POS1063 STAT PHOSPHORYLATION AS A MARKER FOR DISEASE ACTIVITY IN PATIENTS WITH PSORIATIC ARTHRITIS: AN EXPLORATIVE ANALYSIS

Background

Numerous cytokines that influence disease activity in psoriatic arthritis (PsA) are modulators of the Janus Kinases/Signal Transducers and Activators of Transcription (JAK/STAT) pathway. The JAK1/STAT1/STAT3/STAT5 network can drive the expansion of Th17 and regulatory T cells via proinflammatory cytokines in PsA joints,[1], [2] while hyperphosphorylation of STAT3 in immune cells has previously been shown to promote PsA pathogenesis through the Interleukin (IL)-23/IL-17/IL-22 axis.[3] Therefore, the phosphorylation status of STAT molecules in leucocytes of PsA patients may indicate active disease and could potentially guide treatment with JAK inhibitors.

Objectives

To analyse phosphorylated STAT (pSTAT) levels of circulating leucocyte subsets in PsA patients with active and inactive disease

Methods

Whole blood was drawn on consecutive PsA patients fulfilling the CASPAR criteria[4] to perform flow cytometry analysis using the BD FACSLyric platform. Disease activity was assessed using the Disease activity for psoriasis arthritis (DAPSA) score.[5] All steps from storage of drawn blood to cell fixation were performed at 4°C to prevent auto-activation of leucocytes. The geometric mean fluorescence intensities (gMFI) of pSTATs in granulocytes, monocytes, B cells and CD4+/- naïve/memory T cells were compared between patients with moderate to high (MoDA/HDA) and remission to low disease activity (REM/LDA). Correlation analysis between gMFIs and DAPSA scores were performed.

Results

Forty-two patients (female ratio: 0.48) with established PsA (median ± standard deviation, age: 56 ± 12.54 years, disease duration: 8.50 ± 7.10 years) were included in this study. Twenty-one percent of patients were in MoDA/HDA, while the remaining 79% were in REM/LDA. Patients in MoDA/HDA showed significantly higher pSTAT3 levels in CD4+ naïve (gMFI median ± standard deviation: 284.5 ± 79.9 vs 238 ± 92.9, p = 0.011), CD4- naïve (297 ± 107.5 vs 238 ± 98.4, p = 0.04), CD4+ memory (227 ± 62.9 vs 190.5 ± 72.2, p = 0.009) and CD4- memory T cells (209 ± 66.8 vs 167.0 ± 64.9, p = 0.036). On the other hand, PsA patients in remission or low disease activity displayed higher pSTAT1 levels in granulocytes (2509 ± 1887 vs 1330.5 ± 784.1, p = 0.040) and monocytes (255 ± 230 vs 144 ± 62.5, p = 0.049). Positive correlations were found between DAPSA scores and pSTAT3 in CD4+ naïve and memory T cells (Spearman’s correlation coefficient rho (ρ) = 0.5, p = 0.0012 and ρ = 0.47, p = 0.0025 resp.) whereas pSTAT1 in granulocytes and monocytes were negatively correlated with the DAPSA scores (ρ = -0.45, p = 0.0074 and ρ = -0.34, p = 0.05).

Conclusion

Differential phosphorylation of STAT3 and STAT1 molecules in circulating leucocyte subsets indicates PsA disease activity. Further studies to examine the value of STAT phosphorylation patterns guiding JAK inhibitor therapy are underway.

References

[1]U. Fiocco et al., “Ex vivo signaling protein mapping in T lymphocytes in the psoriatic arthritis joints,” J. Rheumatol., vol. 93, pp. 48–52, 2015, doi: 10.3899/jrheum.150636.

[2]S. K. Raychaudhuri, C. Abria, and S. P. Raychaudhuri, “Regulatory role of the JAK STAT kinase signalling system on the IL-23/IL-17 cytokine axis in psoriatic arthritis,” Ann. Rheum. Dis., vol. 76, no. 10, pp. e36–e36, 2017.

[3]E. Calautti, L. Avalle, and V. Poli, “Psoriasis: A STAT3-centric view,” International Journal of Molecular Sciences, vol. 19, no. 1. MDPI AG, Jan. 06, 2018, doi: 10.3390/ijms19010171.

[4]W. Taylor, D. Gladman, P. Helliwell, A. Marchesoni, P. Mease, and H. Mielants, “Classification criteria for psoriatic arthritis: Development of new criteria from a large international study,” Arthritis Rheum., vol. 54, no. 8, pp. 2665–2673, 2006, doi: 10.1002/art.21972.

[5]M. M. Schoels, D. Aletaha, F. Alasti, and J. S. Smolen, “Disease activity in psoriatic arthritis (PsA): Defining remission and treatment success using the DAPSA score,” Ann. Rheum. Dis., vol. 75, no. 5, pp. 811–818, 2016, doi: 10.1136/annrheumdis-2015-207507.

Disclosure of Interests

Barbara Dreo: None declared, Daniel Ruben Pietsch: None declared, Rusmir Husic Speakers bureau: MSD, Lilly und Abbvie, Angelika Lackner: None declared, Johannes Fessler: None declared, Janine Rupp: None declared, Anirudh Subramanian Muralikrishnan: None declared, Jens Thiel Speakers bureau: GSK, BMS, AbbVie, Novartis, Consultant of: GSK, Novartis, Grant/research support from: BMS, Martin Stradner Speakers bureau: Eli Lilly, Pfizer, MSD, BMS, AbbVie, Janssen, Consultant of: Eli Lilly, AbbVie, Janssen, Philipp Bosch Grant/research support from: Pfizer

POS0380 EFFECTIVENESS OF REMOTE CARE INTERVENTIONS: A SYSTEMATIC REVIEW INFORMING THE 2022 EULAR POINTS TO CONSIDER FOR REMOTE CARE IN RHEUMATIC AND MUSCULOSKELETAL DISEASES

Background

While the number of patients with rheumatic musculoskeletal diseases (RMDs) is increasing worldwide, there is no adequate increment in the number of health care professionals, leading to the urgent need for new forms of care to take pressure from health care systems.1 2 Telehealth comprises a number of different types of interventions with the scope of performing certain steps of care, ranging from diagnostics to follow-up visits, in a remote manner. The use of remote care is heterogenous and guidance is needed to optimize the combination with conventional face-to-face (F2F) visits.

Objectives

To perform a systematic literature review (SLR) on different outcomes of remote care compared to F2F care, its implementation into clinical practice and to identify drivers and barriers in order to inform a task force formulating the European Alliance of Associations for Rheumatology (EULAR) Points to Consider for remote care in RMDs.

Methods

Prospective, retrospective, and qualitative studies testing different types of remote care in patients with RMDs were included. Medline, Embase and the Cochrane Library were searched through February 28th, 2021. Two reviewers independently performed standardized data extraction, synthesis, and risk of bias assessment.

Results

A total of 2,240 references were identified. Forty-seven studies, consisting of 26 randomized controlled trials, 8 prospective cohort studies, 8 cross sectional studies, and 5 qualitative studies were included.

