Intermediate filaments in the heart: The dynamic duo of desmin and lamins orchestrates mechanical force transmission

The intermediate filament (IF) cytoskeleton supports cellular structural integrity, particularly in response to mechanical stress. The most abundant IF proteins in mature cardiomyocytes are desmin and lamins. The desmin network tethers the contractile apparatus and organelles to the nuclear envelope and the sarcolemma, while lamins, as components of the nuclear lamina, provide structural stability to the nucleus and the genome. Mutations in desmin or A-type lamins typically result in cardiomyopathies and recent studies emphasized the synergistic roles of desmin and lamins in the maintenance of nuclear integrity in cardiac myocytes. Here we explore the emerging roles of the interdependent relationship between desmin and lamins in providing resilience to nuclear structure while transducing extracellular mechanical cues into the nucleus.

Breast-to-brain metastasis is exacerbated with chemotherapy through blood-cerebrospinal fluid barrier and induces Alzheimer's-like pathology

Control of breast-to-brain metastasis remains an urgent unmet clinical need. While chemotherapies are essential in reducing systemic tumor burden, they have been shown to promote non-brain metastatic invasiveness and drug-driven neurocognitive deficits through the formation of neurofibrillary tangles (NFT), independently. Now, in this study, we investigated the effect of chemotherapy on brain metastatic progression and promoting tumor-mediated NFT. Results show chemotherapies increase brain-barrier permeability and facilitate enhanced tumor infiltration, particularly through the blood-cerebrospinal fluid barrier (BCSFB). This is attributed to increased expression of matrix metalloproteinase 9 (MMP9) which, in turn, mediates loss of Claudin-6 within the choroid plexus cells of the BCSFB. Importantly, increased MMP9 activity in the choroid epithelium following chemotherapy results in cleavage and release of Tau from breast cancer cells. This cleaved Tau forms tumor-derived NFT that further destabilize the BCSFB. Our results underline for the first time the importance of the BCSFB as a vulnerable point of entry for brain-seeking tumor cells post-chemotherapy and indicate that tumor cells themselves contribute to Alzheimer's-like tauopathy.

aVR ST-segment changes and prognosis of ST-segment elevation myocardial infarction

BACKGROUND

Clinical importance of aVR lead-related changes in predicting the prognosis of acute myocardial infarction remains uncertain. The present study aimed to assess the value of ST-segment changes in aVR lead and the outcome and sequels of the first episode of acute ST-segment elevation myocardial infarction.

METHODS

This prospective cohort study was conducted on patients suffering first episode of ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention. Information was collected through hospital-recorded files reading. The electrocardiogram (ECG) was taken from the patients upon entering the hospital and followed-up for 30 days to assess cardiovascular complications.

RESULTS

In patients with anterior STEMI, with the use of multivariate analysis, admission aVR ST elevation ≥1 mm was found to be a strong and independent predictor of major cardiovascular adverse events (MACE) within 30 days of discharging (P value for trend .002). In patients with inferior (± RV) ST-segment elevation myocardial infarction (STEMI), with the use of multivariate analysis, admission aVR ST depression ≥1 mm was found to be a strong and independent predictor of MACE within 30 days of discharging (P value for trend .01).

CONCLUSION

In patients with anterior STEMI, admission aVR STE ≥1 mm was found to be a strong and independent predictor of MACE within 30 days of discharging. On the other hand, in patients with inferior STEMI, aVR ST depression ≥1 mm was found to be a strong and independent predictor of MACE within 30 days of discharging.

How accurate is frozen section pathology compared to permanent pathology in detecting involved margins and lymph nodes in breast cancer?

Background

Frozen section (FS) pathology has multiple limitations, and different institutions report variable experiences with the use of FS for diagnosis of tumor involvement. We aimed to compare the FS accuracy with that of permanent pathology (gold standard) regarding marginal involvement and lymph node status using data from the largest breast cancer registry in Iran.

Methods

In this retrospective study, women who had both FS and permanent pathology reports were included. The two pathology reports were cross compared with regard to the involvement of tumor margins and sentinel lymph nodes.

Results

Overall, 2786 patients entered the study. Mean age of patients was 48.96±11.44 years. A total of 1742 margins were analyzed. Accordingly, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FS pathology for detection of involvement of involved margins were 78.49%, 97.63%, 65.1%, and 98.7%, respectively. The accuracy and area under the curve (AUC) for FS pathology were 96.61% and 0.73 (95% CI: 0.64–0.831), respectively.

