Targeted inhibition of biogenic amine-producing strains by spice extracts and control of biogenic amine accumulation in reduced-salt dry sausages

This study aimed to screen spice extracts that can target the inhibition of biogenic amine (BA)-producing bacteria and reduce the BA accumulation in reduced-salt dry sausages. A total of 59 bacterial strains were isolated from reduced-salt dry sausages; among them, three isolates, namely, Staphylococcus epidermidis S1, S. saprophyticus S2, and S. edaphicus S3, had the strongest ability to produce BA. Eight spice extracts, i.e. Angelica dahurica, cinnamon, ginger, clove, fennel, Amomum, nutmeg, and orange peel, were extracted. The inhibition zone diameter and minimum inhibitory concentration indicated that A. dahurica, Amomum, and clove elicited the strongest inhibitory effect on BA-producing strains. Growth kinetics showed the strongest inhibitory effect of clove extracts, followed by Amomum and A. dahurica. In the medium system, clove extract was the most effective in controlling the total BA content by inhibiting of BA-producing strains S. epidermidis S1, S. saprophyticus S2, and S. edaphicus S3; their contents were reduced by 23.74%, 31.05% and 21.37%, respectively. In the dry sausage system, the control of BA accumulation by clove was quite prominent, and the total BA content was reduced from 373.70 mg/kg to 259.05 mg/kg on day 12.

Improving the bacterial community, flavor, and safety properties of northeastern sauerkraut by inoculating autochthonous Levilactobacillus brevis

The effect of Levilactobacillus brevis as a starter in northeastern sauerkraut fermentation is still unknown, and further evaluation is worthwhile. Hence, this study aimed to evaluate the effect of autochthonous L. brevis inoculation on the bacterial community succession and formation of flavor and harmful substances in sauerkrauts. Inoculation with L. brevis lowered the pH and increased the total acid content of sauerkrauts (P < 0.05). The nitrite content of the inoculated sauerkraut was significantly lower than that of control (P < 0.05). Moreover, the spoilage bacteria of the inoculated sauerkraut were decreased and nitrogen metabolism was improved. The contents of aldehydes, alcohols, esters, acids, and alkanes increased significantly (P < 0.05), and the sensory attributes such as aroma, sourness, and gloss were also improved. L. brevis was positively and negatively correlated with flavor metabolites and nitrite, respectively, which proved to be a potential starter culture to manufacture sauerkraut.

Screening and evaluating microorganisms with broad-spectrum biogenic amine-degrading ability from naturally fermented dry sausage collected from Northeast China

This study aimed to screen autochthonous strains with broad-spectrum biogenic amine (BA) degradation ability from traditional dry sausages and to evaluate their BA-degrading ability in dry sausages. A total of 120 strains were isolated from dry sausages collected from various regions in Northeast China, and 35 of 120 isolates were identified as non-BA producing strains by the in vitro agar method. The random amplified polymorphic DNA polymerase chain reaction technique genotyped these 35 isolates into 18 biotypes. Moreover, high performance liquid chromatography (HPLC) quantification showed that six strains (Latilactobacillus sakei MDJ6; Lactiplantibacillus plantarum SH7; Weissella hellenica DQ9; Staphylococcus saprophyticus JX18 and SYS8; and Macrococcus caseolyticus SYS11) of the 18 biotypes exhibited broad-spectrum BA-degrading ability, all of which had various levels of amine oxidase activity with monoamine oxidase and diamine oxidase activities ranged of 6.60-619.04 and 26.32-352.81 U/mg protein, respectively. These six strains were subsequently inoculated into dry sausages and the results showed that they exhibited varying degrees of BA-degrading ability, of which strain Lat. sakei MDJ6 allowed to have less BA production on dry sausage with a final concentration of 61.33 mg/kg.

Effect of Yeast Inoculation on the Bacterial Community Structure in Reduced-Salt Harbin Dry Sausages: A Perspective of Fungi-Bacteria Interactions

Yeast strains are promising starters to compensate for the flavor deficiencies of reduced-salt dry sausages, but their influence on the bacterial community's structure has not yet been clarified. In this study, the effect of separately inoculating Pichia kudriavzevii MDJ1 (Pk) and Debaryomyces hansenii HRB3 (Dh) on the bacterial community structure in reduced-salt dry sausage was investigated. The results demonstrated that the inoculation of two yeast strains significantly reduced the pH, and enhanced the total acid content, lactic acid bacteria (LAB) counts, and total bacterial counts of reduced-salt sausages after a 12-day fermentation (p < 0.05). Furthermore, high-throughput sequencing results elucidated that the inoculation of yeast strains significantly affected the bacterial composition of the dry sausages. Especially, the relative abundance of bacteria at the firmicute level in the Pk and Dh treatments exhibited a significant increase of 83.22% and 82.19%, respectively, compared to the noninoculated reduced-salt dry sausage treatment (Cr). The relative abundance of Latilactobacillus, especially L. sakei (0.46%, 2.80%, 65.88%, and 33.41% for the traditional dry sausage (Ct), Cr, Pk, and Dh treatments, respectively), increased significantly in the reduced-salt sausages inoculated with two yeast strains. Our work demonstrates the dynamic changes in the bacterial composition of reduced-salt sausages inoculated with different yeast strains, which could provide the foundation for the in-depth study of fungi-bacteria interactions in fermented foods.

Potential low toxic alternative for Na-Cl cotransporter inhibition: A diuretic effect and mechanism study of Pyrrosia petiolosa

BACKGROUND

Hydrochlorothiazide, a diuretic commonly used for the treatment of hypertension, is often associated with serious metabolic side effects. Pyrrosia petiolosa (Christ) Ching is a traditional Chinese medicine that possesses diuretic properties, without any obvious side effects.

AIM

To evaluate the diuretic effect of P. petiolosa (Christ) Ching and to elucidate its underlying mechanism of action.

METHODS

Extracts obtained from different polar components of P. petiolosa (Christ) Ching were analyzed for toxicity in a Kunming mouse model. The diuretic effects of the extracts were compared to that of hydrochlorothiazide in rats. In addition, compound isolation procedures, cell assays of Na-Cl cotransporter inhibition and rat diuretic test of monomeric compounds were conducted to identify the active ingredients in the extract. Subsequently, homology modeling and molecular docking were performed to explain the reason behind the diuretic activity observed. Finally, LC-MS analysis was used to elucidate the underlying mechanism of action of P. petiolosa (Christ) Ching.

RESULTS

No toxicity was observed in mice administered P. petiolosa (Christ) Ching extracts. The ethyl acetate fraction showed the most significant diuretic effect. Similar results were obtained during the analysis for Na+ content in rat urine. Further separation of P. petiolosa (Christ) Ching components led to the isolation of methyl chlorogenate, 2',3'-dihydroxy propyl pentadecanoate, and β-carotene. Results from cell assays showed that the Na-Cl cotransporter inhibitory activity of methyl chlorogenate was greater than that of hydrochlorothiazide. This result was again confirmed by the diuresis tests of monomeric compounds in rats. The molecular simulations explain the stronger interactions between the methyl chlorogenate and Na-Cl cotransporter. Of the compounds determined using LC-MS analysis, 185 were identified to be mostly organic acids.

CONCLUSIONS

P. petiolosa possesses significant diuretic activities without any obvious toxicity, with least two possible mechanisms of action. Further study on this herb is warranted.

Analysis and comparison of the quality and flavour of traditional and conventional dry sausages collected from northeast China

In this study, the physicochemical properties and flavour profile of traditional dry sausages (T-SH, T-DXAL, T-HG, T-MDJ, T-HRB) collected from various wet markets were compared with those of conventional dry sausages (C-QL, C-ND, C-YSD, C-YC, C-HRL) collected from various food companies in northeast China. Traditional dry sausages were characterised by a low moisture content, a low water activity, and a high shear force after a long fermentation time compared with conventional dry sausages. Electronic nose and electronic tongue signals combined with chemometrics methods were applied for a comprehensive qualitative analysis of the odour and taste of dry sausages. A total of 61 volatile compounds were identified using gas chromatography-mass spectrometry, and the multivariate chemometrics analysis confirmed the difference in volatile compounds between traditional and conventional samples. Moreover, the sensory evaluation revealed that conventional dry sausages lacked the characteristic fermented flavour of traditional dry sausages.