Fifty-one percent of the studies involved patients with inflammatory RMDs, including rheumatoid arthritis, and spondyloarthritis, while 49% were on patients with non-inflammatory conditions, such as osteoarthritis and fibromyalgia. Remote monitoring (n=35) was most frequently studied, with telephone/video calls being the most common mode of delivery (n=30). Thirty-four studies investigated outcomes of remote care in comparison to F2F care. The most frequently assessed outcomes concerned efficacy and user perception of remote care, with 34% and 21% of studies, respectively, reporting superior results for the remote care intervention.

Time savings and flexibility were reported as major drivers, while inadequate technical knowledge and concerns in data security were the main barriers to implementing remote care. Implementation of remote care methods into clinical practice was not reported by the included studies. The main limitations were the heterogeneity of outcomes and interventions, and the substantial risk of bias (50% of studies with high risk of bias).

Conclusion

Studies on remote care reported similar to partially better results compared to F2F care concerning efficacy, and user perception outcomes, with the limitation of heterogeneity and considerable risk of bias.

References

[1]World Health Organization. WHO Guideline: recommendations on digital interventions for helath system strengthening. 2019 [Available from: https://apps.who.int/iris/bitstream/handle/10665/311941/9789241550505-eng.pdf?ua=1 accessed 10.01.2022.

[2]James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392(10159):1789-858. doi: https://doi.org/10.1016/S0140-6736(18)32279-7

Disclosure of Interests

Andrea Marques: None declared, Philipp Bosch: None declared, Annette de Thurah Speakers bureau: Pfizer, Eli Lily, Grant/research support from: Novartis, Yvette Meissner Speakers bureau: Pfizer, Louise Falzon: None declared, Chetan Mukhtyar: None declared, Hans Bijlsma Speakers bureau: Abbvie, Arthrogen, BMS, Lilly, MSD, Pfizer, Roche, Sun, UCB, Consultant of: Abbvie, Arthrogen, BMS, Lilly, MSD, Pfizer, Roche, Sun, UCB, Grant/research support from: Roche, Sun, Christian Dejaco Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos, Sanofi, Consultant of: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos, Sanofi, Grant/research support from: Celgene, Pfizer, Tanja Stamm Speakers bureau: AbbVie, Roche, Sanofi, Takeda, Consultant of: Abbvie, Sanofi, Grant/research support from: Abbvie, Roche

POS0102 GO ASK YOUR PATIENTS! PSS-QoL REPORTED PERCEPTION OF DRYNESS CORRELATES WITH LACRIMAL AND SALIVARY FLOW IN PRIMARY SJÖGREN’S SYNDROME

Background:

The patient perspective is an essential outcome parameter in the quest for effective therapy in primary Sjögren’s Syndrome (PSS). The EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) is recommended by EULAR to quantify patient’s symptom burden and has been used in several clinical trials. Surprisingly, the patient’s perception of dryness quantified with ESSPRI does not correlate with objective measures of salivary or lacrimal flow.

Objectives:

Thus, we evaluated a newly developed assessment tool-the Primary Sjögren’s Syndrome Quality of Life Questionnaire (PSS-QoL) - for quantifying symptoms of dryness in comparison with the ESSPRI and objective measurements of salivary and lacrimal flow.

Methods:

Data of patients from the PSS registry of the Medical University of Graz fulfilling the 2016 ACR/EULAR classification criteria for PSS were analysed. The patient perspective was analyzed by PSS-QoL, ESSPRI, Xerostomia Inventory (XI) and Ocular Surface Disease Index (OSDI). Sicca signs were measured with Schirmer’s test, unstimulated salivary flow test (USF) and stimulated salivary flow test (SSF). Patients were categorized into groups based on the presence of subjective and/or objective dryness: 1) objective dryness only, 2) subjective dryness only, and 3) both, subjective and objective dryness. ESSDAI (EULAR Sjögren’s Syndrome Disease Activity Index) and EGA (Evaluator Global Assessment, numeric rating scale from 0 to 10) were obtained. In addition, free light chains (FLC) ĸ and λ, rheumatoid factor (RF) IgM and IgA were determined.

Results:

Data from 123 PSS patients were analyzed; 91.9% (n=113) were female, with a mean disease duration of 6.2 (±5.3) years and mean age of 60.1 (±12.4) years. PSS-QoL-dryness revealed significant negative correlations with Schirmer’s test (r=-0.31, p<0.05) and SSF-test (r=-0.39, p<0.01). In contrast, we found no significant correlation between ESSPRI-dryness and any objective dryness test. Lower perceived dryness was associated with higher immunological activity determined by increased levels of IgG, FLC and RF-IgA. Patients with objective signs and subjective symptoms of dryness had higher clinical and immunological disease activity compared to patients with subjective symptoms only (table 1).

Table 1.

Comparison of perceived dryness-groups with clinical parameters

PSS-QoL MouthpPSS-QoL Eyespsubjobj/subjsubjobj/subjEGA1.0 [0-5]2.0 [0-7]<0.051.0 [0-3]2.0 [0-7]<0.05ESSDAI1.0 [0-144.0 [0-15<0.053.0 [0-74.0 [0-15nsESSPRI-pain3.0 [0-9]3.0 [0-10]ns4.0 [1-8]3.0 [0-10]<0.05RF-IgM19.0 [5-524]31.0 [7-417]ns10.0[5-33]26.0[7-524]<0.01FLC-λ15.1 [7.0-68.3]20.1 [2.6-124.0]<0.0113.4 [7.0-54.5]18.7[2.6-124.0]<0.01IgG11.9 [6.5-37.2]16.1 [7.4-33.8]ns12.8 [6.5-20.6]14.8[7.4-37.2]nsC40.2 [0.01-0.41]0.17 [0.00-0.43]<0.010.2 [0.09-0.41]0.18 [0.00-0.43]nsRF-IgA11.0 [1-500]103 [0-500]<0.014.5 [1-465]63 [0-500]<0.01

C4=Complementfactor 4; EGA=Evaluators Global Assessment; ESSDAI=EULAR Sjögren Syndrome Disease Activity Index; ESSPRI=EULAR Sjögren Syndrome Patient Reported Index; FLC-λ=Free light chain Lambda; IgG=Immunoglobulin G; obj/subj=objective and subjective dryness-group; PSS-QoL=Primary Sjögren Syndrome Quality of Life Questionnaire; RF-IgA=rheumatoid factor Immunoglobulin A; RF-IgM=rheumatoid factor Immunoglobulin M; subj=subjective dryness-group.

Conclusion:

Patients’ perception of dryness assessed by PSS-QoL correlates with objective measurements of salivary gland function while ESSPRI-dryness did not. Based on the PSS-QoL and objective measures of dryness two distinct groups of PSS patients could be distinguished, which may have implications in daily practice and future clinical studies.

Disclosure of Interests:

None declared

OP0309 THE ROLE OF IMAGING TO GUIDE INTERVENTIONAL PROCEDURES IN RHEUMATIC AND MUSCULOSKELETAL DISEASES: A SYSTEMATIC LITERATURE REVIEW TO INFORM EULAR RECOMMENDATIONS

Background:

Imaging guidance gives the opportunity to visualize a needle or other instrument when performing interventions on musculoskeletal sites in patients with rheumatic and musculoskeletal diseases (RMDs). Studies assessing the role of imaging guided procedures have been performed, however, no consensus has been made yet about when and which imaging techniques to use for these interventions.

