n = 217) Era group based on whether procedures occurred before or after the policy change, respectively.

Results

Short-term outcomes were mostly comparable between the two groups, with significantly increased postoperative aspartate aminotransferase maximum values found in the 2nd Era group relative to the 1st Era group (median: 393 vs. 331, p < 0.05). Pain scores at rest during postoperative day 1 and while moving on postoperative days 1, 2, and 3 were significantly lower in the 2nd Era group than in the 1st Era group (p < 0.05, <0.01, <0.05, <0.01, respectively).

Conclusions

Utilization of midline incisions may provide some benefits in postoperative outcomes for right-sided open hepatectomy cases.

•

Utilization of midline incisions may provide better postoperative outcomes in cases of right-sided open hepatectomy.

POS0345 CLINICOGENETIC STUDY OF FIVE NOVEL SUSCEPTIBILITY LOCI FOR TAKAYASU ARTERITIS: SUSCEPTIBILITY LOCI IN THE IL12B AND PTK2B REGION, BUT NOT THE LILRA3, DUSP22, KLHL33 REGIONS, ARE ASSOCIATED WITH VASCULAR DAMAGE IN TAKAYASU ARTERITIS

Background:

We have previously identified single nucleotide polymorphism (SNP) rs6871626 in IL12B, rs103294 in LILRA3, rs17133698 in DUSP22, rs2322599 in PTK2B, and rs1713450 in KLHL33 as non-HLA susceptibility loci in Takayasu arteritis (TAK) [1, 2]. However, the association of these SNPs with clinical features has scarcely investigated.

Objectives:

In this study, we aimed to examine how these SNPs contribute to clinical features and vascular damage in TAK.

Methods:

We enrolled 99 TAK patients who were enrolled in our previous genome-wide association study (GWAS) [2]. To assess vascular damage, Takayasu Arteritis Damage Score (TADS) and Vasculitis Damage Index (VDI) were measured at the last visit before November 2020. As for organ damages, the presence or absence of aortic regurgitation (AR), hypertension, ischemic heart disease, cerebrovascular event, visual loss, end-stage renal failure, and inflammatory bowel disease were evaluated. Treatment profiles including immunosuppressive drugs and vascular interventions were also reviewed.

Results:

The incidence of AR was positively associated with the risk allele of IL12B rs6871626 (p=0.0052; odds ratio (OR) 2.45, 95% confidence interval (CI) 1.27-4.73), and so was the proportion of patients who underwent aortic valve replacement (p=0.023; OR 3.64, 95% CI 1.08-12.24) (table 1). The incidence of hypertension was associated with the risk allele of IL12B rs6871626 (p=0.049; OR 1.82, 95% CI 0.99-3.36) and PTK2B rs2322599 (p=0.044; OR 2.52, 95% CI 0.97-6.54) (table 1). The proportion of biologic users tended to be higher in the risk genotypes of IL12B rs6871626 (p=0.15; OR1.80, 95% CI 0.79-3.99). Regarding vascular damage, there was positive correlation between TADS and the risk allele of IL12B rs6871626 (p=0.0035; β= 1.35) (Figure 1). Moreover, VDI was also positively correlated with the allele (p=0.0054; β= 0.96) (Figure 1). No other clinicogenetic associations were observed between five SNPs and vasculitis-associated damages.

Table 1.

The association of the five SNPs with aortic regurgitation and hypertension

Aortic regurgitationHypertensionOR (95% CI)p valueOR (95% CI)p valueIL12B rs68716262.45 (1.27-4.73)0.0052*1.82 (0.99-3.36)0.049*PTK2B rs23225991.21 (0.51-2.86)0.672.51 (0.97-6.54)0.044*LILRA3 rs1032941.16 (0.52-2.61)0.711.20 (0.55-1.64)0.64DUSP22 rs171336980.56 (0.28-1.13)0.0900.87 (0.46-1.63)0.66KLHL33 rs17134500.89 (0.42-1.91)0.771.48 (0.68-3.22)0.31

SNP, single nucleotide polymorphism; OR, odds ratio; CI, confidence interval

Conclusion:

In the present study, IL12B rs6871626 was closely correlated with vascular damage. We also found association between PTK2B rs2322599 and hypertension. There was no significant relevance between vascular damage and LILRA3 rs103294, DUSP22 rs17133698, or KLHL33 rs1713450.

References:

[1]Terao C et al. Am J Hum Genet. 2013;93(2):289-97.

[2]Terao C et al. Proc Natl Acad Sci U S A. 2018;115(51):13045-50.

Disclosure of Interests:

Keiichiro Kadoba: None declared, Ryu Watanabe Speakers bureau: I have received speaker’s fee from Mitsubishi Tanabe Pharma, Pfizer, Sanofi, AbbVie, Asahi Kasei, Eisai, Eli Lilly, Bristol-Myers Squibb, and Janssen., Takeshi Iwasaki: None declared, Koji Kitagori Grant/research support from: KK has received research grants from GlaxoSmithKline., Syuji Akizuki: None declared, Kosaku Murakami Speakers bureau: I have received speaking fees from Eisai Co. Ltd, Chugai Pharmaceutical Co. Ltd., Pfizer Inc., Bristol-Myers Squibb, Mitsubishi Tanabe Pharma Corporation, UCB Japan Co. Ltd, Daiichi Sankyo Co. Ltd. and Astellas Pharma Inc., Ran Nakashima: None declared, Motomu Hashimoto Speakers bureau: I have received a research grant and/or speaker fee from Bristol-Myers, Eisai, Ely Lilly, Mitsubishi Tanabe Pharma., Grant/research support from: I have received a research grant and/or speaker fee from Bristol-Myers, Eisai, Ely Lilly, Mitsubishi Tanabe Pharma., Masao Tanaka Speakers bureau: I have received research grants and/or speaker fees from AbbVie GK, Asahi Kasei Pharma Corporation, Astellas Pharma Inc., Bristol-Myers Squibb, Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly and Company, Pfizer Inc., UCB Japan Co., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corporation, Novartis Pharma K.K., Taisho Pharma Co., Ltd, and Takeda Pharmaceutical Company Limited., Koichiro Ohmura Speakers bureau: I have received speaker’s fee from Abbvie, Actelion, Asahikasei Pharma, Astellas, AYUMI, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Janssen, JB, Mitsubishi Tanabe, Nippon Kayaku, Nippon Shinyaku, Novartis, Sanofi and Takeda., Grant/research support from: I have received research grants from GlaxoSmithKline., Akio Morinobu Speakers bureau: I have received speaking fees from Chugai Pharmaceutical Co. Ltd., Grant/research support from: I have received research grants from Chugai Pharmaceutical Co. Ltd., Chikashi Terao: None declared, Hajime Yoshifuji Speakers bureau: I have received lecture fees from Chugai., Consultant of: I have been an advisory board for a clinical trial conducted by Janssen.

POS1482-HPR PAIN CATASTROPHIZING IS ASSOCIATED WITH RESIDUAL PAIN AFTER REACHING IMPROVED CONDITIONS OF SWOLLEN/TENDER JOINTS AND SERUM C-REACTIVE PROTEIN LEVEL

Background:

It has long been recognized that immune-mediated inflammatory diseases, such as rheumatoid arthritis (RA), are prone to coexist with depression due to the effects of cytokines, and that these two illnesses lead to an elevation in patients’ pain. However, we often encounter patients with RA who suffer from residual pain despite an improvement in disease activity and inflammation. The specific psychological factors associated with residual pain have not yet been clarified. In addition to the traditional psychological factors, such as depression and anxiety, we focused on pain catastrophizing due to the distortion of pain perception and explored its association with residual pain.

Objectives:

To examine whether psychological factors, such as pain catastrophizing, depression, and anxiety, are associated with self-reported pain visual analogue scale (pain-VAS) scores in RA patients with 1 or less on 28joints- swollen/tender counts (SJC/TJC) and CRP.

Methods:

This was a cross-sectional study of 290 RA outpatients (85% of whom were women) with scores of less than 1 on SJC, TJC, and CRP, with a median (IQR) age of 66 (57–73) years. The participants completed questionnaires, including pain VAS (0–100 mm), Pain Catastrophizing Scale (PCS, 0–52 scale), and Hospital Depression and Anxiety Scale (HADS, 0–42 scale). Using linear regression analyses, we analysed whether PC (PCS ≥30), depression (HADS-D ≥11), and anxiety (HADS-A ≥11) (independent variables) were associated with pain VAS scores (dependent variable). After univariate regression analysis, multivariate analysis adjusted for confounding factors was performed.