A total of 1702 sentinel lymph node biopsies were assessed. Sensitivity, specificity, PPV, and NPV, of FS pathology for detection of lymph node involvement, were 87.1%, 98%, 95.5%, and 93.3%, respectively. Accuracy and AUC of FS for diagnosis of involved lymph nodes were 94.1% and 0.926 (95% CI: 0.909–0.942), respectively.

Conclusion

Frozen pathology is a suitable method for identifying involved sentinel lymph nodes in patients with breast cancer, but this method has a less than optimum efficacy for detecting and confirming marginal involvement.

Cardiovascular diseases burden in COVID-19: Systematic review and meta-analysis

BACKGROUND

High rate of cardiovascular disease (CVD) have been reported among patients with novel coronavirus disease (COVID-19). Meanwhile there were controversies among different studies about CVD burden in COVID-19 patients. Hence, we aimed to study CVD burden among COVID-19 patients, using a systematic review and meta-analysis.

METHODS

We have systematically searched databases including PubMed, Embase, Cochrane Library, Scopus, Web of Science as well as medRxiv pre-print database. Hand searched was also conducted in journal websites and Google Scholar. Meta-analyses were carried out for Odds Ratio (OR) of mortality and Intensive Care Unit (ICU) admission for different CVDs. We have also performed a descriptive meta-analysis on different CVDs.

RESULTS

Fifty-six studies entered into meta-analysis for ICU admission and mortality outcome and 198 papers for descriptive outcomes, including 159,698 COVID-19 patients. Results of meta-analysis indicated that acute cardiac injury, (OR: 13.29, 95% CI 7.35-24.03), hypertension (OR: 2.60, 95% CI 2.11-3.19), heart Failure (OR: 6.72, 95% CI 3.34-13.52), arrhythmia (OR: 2.75, 95% CI 1.43-5.25), coronary artery disease (OR: 3.78, 95% CI 2.42-5.90), and cardiovascular disease (OR: 2.61, 95% CI 1.89-3.62) were significantly associated with mortality. Arrhythmia (OR: 7.03, 95% CI 2.79-17.69), acute cardiac injury (OR: 15.58, 95% CI 5.15-47.12), coronary heart disease (OR: 2.61, 95% CI 1.09-6.26), cardiovascular disease (OR: 3.11, 95% CI 1.59-6.09), and hypertension (OR: 1.95, 95% CI 1.41-2.68) were also significantly associated with ICU admission in COVID-19 patients.

CONCLUSION

Findings of this study revealed a high burden of CVDs among COVID-19 patients, which was significantly associated with mortality and ICU admission. Proper management of CVD patients with COVID-19 and monitoring COVID-19 patients for acute cardiac conditions is highly recommended to prevent mortality and critical situations.

Chronic neurological diseases and COVID-19: Associations and considerations

The 2019 novel coronavirus pandemic, severe acute respiratory syndrome CoV-2 (COVID-19), has been a worldwide urgent public health threat, resulting in six-hundred seventy thousand deaths to date. The COVID-19 pandemic has led to a series of public health challenges. One such challenge is the management of diseases such as chronic neurological diseases during an epidemic event. COVID-19 affects all kinds of people, including older people with chronic underlying diseases, who are particularly at risk of severe infection or even death. Chronic neurological diseases such as epilepsy, dementia, Parkinson's disease (PD), and multiple sclerosis (MS) are frequently associated with comorbidities; thus, these patients are in the high-risk category. Therefore, in this article, we review associations and challenges the people with epilepsy, dementia, PD, and MS faces during the COVID-19 pandemic and suggest approaches to provide consensus recommendations on how to provide the best possible care.

AB0892 PREGNANCY AND LACTATION ASSOCIATED OSTEOPOROSIS: FIRST CASE SERIES IN IRAN

Background:

Osteoporosis is a common rheumatologic disorder in postmenopausal women which could lead to morbidities later in life. However, this condition has not been properly studied in premonapausal women.

During pregnancy, the fetus needs a total of 30 grams of calcium for its skeleton and during lactation, 200 mg of calcium is secreted in the breast milk per day which the mother acquires by doubling its intestinal absorption rate. If the calcium intake of the mother is not sufficient to satisfy the fetus’ needs, it will be provided by bone resorption, which will decrease the maternal calcium reserves [1].

Pregnancy and Lactation Associated Osteoporosis (PLAO) is a rare condition associated with pregnancy that should be considered in premenopausal women. The most commonly affected sites are the vertebrae and, more rarely, the hips, pubic rami and ribs [2].