Objectives:

To inform a EULAR taskforce on the current literature on different imaging techniques, procedures and materials to guide interventions on musculoskeletal sites in RMD patients.

Methods:

Prospective and retrospective studies published in English and comparing either palpation or imaging guided interventions in patients with RMDs were included. MEDLINE, EMBASE, the Cochrane Library and Epistemonikos were searched through October 2021. Risk of bias (RoB) was assessed using the Cochrane RoB tool for randomized trials version 2 (ROB2), the RoB tool for Non-Randomized Studies of Interventions (ROBINS-I) and the appraisal tool for cross-sectional studies (AXIS).

Results:

Sixty-six studies, with moderate to high RoB, consisting of 49 randomized controlled trials, three prospective cohort studies and 14 retrospective studies were included.

Fifty-one studies compared one imaging technique against either another imaging technique, or palpation-guided interventions. Most of the studies were on peripheral joints (47/51), while data on joints of the axial skeleton were scare and heterogeneous (4/51). For peripheral joints, ultrasound (US) was the most studied imaging technique (49/51), followed by fluoroscopy (10/51). Results revealed a higher accuracy and safety (including procedural pain) of US or fluoroscopy compared to palpation- guided interventions. Data on other imaging techniques was scarce (computed tomography: n=3, arthroscopy: n=1) and the results heterogeneous. Results of studies comparing different imaging techniques (12/51) did not favor one imaging method over another.

Three studies comparing different materials used for imaging guided interventions were found (e.g. automatic vs manual syringes), showing little evidence for one material being superior to another one.

Fifteen studies were found comparing different imaging guided procedures (e.g. intraarticular vs periarticular injections). Overall, studies indicated an advantage of targeted vs. not targeted interventions (intraarticular vs periarticular or intraepineurial vs extraepineurial injections) concerning pain levels, while the comparison of different puncture sites to inject (e.g. ulnar vs midline carpal tunnel injection) was inconclusive.

Conclusion:

Imaging guidance, especially US, performs favorably for interventions at the peripheral joints compared to palpation-guided interventions, concerning accuracy and safety. Data for the axial skeleton are scarce. Imaging guided targeted interventions may lead to better outcomes than non-targeted interventions.

Disclosure of Interests:

None declared.

AB1083 CURRENT PRACTICE AND OPINIONS ON IMAGING-GUIDED INTERVENTIONAL PROCEDURES IN RHEUMATIC AND MUSCULOSKELETAL DISEASES: INTERIM RESULTS OF A MULTINATIONAL MULTIDISCIPLINARY SURVEY TO INFORM EULAR POINTS TO CONSIDER

Background:

maging is widely used for diagnostic purposes in patients with rheumatic and musculoskeletal diseases (RMDs). In recent years, it is increasingly used also to guide interventional procedures. However, the extent of imaging application for this purpose as well as the different technical standards employed across Europe are not known.

Objectives:

To learn how much imaging is used for interventional procedures in RMDs. To explore the technical standards employed in different settings and how important they are rated by users.

Methods:

As part of the work of a multidisciplinary EULAR Task Force to develop recommendations for the use of imaging to guide interventional procedures in patients with RMDs, a survey was developed. The survey explored aspects of different interventional procedures (e.g. joint aspiration/injection) such as the use of imaging guide and the technical standards. Respondents provided also a 0-10 rating of how important they considered the same conditions/items with regard to each procedure. The survey was distributed to: rheumatologists across Europe, USA, Central America, South America, Asia and Pacific Area, HPs across Europe, European and American associations of other specialities (e.g. radiology, anaesthesiology). The survey was launched in December 2019. Interim results after 4 weeks are presented.

Results:

200 responses from 36 countries were collected. The respondents were mainly rheumatologists (90%) (Figure 1). 90% of respondents performed interventional procedures related to RMDs and of these, 76% use imaging guide. Ultrasonography (US) is the most commonly used technique (96%) followed by X-ray/fluoroscopy (13%). Among respondents using imaging guide, 60% received training on both imaging and imaging-guided procedures, 20% only on imaging and 16% no training. 49% of respondents perform the whole procedure using direct image guidance, 21% use imaging to find the appropriate anatomical landmark and then perform the procedure blindly. Air and contrast agent to control needle placement are rarely used (≤20%). Respondents provided also a rating (0-10) of how important they considered different technical conditions/items for each procedure and an estimate on a Likert scale of how often they used them for each of the procedures (Figure 1 shows an example). In most cases respondents use always/most of the times the conditions/items that they considered important. Discrepancies were mainly due to barriers at their own center.

Conclusion:

Imaging, mainly US, is widely used to guide interventional procedures. However, training is not homogeneous and the use of imaging guide as well as technical conditions are based on the operator’s opinion/experience. This survey will inform the EULAR points to consider for the use of imaging to guide interventional procedures in patients with RMDs.

Table 1.

Characteristics of respondents (n=200) N

N%Age≤ 30381931 –35562836 – 39502540 - 493316.5≥ 502311.5GenderFemale8944.5Male11155.5Specialty/PositionRheumatology18090Radiology115Physical medicine and rehabilitation31.5Pediatrics42Non-clinical researcher31.5Health professionals31.5Other31.5

Disclosure of Interests:

Francesco Carubbi Speakers bureau: Francesco Carubbi received speaker honoraria from Abbvie and Celgene outside this work., Philipp Bosch: None declared, Pedro M Machado Consultant of: PMM: Abbvie, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Speakers bureau: PMM: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Carlo Alberto Scirè: None declared, Alessia Alunno: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Christian Dejaco: None declared

AB0746 EVALUATING TENDER AND SWOLLEN JOINTS FOR THE ASSESSMENT OF INFLAMMATORY PAIN IN PSORIATIC ARTHRITIS USING ULTRASOUND

Background:

Tender and Swollen Joint Counts (TJC, SJC) are items of disease activity scores in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Recent studies suggest that TJC do not adequately reflect ongoing inflammation in RA when using Ultrasound (US) as a reference standard, and that pain might be due to other, non-inflammatory causes.1, 2In PsA, the role of tenderness and swelling of joints for reflecting active inflammation has not been well studied so far.

Objectives:

To evaluate tender (TJ) and swollen joints (SJ) for the assessment of inflammation in PsA.

Methods:

We performed a prospective study on 83 PsA patients undergoing clinical and ultrasound examinations at two study visits scheduled 12 months apart. Tenderness and swelling were assessed for 68 and 66 joints respectively and US examinations, including grey scale (GS) and power doppler (PD) were conducted at all 68 joints. GS- (range 0-204) und PD sum scores (0-204) were calculated. At patient level, correlations were performed between TJC, SJC and clinical or US values. At joint level a GS value≥1 and/or PD value≥1 was defined as active synovitis, which was compared to whether a joint was tender, swollen or both. A generalized linear mixed model was created to assess the predictive value of TJ and SJ for active synovitis after 12 months, taking into consideration the joint site.