A simple and convenient model combining multiparametric MRI and clinical features to predict tumour-infiltrating lymphocytes in breast cancer

AIM

To develop a simple and convenient method based on multiparametric magnetic resonance imaging (MRI) and clinical features to non-invasively predict tumour-infiltrating lymphocytes (TILs) in breast cancer (BC) and to explore the relationship between TIL levels and disease-free survival (DFS).

MATERIALS AND METHODS

A total of 172 BC patients were enrolled between November 2017 and June 2021 in this retrospective study. The patients were divided into high (≥10%) and low (<10%) TIL groups. Clinicopathological data were collected. MRI features were reviewed by two radiologists. Predictors associated with TILs were determined by using multivariable logistic regression analyses. Kaplan-Meier survival curves based on TIL levels were used to estimate DFS.

RESULTS

A total of 102 patients with low TILs and 70 patients with high TILs were included in the study. Tumour size (odds ratio [OR], 1.040; 95% confidence interval [CI]: 1.006, 1.075; p=0.020), apparent diffusion coefficient (ADC; OR, 1.003; 95% CI: 1.001, 1.005; p=0.015), clinical axillary lymph node status (CALNS; OR, 3.222; 95% CI: 1.372,7.568; p=0.007), and enhancement pattern (OR, 0.284; 95% CI: 0.143, 0.563; p<0.001) were independently associated with TIL levels. These features were used in the ALSE model (where A is ADC, L is CALNS, S is size, and E is enhancement pattern). High TILs were associated with better DFS (p=0.016).

CONCLUSION

The ALSE model derived from multiparametric MRI and clinical features could non-invasively predict TIL levels in BC, and high TILs were associated with longer DFS, especially in human epidermal growth factor receptor 2 (HER2)-positive BC and triple-negative BC (TNBC).

Triple-negative breast cancer: predictive model of early recurrence based on MRI features

AIM

To develop an integrated model based on preoperative magnetic resonance imaging (MRI) features for predicting early recurrence in patients with triple-negative breast cancer (TNBC).

MATERIALS AND METHODS

Women with TNBC who underwent breast MRI and surgery between 2009 and 2019 were evaluated retrospectively. Two breast radiologists reviewed MRI images independently based on the Breast Imaging Reporting and Data System Lexicon (BI-RADS), and classified the breast oedema scores on T2-weighted imaging (WI) as no oedema, peritumoural oedema, prepectoral oedema, or subcutaneous oedema. The relationship between disease-free survival (DFS) and MRI features was analysed by Cox regression, and a nomogram model was generated based on the results.

RESULTS

150 patients with TNBC were included and divided into a training cohort (n=78) and validation cohort (n=72). MRI features including subcutaneous oedema and rim enhancement showed a tendency to worsen DFS in univariate analysis. Multivariate analysis showed that subcutaneous oedema (p=0.049, HR [95% confidence interval {CI} = 8.24 [1.01-67.52]) and rim enhancement (p=0.016, HR [95% CI] = 4.38 [1.32-14.54]) were independent predictors for DFS. In the nomogram, the areas under the curves (AUCs) of the training cohort was 0.808, and that of the validation cohort was 0.875.

CONCLUSION

The presence of subcutaneous oedema or rim enhancement on preoperative breast MRI was shown to be a good predictor of poor survival outcomes in patients with TNBC.

Exploring potential correlations between bacterial communities, organic acids, and volatile metabolites of traditional fermented sauerkraut collected from different regions of Heilongjiang Province in Northeast China

In this study, the bacterial communities and flavor metabolites of 27 traditional naturally fermented sauerkraut samples collected from nine regions of Heilongjiang Province in Northeast China were investigated. The dominant genera were Lactobacillus, Pseudomonas, Alcaligenes, Arcobacter, Pseudarcobacter, Lactococcus, Comamonas, Pediococcus, Prevotella, and Insolitispirillum. A total of 148 volatile compounds were detected in seven categories; esters and acids were the most abundant volatiles. Additionally, the highest content (15.96 mg/g) of lactic acid was detected in YC1. Acetic acid, oleic acid, palmitic acid, elaidic acid, and dehydroacetic acid were the key differential volatile compounds, which may be related to the bacterial communities. Spearman's correlation analysis revealed that Lactococcus and Lactobacillus were significantly positively correlated with flavor metabolites, suggesting that they may play a more significant role in flavor formation. The results of this study can help in the development of better quality of fermented vegetables.

[Low-frequency fluctuation amplitude changes in resting-state brain functional magnetic resonance imaging and its correlation with clinical hearing levels in patients with unilateral hearing impairment]

Objective: To investigate low-frequency fluctuation amplitude changes in resting-state brain fMRI and its correlation with clinical hearing levels in patients with clinical hearing level in patients with unilateral hearing impairment. Methods: Forty-five patients with unilateral hearing impairment[12 males and 33 females, aged 36-67 (46.0±9.7) years], and 31 controls with normal hearing[9 males and 22 females, aged 36-67 (46.0±10.1) years], were retrospectively included. All subjects underwent blood oxygen level-dependent (BOLD) resting-state functional magnetic resonance imaging and high-resolution T1-weighted imaging. The patients were divided into the left-sided hearing impaired group(24 cases), and the right-sided hearing impaired group(21 cases). After data being preprocessed, differences in low frequency amplitude (ALFF) metrics between the evaluated patients and controls were calculated and analyzed, and the statistics were corrected for Gaussian random field (GFR). Results: Overall comparative analysis of patients with hearing impairment showed that one-way ANOVA among the three groups showed abnormal ALFF values only in the right anterior cuneiform lobe (GRF adjusted P=0.002). The ALFF value of the hearing impaired group was higher than that of the control group in one cluster (peak coordinates: X=9, Y=-72, Z=48, T=5.82), involving the left occipital gyrus, right anterior cuneiform lobe, left superior cuneiform lobe, left superior parietal gyrus, and left angular gyrus (GRF adjusted P=0.031). The ALFF value of the hearing impaired group was lower than that of the control group in three clusters (peak coordinates: X=57, Y=-48, Z=-24; T=-4.99; X=45, Y=-66, Z=0, T=-4.06; X=42, Y=-12, Z=36, T=-4.03), involving the right inferior temporal gyrus, the right middle temporal gyrus, and the right precentral gyrus (GRF adjusted P=0.009). Compared with the control group, the ALFF value of the left hearing impairment group was significantly higher than that of the control group in one cluster (peak coordinates: X=-12, Y=-75, Z=45, T=5.78), involving the left anterior cuneiform lobe, right anterior cuneiform lobe, left middle occipital gyrus, left superior parietal gyrus, left superior occipital gyrus, left cuneiform lobe, and right cuneiform lobe (P=0.023 after GRF correction). Compared with the control group, the right hearing impairment group had a significantly higher ALFF value in one cluster (peak coordinates: X=9, Y=-46, Z=22, T=6.06), involving the left middle occipital gyrus, right anterior cuneiform lobe, left cuneiform lobe, right cuneiform lobe, left superior occipital gyrus, and right superior occipital gyrus (GRF adjusted P=0.022); The brain area with reduced ALFF values is located in the right inferior temporal gyrus (GRF adjusted P=0.029). Spearman's two-tailed correlation analysis between ALFF values and pure tone average in the abnormal brain regions showed that ALFF values in the abnormal brain regions correlated to some extent with the pure tone average (PTA) only in the left-sided hearing impaired group(PTA=2 000 Hz, r=0.318,P=0.033;PTA=4 000 Hz,r=0.386,P=0.009). Conclusion: The abnormal neural activity within the brain are different in patients with left-sided and right-sided hearing impairment, and the severity of hearing impairment is related to the difference in functional integration of brain regions.