Results:

Patients reported a wide range of pain severity with a median (range) pain VAS score of 9 (0–96mm). The prevalence of anxiety and depression were 5.5% and 5.9%, respectively. Meanwhile, 24.1% of the patients experienced pain catastrophizing. Pain catastrophizing was associated with pain VAS scores in univariate and multivariate analyses (Table 1). The presence of anxiety and depression was not associated with pain VAS scores in any model. Multivariate analysis of other covariates showed that age, disease duration, and presence of SJC/TJC of joints other than the 28 joints were positively correlated with pain VAS scores.

Table 1.

Univariate and multivariate regression analysis for independent variables associated with pain-VAS scores

UnivariateMultivariate independent variablesModel 1*Model 2**Pain catastrophizingEstimate3.74.13.695%CI 0.7 to 6.61.1 to 7.00.5 to 6.6p-value0.0150.0060.021AnxietyEstimate3.74.40.595%CI -1.9 to 9.2 -1.0 to 9.9 -3.5 to 7.9p value0.1980.1080.453DepressionEstimate3.54.23.995%CI -1.9 to 8.9 -1.1 to 9.5 -1.9 to 8.7p-value0.2040.1190.210

The covariates in multivariate analysis are as follows: age, sex, body mass index, disease duration, Steinbrocker’s Stage, prednisolone dosage, biologic agents use, and presence of swollen joint counts/tender joint counts of joints other than the 28 joints.

*Model 1: each psychological independent variable and the above covariates.

**Model 2: all psychological independent variables and the above covariates.

Conclusion:

Pain catastrophizing was associated with pain VAS scores in RA patients with 1 or less on 28joints-SJC/TJC and CRP, emphasising that residual pain in the patients should be treated in a biopsychosocial framework focussing on pain catastrophizing.

Disclosure of Interests:

Tamami Yoshida: None declared, Motomu Hashimoto Speakers bureau: Mitsubishi Tanabe Pharma Corporation; Bristol-Myers Squibb; Eisai Co., Ltd.; and Eli Lilly and Company., Grant/research support from: Mitsubishi Tanabe Pharma Corporation; Bristol-Myers Squibb; Eisai Co., Ltd.; and Eli Lilly and Company., Kosaku Murakami Speakers bureau: Eisai Co., Ltd.; Chugai Pharmaceutical Co., Ltd.; Pfizer Inc.; Bristol-Myers Squibb; Mitsubishi Tanabe Pharma Co; UCB Japan Co., Ltd.; Daiichi Sankyo Co., Ltd.; and Astellas Pharma Inc., Consultant of: Eisai Co., Ltd.; Chugai Pharmaceutical Co., Ltd.; Pfizer Inc.; Bristol-Myers Squibb; Mitsubishi Tanabe Pharma Co; UCB Japan Co., Ltd.; Daiichi Sankyo Co., Ltd.; and Astellas Pharma Inc., Koichi Murata Speakers bureau: Eisai Co., Ltd. and Astellas Pharma Inc., Consultant of: Eisai Co., Ltd. and Astellas Pharma Inc., Kohei Nishitani Grant/research support from: Asahi-Kasei Pharma., Ryu Watanabe Speakers bureau: Mitsubishi Tanabe Pharma Co; Pfizer Inc.; Sanofi S.A.; AbbVie GK; Asahi Kasei Pharma; Eisai Co., Ltd.; Eli Lilly and Company; Bristol-Myers Squibb; and Janssen Pharmaceutical K.K., Teruhide Koyama: None declared, Ritei Uehara: None declared, Masao Tanaka Speakers bureau: AbbVie GK, Asahi Kasei Pharma., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Novartis Pharma K.K., Pfizer Inc., Taisyo Pharma., Ltd., UCB Japan Co., Ltd., Grant/research support from: AbbVie GK, Asahi Kasei Pharma., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Novartis Pharma K.K., Pfizer Inc., Taisyo Pharma., Ltd., UCB Japan Co., Ltd., Hiromu Ito Grant/research support from: Bristol-Myers Squibb, Eisai Co, Taisyo Pharma., and Mochida., Shuichi Matsuda: None declared

POS0544 INFLUENCE OF EATING HABITS ON FRAILTY AMONG PATIENTS WITH RHEUMATOID ARTHRITIS: KURAMA COHORT

Background:

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that contributes to accelerating frailty, a clinical state of increased vulnerability due to declined physiological function. Although accumulating evidence suggests the importance of nutritional therapy for frailty in the general population, there is little evidence on dietary recommendations for preventing frailty in patients with RA.

Objectives:

The present study aimed to reveal clinical associations between frailty status, eating habits and RA disease activity.

Methods:

We conducted a cross-sectional study of 306 female outpatients enrolled from the KURAMA (Kyoto University Rheumatoid Arthritis Management Alliance) cohort database. The participants were classified into three groups (robust, prefrail and frail) according to simplified frailty scale (SOF index), and dietary data were collected using a self-reported food frequency questionnaire as previously reported. We performed multivariate logistic analyses for the presence of frailty/prefrailty with or without eating habits.

Results:

Frail group showed physical decline such as decreased skeletal muscle index, hand grip strength and walking speed, and DAS28-ESR in the frail group was significantly higher compared to that in the others. In multivariate logistic analysis, the presence of frailty/prefrailty was correlated with DAS28-ESR (OR 1.71, p=0.00004) and methotrexate use (OR 0.47, p=0.0097). Cochran-Armitage trend test also showed that the intake frequency of five ingredients (meat, fish, milk, fruits and vegetables) was inversely associated with the prevalence of frailty/prefrailty. In additional multivariate logistic analyses with dietary habits, habitual intake of fish (at least three times per week), rather than meat or other foods, was independently correlated with the presence of frailty/prefrailty (OR 0.33, p=0.00027).

Conclusion:

Our results suggest that habitual intake of fish, rather than meat or other foods, may be beneficial in preventing frailty among RA patients.

References:

[1]Ferrucci, L. & Fabbri, E. Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. Nat Rev Cardiol 15, 505-522, doi:10.1038/s41569-018-0064-2 (2018).

[2]Hernandez Morante, J. J., Gomez Martinez, C. & Morillas-Ruiz, J. M. Dietary factors associated with frailty in old adults: a review of nutritional interventions to prevent frailty development. Nutrients 11, doi:10.3390/nu11010102 (2019).

Table 1.

Multivariate logistic analysis for RA patients with prefrailty or frailty

variables including eating habitsFish + MeatAllOR (95% CI)P valueOR (95% CI)P valueDAS28-ESR1.78 (1.34 - 2.37)0.000031.73 (1.30 - 2.30)0.00009MTX use0.43 (0.23 - 0.79)0.00550.42 (0.23 - 0.78)0.0050Age (1 year)1.02 (1.00 - 1.05)0.0371.03 (1.01 - 1.06)0.0015PSL use1.23 (0.69 - 2.21)0.491.22 (0.67 - 2.20)0.51Duration of RA (1 year)1.00 (0.98 - 1.02)0.721.00 (0.98 - 1.02)0.84Body mass index1.00 (0.93 - 1.07)0.980.99 (0.92 - 1.07)0.85Biological agents use1.02 (0.60 - 1.72)0.941.04 (0.62 - 1.77)0.87Fish dish0.31 (0.17 - 0.55)0.000040.33 (0.18 - 0.61)0.00027Meat dish0.86 (0.49 - 1.50)0.600.89 (0.51 - 1.57)0.69Milk0.71 (0.41 - 1.24)0.23Vegetable0.95 (0.47 - 1.93)0.89Fruits0.77 (0.41 - 1.42)0.40Figure 1.

The prevalence of prefrailty or frailty for subjects by intake frequency

Acknowledgements:

We thank S. Nakagawa and M. Iida for technical assistance.

Disclosure of Interests:

Masao Katsushima: None declared, Hiroto Minamino: None declared, Mie Torii: None declared, Motomu Hashimoto Speakers bureau: M.H. receives grants and/or speaker fees from Bristol-Meyers, Eisai, Eli Lilly, and Tanabe Mitsubishi., Grant/research support from: M.H. belongs to the department financially supported by Nagahama City, Shiga, Japan, Toyooka City, Hyogo, Japan and five pharmaceutical companies (Tanabe-Mitsubishi, Chugai, UCB Japan, Ayumi and Asahi-Kasei).