Results:

At baseline the median TJC and SJC for 83 patients was 4 (range 0-59) and 1 (0-20), respectively and the median GSS- and PD sum score was 16 (3-56) and 3 (0-31) respectively. SJC correlated with the GSS sum score (r= 0.37, p=0.004) and PD sum score (r =0.47, p<0.001), while TJC only correlated with PD sum score (r=0.33, p=0.01). TJC correlated better than SJC with patient reported outcomes like patient global assessment (TJC: r=0.57, p<0.001; SJC r=0.39, p=0.002) and health assessment questionnaire (TJC: r=0.50, p<0.001, SJC no significant correlation). Swollen joints (with or without tenderness) showed active synovitis (GSS≥1 and/or PD≥1) in 67.6% of cases, while tender joints (with or without swelling) showed signs of US activation in only 34.5%. A joint that was considered swollen at baseline was more likely to express active synovitis after 12 months (OR: 4.3, 97.5 CI: 2.9-6.2), compared to a joint that was either tender or swollen at baseline (OR: 2.8, 97.5 CI: 2.1-3.5).

Conclusion:

SJC are more closely linked with US signs of inflammation as compared to TJC in PsA. While swelling of a joint predicts US inflammation after a year, the information whether the joint is additionally tender or not, gives no additional predictive information.

References:

[1]Hammer HB, Michelsen B, Sexton J, et al. Swollen, but not tender joints, are independently associated with ultrasound synovitis: results from a longitudinal observational study of patients with established rheumatoid arthritis.Ann Rheum Dis2019;78:1179-85.

[2]Hammer HB, Michelsen B, Provan SA, et al. Tender joint count may not reflect inflammatory activity in established rheumatoid arthritis patients - results from a longitudinal study.Arthritis Care Res (Hoboken) 2018

Disclosure of Interests:

None declared

The accuracy of diagnostic Imaging techniques in patients with a suspected Fracture-related Infection (IFI) trial: study protocol for a prospective multicenter cohort study

INTRODUCTION

The optimal diagnostic imaging strategy for fracture-related infection (FRI) remains to be established. In this prospective study, the three commonly used advanced imaging techniques for diagnosing FRI will be compared. Primary endpoints are (1) determining the overall diagnostic performances of white blood cell (WBC) scintigraphy, fluorodeoxyglucose positron emission tomography (FDG-PET) and magnetic resonance imaging (MRI) in patients with suspected FRI and (2) establishing the most accurate imaging strategy for diagnosing FRI.

METHODS AND ANALYSIS

This study is a non-randomised, partially blinded, prospective cohort study involving two level 1 trauma centres in The Netherlands. All adult patients who require advanced medical imaging for suspected FRI are eligible for inclusion. Patients will undergo all three investigational imaging procedures (WBC scintigraphy, FDG-PET and MRI) within a time frame of 14 days after inclusion. The reference standard will be the result of at least five intraoperative sampled microbiology cultures, or, in case of no surgery, the clinical presence or absence of infection at 1 year follow-up. Initially, the results of all three imaging modalities will be available to the treating team as per local protocol. At a later time point, all scans will be centrally reassessed by nuclear medicine physicians and radiologists who are blinded for the identity of the patients and their clinical outcome. The discriminative ability of the imaging modalities will be quantified by several measures of diagnostic accuracy.

ETHICS AND DISSEMINATION

Approval of the study by the Institutional Review Board has been obtained prior to the start of this study. The results of this trial will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.

TRIAL REGISTRATION NUMBER

The IFI trial is registered in the Netherlands Trial Register (NTR7490).

Diagnostic accuracy of serum inflammatory markers in late fracture-related infection: a systematic review and meta-analysis

AIMS

To assess the diagnostic value of C-reactive protein (CRP), leucocyte count (LC), and erythrocyte sedimentation rate (ESR) in late fracture-related infection (FRI).

MATERIALS AND METHODS

PubMed, Embase, and Cochrane databases were searched focusing on the diagnostic value of CRP, LC, and ESR in late FRI. Sensitivity and specificity combinations were extracted for each marker. Average estimates were obtained using bivariate mixed effects models.

RESULTS

A total of 8284 articles were identified but only six were suitable for inclusion. Sensitivity of CRP ranged from 60.0% to 100.0% and specificity from 34.3% to 85.7% in all publications considered. Five articles were pooled for meta-analysis, showing a sensitivity and specificity of 77.0% and 67.9%, respectively. For LC, this was 22.9% to 72.6%, and 73.5% to 85.7%, respectively, in five articles. Four articles were pooled for meta-analysis, resulting in a 51.7% sensitivity and 67.1% specificity. For ESR, sensitivity and specificity ranged from 37.1% to 100.0% and 59.0% to 85.0%, respectively, in five articles. Three articles were pooled in meta-analysis, showing a 45.1% sensitivity and 79.3% specificity. Four articles analyzed the value of combined inflammatory markers, reporting an increased diagnostic accuracy. These results could not be pooled due to heterogeneity.

CONCLUSION

The serum inflammatory markers CRP, LC, and ESR are insufficiently accurate to diagnose late FRI, but they may be used as a suggestive sign in its diagnosis.

203 Genome Modifications by Sleeping Beauty Transposition and CRISPR/Cas9 to Improve Cow Milk Composition for Human Consumption

Genome manipulation of cattle represents a powerful tool to increase the nutritional value and reduce allergenicity of cow milk for human consumption. This could be accomplished by improving the amount of polyunsaturated fatty acids (ω-3 and ω-6) and simultaneously abolishing β-lactoglobulin (BLG), a potent allergen for predisposed humans. The aim of this study was to introduce the sequence for a desaturase construct (mFAT-2, from C. elegans), which is able to catalyse the synthesis of ω-3 and ω-6 fatty acids, into the bovine genome by Sleeping Beauty (SB) transposition, and simultaneously knocking out the bovine β-lactoglubulin gene using CRISPR/Cas9 system. The sgRNA (AAGTGCCTCCTGCTTGCCC) targeted to BLG exon 1 was synthesised as an oligo linker and cloned into the px459-Cas9. The mutation activity of the designed sgRNA at the target locus was determined by T7 endonuclease assay I (T7EI) mismatch detection assay. Briefly, bovine fetal fibroblasts (BFF) were seeded at 0.5 × 105 cells per well of a 24-well plate in triplicate, when the cells reached 80% confluence (12–24 h), cultures were transfected with 1 μg of px459-Cas9::BLG plasmid co-expressing Cas9 and sgRNA using polyethylenimine reagent (PEI; 3 ng μL−1). After 3 days of puromycin selection, genomic DNA from transfected cells were extracted and the sequence of interest was PCR-amplified and digested by T7EI restriction enzyme. Digestion products showed a mutation efficiency at the target locus of 29%. Subsequently, we chemically cotransfected 0.5 × 105 BFF with 0.5 μg of knockout vector (px459-Cas9::BLG) and 0.5 μg of SB plasmids (carrying mFAT-2 cDNA for mammary gland-specific expression) using 3 ng μL−1 PEI in triplicate. At 48 h post-transfection, cell cultures were subjected to 3 days of puromycin and 21 days of neomycin selection. PCR analysis of antibiotic resistant colonies revealed the presence of mFAT-2 transgene in almost 70% of the analysed cells lines. Genotyping of BLG exon 1 was performed by direct sequencing of PCR amplicons using primers flanking the target site. Despite the appreciable gene mutation activity of the sgRNA sequence previously determined by T7EI assay (29%), none of the cell lines analysed showed modification in the BLG target locus. We speculate that the SB vector might have disrupted the activity of targeting vector. We are currently performing additional experiments to accomplish gene addition (mFAT) and gene knockout (BGL) in one step using these highly efficient and precise transgenic tools. Genetically modified cells will be used as nuclear donor to produce transgenic cows by somatic cells nuclear transfer. The financial support of CONICET, UNRC and FONCYT is gratefully acknowledged.