A computational model for the transit of a cancer cell through a constricted microchannel

We propose a three-dimensional computational model to simulate the transient deformation of suspended cancer cells flowing through a constricted microchannel. We model the cell as a liquid droplet enclosed by a viscoelastic membrane, and its nucleus as a smaller stiffer capsule. The cell deformation and its interaction with the suspending fluid are solved through a well-tested immersed boundary lattice Boltzmann method. To identify a minimal mechanical model that can quantitatively predict the transient cell deformation in a constricted channel, we conduct extensive parametric studies of the effects of the rheology of the cell membrane, cytoplasm and nucleus and compare the results with a recent experiment conducted on human leukaemia cells. We find that excellent agreement with the experiment can be achieved by employing a viscoelastic cell membrane model with the membrane viscosity depending on its mode of deformation (shear versus elongation). The cell nucleus limits the overall deformation of the whole cell, and its effect increases with the nucleus size. The present computational model may be used to guide the design of microfluidic devices to sort cancer cells, or to inversely infer cell mechanical properties from their flow-induced deformation.

POS0558 A INFLAMMATORY FACTOR-BASED NOMOGRAM PREDICTS FIRST REMISSION TIME OF RHEUMATOID ARTHRITIS PATIENTS WITH BASELINE GALECTIN-9

Background

Rheumatoid arthritis (RA) is an autoimmune disease. The core treatment principle of RA is to achieve remission or low disease activity as soon as possible to ensure optimal outcomes. Predicting the first remission time according to the patient’s risk factors is very important for the choice of treatment scheme.

Objectives

We aimed to verify the prognostic value of inflammatory factors in RA and establish a nomogram based on Human Interleukin-6(IL-6), Galectin-9(Gal-9)and disease activity to predict the first remission time after conventional synthetic DMARDstreatment.

Methods

184 RA active patients(DAS28-ESR> 3.2, ACR 1987 criteria or EULAR 2010 criteria) were enrolled in the rheumatology department of Qilu Hospital of Shandong University from June 2014 to June 2020.129 patients were assigned to the development cohort and 55 patients were assigned to the validation cohort randomly. Baseline clinical data and plasma were collected. The expressions of Tumour Necrosis Factor α (TNF-α), Vascular Endothelial Growth Factor (VEGF), IL-6 and Gal-9 in plasma of RA patients were detected by ELISA. All patients were treated with csDMARDs and we recorded activity of each follow-up visit until 36 months. Lasso regression and Cox regression analysis were used to screen the 14 variables (including activity indices and cytokines) at baseline, and the prediction model was established to draw the nomogram.

Results

Patient age, CRP, IL-6, Gal-9, HAQ and DAS28-ESR were the significant prognostic factors in the lasso and Cox regression analyses, especially Gal-9. The multivariate analysis revealed that IL-6≤ 9.04 pg/ml(HR =0.54, 95% CI:0.31–0.95), Gal-9≤ 4490 pg/ml(HR =0.43, 95% CI:0.21–0.89) were independent protective factors (Table 1). Above-mentioned six factors were included in our model as predictors (Figure 1). The resulting model containing six factors had good discrimination ability in both the development cohort (C-index, 0.729) and the validation cohort (C-index, 0.710). Time-dependent ROC curve (Figure 2), calibration analysis (Figure 3) and decision curve analysis (DCA) show that the nomogram has significant discriminant power, stability and clinical practicability in predicting the first remission time.

Conclusion

We constructed and validated a nomogram with baseline activity indices and cytokines that can predict first remission time in RA patients after csDMARDs treatment. Using this simple-to-use model with plasma Gal-9 at baseline, the remission rate can be determined for an individual patient and could be useful for the early identification of high-risk patients.

References

[1]SUN J, SUI Y, WANG Y, et al. Galectin-9 expression correlates with therapeutic effect in rheumatoid arthritis [J]. Scientific reports, 2021, 11(1): 5562.

[2]ZHANG L, CHEN F, GENG S, et al. Methotrexate (MTX) Plus Hydroxychloroquine versus MTX Plus Leflunomide in Patients with MTX-Resistant Active Rheumatoid Arthritis: A 2-Year Cohort Study in Real World [J]. Journal of inflammation research, 2020, 13: 1141-50.

[3]FORNARO M, CACCIAPAGLIA F, LOPALCO G, et al. Predictors of long-term clinical remission in rheumatoid arthritis [J]. European journal of clinical investigation, 2021, 51(2): e13363.

Acknowledgements

Funded by ECCM Program of Clinical Research Center of Shandong University (No. 2021SDUCRCB010)

Disclosure of Interests

None declared.

POS0306 EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS WITH ACTIVE ANKYLOSING SPONDYLITIS REFRACTORY TO BIOLOGIC THERAPY: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED PHASE 3 TRIAL

Background

Upadacitinib (UPA) was shown to be safe and effective through 2 years in patients (pts) with active ankylosing spondylitis (AS) naïve to biologic disease-modifying antirheumatic drugs (bDMARDs) in the pivotal phase 2/3 SELECT-AXIS 1 trial.1,2

Objectives

To assess the efficacy and safety of UPA in pts with active AS with an inadequate response (IR) to bDMARDs.

Methods

SELECT-AXIS 2 (NCT04169373) was conducted under a master protocol and includes two separate studies (one for AS bDMARD-IR and one for non-radiographic axial spondyloarthritis [nr-axSpA]). The AS bDMARD-IR study is a randomized, double-blind, placebo (PBO)-controlled, phase 3 trial that enrolled adults ≥18 years with AS who met modified New York criteria, had BASDAI and pt’s assessment of total back pain scores ≥4 (numeric rating scale 0–10) at study entry, and had an IR to one or two bDMARDs (TNF inhibitor or IL-17 inhibitor). Pts were randomized 1:1 to receive oral UPA 15 mg once daily (QD) or PBO during the 14-week (wk) double-blind treatment period. The primary endpoint was ASAS40 response at wk 14. Multiplicity-controlled secondary endpoints evaluated at wk 14 were improvements from baseline in disease activity (ASDAS [CRP], ASDAS ID [<1.3], ASDAS LDA [<2.1], BASDAI50, ASAS20, and ASAS PR), pain (total and nocturnal back pain), function (BASFI), objective measure of inflammation (SPARCC MRI score of the spine), spinal mobility (BASMI), enthesitis (MASES), and quality of life (ASQoL and ASAS HI). Non-responder imputation incorporating multiple imputation (NRI-MI) was used to handle intercurrent events and missing data for binary endpoints. Cochran-Mantel-Haenszel (CMH) test and mixed-effect model for repeated measures (MMRM) were used for analyzing binary and continuous endpoints, respectively. Treatment-emergent adverse events (TEAEs) assessed through wk 14 are reported for pts who had ≥1 dose of study drug.

Results

All 420 randomized pts with active AS received assigned treatment (UPA 15 mg, n=211; PBO, n=209); 409 (97%) received study drug through wk 14. Baseline demographic and disease characteristics were generally similar between treatment groups and reflective of an active AS bDMARD-IR population (74% male; mean age 42.4 years; mean disease duration 7.7 years; 83% HLA-B27 positive; mean BASDAI 6.8). Significantly more pts achieved the primary endpoint of ASAS40 response at wk 14 with UPA vs PBO (45% vs 18%; P<0.0001; Figure 1); UPA showed onset of effect in ASAS40 as early as wk 4 (nominal P≤0.05). All multiplicity-controlled secondary endpoints met statistical significance for UPA vs PBO at wk 14 across multiple clinical domains of AS (P<0.0001; Figure 1). The rate of TEAEs was similar between treatment groups through wk 14 (UPA, 41%; PBO, 37%). TEAEs led to discontinuation in 3 (1.4%) pts treated with PBO and none with UPA. Serious infections occurred with UPA (2.4%) but not with PBO and included 4 events of COVID-19 and 1 event of uveitis. Additional events of uveitis were reported in 3 (1.4%) pts treated with PBO. Inflammatory bowel disease (IBD) occurred in 1 (0.5%) pt on UPA and none on PBO. No malignancy, major adverse cardiovascular events, venous thromboembolic events, or death were reported with UPA; 1 event of malignancy was observed with PBO.

Conclusion

UPA 15 mg QD was significantly more effective than PBO over 14 wks of treatment in pts with active AS and IR to bDMARDs. No new safety risks were identified with UPA compared with its known safety profile.3,4 These findings are consistent with and complementary to those of SELECT-AXIS 1 (bDMARD-naïve AS population),1,2 and support the use of UPA in pts with active AS, including those who had a previous IR to bDMARD therapy.