KURAMA cohort study is supported by a grant from Daiichi Sankyo Co. Ltd., Wataru Yamamoto: None declared, Ryu Watanabe Grant/research support from: R.W. belongs to the department that is financially supported by Nagahama City, Shiga, Japan, Toyooka City, Hyogo, Japan and five pharmaceutical companies (Tanabe-Mitsubishi, Chugai, UCB Japan, Ayumi and Asahi-Kasei). KURAMA cohort study is supported by a grant from Daiichi Sankyo Co. Ltd., Kosaku Murakami: None declared, Koichi Murata Grant/research support from: K.M. belongs to the department that is financially supported by Nagahama City, Shiga, Japan, Toyooka City, Hyogo, Japan and five pharmaceutical companies (Tanabe-Mitsubishi, Chugai, UCB Japan, Ayumi and Asahi-Kasei).

KURAMA cohort study is supported by a grant from Daiichi Sankyo Co. Ltd., Masao Tanaka Grant/research support from: M.T. belongs to the department that is financially supported by Nagahama City, Shiga, Japan, Toyooka City, Hyogo, Japan and five pharmaceutical companies (Tanabe-Mitsubishi, Chugai, UCB Japan, Ayumi and Asahi-Kasei).

KURAMA cohort study is supported by a grant from Daiichi Sankyo Co. Ltd., Hiromu Ito Speakers bureau: H.I. receives a research grant and/or speaker fee from Bristol-Myers, Eisai, Mochida, Taisho, and Asahi-Kasei., Grant/research support from: H.I. belongs to the department that is financially supported by Nagahama City, Shiga, Japan, Toyooka City, Hyogo, Japan and five pharmaceutical companies (Tanabe-Mitsubishi, Chugai, UCB Japan, Ayumi and Asahi-Kasei). KURAMA cohort study is supported by a grant from Daiichi Sankyo Co. Ltd., Akio Morinobu Speakers bureau: A.M. has received speaking fees and/or research grants from Eli Lilly Japan K.K., Ono Pharmaceutical Co., Pfizer Inc., UCB Japan, AbbVie G.K., Asahi Kasei Pharma and Chugai Pharmaceutical Co. Ltd., Grant/research support from: A.M. has received speaking fees and/or research grants from Eli Lilly Japan K.K., Ono Pharmaceutical Co., Pfizer Inc., UCB Japan, AbbVie G.K., Asahi Kasei Pharma and Chugai Pharmaceutical Co. Ltd.

Observation of topological superconductivity in a stoichiometric transition metal dichalcogenide 2M-WS2

Topological superconductors (TSCs) are unconventional superconductors with bulk superconducting gap and in-gap Majorana states on the boundary that may be used as topological qubits for quantum computation. Despite their importance in both fundamental research and applications, natural TSCs are very rare. Here, combining state of the art synchrotron and laser-based angle-resolved photoemission spectroscopy, we investigated a stoichiometric transition metal dichalcogenide (TMD), 2M-WS₂ with a superconducting transition temperature of 8.8 K (the highest among all TMDs in the natural form up to date) and observed distinctive topological surface states (TSSs). Furthermore, in the superconducting state, we found that the TSSs acquired a nodeless superconducting gap with similar magnitude as that of the bulk states. These discoveries not only evidence 2M-WS₂ as an intrinsic TSC without the need of sensitive composition tuning or sophisticated heterostructures fabrication, but also provide an ideal platform for device applications thanks to its van der Waals layered structure.

A Fragment of S38AA is a Novel Plasma Biomarker of Alzheimer's Disease

Alzheimer's disease (AD) is a progressive neurodegenerative disease without a cure. The pathological process starts decades before clinical onset, and thus clinical trials of drugs aimed at treating AD should start at a presymptomatic stage. Therefore, it is critical to diagnose AD at an early stage. Tau, phosphorylated tau, and amyloid-β peptide (Aβ) in cerebrospinal fluid (CSF), and positron emission tomography (PET) imaging of Aβ or tau accumulation are supportive biomarkers for AD diagnosis, but there is no reliable presymptomatic diagnostic marker. Since CSF sampling is invasive, and PET imaging is expensive and available only at specialized centers, a reliable blood biomarker has long been sought for. Here we describe a novel extramembrane fragment from solute carrier family 38 member 10 (SLC38A10, S38AA) that we found to be decreased in pyramidal neurons in AD cases by proteomics and immunohistochemical analysis. We detected a S38AA fragment in CSF and found the levels to correlate with severity of AD and APOE genotype. Importantly, the plasma levels of the fragment also showed a significant correlation with Mini-Mental State Examination scores in AD. Moreover, plasma from other neurodegenerative disease was analyzed and the fragment was found to be increased specifically in AD. Interestingly, the fragment is detected in mouse, rat, and monkey, and increases in amyloid precursor protein transgenic mice as the AD-like pathology progresses. We propose that the S38AA fragment in plasma could be a novel quantitative diagnostic marker for AD and potentially a marker of disease progression in AD.

Deletion of the Dishevelled family of genes disrupts anterior-posterior axis specification and selectively prevents mesoderm differentiation

The Dishevelled proteins transduce both canonical Wnt/β-catenin and non-canonical Wnt/planar cell polarity (PCP) signaling pathways to regulate many key developmental processes during embryogenesis. Here, we disrupt both canonical and non-canonical Wnt pathways by targeting the entire Dishevelled family of genes (Dvl1, Dvl2, and Dvl3) to investigate their functional roles in the early embryo. We identified several defects in anterior-posterior axis specification and mesoderm patterning in Dvl1+/-; Dvl2-/-; Dvl3-/- embryos. Homozygous deletions in all three Dvl genes (Dvl TKO) resulted in defects in distal visceral endoderm migration and a complete failure to induce mesoderm formation. To identify potential mechanisms that lead to the defects in the developmental processes preceding gastrulation, we generated Dvl TKO mouse embryonic stem cells (mESCs) and compared the transcriptional profile of these cells with wild-type (WT) mESCs during germ lineage differentiation into 3D embryoid bodies (EBs). While the Dvl TKO mESCs displayed similar morphology, self-renewal properties, and minor transcriptional variation from WT mESCs, we identified major transcriptional dysregulation in the Dvl TKO EBs during differentiation in a number of genes involved in anterior-posterior pattern specification, gastrulation induction, mesenchyme morphogenesis, and mesoderm-derived tissue development. The absence of the Dvls leads to specific down-regulation of BMP signaling genes. Furthermore, exogenous activation of canonical Wnt, BMP, and Nodal signaling all fail to rescue the mesodermal defects in the Dvl TKO EBs. Moreover, endoderm differentiation was promoted in the absence of mesoderm in the Dvl TKO EBs, while the suppression of ectoderm differentiation was delayed. Overall, we demonstrate that the Dvls are dispensable for maintaining self-renewal in mESCs but are critical during differentiation to regulate key developmental signaling pathways to promote proper axis specification and mesoderm formation.

Cell competition controls differentiation in mouse embryos and stem cells

Cell competition is a short-range intercellular communication, in which cells compare their fitness with that of their neighbors and eliminate the cells with relatively lower fitness. It is considered important for the formation and maintenance of healthy tissues; however, its exact role during development, especially in mammals, has been obscure. Recent studies in mouse embryonic epiblast and skin tissues revealed that cell differentiation in early embryos and stem cell proliferation tends to produce suboptimal cells, especially during early developmental stages. Cell competition occurs at multiple stages and via multiple mechanisms during development to ensure elimination of such low-quality cells. Thus, quality control via cell competition supports correct development by overcoming the heterogeneity produced during cell differentiation and stem cell proliferation.

AB1103 AUTOMATIC FINGER JOINT BONE EROSION SCORE PREDICTION CONSIDERING 2-TIME-POINT X-RAYS OF PATIENTS WITH RHEUMATOID ARTHRITIS BY DEEP LEARNING

Background:

Medical image analysis using deep learning (DL) has been attracting attention. In previous research, we proposed a DL method for detection of joint region and evaluation for bone destruction at a single point in time in hand X-rays of patients with rheumatoid arthritis (RA) [1-2]. However, in the score of van der Heijde-modified total Sharp scores (mTSS) in X-rays, it is difficult to apply the method as it is. In mTSS, score difference between 2-time points is important, and there is a problem that the score at each time varies depending on the doctor who evaluates.

Objectives:

We aimed at developing an mTSS scoring method considering 2-time-point difference with a DL method.

Methods:

A total of 104 X-ray image sets of both hands at two time points with an interval of ≥1 year were randomly obtained from patients with RA who had visited our clinic in 2015. Well-trained doctors determined the erosion scores of MP and PIP/IP joints of each hand in X-rays according to mTSS. These evaluations of hand joints were performed using our developed annotation software tool. In the learning phase, joint images were randomly divided into five sets for 5-fold cross-validation. We utilized a convolutional neural network model, such as SSD [3], for detecting joint regions and classifying the scores (Fig 1).

Figure1.