Transfection of bovine fetal fibroblast with polyethylenimine (PEI) nanoparticles: effect of particle size and presence of fetal bovine serum on transgene delivery and cytotoxicity

The development of efficient transfection protocols for livestock cells is crucial for implementation of cell-based transgenic methods to produce genetically modified animals. We synthetized fully deacylated linear 22, 87 and 217 kDa polyethylenimine (PEI) nanoparticles and compared their transfection efficiency and cytotoxicity to commercial branched 25 kDa PEI and linear 58 kDa poly(allylamine) hydrochloride. We studied the effect of PEI size and presence of serum on transfection efficiency on primary cultures of bovine fetal fibroblasts and established cells lines (HEK 293 and Hep G2). We found that transfection efficiency was affected mainly by polymer/pDNA ratio and DNA concentration and in less extent by PEI MW. In bovine fibroblast, preincubation of PEI nanoparticles with fetal bovine serum (FBS) greatly increased percentage of cells expressing the transgene (up to 82%) while significantly decreased the polymer cytotoxic effect. 87 and 217 kDa PEI rendered the highest transfection rates in HEK 293 and Hep G2 cell lines (>50% transfected cells) with minimal cell toxicity. In conclusion, our results indicate that fully deacylated PEI of 87 and 217 kDa are useful DNA vehicles for non-viral transfection of primary cultures of bovine fetal fibroblast and HEK 293 and Hep G2 cell lines.

Simultaneous Measurement of Fluorescence, Conversion and Physical/mechanical Properties for Monitoring Bulk and Localized Photopolymerization Reactions in Heterogeneous Systems

An FT-NIR spectrometer, rheometer and fluorescence spectrophotometer were coupled for the real-time monitoring of polymerization reactions, allowing the simultaneous tracking of polymerization kinetics, storage modulus as well as fluorescence. In this study, a methacrylate functionalized dansyl chromophore (DANSMA) was synthesized and two different nanogels were made from urethane dimethacrylate and isobornyl methacrylate. Two series of resin formulations were prepared using the DANSMA probe, ethoxylated bisphenol A dimethacrylate as the matrix monomer, Irgacure® 651 as the initiator and the dispersed, monomer-swollen nanogels to give clear UV-curable resins. Placement of the fluorescent probe either throughout the resin or linked into the nanogel before its dispersion in the matrix provides a tool to study how the nanogel structure affects local network development by means of fluorescence from the DANSMA probe. We demonstrate the potential of this new technique using a composite as the two phase system (resin and polymerizable nanogel) including a dansyl derivative as a polymerizable probe to follow the reactions that are taking places in both phases.

242 HIGHLY EFFICIENT SLEEPING BEAUTY TRANSPOSON-MEDIATED TRANSGENESIS IN BOVINE FETAL FIBROBLASTS

Active transposon-mediated transgenesis is an emerging tool for basic and applied research in livestock. We have demonstrated the effectiveness of a helper-independent piggyBac transposon (pGENIE-3) for gene transfer into the genome of bovine cells (Alessio et al. 2014 Reprod. Domest. Anim. 49, 8). Here, we extend our previous research by examining the suitability of a Sleeping Beauty (SB) transposon-based methodology to deliver transgenes into the genome of bovine fetal fibroblasts (BFF), and the ability of these cells to support in vitro embryo development upon somatic cell nuclear transfer (SCNT). In a first experiment, BFF were chemically cotransfected (JetPRIME®, Polyplus-transfection, Illkirch, France) with a helper plasmid (pCMV-SB100X), which carries an expression cassette for the SB transposase, and the donor vector (pT2/Venus/RMCE) harboring an expression cassette for a fluorescent protein (Venus) flanked by the SB inverted terminal repeats (ITR). Three different ratios of helper and donor plasmids were studied: 1 : 2, 1 : 1 and 2 : 1. After 15 days of culture, the number of fluorescent colonies was counted on an inverted microscope. When vectors were used at ratios of 1 : 1 and 2 : 1, a 78-fold and 88-fold increase (P ≤ 0.05) in the number of fluorescent colonies compared with that in the no-transposase control were calculated. In a second experiment, BFF were chemically cotransfected with the helper vector pCMV-SB100X, and 2 donor transposons: pT2/Venus/RMCE and pT2/SV40-Neo. The former harbors a neo resistance cassette framed by SB ITRs. Different ratios of helper:donors (1 : 1 : 1, 2 : 1 : 1 and 2 : 0.5 : 0.5) were studied, and each ratio compared with a no-transposase control. After 15 days of antibiotic selection, the number of G418-resistant colonies was determined. Every time a functional SB transposase vector was included, the number of fluorescent and G418-resistant colonies was markedly higher compared with that in the respective control without transposase (P ≤ 0.001). Interestingly, all G418-resistant colonies expressed Venus. Molecular characterisation of genomic insertions in 6 monoclonal cell lines was performed by PCR and splinkerette PCR. PCR analysis confirmed presence of the Venus transgene in all cell lines. Splinkerette PCR results revealed at least 15 transposase-catalyzed genomic insertions of the transgene. Individual cells from a polyclonal SB transgenic fibroblast culture were used as nuclear donors to produce zona-free SCNT embryos. Of the reconstructed embryos, 33% reached blastocyst stage and about half of them expressed Venus. In conclusion, SB transposase is able to actively transpose monomeric copies of transgenes into the genome of bovine cells, which can be reprogrammed upon nuclear transfer to generate morphologically normal embryos expressing the transgene of interest.

Lipid peroxidation affects red blood cells membrane properties in patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune, chronic inflammatory, non-organ specific disease with an important morbimortality affecting several organs and systems. Oxidative stress is a well documented mechanism of red blood cells (RBC) mechanical impairment. Free radicals could produced, through lipid peroxidation, physical and chemical alterations in the cellular membrane properties modifying its composition, packing and lipid distribution on the membrane erythrocyte. The aim of the present work is to study the lipid peroxidation in the RBC membrane in SLE patients (n = 42) affecting so far the lipid membrane fluidity and erythrocyte deformability in comparison with healthy controls (n = 52). Malonildialdehyde (MDA) is a subrogate assessing lipidic peroxidation, rigidity index estimating erythrocyte deformability and the anisotropy coefficient estimating lipid membrane fluidity were used. Our results show that MDA values are increased, while erythrocyte deformability and membrane fluidity are significantly decreased in erythrocyte membrane from SLE patients in comparison with normal controls. The association of thiobarbituric acid reactive substances (TBARS) with membrane lipid fluidity and erythrocyte deformability confirms that the damage of membrane properties is produced by lipid peroxidation.