References

[1]van der Heijde D, et al. Arthritis Rheumatol. 2021;73(suppl 10).

[2]van der Heijde D, et al. Lancet. 2019;394(10214):2108–2117.

[3]Cohen SB, et al. ARD. 2021;80:304–311.

[4]Burmester G, et al. Rheumatol Ther. 2021;1–19.

Acknowledgements

AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Julia Zolotarjova, MSc, MWC, of AbbVie.

Disclosure of Interests

Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, and UCB, Employee of: Director of Imaging Rheumatology BV, Xenofon Baraliakos Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, and UCB, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, and Werfen, Grant/research support from: AbbVie, Novartis, Joachim Sieper Speakers bureau: AbbVie, Janssen, Merck, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Merck, and Pfizer, Atul Deodhar Consultant of: AbbVie, Amgen, Aurinia, BMS, Celgene, GSK, Janssen, Lilly, MoonLake, Novartis, Pfizer, and UCB., Grant/research support from: AbbVie, GSK, Lilly, Novartis, Pfizer, and UCB, Robert Inman Consultant of: AbbVie, Amgen, Janssen, Lilly, Novartis, Pfizer, and Sandoz, Grant/research support from: AbbVie, Amgen, and Janssen, Hideto Kameda Speakers bureau: AbbVie, Asahi-Kasei, BMS, Chugai, Eisai, Janssen, Lilly, Mitsubishi-Tanabe, Novartis, and Pfizer, Consultant of: AbbVie, Janssen, Lilly, Novartis, Sanofi, and UCB, Grant/research support from: AbbVie, Asahi-Kasei, Boehringer Ingelheim, Chugai, Eisai, and Mitsubishi-Tanabe, Xiaofeng Zeng: None declared, Yunxia Sui Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, Xianwei Bu Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, Aileen Pangan Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, Peter Wung Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, In-Ho Song Shareholder of: May own AbbVie stock or options, Employee of: AbbVie

AB0407 EFFICACY AND SAFETY OF 144-WEEK TREATMENT WITH TACROLIMUS AS THE FIRST-LINE CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUG (csDMARD) FOR PATIENTS WITH ACTIVE REFRACTORY RHEUMATOID ARTHRITIS： A PROSPECTIVE, COHORT STUDY

Background

The T2T guideline in RA recommended the normal csDMARDs irresponsive patients (pts) switching to other treatment target. Tacrolimus (TAC), the inhibitor of T cell activation, is candidate for these pts, especially with extrarticular complications (EC).

Objectives

To observe the efficacy and safety of TAC-based csDMARDS regimen refractory RA (RRA) pts and the characteristics of TAC combined treatment.

Methods

This prospective cohort study (ClinicalTrials.gov Identifier NCT02837978) was conducted in China. According to baseline DAS28-ESR, RRA pts (ACR 1987 criteria [1]) were classified to severe (>5.1, S) or moderate (> 3.2,≦5.1, M) groups. The efficacy indicators and AE were recorded untill 144w.

The combined medicine with TAC was based on the past history of csDMARD prescription and EC, including TAC with/wo MTX (T+M or T group), Pred, HCQ.

Results

150 pts (52±14y) were involved, 15 finished 144w observation, 50 still following up and 85 lost.

As shown with GEE analysis, DAS28-ESR, CRP, HAQ were decreased significantly in all pts within 24ws, and maintained stable in later period (Figure 1). The REM or LDA, achieved ACR20, good or moderate EULAR response (G+M) proportion of 103 pts completed the 24w were 41.75%, 56.31%, 76.70%.

Figure 1.

Disease activity index of 150 RRA pts decreased in 144weeks

Similar to the Japanese study [2], DAS28-ESR, CRP and HAQ typically declined rapidly in S group, but still higher than M (Figure 2A-C). According to GBTM analysis, S group, longer disease course or higher HAQ had a higher ACR20 remission rate (Figure 2D).

Figure 2.

Disease activity index of 103 pts declined rapidly in 24weeks.

(A). DAS28-ESR; (B) CRP; (C). HAQ declined significantly in S (n=53) than M (n=50) during 24ws. (D).higher increased ACR20 remission group (90.6%), compared with low-stable (0%) in 24ws. *p< 0.05, compared to M; #p< 0.05, compared to baseline.

A total of 69 RA pts (46.0%) had 177 times (23.07%) AE, including 2 SAEs. Infection was the dominating AE (30%) due to asymptomatic positive urinary leucocyte and cold were classified, higher than (3.4%) Japanese study [3]. AEs were mainly happened in pts with higher TAC blood concentration 4.55(3-14.5) ng/ml, compared to No AE group 3.8(2.4-7.8) ng/ml, p=0.048, extremely in those abnormal glucose tolerance and hypertensive pts, p=0.002, 0.022.

The most common reasons of lost were drug ineffective (32.94%), economic reasons (29.1%). There was no difference in efficacy of TAC combined treatment. Combination MTX reduce AE, decrease the usage rate and dosage of Pred. Combination Pred increased AE.

Pts that achieved REM+LDA, G+M, had better TAC survival rate (Figure 3A-B). The combination of MTX, HCQ reduce lost rate (Figure 3C-D).

Figure 3.

TAC survival ratio were compared in different response and csDMARDs combination groups.

(A).The pts acquired remission (n= 31) or LDA (n= 18) had higher TAC survival rate than high (n=28) & moderate (n=73) group, * p < 0.05, compared to group High; # p < 0.05, compared to Moderate; & p < 0.05, compared to Low; (B). The pts G+M (n=95) had better TAC survival rate, compared with no response (N, n=55), ** p < 0.01; (C). Combine MTX reduced lost rate, ** p < 0.01, compared to T; (D). Combine MTX and HCQ reduced lost rate, * p < 0.05 compared to MTX-HCQ-; # p < 0.05 compared to MTX+HCQ-.

The Logistic regression showed baseline DAS28-ESR was an independent protective factor for poor response. Baseline DAS28-ESR and previous Perd use were independent protective factors for ACR20 remission.　

Conclusion

TAC-based combined therapies are effective and tolerable for RRA, especially to the higher disease activity pts. TAC blood concentration related to AE. The lower disease activity index and better respond, the higher TAC survival ratio. MTX is recommended as TAC combined treatment.

References

[1]Levin RW, et al. Scand J Rheumatol 1996, 25(5):277-281.

[2]Kanzaki T,et al., Rheumatology International,2013. 33(4):871-877.

[3]Takeuchi T, et al. Mod Rheumatology 2018,28(1): 48-57.

Acknowledgements

Acknowledgements: Funded by ECCM Program of Clinical Research Center of Shandong University (No. 2021SDUCRCB010)

Disclosure of Interests

None declared

Thermal Dynamics of Charge Density Wave Pinning in ZrTe_{3}

Impurity pinning has long been discussed to have a profound effect on the dynamics of an incommensurate charge density wave (CDW), which would otherwise slide through the lattice without resistance. Here, we visualize the impurity pinning evolution of the CDW in ZrTe_{3} using the variable temperature scanning tunneling microscopy. At low temperatures, we observe a quasi-1D incommensurate CDW modulation moderately correlated to the impurity positions, indicating a weak impurity pinning. As we raise the sample temperature, the CDW modulation gets progressively weakened and distorted, while the correlation with the impurities becomes stronger. Above the CDW transition temperature, short-range modulations persist with the phase almost all pinned by impurities. The evolution from weak to strong impurity pinning through the CDW transition can be understood as a result of losing phase rigidity.

AB0260 LONG-TERM EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS FROM CHINA, BRAZIL, AND SOUTH KOREA WITH RHEUMATOID ARTHRITIS AND AN INADEQUATE RESPONSE TO CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS: RESULTS AT 64 WEEKS

Background:

Upadacitinib (UPA), an oral Janus kinase inhibitor, in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), showed significant improvements in clinical and functional measures compared with placebo (PBO) up to 12 weeks (wks), in patients (pts) from China, Brazil, and South Korea with rheumatoid arthritis (RA) and prior inadequate response to csDMARDs (csDMARD-IR).1

Objectives:

To assess the efficacy and safety of UPA up to 64 wks (long-term extension; LTE) in csDMARD-IR pts with RA from China, Brazil, and South Korea.