The models for classification were designed in consideration of the difference in erosion scores of each patient between the 2-time points of X-rays. The loss function of the DL model was defined bellow;

Here, the coefficient γ is designed to reduce the error for another set of scores with equal differences. The first term of the loss function works to optimize the score at each time point, and the second term works to optimize the score difference at both time points. Thus, our method can be trained without being affected by characteristic training data.

Results:

The number of joints with differences in erosion score between the former and latter time points was 1 (-2 points), 9 (-1), 2015 (0), 32 (+1), 17 (+2), and 6 (+3). There were no joints with score changes of -5, -4, -3, +4, and +5 points.

As a performance of predicting the difference in erosion score between the 2-time points of each patient’s X-ray, our models presented a mean error of 0.412 per each joint in one set for 5-cross validation as compared with physicians’ evaluation (Fig 2).

Figure 2.

Conclusion:

Our DL-based models to predict hand joint erosion scores in X-rays were developed with relatively small samples. This suggests that the predictive performance may increase by collecting more training dataset. Next, we will apply our method to the prediction of joint space narrowing score.

References:

[1]Izumi K, Hashimoto M, Suzuki K, et al. Detecting Hand Joint Ankylosis in Radiographic Images Using Deep Learning: A Step in Developing Automatic Radiographic Scoring System for Bone Destruction.Arthritis Rheumatol2018;70 (suppl 10).

[2]Izumi K, Suzuki K, Hashimoto M, et al. SAT0543 AUTOMATIC DETECTION OF HAND JOINT REGION, ANKYLOSIS AND SUBLUXATION IN RADIOGRAPHIC IMAGES USING DEEP LEARNING: DEVELOPMENT OF ARTIFICIAL INTELLIGENCE-BASED RADIOGRAPHIC EVALUATION SYSTEM FOR BONE DESTRUCTION.Annals of the Rheumatic Diseases2019;78 (suppl 2), pp. 1364-1364.

[3]Liu W, Anguelov D, Szgedy C, et al. SSD: single shot multibox detector.European Conference on Computer Vision (ECCV) 2016.

Acknowledgments:

Izumi and Suzuki are contributed equally.

Disclosure of Interests:

Keisuke Izumi Grant/research support from: Asahi Kasei Pharma, Takeda Pharmaceutical Co., Ltd., Speakers bureau: Asahi Kasei Pharma Corp, Astellas Pharma Inc., Bristol Myers Squibb, Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., Mitsubishi Tanabe Pharma Co., Kanata Suzuki Employee of: Fujitsu Laboratories Ltd., Masahiro Hashimoto: None declared, Toshio Endoh Employee of: Fujitsu Laboratories Ltd., Kentaro Doi Employee of: Fujitsu Ltd., Yuki Iwai Employee of: Fujitsu Ltd., Yuko Kaneko Speakers bureau: AbbVie, Eisai Pharmaceutical, Chugai Pharmaceutical Co., Ltd., Bristol Myers Squibb, Astellas Pharma Inc., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Janssen Pharmaceutical K.K., Eli Lilly Japan K.K., Santen Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co. Ltd. and UCB Japan Co. Ltd., Masahiro Jinzaki: None declared, Shigeru Ko Grant/research support from: Fujitsu Ltd., Tsutomu Takeuchi Grant/research support from: Astellas Pharma Inc, Chugai Pharmaceutical Co, Ltd., Daiichi Sankyo Co., Ltd., Takeda Pharmaceutical Co., Ltd., AbbVie GK, Asahikasei Pharma Corp., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Eisai Co., Ltd., AYUMI Pharmaceutical Corporation, Nipponkayaku Co. Ltd., Novartis Pharma K.K., Teijin, Consultant of: Astra Zeneca K.K., Eli Lilly Japan K.K., Novartis Pharma K.K., Mitsubishi Tanabe Pharma Co., Abbivie GK, Nipponkayaku Co.Ltd, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Taiho Pharmaceutical Co. Ltd., Chugai Pharmaceutical Co. Ltd., Taisho Toyama Pharmaceutical Co. Ltd., GlaxoSmithKline K.K., UCB Japan Co. Ltd., Speakers bureau: Astellas Pharma Inc., Bristol Myers Squibb, Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Santen Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Ltd., AbbVie GK, Asahi Kasei Pharma Corp., Taisho Toyama Pharmaceutical Co., Ltd., SymBio Pharmaceuticals Ltd., Janssen Pharmaceutical K.K., Celltrion Inc., Nipponkayaku Co. Ltd., and UCB Japan

SAT0349 CTLA4-IG DECREASES TH17 CELL LEVELS BUT MAINTAINS ILC3S WITH AN INCREASE IN THE ILC3/ILC1 RATIO IN THE GUT OF SKG MICE AS A MODEL OF SPONDYLOARTHRITIS

Background:

SKG mice have been known for their autoreactive Th17 cells resulting from the insufficient thymic negative selection due to a Zap70 mutation1,2). Under specific pathogen-free conditions, they acquire features of spondyloarthritis (SpA) by intraperitoneal injection of curdlan, a (1,3)-β-glucan3). Several reports have shown that Th17 cells also increase in human SpA4). However, CTLA4-Ig, which ameliorates rheumatoid arthritis by suppressing pathogenic cells such as effector T cells, was unable to show adequate efficacy as much as expected in SpA patients5). Around the same time, innate lymphocytes began to be focused on, in the pathogenesis of SpA, including innate lymphoid cells (ILCs), which abundantly reside in the gut6).

Objectives:

This study aimed to clarify the effects of CTLA4-Ig on the pathogenesis of SpA by using curdlan-treated SKG mice, focusing on type 3 immunity such as Th17 cells and ILC3s.

Methods:

Two- to three-month-old female SKG mice were injected intraperitoneally with 3mg of curdlan or PBS at the beginning and with 500 µg of CTLA4-Ig or PBS every other week (n=5 per group). The body weight and arthritis score were measured weekly for a month. Then, the changes in the proportion of T cells and ILCs in the spleen and Peyer’s patches (PPs) were analysed by flow cytometry (FCM). BALB/c mice, without treatment, were also examined by FCM as a control cohort. In addition, a next-generation analysis of their feces was performed on 16S ribosomal coding genes before curdlan and CTLA4-Ig treatment.

Results:

SKG mice contained not only more Th17 cells but also more ILC1s and ILC3s than BALB/c mice, in their guts (the PPs). The feces of SKG mice intrinsically showed a decrease in the number of bacterial species, suggesting a dysbiosis. Then, in curdlan-treated SKG mice, CTLA4-Ig administration decreased the proportion of both Th17 cells and ILC3s in the spleen, but did not decrease the proportion of ILC3s in the PPs. Moreover, the ILC3/ILC1 ratio in the PPs was from low to high in the order of SKG mice without treatment, SKG mice injected with curdlan, and SKG mice injected with both curdlan and CTLA4-Ig. The phenotype corresponding to SpA features, in curdlan-treated SKG mice, continued after repeated CTLA4-Ig administration.

Conclusion:

Curdlan provoked SpA features in SKG mice with an intrinsic dysbiosis. Additional CTLA4-Ig injection decreased the proportion of Th17 cells but maintained that of ILC3s with increased ILC3/ILC1 ratio in the gut. This result supports the hypothesis that in the SpA pathophysiology, a weakened acquired immunity in the gut might lead to ILC3 activation, via dysbiosis, and its continuous disease progression, suggesting that ILC3s are a promising therapeutic target in SpA.

References:

[1]Sakaguchi N, Sakaguchi S, et al. Altered thymic T-cell selection due to a mutation of the ZAP-70 gene causes autoimmune arthritis in mice.Nature2003;426:454-460.

[2]Hirota K, Sakaguchi S, et al. T cell self-reactivity forms a cytokine milieu for spontaneous development of IL-17+ Th cells that cause autoimmune arthritis.J Exp Med2007;204:41-47.

[3]Ruutu M, Thomas R, et al. β-glucan triggers spondylarthritis and Crohn’s disease–like ileitis in SKG mice.Arthritis Rheum2012;64:2211-2222.

[4]Shen H, Gaston JS, et al. Frequency and phenotype of peripheral blood Th17 cells in ankylosing spondylitis and rheumatoid arthritis.Arthritis Rheum2009;60:1647-1656.

[5]Song I-H, Sieper J, et al. Treatment of active ankylosing spondylitis with abatacept: an open-label, 24-week pilot study.Ann Rheum Dis2011;70:1108-1110.

[6]Ciccia F, Triolo G, et al. Type 3 innate lymphoid cells producing IL-17 and IL-22 are expanded in the gut, in the peripheral blood, synovial fluid and bone marrow of patients with ankylosing spondylitis.Ann Rheum Dis2015;74:1739-1747.