356 SLEEPING BEAUTY TRANSGENESIS IN CATTLE

Transposon-mediated transgenesis is a well-established tool for genome modification in small animal models. However, translation of this active transgenic method to large animals warrants further investigations. Here, the Sleeping Beauty (SB) transposon system was assessed for stable gene transfer into the cattle genome. The transposon plasmids encoded a ubiquitously active CAGGS promoter-driven Venus reporter and a lens-specific α A-crystallin promoter driven tdTomato fluorophore, respectively. The helper plasmid carried the hyperactive SB100x transposase variant. In total, 50 in vitro-derived zygotes were co-injected (Garrels et al. 2011 PLoS ONE 6; Ivics et al. 2014 Nat. Protoc. 9) and cultured up to blastocyst stage (Day 8). Two blastocysts were Venus-positive and were transferred to synchronized heifers, resulting in one pregnancy. The resulting calf was normally developed and vital; however, it died shortly after cesarean section due to spontaneous bleeding from an undetected aneurism. Phenotypic analysis suggested that the calf was indeed double-transgenic, showing widespread expression of Venus and lens-specific expression of tdTomato. Genotyping and molecular analyses confirmed the integration of both reporter transposons and the faithful promoter-dependent expression patterns. Subdermal tissue of an ear biopsy was used to culture fibroblasts, which were employed in somatic cell nuclear transfer experiments. In total, 39 embryos were reconstructed, of which 34 underwent cleavage, and at the end of culture 12 morulas and 12 blastocysts were obtained. Ten of the blastocysts were Venus positive, and embryo transfer of Venus-positive blastocysts is planned. In summary, we showed that the cytoplasmic injection of SB components is a highly efficient method for transgenesis in cattle. Due to the modular composition of SB plasmids, even double transgenic cattle can be generated in a one-step procedure. Importantly, the SB-catalyzed integration seems to favour transcriptionally permissive loci in the genome, resulting in faithful and robust promoter-dependent expression of the transgenes. The transposon constructs carry heterospecific loxP sites, which will be instrumental for targeted insertion of functional transgenes by Cre recombinase-mediated cassette exchange.Financial support of DFG (Ku 1586/3-1), UNRC, CONICET and Agencia Nacional de Promoción Científica y Tecnológica de la Argentina (ANPCyT) is gratefully acknowledged.

357 EARLY FETAL DEVELOPMENT OF NUCLEAR TRANSFER BOVINE EMBRYOS GENERATED FROM FIBROBLASTS GENETICALLY MODIFIED BY piggyBac TRANSPOSITION

Transposon-mediated transgenesis is a well-established tool for genome manipulation in small animal models. However, translation of this active transgenesis method to the large animal setting requires further investigation. We have previously demonstrated that a helper-independent piggyBac (PB) transposon system can efficiently transpose transgenes into the bovine genome [Alessio et al. 2014 Reprod. Domest. Anim. 49 (Suppl. 1), 8]. The aims of the current study were a) to investigate the effectiveness of a hyperactive version of the PB transposase, and b) to determine the ability of the genetically modified cells to support early embryo and fetal development upon somatic cell nuclear transfer (SCNT). Bovine fetal fibroblasts (BFF) were chemically transfected with either pmGENIE-3 (a helper-independent PB transposon conferring genes for hygromycin resistance and enhanced green fluorescent protein (EGFP); Urschitz et al. 2010 PNAS USA 107, 8117–8122), pmhyGENIE-3 (carrying an hyperactive version of the PB transposase; Marh et al. 2012 PNAS USA 109, 19 184–19 189), or pmGENIE-3/Δ PB (a control plasmid lacking a functional PB transposase). Upon transfection, cell cultures were subjected to 14 days of hygromycin selection. Antibiotic-resistant and EGFP+ colonies were counted and data analysed by ANOVA and Tukey's test. For SCNT, pmhyGENIE-3 and pmGENIE-3 polyclonal cell lines were selected by FACS and individual cells used as nuclear donors. Day 7 blastocysts were nonsurgically transferred to synchronized recipients. Conceptuses were recovered by Day 35 of gestation, observed under fluorescence excitation, and genotyped. The mean number of colonies in pmhyGENIE-3 group was significantly higher than those in pmGENIE-3 and the control group (324.0 ± 17.8 v. 100.0 ± 16.1 and 2.8 ± 0.8 respectively, n = 4–7; P < 0.05). The hyperactive transposase increased transgene integration efficiency 3.24 times compared with the conventional PB transposase. The SCNT and early fetal development data are summarised in Table 1. Phenotypic analysis revealed that both transgenic fetuses and the extraembryonic membranes expressed EGFP with no macroscopic evidence of variegated transgene expression. Molecular analysis by PCR confirmed that both fetuses carried the transposon DNA. Here, we demonstrate that a hyperactive version of the PB transposase is more active in bovine cells than the conventional PB transposase. In addition, SCNT embryos generated from genetically modified cells by the pGENIE transposon system can progress to early stages of fetal development. Table 1.SCNT and early fetal development of bovine fibroblasts transposed with piggyBac1 The financial support of UNRC, CONICET and ANPCyT from Argentina is gratefully acknowledged.

331 OPTIMIZATION OF BRANCHED 25kDa POLYETHYLENIMINE FOR EFFICIENT GENE DELIVERY IN BOVINE FETAL FIBROBLASTS

Cost-effective, highly efficient, and noncytotoxic transfection of bovine fetal fibroblasts (BFF) has proven difficult to achieve by regular chemical and physical methods. The aims of this study were to evaluate transient transfection efficiency and toxicity of commercially available branched 25 kDa polyethylenimine (25 kDa PEI, Sigma-Aldrich, St. Louis, MO, USA) and to optimize the transfection conditions leading to high percentages of PEI-transfected fibroblasts with minimum cytotoxic effects. Bovine fetal fibroblast (BFF) cells were seeded a day before transfection in 24-well plates at a density of 3 × 104 cells per well in DMEM with antibiotics and 10% SFB. When 70 to 90% confluence was reached, cells were washed with PBS and incubated in DMEM without antibiotics or SFB. For the transfection-mix preparation, increasing amounts of plasmidic DNA (pZsGreen1; 2 to 6 µg) were added to 50 µL of DMEM without antibiotics or SFB, incubated for 5 min at room temperature, and complexed with 0.5 to 4 µg of PEI (from 1 mg mL–1 solution) in 50 µL of PBS for 10 min. This transfection mix was added to the cell cultures and, 2 h later, 500 µL of DMEM with antibiotics and 10% SFB was added to each well. Detection of green fluorescent protein (GFP) expression by flow cytometry (reported as percentage of green fluorescent cells) was performed 48 h after transfection. Results were analysed by ANOVA and Tukey test and expressed as mean ± SEM (P < 0.05). We found no significant difference between the percentage of GFP-positive cells transfected with 1 or 2 µg of 25 kDa PEI at 2 µg of DNA/well (15.2 ± 1.3 v. 16.9 ± 0.9%, respectively; P > 0.05), whereas cells transfected with 1 or 2 µg of low-molecular-weight PEI (2 kDa) showed extremely low transfection efficiencies. Increasing the DNA load up to 6 µg significantly enhanced cell transfection (3.5- and 6-fold comparing 2 µg v. 4 µg and 6 µg of DNA, respectively; P < 0.05) at 1 and 2 µg of 25 kDa PEI/well. In order to evaluate the cytotoxic effect of PEI, cell viability was determined using the MTT assay in 96-well plates (cells/well), with each condition scaled down to replicate the effect of 2 kDa or 25 kDa PEI in a 24-well plate. The MTT results (expressed as % of the control) indicated that PEI became cytotoxic at concentrations equivalent to 2 and 4 µg/well (54.7 ± 3.4 and 18.5 ± 5.7, respectively), whereas 1 µg/well produced a slight detrimental effect on cell viability (90.0 ± 2.6). No evidence of cytotoxicity was observed when the BFF were incubated with 0.5 µg/well of 25 kDa PEI and 1 or 2 µg/well of 2 kDa PEI. To study if a combination of low- and high-molecular-weight PEI could improve transfection efficiency and reduce toxicity, we tested a mixture (1 : 1) of 2 kDa and 25 kDa PEI. Even though the 1 : 1 mixture was less cytotoxic, the efficiency of gene delivery was not improved. We conclude that, under our experimental conditions, the highest percentage of GFP-expressing cells with good viability was obtained when 1 µg of 25 kDa PEI was added per well. Therefore, branched 25 kDa PEI transfection represents an efficient, simple, and cost-effective alternative for gene delivery in bovine fibroblast cells in culture.