Methods:

Pts were randomized to 12 wks of blinded treatment with UPA 15 mg once daily (QD) or PBO, in combination with csDMARDs. From Wk 12 onward, pts could continue to receive open-label UPA 15 mg QD. Efficacy endpoints were analyzed by original randomized treatment group sequences over 64 wks and included American College of Rheumatology (ACR) responses, and key remission and low disease activity measures. Non-responder imputation was used to handle missing data for binary endpoints. Treatment-emergent adverse events (TEAEs) per 100 patient-years (PY) were summarized for pts receiving ≥1 dose of UPA from baseline through to Wk 64.

Results:

Of 338 randomized pts who received ≥1 dose of study drug, 310 (91.7%) entered the LTE and 275 (81.4%) completed 64 wks of treatment. Among those initially randomized to UPA, the proportion of pts achieving 20%/50%/70% improvement in ACR criteria, and key remission and low disease activity measures increased over 64 wks of treatment (Figure 1). Improvements from baseline in the Health Assessment Questionnaire-Disability Index and pts’ assessment of pain were observed over 64 wks of UPA treatment (data not shown). By Wk 64, efficacy results for pts who switched from PBO to UPA at Wk 12 followed a similar trajectory to those originally randomized to UPA.

The observed rate of serious infections was 8.1 events/100 PY. Herpes zoster events were mostly non-serious, involving only 1 or 2 dermatomes. Most cases of hepatic disorders were Grade 1 or 2 hepatic transaminase elevations. There was 1 case of venous thromboembolic event (VTE; concurrent pulmonary embolism and deep vein thrombosis [DVT] in a patient with a history of DVT) and 3 cases of malignancy. Adjudicated major adverse cardiovascular events (Table 1) occurred in 2 pts (1 with non-fatal myocardial infarction and 1 with non-fatal stroke) who had underlying risk factors for cardiovascular disease. There were no deaths, active tuberculosis, or renal dysfunction.

Conclusion:

UPA 15 mg was effective in treating the signs and symptoms of RA and in improving physical function over 64 wks with no new safety signals1 in csDMARD-IR pts with RA from China, Brazil, and South Korea.

References:

[1]Zeng A, et al. Ann Rheum Dis 2020;79(Suppl 1):1016 [abstract SAT0160]

Table 1.

TEAEs at Wk 64

Event (E/100 PY)UPA 15 mg(n=322; PY=334.5)Any AE421.5 (399.8–444.1) Serious AE19.1 (14.7–24.4) AE leading to discontinuation of study drug9.0 (6.1–12.8) Deathsa0AEs of special interest Serious infection8.1 (5.3–11.7) Opportunistic infection0.9 (0.2–2.6) Herpes zoster9.0 (6.1–12.8) Hepatic disorder42.2 (35.5–49.7) Gastrointestinal perforation (adjudicated)0.3 (0.0–1.7) Any malignancy (excluding NMSC)0.6 (0.1–2.2) NMSC0.3 (0.0–1.7) MACE (adjudicated)b0.6 (0.1–2.2) VTE (adjudicated)c0.3 (0.0–1.7) Anemia11.1 (7.8–15.2) Neutropenia11.7 (8.3–15.9) Lymphopenia7.8 (5.1–11.4) CPK elevation11.1 (7.8–15.2)

aIncluding non-treatment-emergent deaths. bDefined as cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. cIncluding DVT and pulmonary embolism.

AE, adverse event; CPK, creatine phosphokinase; E, events; MACE, major adverse cardiovascular event; NMSC, non-melanoma skin cancer

Acknowledgements:

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Yanna Song, PhD, of AbbVie provided statistical support. Medical writing support was provided by Laura Chalmers, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.

Disclosure of Interests:

Xiaofeng Zeng: None declared, Dongbao Zhao: None declared, Sebastiao Radominski: None declared, MAURO KEISERMAN: None declared, Chang-Keun Lee: None declared, Naomi Martin Employee of: AbbVie employee and may own stock or options, Sebastian Meerwein Employee of: AbbVie employee and may own stock or options, Yunxia Sui Employee of: AbbVie employee and may own stock or options, Won Park: None declared

OP0144 EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS WITH ACTIVE ANKYLOSING SPONDYLITIS: 1-YEAR RESULTS FROM A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY WITH OPEN-LABEL EXTENSION

Background:

Upadacitinib (UPA) was efficacious and well tolerated vs placebo (PBO) during the first 14 weeks (wks) of the phase 2/3 SELECT-AXIS 1 study in patients (pts) with active ankylosing spondylitis (AS) who had an inadequate response to NSAIDs.1

Objectives:

To report efficacy and safety of UPA through 1 year in the SELECT-AXIS 1 study.

Methods:

In SELECT-AXIS 1 (NCT03178487) pts were randomized 1:1 to UPA 15 mg once daily (QD) or PBO; at wk 14, pts continued in the 90-wk open-label extension and received UPA 15 mg QD; reported here are data up to wk 64. The study enrolled pts (≥18 y) with active AS (defined as BASDAI ≥4 and pt assessment of back pain ≥4 [numeric rating scale, 0–10] at screening and baseline [BL]) who had inadequate response to ≥2 NSAIDs or intolerance to or contraindication for NSAIDs and were biologic DMARD naive. Efficacy assessments included percentage of pts with Assessment of SpondyloArthritis international Society (ASAS) 20/40 response, ASAS partial remission, BASDAI50, AS Disease Activity Score (ASDAS) and change from BL in ASDAS and BASFI. Data are reported as observed and by using non-responder imputation (NRI). Treatment-emergent adverse events (TEAEs) were reported as events per 100 patient-years (PY) up to January 31, 2020.

Results:

Of 187 pts, 178 pts (each n=89 for UPA and PBO arms) completed wk 14 on study drug and entered the open-label extension; 160 pts completed wk 64. Efficacy was maintained or continued to improve throughout the study in the continuous UPA group: 85% (95% CI, 77%–93%) of pts achieved ASAS40 at wk 64 in the as-observed analysis and 72% (63%–81%) in the NRI analysis (Figure). Pts who switched from PBO to UPA at wk 14 showed similar speed of onset and magnitude of response vs pts initially randomized to UPA: 81% (95% CI, 72%–89%) in the as-observed analysis and 70% (61%–80%) in the NRI analysis achieved ASAS40 at wk 64 (Figure). Similar results were observed for other efficacy endpoints (Figure). Among all 182 pts receiving UPA, 618 AEs were reported. AEs leading to discontinuation and serious AEs were low (Table). No serious infections, active tuberculosis, venous thromboembolic events, gastrointestinal perforation, major adverse cardiovascular events, renal dysfunction, or deaths were reported.

Table 1.

TEAEs per 100 PYs

Events/(E/100 PY)UPA 15 mg QDN=182 (237.6 PY)Any AE618 (260.1)Serious AE14 (5.9)AE leading to discontinuation15 (6.3)Infections205 (86.3) Opportunistic infection*2 (0.8) Herpes zoster†5 (2.1)Creatine phosphokinase elevation‡28 (11.8)Hepatic disorder§24 (10.1)Neutropenia||7 (2.9)Anemia||3 (1.3)Lymphopenia||2 (0.8)Malignancy¶1 (0.4)Death0

AE, adverse event; PY, patient-year; QD, once daily; TEAE, treatment-emergent AE; UPA, upadacitinib.

*Two non-serious events of esophageal candidiasis in the same patient.

†Five events in 4 patients; all non-serious and limited to 1 dermatome.

‡All events were non-serious and none led to study drug discontinuation; majority were asymptomatic.

§Majority based on asymptomatic alanine aminotransferase/aspartate aminotransferase elevations; all were non-serious and none led to study drug discontinuation.

||All events were non-serious and none led to study drug discontinuation.

¶Squamous cell carcinoma of tongue in 61-year-old male former smoker; no reasonable possibility to be study drug related per investigator.