Disclosure of Interests:

Yuya TABUCHI Paid instructor for: Astellas Pharma, GlaxoSmithKline, Mitsubishi Tanabe Pharma, and Nippon Shinyaku., Speakers bureau: AbbVie, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Shinyaku, and Novartis Pharma., Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Syuji Akizuki: None declared, Ran Nakashima Grant/research support from: Takeda Pharmaceutical. (Outside the field of the present study.), Speakers bureau: Astellas Pharma, Medical & Biological Laboratories, AstraZeneca, and Boehringer Ingelheim. (Outside the field of the present study.), Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Hajime Yoshifuji Grant/research support from: Astellas Pharma. (Outside the field of the present study.), Speakers bureau: Chugai Pharmaceutical. (Outside the field of the present study.), Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

, Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Koichiro Ohmura Grant/research support from: Astellas Pharma, AYUMI Pharmaceutical, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Nippon Kayaku, Nippon Shinyaku, Sanofi, and Takeda Pharmaceutical., Speakers bureau: AbbVie, Actelion Pharmaceuticals Japan, Asahi Kasei Pharma, AYUMI Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, and Sanofi.

THU0285 ANALYSIS OF THE RELATIONSHIP BETWEEN ORGAN DAMAGE AND QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic lupus erythematosus (SLE) is an autoimmune disease that can not only cause systemic symptoms, such as fever and arthritis, but can also damage important organs, such as those of the central nervous system and the kidneys. Prevention of irreversible organ damage is important for better prognosis [1]. Additionally, the importance of maintaining the quality of life (QOL) of patients has recently been emphasized. However, only a few studies have examined the relationship between irreversible organ damage and patient QOL.

Objectives:

To assess the relationship between organ damage and QOL, and to survey which organs have more significant effects on QOL.

Methods:

We conducted a questionnaire-based survey of 183 patients with SLE at Kyoto University Hospital from September to December 2019. We used the SLICC/ACR Damage Index (SDI) to evaluate organ damage [2]. The following five scales were employed to evaluate QOL: the physical (PCS) and mental component summary (MCS) of the Medical Outcome Study (MOS) 36-Item Short-Form Health Survey version 2.0 (SF-36v2) [3], health (HRQOL) and non-health-related QOL (N-HRQOL) of LupusPRO [4], and SLE Symptom Checklist (SSC) [5].

Results:

Linear regression analysis showed significant correlation between the SDI score and all QOL scales except for N-HRQOL, suggesting negative effects of organ damage on QOL (Table 1). Next, we analysed whether there was a significant difference in the SF-36 score between those who were positive and negative for each SDI item (41 in total), using the Wilcoxon rank sum test. Muscle atrophy or weakness (p= 3.0×10-10), osteoporosis with fracture or vertebral collapse (p= 9.7×10-8), claudication (p= 7.4×10-5), and cognitive impairment or major psychosis (p= 9.9×10-5) significantly correlated (p< 1.2×10-3) with PCS, and scarring chronic alopecia (p= 3.4×10-4) with MCS (Table 2). In addition, the five SDI items significantly correlated with the remaining three QOL scales (HRQOL, N-HRQOL, and SSC;p< 0.05).

Table 1.

Relationship between the SDI score and QOL

SF-36LupusPROSSCPCSMCSHRQOLN-HRQOLp-value<2.0×10-161.7×10-32.2×10-110.231.9×10-8Table 2.

Relationship between each SDI item and the SF-36 score (p< 1.2×10-3

SDI itemPCS scorep-valuePositive(Median (IQR))Negative(Median (IQR))Muscle atrophy/weakness33 (19-45)50 (43-54)3.0×10-10Osteoporosis with fracture/vertebral collapse24 (12-32)49 (38-54)9.7×10-8Claudication31 (19-35)49 (38-54)7.4×10-5Cognitive impairment/psychosis27 (17-33)49 (38-54)9.9×10-5SDI itemMCS scorep-valuePositive(Median (IQR))Negative(Median (IQR))Scarring chronic alopecia42 (29-51)49 (39-54)3.4×10-4

Conclusion:

We demonstrated that organ damage has negative effects on patient QOL, indicating the importance of preventing irreversible organ damage for maintaining QOL. Moreover, muscle atrophy/weakness, osteoporosis with fracture/vertebral collapse, claudication, cognitive impairment/major psychosis, and scarring chronic alopecia significantly correlated with QOL deterioration, suggesting that these items should be examined with special care in clinical practice.

References:

[1]Lopez R, et al. Rheumatology (Oxford). 2012; 51:491-498.

[2]Gladman D, et al. Arthritis Rheum. 1996; 39:363-369.

[3]Fukuhara S, et al. J Clin Epidemiol. 1998; 51:1037-1044.

[4]Inoue M, et al. Lupus. 2017; 26:849-856.

[5]Grootscholten C, et al. Qual Life Res. 2003; 12:635–644.

Disclosure of Interests:

Yudai Takase: None declared, Hiroshi Doi: None declared, Takeshi Iwasaki: None declared, Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Ryuta Inaba: None declared, Tomohiro Kozuki: None declared, Masashi Taniguchi: None declared, Yuya Tabuchi Paid instructor for: Astellas Pharma, GlaxoSmithKline, Mitsubishi Tanabe Pharma, and Nippon Shinyaku., Speakers bureau: AbbVie, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Shinyaku, and Novartis Pharma. (Outside the field of the present study.), Koji Kitagori: None declared, Syuji Akizuki: None declared, Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Ran Nakashima Grant/research support from: Takeda Pharmaceutical. (Outside the field of the present study.), Speakers bureau: Astellas Pharma, Medical & Biological Laboratories, AstraZeneca, and Boehringer Ingelheim. (Outside the field of the present study.), Hajime Yoshifuji Grant/research support from: Astellas Pharma. (Outside the field of the present study.), Speakers bureau: Chugai Pharmaceutical. (Outside the field of the present study.), Wataru Yamamoto: None declared, Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

, Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Koichiro Ohmura Grant/research support from: Astellas Pharma, AYUMI Pharmaceutical, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Nippon Kayaku, Nippon Shinyaku, Sanofi, and Takeda Pharmaceutical., Speakers bureau: AbbVie, Actelion Pharmaceuticals Japan, Asahi Kasei Pharma, AYUMI Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, and Sanofi.

THU0107 OBESITY PREDICTS RESPONSE TO NOT ALL BUT CERTAIN BIOLOGICAL / TARGETED DISEASE MODIFYING ANTI-RHEUMATIC DRUGS FOR RHEUMATOID ARTHRITIS - RESULTS FROM KANSAI CONSORTIUM FOR WELL-BEING OF RHEUMATIC DISEASE PATIENTS (ANSWER COHORT)

Background:

A number of previous reports suggested that obesity is one of the baseline factors indicates refractory to biologic disease-modifying antirheumatic drugs (bDMARDs). However, difference of the significant responses appears on obesity patients depending on each kind of drug is yet unclear. However, it is yet unclear how the significant responses on obesity patients vary on each kind of drug.

Objectives:

To assess whether obesity affects clinical outcome in rheumatoid arthritis (RA) treated with each molecular-targeted agent including bDMARDs and tofacitinib.

Methods:

In Kansai consortium for well-being of rheumatic disease patients (ANSWER) cohort, which was the real-world retrospective cohort of clinical database for rheumatic diseases, RA patients who initiated biological / targeted disease modifying anti-rheumatic drugs were included and consecutively followed. Obesity was defined as BMI over than 25, and patients were divided between obese (“Ob”) and non-obese (“non-Ob”) patients. SDAI (simplified disease activity index) was compared between non-Ob and Ob at month 0, 3, 6, 9, 12 after the indicated drugs were administered. Using logistic regression analysis, odds ratio (OR) and their corresponding 95% confidence intervals (95% CIs) were further calculated to estimate achievement rate of SDAI remission defined as lower than 3.3 by obesity and other relevant clinical parameters. Once after the drugs were discontinued by any unfavorable reason, disease activities were no more scored and the Last Observation Carried Forward (LOCF) imputation method was used for SDAI at month 3 and thereafter.