46 MEGANUCLEASE I-SceI ENHANCES STABLE TRANSGENE INTEGRATION IN CULTURED BOVINE FETAL FIBROBLASTS

Production of genetically modified large animals through somatic cell nuclear transfer (SCNT) requires genetic manipulation of cultured cells, which are subsequently used as nuclear donors to generate a transgenic animal. Stable transgene integration into the donor cell genome is an inefficient process that involves integration of transgenes in randomly occurring DNA double-strand breaks. Therefore, our objective was to evaluate transient and stable transfection in cultured bovine fetal fibroblasts (BFF) using a transgenic strategy based on the simultaneous presence of a meganuclease (I-SceI) and a transgene flanked by restriction sites for I-SceI. Bovine fetal fibroblasts (2.63 × 104 cells cm–2 in 24-well plates) were co-transfected with a plasmid vector (pBSII-I-SceI-ZsGreen1-Neo) carrying expression cassettes for ZsGreen1 (fluorescent protein) and neomycin resistance flanked by restriction sites for I-SceI along with an expression plasmid for I-SceI (pCBASce). As controls, BFF were co-transfected with pBSII-I-SceI-ZsGreen1-Neo plus a plasmid that lacks the I-SceI expression cassette (pCBA). Lipofectamine 2000 (Invitrogen) was used as the transfection reagent as per manufacturer’s instructions. Two different relationships of vector pBSII-I-SceI-ZsGreen1-Neo to pCBASce or pCBA (control) were tested: 1 : 1 and 1 : 3 (total amount of plasmid DNA per well was 500 ng). Transient transfection was evaluated by flow cytometry and reported as percentage of green fluorescent cells 72 h post-co-transfection. Stable integration of transgene sequences was assessed 21 days after co-transfection by determining the number of fluorescent cell colonies (FCC) that developed in selective media (DMEM + 250 µg mL–1 of G418). Data were analyzed by ANOVA and Tukey test and expressed as mean ± standard error of the mean. Flow cytometric analysis at 72 h post-transfection showed no statistical differences between the proportions of fluorescent cells in cultures co-transfected with pCBASce compared with those transfected with the control plasmid. The number of FCC developed from cultures co-transfected with pBSII-I-SceI-ZsGreen1-Neo plus pCBASce at a 1 : 1 ratio was 6.4-fold higher compared with those observed in the control group at the same ratio (8.00 ± 2.16 v. 1.25 ± 0.62 colonies; P < 0.05). However, there was no difference in the number of FCC formed at a plasmid ratio of 1 : 3 between the treatment (3.75 ± 1.03 colonies) and the control (2.70 ± 1.35 colonies; P > 0.05). Several transgenic BFF cell lines were generated by subculturing individual colonies. Polymerase chain reaction and Southern blotting confirmed that antibiotic-resistant and phenotypically positive colonies had integrated the ZsGreen1 transgene. Western blot analysis using an anti-HA antibody revealed a band of the expected size (30 kDa) in cells transfected with pCBASce. We conclude that I-SceI transgenesis significantly increases the functional integration of plasmid DNA into the bovine fibroblast genome as has been reported in embryos of other vertebrates, up to now by unknown mechanisms. This transgenic strategy should facilitate stable transfection of bovine fibroblasts to generate genetically modified animals though SCNT.

Erythrocyte aggregation in patients with systemic lupus erythematosus

Systemic Lupus Erythematosus (SLE) is an autoimmune, chronic inflammatory, non-organ specific disease. SLE patients present a high prevalence of thrombotic and arteriosclerotic disease. The aim of the present work was to study the erythrocyte aggregation kinetics, and the effect of plasma factors, namely, immunoglobulin and fibrinogen concentration, as well as cell factors such as deformability and erythrocyte membrane lipid fluidity on the erythrocyte aggregation, in SLE patients and healthy controls. The results show that SLE patients red blood cells aggregate at higher rate and the aggregates size are also greater than controls due to an increase of immunoglobulin and plasma fibrinogen. The negative correlation between aggregation parameters and rigidity index could point out that the altered deformability diminishes the erythrocyte aggregation. Correlation between rigidity index and anisotropy suggests that the decrease of membrane lipid fluidity might be a cause of deformability decrease. The erythrocyte aggregation increase in these patients could induce a decreased flow that might contribute to the thromboembolic process present in SLE patients.

Combinatorial approach for fabrication of coatings to control bacterial adhesion

Due to the high importance of bacterial infections in medical devices there is an increasing interest in the design of anti-fouling coatings. The application of substrates with controlled chemical gradients to prevent microbial adhesion is presented. We describe here the co-polymerization of poly(ethylene glycol) dimethacrylate with a hyperbranched multimethacrylate (H30MA) using a chemical gradient generator; and the resulting films were characterized with respect to their ability to serve as coating for biomedical devices. The photo-polymerized materials present special surface properties due to the hyperbranched structure of H30MA and phase separation at specific concentrations in the PEGDM matrix. This approach affords the investigation of cell response to a large range of different chemistries on a single sample. Two bacterial strains commonly associated with surgical site infections, Escherichia coli and Pseudomonas aeruginosa, have been cultured on these substrates to study their attachment behaviour. These gradient-coated samples demonstrate less bacterial adhesion at higher concentrations of H30MA, and the adhesion is substantially affected by the extent of surface phase segregation.

Influence of cation nature on stabilization of gold nanospecies in mordenites

Gold species deposited on NH4(+)- and H(+)-mordenites were studied by X-ray diffraction, xenon adsorption, NMR of 27Al and 129Xe, UV-Visible spectroscopy and TPR. Mordenite ion-exchange cations exert a significant effect on size distribution and electronic state of gold species supported on the zeolites. AuNH4M contains larger nanoparticles of gold on its external surface than AuHM because protonic form of zeolite has stronger sites for stabilization of gold nanospecies. In the case of NH4(+)-mordenite, Au clusters inside zeolite channels have bigger size and fill the side-pockets completely after gold deposition due to more complete reduction of gold entities, while in H(+)-mordenite only half the side-pockets are filled by gold species. H(+)-mordenite favors the stabilization of both small gold clusters and cations. Even after the reduction of gold by hydrogen flow at 100 degrees C, some gold species are not completely reduced and have certain effective charge (Au(n)delta+ clusters).