Conclusion:

UPA 15 mg QD showed sustained and consistent efficacy over 1 year. Pts who switched from placebo to UPA at wk 14 showed a similar efficacy response compared with pts who received continuous UPA. No new safety findings were observed compared with safety data from the UPA clinical development program in other indications.2

References:

[1]van der Heijde D, et al. Lancet. 2019;394(10214):2108-2117.

[2]Cohen, et al. Arthritis Rheumatol. 2019;71(suppl 10).

Acknowledgements:

AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship. Medical writing support was provided by M Hovenden and J Matsuura of ICON plc (North Wales, PA) and was funded by AbbVie.

Disclosure of Interests:

Atul Deodhar Speakers bureau: Novartis, Pfizer, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, GlaxoSmithKline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer, UCB, Désirée van der Heijde Consultant of: AbbVie, BMS, Cyxone, Eisai, Galapagos, Gilead, GlaxoSmithKline, Lilly, Novartis, Pfizer, and UCB Pharma, Joachim Sieper Speakers bureau: AbbVie, Janssen, Lilly, Merck, and Novartis, Consultant of: AbbVie, Janssen, Lilly, Merck, and Novartis, Filip van den Bosch Speakers bureau: AbbVie, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB Pharma, Walter P Maksymowych Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Novartis and Pfizer, Tae-Hwan Kim Speakers bureau: AbbVie, Celltrion, Kirin, Lilly, and Novartis, Mitsumasa Kishimoto Consultant of: AbbVie, Amgen-Astellas BioPharma, Asahi-Kasei Pharma, Astellas, Ayumi Pharma, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Kyowa Kirin, Novartis, Pfizer, Tanabe-Mitsubishi, Teijin Pharma, and UCB Pharma, Andrew Ostor Consultant of: AbbVie, BMS, Roche, Janssen, Lilly, Novartis, Pfizer, UCB, Gilead, and Paradigm, Bernard Combe Speakers bureau: AbbVie, Lilly, Merck, Consultant of: AbbVie, Lilly, Gilead, Janssen, Novartis, Roche-Chugai, and Sanofi, Grant/research support from: AbbVie and Lilly, Yunxia Sui Shareholder of: AbbVie, Employee of: AbbVie, xin wang Shareholder of: AbbVie, Employee of: AbbVie, Alvina Chu Shareholder of: AbbVie, Employee of: AbbVie, In-Ho Song Shareholder of: AbbVie, Employee of: AbbVie

Potential of Bradyrhizobia inoculation to promote peanut growth and beneficial Rhizobacteria abundance

AIMS

To investigate the effects of three symbiotic Bradyrhizobium strains on peanut growth and on rhizobacterial communities in flowering and harvest stages in an organic farm, also to evaluate the role of plant development in influencing peanut rhizobacterial microbiota and correlations among the inoculants, rhizobacterial communities and plant growth.

METHODS AND RESULTS

Peanut seeds were inoculated with three individual Bradyrhizobium strains, plant growth performance was measured in two developmental stages and rhizobacterial communities were analysed by Illumina sequencing of rpoB gene amplicons from peanut rhizosphere. The three bradyrhizobial inoculants significantly increased the nodule numbers and aboveground fresh weight of peanut plants regardless of the different growth stages, and the pod yields were increased to some extent and significantly positively correlated with Bradyrhizobium abundances in rhizosphere. Principal coordinate analysis indicated that the rhizobacterial communities were strongly influenced by the inoculation and peanut developmental stages. The bradyrhizobia inoculation increased relative abundances of potentially beneficial bacteria in peanut rhizosphere, and also altered rhizobacterial co-occurrence association networks and important network hub taxa. Similarly, plant development also significantly influenced the structure, composition and co-occurrence association networks of rhizobacterial communities.

CONCLUSIONS

Bradyrhizobial inoculants increased peanut growth and yields, they and plant development affected the assembly of peanut rhizobacterial communities.

SIGNIFICANCE AND IMPACT OF THE STUDY

Rhizobial inoculants improved the host plant performance that might also be associated with the dynamic changes in rhizobacterial community except enhancing the biological nitrogen fixation and helps to profoundly understand the mechanism how rhizobia inoculants improve plant growth and yields.

SAT0160 EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS FROM CHINA, BRAZIL, AND SOUTH KOREA WITH RHEUMATOID ARTHRITIS WHO HAVE HAD INADEQUATE RESPONSE TO CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS

Background:

Upadacitinib (UPA), an oral, selective JAK-1 inhibitor was effective in global ph 3 trials in rheumatoid arthritis (RA) patients with inadequate response (IR)/intolerance to csDMARDs and bDMARDs.

Objectives:

This Phase 3, randomized, double-blind, placebo (PBO)-controlled study assessed the efficacy and safety of UPA in combination with csDMARDs in csDMARD-IR patients with RA from China, Brazil, and South Korea.

Methods:

Patients were randomized 1:1 to receive UPA 15 mg once daily (QD) or PBO in combination with csDMARDs. The primary endpoint was ACR20 response at Week 12, using non-responder imputation.

Results:

338 patients were randomized, and 310 (91.7%) completed Week 12. At Week 12, statistically significantly more patients receiving UPA vs PBO achieved the primary endpoint of ACR20 (71.6% vs 31.4%, p<0.001). UPA also demonstrated statistically significant improvements in all ranked secondary endpoints vs PBO at Week 12 (Table 1), including mean change in DAS28(CRP), HAQ-DI, and SF-36 PCS, and patients achieving DAS28(CRP) ≤3.2, DAS28(CRP) <2.6, and CDAI ≤10. Greater responses were also seen with UPA vs PBO for other key secondary endpoints including ACR50 and ACR70. Onset of UPA action was rapid with more patients on UPA achieving ACR20 by Week 1 (25.4% vs 5.9%, p<0.001). The frequency of AEs (61.5% vs 49.1%) and serious AEs (7.1% vs 3.0%) was higher with UPA vs PBO. The frequency of AEs of special interest was generally similar between UPA and PBO, with the exception of herpes zoster (1.8% vs 0.6%), hepatic disorders (9.5% vs 7.1%), neutropenia (3.0% vs 0%), and elevated creatine phosphokinase (1.8% vs 0.6%), which were higher with UPA. One case of breast cancer (on Day 1 of study) and one VTE (pulmonary embolism and deep vein thrombosis in a patient with history of deep vein thrombosis) were reported with UPA treatment.

Table 1.

Efficacy endpoints at Week 12

EndpointaUPA 15 mg QD (n=169)PBO(n=169)Primary endpointACR20, %71.6***31.4Secondary endpointsΔ DAS28(CRP)-2.56***-0.95Δ HAQ-DI-0.62***-0.18Δ SF-36 PCS8.93c***3.36dDAS28(CRP) ≤3.2, %46.2***13.6DAS28(CRP) <2.6, %29.6***5.3CDAI ≤10, %35.5***11.2ACR50, %b40.8***8.3ACR70, %b21.3***3.6ACR20 at Week 1, %b25.4***5.9

***p<0.001 vs PBO

aNRI for binary endpoints; ANCOVA with multiple imputation for DAS28(CRP) and HAQ-DI; mixed model repeated measures for other continuous endpoints

bUnranked secondary endpoint.cn=143.dn=149

Conclusion:

Efficacy of UPA was demonstrated in this csDMARD-IR population from China, Brazil, and South Korea. The safety of UPA was comparable with the global Phase 3 program.

Disclosure of Interests: :

Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Dongbao Zhao: None declared, Sebastiao Radominski: None declared, MAURO KEISERMAN Speakers bureau: Pfizer, Abbott, Actelion, AstraZeneca, Amgen, Roche, Bristol Myers Squibb, and Janssen and has received clinical trial honoraria from Pfizer, Amgen, AstraZeneca, Anthera Pharmaceuticals, Bristol-Myers Squibb, Biogen Idec Inc, Celltrion Inc., Eli Lilly, Human Genome Sciences, Novartis, Roche, Sanofi, UCB Inc., Chang-Keun Lee: None declared, Sebastian Meerwein Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jeffrey Enejosa Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Yunxia Sui Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Mohamed-Eslam Mohamed Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Won Park: None declared

Dexamethasone alleviates allergic asthma immature rat through Toll like receptor 4

OBJECTIVE

The allergic asthma model induced by ovalbumin (OVA) was established in the immature rat. Dexamethasone (DXM) was adopted for intervention to analyze the treatment effect and to explore the relationship with toll-like receptor 4 (TLR4).