Results:

A total of 1936 patients met in the inclusion criteria were under the analysis. In each drug, SDAI remission rate (non-Ob, Ob, p-value by Chi-square test) at month 12 was as follows; Infliximab (IFX, n=135): 43%, 38%, NS (not significant); Etanercept (ETN, n=188): 44%, 19%, p=0.0122; Adalimumab (ADA, n=169): 50%, 56%, NS; Golimumab (GLM, n=315): 36%, 30%, NS; Certolizumab pegol (CZP, n=131): 33%, 56%, p=0.0287; Tocilizumab (TCZ, n=423): 41%, 29%, p=0.0456; Abatacept (ABT, n=144): 26%, 23%, NS; Tofacitinib (TOF, n=69): 27%, 23%, NS. In multivariate analysis to predict SDAI remission at month 12, obesity was an independent protective factor in CZP (OR: 0.29, 95% CIs: 0.10 – 0.83), but was an independent risk factor in TCZ (OR: 1.9, 95% CIs: 1.01 – 3.61) irrespective of age, sex, disease duration, SDAI at month 0 or number of previous bDMARDs. Any other drug including ETN did not show significant result between non -Ob and Ob in the multivariate analysis.

Conclusion:

Obese patients were more resistant to TCZ but more effective in CZP than non-obese patients.

References:

[1]Ann Rheum Dis. 2018;77(10):1405-1412. Joint Bone Spine. 2019;86(2):173-183.

Disclosure of Interests:

Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Koichi Murata Grant/research support from: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Employee of: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Speakers bureau: KMurak has received speaking fees, and/or consulting fees from Eisai Co. Ltd, Chugai Pharmaceutical Co. Ltd., Pfizer Japan Inc, Bristol-Myers Squibb, Mitsubishi-Tanabe Pharma Corporation, UCB, Daiichi Sankyo Co. Ltd. and Astellas Pharma Inc., Wataru Yamamoto: None declared, Ryota Hara Speakers bureau: RH received a speaker fee from AbbVie, Masaki Katayama: None declared, Akira Onishi Speakers bureau: AO received a speaker fee from Chugai, Ono Pharmaceutical, Eli Lilly, Mitsubishi-Tanabe, Asahi-Kasei, and Takeda, Kengo Akashi: None declared, Koji Nagai: None declared, Yonsu Son: None declared, Hideki Amuro: None declared, Toru Hirano Grant/research support from: TH received a research grant and/or speaker fee from Astellas, Chugai, Nippon Shinyaku, Abbvie, Eisai, and Ono Pharmaceutical, Speakers bureau: TH received a research grant and/or speaker fee from Astellas, Chugai, Nippon Shinyaku, Abbvie, Eisai, and Ono Pharmaceutical, Kosuke Ebina Grant/research support from: KE has received research grants from Abbie, Asahi-Kasei, Astellas, Chugai, Eisai, Ono Pharmaceutical, and UCB Japan., Employee of: KE is affiliated with the Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, which is supported by Taisho., Speakers bureau: KE has received payments for lectures from Abbie, Asahi-Kasei, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Janssen, Mitsubishi-Tanabe, Ono Pharmaceutical, Sanofi, and UCB Japan., Kohei Nishitani Grant/research support from: KN belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

, Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Hiromu Ito: None declared, Koichiro Ohmura Grant/research support from: Astellas Pharma, AYUMI Pharmaceutical, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Nippon Kayaku, Nippon Shinyaku, Sanofi, and Takeda Pharmaceutical., Speakers bureau: AbbVie, Actelion Pharmaceuticals Japan, Asahi Kasei Pharma, AYUMI Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, and Sanofi.

AB0197 INCREASED CIRCULATING ADIPONECTIN IS AN INDEPENDENT DISEASE ACTIVITY MARKER IN PATIENTS WITH RHEUMATOID ARTHRITIS: A CROSS-SECTIONAL STUDY USING THE KURAMA DATABASE

Background:

Adiponectin is a major adipokine with pleiotropic effects on inflammatory conditions including rheumatoid arthritis (RA). Adiponectin generally has anti-atherogenic effects, and its serum level inversely correlates with body mass index (BMI) and visceral fat area (VFA). On the other hand, several studies have indicated a deleterious role of adiponectin in RA progression [1]. Recently, both low BMI and increased serum adiponectin have been reported as poor prognostic factors of RA [2, 3]. However, large-scale surveys have not been done focusing on both BMI and serum adiponectin, and it is unclear which factor provides further contribution to RA disease activity. In addition, the effects of biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase (JAK) inhibitors on serum adiponectin are largely unknown.

Objectives:

To clarify the relationship among serum adiponectin, body composition, current disease activity and therapeutic agents of RA.

Methods:

We conducted a cross-sectional study in RA patients under treatment with agents including bDMARDs and JAK inhibitors. A total of 351 subjects from the Kyoto University RA Management Alliance cohort (KURAMA) were enrolled. We classified the participants into five body composition groups (overweight with or without visceral adiposity, normal with or without visceral adiposity, and underweight), according to the cut-off points for obesity and visceral fat used in Japan: BMI, 18.5 kg/m2for underweight and 25.0 kg/m2for obesity, and VFA, 100 cm2for visceral adiposity. Differences of continuous variables among the five groups were assessed by the Steel-Dwass test or one-way analysis of variance (ANOVA). We adopted a multiple standardized linear regression model to analyze effects of serum adiponectin level on DAS28-ESR.

Results:

Serum adiponectin levels (20.9±12.5 vs. 14.7±8.4 µg/ml, p < 0.001) and DAS28-ESR (3.04±1.0 vs. 2.63±0.9,p= 0.017) in the underweight group were significantly higher than those in the others. In multiple regression analysis, serum adiponectin level, but not BMI, was positively correlated with DAS28-ESR (estimate = 0.0127,p= 0.0258). Subanalysis also showed that the use of bDMARD or JAK inhibitor did not have an obvious influence on circulating adiponectin.

Conclusion:

In the multiple regression analysis we revealed a positive and independent correlation between serum adiponectin and DAS28-ESR in Japanese RA patients. Thus, serum adiponectin is an potential marker reflecting high disease activity of RA regardless of current medications.

References:

[1]Frommer KW, Zimmermann B, Meier FM, Schroder D, Heil M, Schaffler A, et al. Adiponectin-mediated changes in effector cells involved in the pathophysiology of rheumatoid arthritis. Arthritis Rheum. 2010;62(10):2886-99.

[2]Kaufmann J, Kielstein V, Kilian S, Stein G, Hein G. Relation between body mass index and radiological progression in patients with rheumatoid arthritis. Journal of Rheumatology. 2003;30(11):2350-5.

[3]Ebina K, Fukuhara A, Ando W, Hirao M, Koga T, Oshima K, et al. Serum adiponectin concentrations correlate with severity of rheumatoid arthritis evaluated by extent of joint destruction. Clin Rheumatol. 2009;28(4):445-51.

Acknowledgments:

We would like to thank to Ms. Sumie Nakagawa for management of blood specimens, Ms. Noriko Kitayama and Ms. Maki Yoneyama for support of the patients. We also thank Drs. Takao Fujii, Chicashi, Terao, Masahide Hamaguchi, Hiroyuki Yoshitomi, and Masahiro Ishikawa for their thoughtful comments.

Disclosure of Interests:

Masao Katsushima: None declared, Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Mirei Shirakashi: None declared, Tamami Yoshida: None declared, Wataru Yamamoto: None declared, Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Koichi Murata Grant/research support from: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Employee of: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Speakers bureau: KMurak has received speaking fees, and/or consulting fees from Eisai Co. Ltd, Chugai Pharmaceutical Co. Ltd., Pfizer Japan Inc, Bristol-Myers Squibb, Mitsubishi-Tanabe Pharma Corporation, UCB, Daiichi Sankyo Co. Ltd. and Astellas Pharma Inc., Kohei Nishitani Grant/research support from: KN belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Hiromu Ito: None declared, Shuichi Matsuda: None declared

OP0025 DRUG RETENTION OF 7 BIOLOGICS AND TOFACITINIB IN BIOLOGICS-NAÏVE AND BIOLOGICS-SWITCHED PATIENTS WITH RHEUMATOID ARTHRITIS -THE ANSWER COHORT STUDY

Background:

EULAR recommendation announced that biological disease-modifying antirheumatic drugs (bDMARDs) and janus kinase inhibitors (JAKi) are considered as equivalent in the treatment of rheumatoid arthritis (RA). However, we still lack reliable evidence of direct comparison between these agents’ retention, which may reflect both effectiveness and safety.

Objectives:

The aim of this multi-center (7 university-related hospitals), retrospective study is to clarify retention rates and reasons for discontinuation of 7 bDMARDs and tofacitinib (TOF), one of the JAKi, in both bDMARDs-naïve and bDMARDs-switched cases.