Microfluidic approaches for the fabrication of gradient crosslinked networks based on poly(ethylene glycol) and hyperbranched polymers for manipulation of cell interactions

High-throughput methods allow rapid examination of parameter space to characterize materials and develop new polymeric formulations for biomaterials applications. One limitation is the difficulty of preparing libraries and performing high-throughput screening with conventional instrumentation and sample preparation. Here, we describe the fabrication of substrate materials with controlled gradients in composition by a rapid method of micromixing followed by a photopolymerization reaction. Specifically, poly(ethylene glycol) dimethacrylate was copolymerized with a hyperbranched multimethacrylate (P1000MA or H30MA) in a gradient manner. The extent of methacrylate conversion and the final network composition were determined by near-infrared spectroscopy, and mechanical properties were measured by nanoindentation. A relationship was observed between the elastic modulus and network crosslinking density. Roughness and hydrophilicity were increased on surfaces with a higher concentration of P1000MA. These results likely relate to a phase segregation process of the hyperbranched macromer that occurs during the photopolymerization reaction. On the other hand, the decrease in the final conversion in H30MA polymerization reactions was attributed to the lower termination rate as a consequence of the softening of the network. Valvular interstitial cell attachment was evaluated on these gradient substrates as a demonstration of studying cell morphology as a function of the local substrate properties. Data revealed that the presence of P1000MA affects cell–material interaction with a higher number of adhered cells and more cell spreading on gradient regions with a higher content of the multifunctional crosslinker.

MDMA causes a redistribution of serotonin transporter from the cell surface to the intracellular compartment by a mechanism independent of phospho-p38-mitogen activated protein kinase activation

3,4-methylenedioxymethamphetamine (MDMA) causes long-term serotonin depletion and reduced serotonin transporter (SERT) function in humans and in animal models. Using quantitative Western blotting and real-time PCR, we have shown that total SERT protein in the striatum and nucleus accumbens and mRNA levels in the dorsal raphe nucleus were not significantly changed following MDMA exposure in rats (4 x 2 h i.p. injections, 10 mg/kg each). In mouse neuroblastoma (N(2)A) cells transiently expressing green fluorescent protein-tagged human SERT (GFP-hSERT), we have shown redistribution of SERT from the cell surface to intracellular vesicles on exposure to MDMA using cell surface biotinylation, total internal reflection fluorescence microscopy (TIRFM) and live-cell confocal microscopy. To investigate the mechanism responsible for SERT redistribution, we used specific antibodies to phospho-p38-mitogen activated protein kinase (p38 MAPK), a known signalling pathway involved in SERT membrane expression. We found that p38 MAPK activation was not involved in the MDMA-induced redistribution of SERT from the cell-surface to the cell interior. A loss of SERT from the cell surface on acute exposure to MDMA may contribute to the decreased SERT function seen in rats exposed to MDMA.

Subcutaneous IGF-1 is not beneficial in 2-year ALS trial

BACKGROUND

Previous human clinical trials of insulin-like growth factor type I (IGF-1) in amyotrophic lateral sclerosis (ALS) have been inconsistent. This phase III, randomized, double-blind, placebo-controlled study was undertaken to address whether IGF-1 benefited patients with ALS.

METHODS

A total of 330 patients from 20 medical centers were randomized to receive 0.05 mg/kg body weight of human recombinant IGF-1 given subcutaneously twice daily or placebo for 2 years. The primary outcome measure was change in their manual muscle testing score. Secondary outcome measures included tracheostomy-free survival and rate of change in the revised ALS functional rating scale. Intention to treat analysis was used.

RESULTS

There was no difference between treatment groups in the primary or secondary outcome measures after the 2-year treatment period.

CONCLUSIONS

Insulin-like growth factor type I does not provide benefit for patients with amyotrophic lateral sclerosis.

Characterization of dental fillings found in skulls from individuals buried in San Jeronimos Church, New Spain: historical and archaeological evidences

Repair of teeth during the XIX century was often a very costly and painful procedure. During this period, restoration of teeth was a procedure limited only to those who could afford such care. In this study we analyzed teeth from a skull sample found in San Jeronimo's Church. The characterization of molar fillings was made with techniques such as X-ray fluorescence, X-ray diffraction and electron microscopy. The purpose of this investigation was to establish technical procedures for analysis, and to discuss the results within the context of the socioeconomic status of these individuals and the written descriptions of the dental practice during the XIX century.

Cobalt sorption in silica-pillared clays

Silicon pillared samples were prepared following conventional and microwave irradiation methods. The samples were characterized and tested in cobalt sorption. Ethylenediammine was added before cobalt addition to improve the amount of cobalt retained. The amount of cobalt introduced in the original clay in the presence of ethylenediammine was the highest. In calcined pillared clays the cobalt retention with ethylenediammine was lower (ca. 40%). In all cases the presence of ethylenediammine increased twice the amount of cobalt sorption measured for aqueous solutions.

Efficient adenoviral-mediated gene delivery into porcine mesenchymal stem cells

Mesenchymal stem cell (MSC) mediated gene therapy research has been conducted predominantly on rodents. Appropriate large animal models may provide additional safety and efficacy information prior to human clinical trials. The objectives of this study were: (a) to optimize adenoviral transduction efficiency of porcine bone marrow MSCs using a commercial polyamine-based transfection reagent (GeneJammer, Stratagene, La Jolla, CA), and (b) to determine whether transduced MSCs retain the ability to differentiate into mesodermal lineages. Porcine MSCs (pMSCs) were infected under varying conditions, with replication-defective adenoviral vectors carrying the GFP gene and GFP expression analyzed. Transduced cells were induced to differentiate in vitro into adipogenic, chondrogenic, and osteogenic lineages. We observed a 5.5-fold increase in the percentage of GFP-expressing pMSCs when adenovirus type 5 carrying the adenovirus type 35 fiber (Ad5F35eGFP) was used in conjunction with GeneJammer. Transduction of pMSCs at 10.3-13.8 MOI (1,500-2,000 vp/cell) in the presence of Gene Jammer yielded the highest percentage of GFP-expressing cells ( approximately 90%) without affecting cell viability. A similar positive effect was detected when pMSCs were infected with an Ad5eGFP vector. Presence of fetal bovine serum (FBS) during adenoviral transduction enhanced vector-encoded transgene expression in both GeneJammer-treated and control groups. pMSCs transduced with adenovirus vector in the presence of GeneJammer underwent lipogenic, chondrogenic, and osteogenic differentiation. Addition of GeneJammer during adenoviral infection of pMSCs can revert the poor transduction efficiency of pMSCs while retaining their pluripotent differentiation capacity. GeneJammer-enhanced transduction will facilitate the use of adenoviral vectors in MSC-mediated gene therapy models and therapies.