MATERIALS AND METHODS

Immature SD rat was treated by OVA to construct allergic asthma model and intervened by DXM. The rats were randomly divided into model group, experimental group, and control group. The changes in lung tissue were observed by light microscope. The EOS infiltration and reactivity of airway wall were compared. The expressions of TLR2 and TLR4 protein and mRNA in the lung tissue were tested by Western blot and RT-PCR.

RESULTS

The lung tissue in the model group was infiltrated by a lot of inflammatory cells, and mucous membrane edema was observed, compared with that in the control group. There were only a few inflammatory cells in the interstitial tissue and pulmonary alveoli in the experimental group compared with that in the model group. EOS count of airway wall and airway reactivity decreased in the experimental group. The levels of TLR2 and TLR4 were significantly elevated in the third week compared with the first week (p<0.05).

CONCLUSIONS

The treatment of DXM can alleviate the pathological changes of the lung tissue in SD immature rat with allergic asthma, reduce EOS infiltration in the airway wall, decrease airway reactivity, and elevate expressions of TLR2 and TLR4.

Abstract P4-08-17: Expression score (Escore) for the prediction of likelihood of recurrence of DCIS

Background: Ductal carcinoma in situ (DCIS) accounts for at least 20% of breast cancers. Factors associated with recurrence of DCIS or progression to invasive carcinoma are not well delineated. The goals of the current study were to profile the epithelial cells using the GE Cell DIVE™ immuno-fluorescent based analyses. This was coupled with semi-automated algorithms to characterize the inter-relationships between cell populations and likelihood of recurrence.

Patients and Methods: A TMA-based (total 8 TMAs) cohort of cases of DCIS with and without recurrence was obtained from Oxford University. Recurrence in this cohort was defined as ipsilateral DCIS, ipsilateral invasive, contralateral invasive and metastatic. Analysis for 31 epithelial markers (HER4, CK56, ABCG2, PTEN, S6, CKAE1, PR, ER, NaKATPase, CK19, ALDH1, CK PCK26, cMET, CD44v6, HER2, CDCP1, p53, CK15, COX2, VEGFR2, ABCb1, HTF9C, CD10, MRP4, CEACAM5, EGFR, p21, MRP5, SLC7A5, Ki67, DAPI) was performed on a single FFPE TMA section containing cases of DCIS. Briefly, FFPE sections from TMAs containing DCIS were sequentially (cyclically) stained for the markers. Each cycle entailed staining with 2-3 markers followed by imaging, dye inactivation, and re-staining. DAPI was used for nuclear demarcation and for registration of the images, while S6, pan-cadherin, Na+K+ATPase and pan-cytokeratin were used for epithelial segmentation. K-means clustering followed regression analysis was performed to identify inter-relationships between markers and association with likelihood of recurrence. Log-rank analysis was performed and the relapse-free survival data depicted using Kaplan Meier plots. Escore was developed by logistic regression model, classification model on recurrence

Results: Filtering of the expression analysis by the quality, specificity, compartment localization and fields entirely composed of DCIS, in addition to availability of clinical data resulted final analysis of 31 markers in 67 cases. Correlation analyses were performed on each of the markers to identify markers that were significantly correlated in univariate analysis. K-means cluster analysis was performed using a set of 4 markers (ER, HER2, SLC7A5 and cMET) to identify 6 clusters. High cMET (cluster 1; low HER2 and SLC7A5) and High ER (low cMET, HER2, SLC7A5; Cluster 5) were associated with low risk of recurrence (p values 0.014 and &lt;0.0001). In contrast, Cluster 2 (High HER2, high SLC7A5, low ER) and Cluster 3 (High HER2, low ER, SLC7A5and cMET) were associated with increased risk of recurrence (P values 0.038 and 0.076). A regression analysis based algorithm was developed using these markers to calculate a numerical score which could predict likelihood of recurrence. As depicted in the KM plots, the HR for recurrence increases significantly (P-value 2.4E-05; p=0.02 with LOOCV) with increase in expression score (Escore).

Conclusions: We describe the development of an Escore using expression 4 markers to predict likelihood of recurrence. Additional ongoing studies will seek to validate the utility of the Escore in predicting likelihood of recurrence of DCIS and development of invasive carcinomas and comparison with other scoring systems.

Citation Format: Badve SS, Cho S, Gokmen-Polar Y, Zavodszky M, Sui Y, Chadwick C, Tan PH, Gerdes M, Harris AL, Ginty F. Expression score (Escore) for the prediction of likelihood of recurrence of DCIS [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-17.

Effect of pressure on the self-hole-doped superconductor RbGd2Fe4As4O2

RbGd₂Fe₄As₄O₂ is a newly discovered self-hole-doped stoichiometric superconductor, which has a hybrid structure with separated double FeAs layers and exhibits a high superconducting transition temperature T _c  =  35 K. Here, we report the effect of pressure (P) on its T _c and normal-state transport properties by measuring the temperature dependence of resistivity ρ(T) under various pressures up to 14 GPa with a cubic anvil cell apparatus. We found that the T _c is suppressed monotonically to ca. 12.5 K upon increasing pressure to 14 GPa with a slope change of T _c(P) at around 4 GPa. In addition, the low-temperature normal-state ρ(T), which is proportional to T ⁿ , also evolves gradually from a non-Fermi-liquid with n  =  1 at ambient pressure to a Fermi liquid with n  =  2 at P  ⩾  4 GPa. Accompanying with the non-Fermi-liquid to Fermi-liquid crossover, the quadratic temperature coefficient of resistivity, which reflects the effective mass of charge carriers, also experiences a significant reduction as commonly observed in the vicinity of a magnetic quantum critical point (QCP). Our results indicate that the stoichiometric RbGd₂Fe₄As₄O₂ at ambient pressure might be located near a QCP such that the enhanced critical spin fluctuations lead to high-T _c superconductivity. The application of pressure should broaden the electronic bandwidth and weaken the spin fluctuations, and then restore a Fermi-liquid ground state with lower T _c.

Pressure-induced enhancement of thermoelectric power factor in pristine and hole-doped SnSe crystals

We evaluate the influence of pressure on the thermoelectric power factors PF ≡ S²σ of pristine and Na-doped SnSe crystals by measuring their electrical conductivity σ(T) and Seebeck coefficient S(T) up to ∼22 kbar with a self-clamped piston-cylinder cell. For both cases, σ(T) is enhanced while S(T) reduced with increasing pressure as expected, but their imbalanced variations lead to a monotonic enhancement of PF under pressure. For pristine SnSe, σ(290 K) increases by ∼4 times from ∼10.1 to 38 S cm⁻¹, while S(290 K) decreases by only ∼12% from 474 to 415 μV K⁻¹, leading to about three-fold enhancement of PF from 2.24 to 6.61 μW cm⁻¹ K⁻², which is very close to the optimal value of SnSe above the structural transition at ∼800 K at ambient pressure. In comparison, the PF of Na-doped SnSe at 290 K is enhanced moderately by ∼30% up to 20 kbar. In contrast, the PF of isostructural black phosphorus with a simple band structure was found to decrease under pressure. The comparison with black phosphorus indicates that the multi-valley valence band structure of SnSe is beneficial for the enhancement of PF by retaining a large Seebeck coefficient under pressure. Our results also provide experimental confirmation on the previous theoretical prediction that high pressure can be used to optimize the thermoelectric efficiency of SnSe.

The thermoelectric power factor of SnSe is enhanced by three times under a hydrostatic pressure of 22.5 kbar.

Abstract P1-06-02: Impact of heterogeneity of DCIS on immune cell infiltrations

Background: Ductal carcinoma in situ (DCIS) accounts for at least 20% of breast cancers. Factors associated with recurrence of DCIS or progression to invasive carcinoma are not well delineated. The goals of the current study were to profile the epithelial and immune cells using the MultiOmyx hyperplexed immuno-fluorescent based analyses. This was coupled with semi-automated algorithms to characterize the inter-relationships between cell populations within individual DCIS lesions.