Methods:

This study assessed 3,897 patients and 4,415 treatment courses of with bDMARDs and TOF from 2001 to 2019 (2,737 bDMARDs-naïve patients and 1,678 bDMARDs-switched patients [59.5% switched to their second agent], female 82.3%, baseline age 57.4 years, disease duration 8.5 years; rheumatoid factor positivity 78.4%; DAS28-ESR 4.3; concomitant prednisolone [PSL] 6.1 mg/day [42.4%] and methotrexate [MTX] 8.5 mg/week [60.9%]). Treatment courses included abatacept (ABT; n=663), adalimumab (ADA; n=536), certolizumab pegol (CZP; n=226), etanercept (ETN; n=856), golimumab (GLM; n=458), infliximab (IFX; n=724), tocilizumab (TCZ; n=851), and TOF (n=101/only bDMARDs-switched cases). Reasons for discontinuation were classified into four categories by each attending physician: 1) lack of effectiveness, 2) toxic adverse events, 3) non-toxic reasons, and 4) remission. Retention rates of each discontinuation reason were estimated at 36 months using the Kaplan-Meier method and adjusted for potential clinical confounders (age, sex, disease duration, concomitant PSL and MTX, starting date and number of switched bDMARDs) using Cox proportional hazards modeling.

Results:

Adjusted drug retention rates for each discontinuation reason were as follows: lack of effectiveness in the bDMARDs-naïve group (from 70.8% [CZP] to 85.1% [ABT]; P=0.001 between agents) and the bDMARDs-switched group (from 52.8% [CZP] to 78.7% [TCZ]; P<0.001 between agents). Toxic adverse events in the bDMARDs-naïve group (from 86.9% [IFX] to 96.3% [ABT]; P<0.001 between agents) and the bDMARDs-switched group (from 81.1% [ADA] to 95.4% [ETN]; P=0.01 between agents). Finally, overall retention rates excluding discontinuation for non-toxic reasons or remission ranged from 64.2% (IFX) to 82.0% (ABT) (P<0.001 between agents) in the bDMARDs-naïve group (figure a) and from 44.2% (ADA) to 66.8% (TCZ) (P<0.001 between agents) in the bDMARDs-switched group (figure b).

Conclusion:

Remarkable differences were observed in drug retention of 7 bDMARDs and TOF between bDMARDs-naïve and bDMARDs-switched cases.

Disclosure of Interests:

Kosuke Ebina Grant/research support from: KE has received research grants from Abbie, Asahi-Kasei, Astellas, Chugai, Eisai, Ono Pharmaceutical, and UCB Japan., Employee of: KE is affiliated with the Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, which is supported by Taisho., Speakers bureau: KE has received payments for lectures from Abbie, Asahi-Kasei, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Janssen, Mitsubishi-Tanabe, Ono Pharmaceutical, Sanofi, and UCB Japan., Toru Hirano Grant/research support from: TH received a research grant and/or speaker fee from Astellas, Chugai, Nippon Shinyaku, Abbvie, Eisai, and Ono Pharmaceutical, Speakers bureau: TH received a research grant and/or speaker fee from Astellas, Chugai, Nippon Shinyaku, Abbvie, Eisai, and Ono Pharmaceutical, Yuichi Maeda Grant/research support from: YM received a research grant and/or speaker fee from Eli Lilly, Chugai, Pfizer, Bristol-Myers Squibb, and Mitsubishi-Tanabe, Speakers bureau: YM received a research grant and/or speaker fee from Eli Lilly, Chugai, Pfizer, Bristol-Myers Squibb, and Mitsubishi-Tanabe, Wataru Yamamoto: None declared, Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Koichi Murata Grant/research support from: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Employee of: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Speakers bureau: KMurak has received speaking fees, and/or consulting fees from Eisai Co. Ltd, Chugai Pharmaceutical Co. Ltd., Pfizer Japan Inc, Bristol-Myers Squibb, Mitsubishi-Tanabe Pharma Corporation, UCB, Daiichi Sankyo Co. Ltd. and Astellas Pharma Inc., Tohru Takeuchi Grant/research support from: TT received a research grant from Chugai, CoverLetter and a speaker fee from Astellas, Chugai, Eisai, Mitsubishi-Tanabe, Abbvie, Bristol-Myers Squibb, Ayumi, Daiichi Sankyo, Eisai, Takeda, and Asahi-Kasei, Employee of: TT is affiliated with a department that is financially supported by six pharmaceutical companies (Mitsubishi-Tanabe, Chugai, Ayumi, Astellas, Eisai, and Takeda), Hideyuki Shiba: None declared, Yonsu Son: None declared, Hideki Amuro: None declared, Akira Onishi Speakers bureau: AO received a speaker fee from Chugai, Ono Pharmaceutical, Eli Lilly, Mitsubishi-Tanabe, Asahi-Kasei, and Takeda, Kengo Akashi: None declared, Ryota Hara Speakers bureau: RH received a speaker fee from AbbVie, Masaki Katayama: None declared, Keiichi Yamamoto: None declared, Atsushi Kumanogoh Grant/research support from: AK received a research grant and/or speaker fee from Mitsubishi-Tanabe, Chugai, Eisai, Asahi-Kasei, Astellas, Abbvie, Bristol-Myers Squibb, Ono Pharmaceutical, and Pfizer, Speakers bureau: AK received a research grant and/or speaker fee from Mitsubishi-Tanabe, Chugai, Eisai, Asahi-Kasei, Astellas, Abbvie, Bristol-Myers Squibb, Ono Pharmaceutical, and Pfizer, Makoto Hirao Speakers bureau: MHirao received a speaker fee from Astellas, Ono Pharmaceutical, Eli Lilly, Mitsubishi-Tanabe, Pfizer, Ayumi, and Takeda

THU0174 ANTI-IL-6 RECEPTOR ANTIBODY AMELIORATES DISEASE ACTIVITY OF RHEUMATOID ARTHRITIS PATIENTS WITH KNEE JOINT INVOLVEMENT -ANSWER COHORT STUDY-

Background:

It has been reported that rheumatoid arthritis (RA) patients who have large joint involvement associated with higher serological inflammatory markers and more functional disability1. Moreover, a previous report showed that these patients were more difficult to achieve clinical remission. However, it remains unclear which biologics are effective in the patients with RA who have large joint involvement.

Objectives:

The aim of this study is to investigate the efficacy of anti-IL-6 receptor antibody (aIL-6) or TNF-inhibitor (TNFi) in the treatment of RA patients who have knee joint involvement.

Methods:

We enrolled the 784 patients who visited our hospitals in 2003 to 2019 and were treated with aIL-6 or TNFi more than 12 weeks. We divided the patients into 2 groups with or without knee joint involvement for further analysis. Knee joint involvement was defined as the patients had at least one swelling joint of knee at baseline. We investigated the CDAI levels at baseline and 12 weeks after the initiation of biologics.

Results:

Interestingly, the patients who had knee joint involvement with aIL-6 significantly ameliorated ΔCDAI (n=95, 15.0±10.8; mean±SD) compared to those with TNFi (n=148, 11.4±10.3) at 12 weeks (P=0.003). aIL-6 group consists of 95 tocilizumab treated patients. TNFi group includes 25 adalimumab, 25 certolizumab pegol, 14 etanercept, 54 golimumab and 30 infliximab treated patients. Baseline clinical characteristics of the 243 RA patients who had knee joint involvement were shown in Table 1. Mean ages, sex and disease durations were not significantly different between the two groups. Baseline CDAI levels of aIL-6 group (24.8±11.8) were slightly elevated compared to those of TNFi group (21.7 ±10.9). Multivariate analysis adjusted for age, gender and baseline CDAI levels revealed that aIL-6 significantly improved ΔCDAI levels compared to TNFi (P=0.04). By contrast, in the RA patients who had no swelling of knee joints, there was no significant difference of ΔCDAI improvement between aIL-6 group (n=156, 5.5±7.4) and TNFi group (n=385, 6.7±8.9).

Table 1.

Baseline clinical characteristics of 243 RA patients who had knee joint involvement

aIL-6 group(n=95)TNFi group(n=148)p ValueAge (mean±SD)60.7±15.261.9±14.40.58Gender (female, %)80.079.10.97Duration (year)9.3 ±10.38.4±10.50.56DAS28ESR (mean±SD)5.3±1.25.2 ±4.80.03CDAI (mean ±SD)24.8±11.821.7 ±10.90.04MTX use, (%)45.462.20.02MTX dose (mg/day)8.7 ±3.39.0 ±3.50.61PSL use, (%)44.345.60.74PSL dose (mg/day)5.5 ±3.55.1 ±2.90.55

Conclusion:

Thus, these findings suggest that anti-IL-6 receptor antibody was more effective in the RA patients with knee joint involvement compared to TNF- inhibitor.

References:

[1]Burgers LE, et al.Ann Rheum Dis. 2018;77:e33.