An important complication of osteoporosis is fracture and a preemptive diagnosis and treatment thereof, can have drastic effects on the quality of life.

Objectives:

Our objective is to document the relevant risk factors, present signs and symptoms, course of illness, and response to treatment in three cases of PLAO. It is quite possible that osteoporosis in pregnancy

and lactation is more frequent than recognized, simply because it is only recognized when an-unexpected fracture occurs[3]. Thus, in this article we are presenting three cases that showcase the need for more rigorous research on PLAO risk factors, the need for screening in high risk patients, and the advantages of early detection in patients’ outcome.

Methods:

The clinical cases of the patients whose PLAO diagnoses had been confirmed by both a radiologist and a rheumatologist in the past year was extracted. Information related to demographic indices, clinical manifestations, and the treatment methods was evaluated and compared.

Results:

In the past year, three patients with a chief complaint of low-back pain have visited our clinic. The first, a 22-year-old woman with a nursing history of 2 months, the next one, a 31-year-old woman with a nursing history of 3 months, and the last, a 22-year-old woman with a nursing history of 4 months. All three patients had low back pain and tenderness. Two out of three patients had deficient vitamin D levels and the other had a normal one. All three patients had low BMD in lumbar vertebra and MRI imagings indicative of osteoporotic fracture.

Table 1.

General and pregnancy-relatedcharacteristics of the case studies

VariablesCase 1Case 2Case 3Age223122Nursing duration2 months3months4monthsBMD(lumbar spine)-3.6-3.5-3.1Vitamin D level12.6(ng/ml)31.6(ng/ml)8(ng/ml)FractureT12,L1T4,5,6,7,10,L2L1,2,3,4,5

Conclusion:

Since the symptoms of PLAO are often confused with pain in other low-back pain conditions associated with pregnancy, PLAO is a mostly overlooked diagnosis[4]. It is only recognized when an unexpected fracture occurs [3]Therefore, high risk patients with less severe symptoms are usually not diagnosed and thusly, should undergo a proper screening test, so that they are recognized early and the morbid sequelae are averted.

References:

[1]Kovacs, C. S., and S. H. Ralston. “Presentation and Management of Osteoporosis Presenting in Association with Pregnancy or Lactation.”Osteoporosis International, vol. 26, no. 9, 2015, pp. 2223–2241., doi:10.1007/s00198-015-3149-3.

[2]Gregorio, Silvana Di, et al. “Osteoporosis with Vertebral Fractures Associated with Pregnancy and Lactation.”Nutrition, vol. 16, no. 11-12, 2000, pp. 1052–1055., doi:10.1016/s0899-9007(00)00430-5.

[3]Bartl, Reiner, and Christoph Bartl. “The Osteoporosis Manual.” 2019, doi:10.1007/978-3-030-00731-7.

[4]Eroglu, Semra, et al. “Evaluation of Bone Mineral Density and Its Associated Factors in Postpartum Women.”Taiwanese Journal of Obstetrics and Gynecology, vol. 58, no. 6, 2019, pp. 801–804., doi:10.1016/j.tjog.2019.09.013.

Disclosure of Interests:

None declared

Immunomodulation in systemic lupus erythematosus: induction of M2 population in monocyte-derived macrophages by pioglitazone

Macrophages have recently gained attention in systemic lupus erythematosus (SLE) pathogenesis for their role in the anti-inflammatory clearance of apoptotic cells. The M1/M2 polarization of macrophages improves efferocytic capability. Peroxisome proliferator-activated receptor γ is proposed to function in the expansion of the M2 subpopulation. Pioglitazone is a peroxisome proliferator-activated receptor γ agonist with a variety of anti-inflammatory effects. In this paper, we investigated the ex vivo alterations of monocyte-derived macrophages of 15 newly diagnosed SLE patients and 10 normal subjects triggered by apoptotic cells among SLE patients following pioglitazone treatment. The phagocytosis capacity of macrophages and M1/M2 polarization (CD86/CD163) was evaluated. The supernatants were also analyzed for the expression of interleukin (IL)-10, IL-12, transforming growth factor β1 and TNF-α. The mRNA expression of IL-1β and mannose receptor C-type 1 were also quantified among treated and non-treated monocyte-derived macrophages. We found that efferocytosis is defective among monocyte-derived macrophages of SLE patients and might be a major underlying mechanism involved in the sustained inflammation. Pioglitazone could enhance alternative activation of monocyte-derived macrophages and consequently immunomodulation in these patients.