Disclosure of Interests:

Yuichi Maeda Grant/research support from: YM received a research grant and/or speaker fee from Eli Lilly, Chugai, Pfizer, Bristol-Myers Squibb, and Mitsubishi-Tanabe, Speakers bureau: YM received a research grant and/or speaker fee from Eli Lilly, Chugai, Pfizer, Bristol-Myers Squibb, and Mitsubishi-Tanabe, Toru Hirano Grant/research support from: TH received a research grant and/or speaker fee from Astellas, Chugai, Nippon Shinyaku, Abbvie, Eisai, and Ono Pharmaceutical, Speakers bureau: TH received a research grant and/or speaker fee from Astellas, Chugai, Nippon Shinyaku, Abbvie, Eisai, and Ono Pharmaceutical, Ryota Hara Speakers bureau: RH received a speaker fee from AbbVie, Kosuke Ebina Grant/research support from: KE has received research grants from Abbie, Asahi-Kasei, Astellas, Chugai, Eisai, Ono Pharmaceutical, and UCB Japan., Employee of: KE is affiliated with the Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, which is supported by Taisho., Speakers bureau: KE has received payments for lectures from Abbie, Asahi-Kasei, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Janssen, Mitsubishi-Tanabe, Ono Pharmaceutical, Sanofi, and UCB Japan., Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Wataru Yamamoto: None declared, Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Takuya Kotani: None declared, Kenichiro Hata: None declared, Yonsu Son: None declared, Hideki Amuro: None declared, Akira Onishi Speakers bureau: AO received a speaker fee from Chugai, Ono Pharmaceutical, Eli Lilly, Mitsubishi-Tanabe, Asahi-Kasei, and Takeda, Jinno Sadao: None declared, Masaki Katayama: None declared, Atsushi Kumanogoh Grant/research support from: AK received a research grant and/or speaker fee from Mitsubishi-Tanabe, Chugai, Eisai, Asahi-Kasei, Astellas, Abbvie, Bristol-Myers Squibb, Ono Pharmaceutical, and Pfizer, Speakers bureau: AK received a research grant and/or speaker fee from Mitsubishi-Tanabe, Chugai, Eisai, Asahi-Kasei, Astellas, Abbvie, Bristol-Myers Squibb, Ono Pharmaceutical, and Pfizer

Targeting the IGF-Axis for Cancer Therapy: Development and Validation of an IGF-Trap as a Potential Drug

The insulin-like growth factor (IGF)-axis was implicated in cancer progression and identified as a clinically important therapeutic target. Several IGF-I receptor (IGF-IR) targeting drugs including humanized monoclonal antibodies have advanced to phase II/III clinical trials, but to date, have not progressed to clinical use, due, at least in part, to interference with insulin receptor signaling and compensatory signaling by the insulin receptor (IR) isoform A that can bind IGF-II and initiate mitogenic signaling. Here we briefly review the current state of IGF-targeting biologicals, discuss some factors that may be responsible for their poor performance in the clinic and outline the stepwise bioengineering and validation of an IGF-Trap—a novel anti-cancer therapeutic that could bypass these limitations. The IGF-Trap is a heterotetramer, consisting of the entire extracellular domain of the IGF-IR fused to the Fc portion of human IgG₁. It binds human IGF-I and IGF-II with a three-log higher affinity than insulin and could inhibit IGF-IR driven cellular functions such as survival, proliferation and invasion in multiple carcinoma cell models in vitro. In vivo, the IGF-Trap has favorable pharmacokinetic properties and could markedly reduce metastatic outgrowth of colon and lung carcinoma cells in the liver, outperforming IGF-IR and ligand-binding monoclonal antibodies. Moreover, IGF-Trap dose-response profiles correlate with their bio-availability profiles, as measured by the IGF kinase receptor-activation (KIRA) assay, providing a novel, surrogate biomarker for drug efficacy. Our studies identify the IGF-Trap as a potent, safe, anti-cancer therapeutic that could overcome some of the obstacles encountered by IGF-targeting biologicals that have already been evaluated in clinical settings.

Sexual dimorphism and the role of estrogen in the immune microenvironment of liver metastases

Liver metastases (LM) remain a major cause of cancer-associated death and a clinical challenge. Here we explore a sexual dimorphism observed in the regulation of the tumor immune microenvironment (TIME) of LM, wherein the accumulation of myeloid-derived suppressor cells (MDSC) and regulatory T cells in colon and lung carcinoma LM is TNFR2-dependent in female, but not in male mice. In ovariectomized mice, a marked reduction is observed in colorectal, lung and pancreatic carcinoma LM that is reversible by estradiol reconstitution. This is associated with reduced liver MDSC accumulation, increased interferon-gamma (IFN-γ) and granzyme B production in CD8+ T cells and reduced TNFR2, IDO2, TDO and Serpin B9 expression levels. Treatment with tamoxifen increases liver cytotoxic T cell accumulation and reduces colon cancer LM. The results identify estrogen as a regulator of a pro-metastatic immune microenvironment in the liver and a potential target in the management of liver metastatic disease.

Spectroscopic Evidence for Electron-Boson Coupling in Electron-Doped Sr_{2}IrO_{4}

The pseudogap, d-wave superconductivity and electron-boson coupling are three intertwined key ingredients in the phase diagram of the cuprates. Sr_{2}IrO_{4} is a 5d-electron counterpart of the cuprates in which both the pseudogap and a d-wave instability have been observed. Here, we report spectroscopic evidence for the presence of the third key player in electron-doped Sr_{2}IrO_{4}: electron-boson coupling. A kink in nodal dispersion is observed with an energy scale of ∼50  meV. The strength of the kink changes with doping, but the energy scale remains the same. These results provide the first noncuprate platform for exploring the relationship between the pseudogap, d-wave instability, and electron-boson coupling in doped Mott insulators.

Band-dependent superconducting gap in SrFe2(As0.65P0.35)2 studied by angle-resolved photoemission spectroscopy

The isovalent-substituted iron pnictide compound SrFe₂(As_1−xP_x)₂ exhibits multiple evidence for nodal superconductivity via various experimental probes, such as the penetration depth, nuclear magnetic resonance and specific heat measurements. The direct identification of the nodal superconducting (SC) gap structure is challenging, partly because the presence of nodes is not protected by symmetry but instead caused by an accidental sign change of the order parameter, and also because of the three-dimensionality of the electronic structure. We have studied the SC gaps of SrFe₂(As_0.65P_0.35)₂ in three-dimensional momentum space by synchrotron and laser-based angle-resolved photoemission spectroscopy. The three hole Fermi surfaces (FSs) at the zone center have SC gaps with different magnitudes, whereas the SC gaps of the electron FSs at the zone corner are almost isotropic and k_z-independent. As a possible nodal SC gap structure, we propose that the SC gap of the outer hole FS changes sign around the Z-X [(0, 0, 2π) − (π, π, 2π)] direction.

Oral steroid decreases the progression of joint destruction of large joints in the lower extremities in rheumatoid arthritis

To identify the risk factors for destruction of large joints in the lower extremities in patients with rheumatoid arthritis (RA) during a 4-year follow-up period in a prospective study.We enrolled consecutive patients who participated in both 2012 and 2016. Clinical data, disease activity, and types of medication were collected in 2012. Standard anteroposterior radiographs of weight-bearing joints (hips, knees, and ankles) were taken in 2012 and 2016. Radiographic progression was defined as progression in the Larsen grade or the need for joint arthroplasty or arthrodesis. The association between baseline characteristics and the incidence of radiographic progression was statistically assessed.A total of 213 patient were enrolled, and, after exclusion, 186 patients were analyzed. Sixty 9 patients (37.1%) showed radiographic progression in 1 of the large joints in the lower extremities. Multivariate regression analysis showed that radiographic progression was associated with older age, higher disease activity, and the presence of radiographic destruction at the baseline. The lower dosage of oral prednisolone was a significant risk factor compared with higher dosage when used.Patients with the risk factors should be followed closely to limit the progression of large joint destruction in the lower extremities.

Momentum Dependence of the Nematic Order Parameter in Iron-Based Superconductors

The momentum dependence of the nematic order parameter is an important ingredient in the microscopic description of iron-based high-temperature superconductors. While recent reports on FeSe indicate that the nematic order parameter changes sign between electron and hole bands, detailed knowledge is still missing for other compounds. Combining angle-resolved photoemission spectroscopy with uniaxial strain tuning, we measure the nematic band splitting in both FeSe and BaFe_{2}As_{2} without interference from either twinning or magnetic order. We find that the nematic order parameter exhibits the same momentum dependence in both compounds with a sign change between the Brillouin center and the corner. This suggests that the same microscopic mechanism drives the nematic order in spite of the very different phase diagrams.