Patients and Methods: Analysis for 15 antibody markers (EGFR, Her2, Her4, S6, pMTOR, PCAD, CD44v6, NaKATPase, SLC7A5, CD4, CD8, CD20, CD68, and CD10) was performed on a single FFPE section containing 10-20 distinct ducts from 13 cases of DCIS. Briefly, approximately 40 fields of view (FOV) from digitized sections containing DCIS or normal tissue were sequentially (cyclically) stained for the 15 markers. Each cycle entailed staining with 2-3 markers followed by imaging, dye inactivation, and re-staining. DAPI was used for nuclear demarcation and for registration of the images, while S6, pan-cadherin, Na+K+ATPase and pan-cytokeratin were used for epithelial segmentation. K-means clustering was used to determine patterns of co-expression of markers at the single cell, duct, and patient levels. These clusters were then correlated with immune marker expression by tumor infiltrating lymphocytes (TILs) by marker type (CD4, CD8, and CD20) and tumor compartment (stromal versus intraepithelial).

Results: Analysis of the epithelial component in each of 13 cases of DCIS (n= 415 ducts) revealed 8 distinct expression patterns (clusters) using a panel of 7 markers (EGFR, Her2, Her4, pmTOR, CD44v6, SLC7A5, and CD10). The frequency and distribution of clusters, annotated at the single cell level, showed that 4 DCIS's were dominated (&gt;80%) by a single cell phenotype represented by cluster groups 3 and 7 (high Her2), cluster 6 (High Her4 and SLC7A5 and low Her2), or cluster 4 (non-descript). In 5 pts, the pattern was more heterogeneous consisting of mixture of cell populations with 50-70% of the cells belonging to cluster 1 (moderate to high levels for all markers except EGFR and CD10). The remaining pts had a strong representation of cluster 4 and 5 (CD44v6 and phospho-mTOR) cells. The distribution of both intra-epithelial and stromal TILs in DCIS cases were either consisted of a mixed B-cell (CD20+) and T-cell response (n=4), or one dominated by T-cells. Cluster 2 (High EGFR and CD10) was associated with a largely T-cell response (rs = 0.83, P value = 0.0004), while Cluster 7 (strong HER2) was associated with a B-cell response (rs = 0.68, P value = is 0.009).

Conclusions: Analysis 15 markers and use of K-means clustering algorithm, shows prominent inter-tumoral (but not intra-tumoral) heterogeneity in DCIS. Furthermore, epithelial cell specific clusters (high HER2 or EGFR) were associated with distinct B or T cell infiltration by TILs. Additional ongoing studies will determine the clinical significance of the clusters with respect to recurrence of DCIS and development of invasive carcinomas.

Citation Format: Badve S, Gökmen-Polar Y, Harris AL, Sui Y, Sevinsky C, Santamaria-Pang A, Ginty F, Tan PH, Gerdes MJ. Impact of heterogeneity of DCIS on immune cell infiltrations [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-06-02.

Differentiation of Low- and High-Grade Gliomas Using High b-Value Diffusion Imaging with a Non-Gaussian Diffusion Model

BACKGROUND AND PURPOSE

Imaging-based tumor grading is highly desirable but faces challenges in sensitivity, specificity, and diagnostic accuracy. A recently proposed diffusion imaging method by using a fractional order calculus model offers a set of new parameters to probe not only the diffusion process itself but also intravoxel tissue structures, providing new opportunities for noninvasive tumor grading. This study aimed to demonstrate the feasibility of using the fractional order calculus model to differentiate low- from high-grade gliomas in adult patients and illustrate its improved performance over a conventional diffusion imaging method using ADC (or D).

MATERIALS AND METHODS

Fifty-four adult patients (18-70 years of age) with histology-proved gliomas were enrolled and divided into low-grade (n = 24) and high-grade (n = 30) groups. Multi-b-value diffusion MR imaging was performed with 17 b-values (0-4000 s/mm(2)) and was analyzed by using a fractional order calculus model. Mean values and SDs of 3 fractional order calculus parameters (D, β, and μ) were calculated from the normal contralateral thalamus (as a control) and the tumors, respectively. On the basis of these values, the low- and high-grade glioma groups were compared by using a Mann-Whitney U test. Receiver operating characteristic analysis was performed to assess the performance of individual parameters and the combination of multiple parameters for low- versus high-grade differentiation.

RESULTS

Each of the 3 fractional order calculus parameters exhibited a statistically higher value (P ≤ .011) in the low-grade than in the high-grade gliomas, whereas there was no difference in the normal contralateral thalamus (P ≥ .706). The receiver operating characteristic analysis showed that β (area under the curve = 0.853) produced a higher area under the curve than D (0.781) or μ (0.703) and offered a sensitivity of 87.5%, specificity of 76.7%, and diagnostic accuracy of 82.1%.

CONCLUSIONS

The study demonstrated the feasibility of using a non-Gaussian fractional order calculus diffusion model to differentiate low- and high-grade gliomas. While all 3 fractional order calculus parameters showed statistically significant differences between the 2 groups, β exhibited a better performance than the other 2 parameters, including ADC (or D).

A Diffusion Tensor Imaging Study on White Matter Abnormalities in Patients with Type 2 Diabetes Using Tract-Based Spatial Statistics

BACKGROUND AND PURPOSE

Patients with type 2 diabetes mellitus have considerably higher risk of developing cognitive impairment and dementia. WM changes in these patients have been reported. Our aim was to demonstrate that gradual and continuous WM change and the associated cognitive decline in patients with type 2 diabetes mellitus can be captured by DTI parameters, which can be used to complement neuropsychological test scores in identifying patients with type 2 diabetes mellitus with and without mild cognitive impairment.

MATERIALS AND METHODS

Forty-two patients with type 2 diabetes mellitus, divided into a group with mild cognitive impairment (n = 20) and a group with normal cognition (n = 22), were enrolled with age-, sex-, and education-matched healthy controls (n = 26). 3T DTI followed by Tract-Based Spatial Statistics analysis was used to investigate the differences in fractional anisotropy, mean diffusivity, axial diffusivity (λ1), and radial diffusivity (λ23) among the groups. A receiver operating characteristic analysis assessed the performance of DTI parameters for separating the 2 groups with type 2 diabetes mellitus.

RESULTS

The whole-brain Tract-Based Spatial Statistics analysis revealed that 7.3% and 24.9% of the WM exhibited decreased fractional anisotropy and increased mean diffusivity (P < .05), respectively, between the diabetes mellitus with mild cognitive impairment and the diabetes mellitus with normal cognition groups, while considerably larger WM regions showed fractional anisotropy (36.6%) and mean diffusivity (58.8%) changes between the diabetes mellitus with mild cognitive impairment and the healthy control groups. These changes were caused primarily by an elevated radial diffusivity observed in the patients with diabetes mellitus with mild cognitive impairment. Radial diffusivity also exhibited subtle but statistically significant changes between the diabetes mellitus with normal cognition and the healthy control groups. Analyses on individual fiber tracts showed pronounced fractional anisotropy reduction and mean diffusivity elevation in regions related to cognitive functions. The receiver operating characteristic analysis on the right cingulum (hippocampus) showed that fractional anisotropy produced a larger area under the curve (0.832) than mean diffusivity (0.753) for separating mild cognitive impairment from normal cognition among patients with type 2 diabetes mellitus. When fractional anisotropy was combined with mean diffusivity, the area under the curve was further improved to 0.857.

CONCLUSIONS

DTI parameters can show a substantial difference between patients with type 2 diabetes mellitus with and without mild cognitive impairment, suggesting their potential use as an imaging marker for detecting cognitive decline in patients with type 2 diabetes mellitus. More important, DTI parameters may capture gradual and continuous WM changes that can be associated with early stages of cognitive decline in patients with type 2 diabetes mellitus before they can be diagnosed clinically by using conventional neuropsychological tests.

Decreased interhemispheric functional coordination underlying the cognitive impairment in late-onset depression

Background

The intuitive association between cognitive dysfunction in late onset depression (LOD) and the aberrant functional activity in the brain's default-mode network (DMN) has prompted interest in exploring the role of the DMN in LOD. The altered pattern of resting state voxel-mirrored homotopic connectivity (VMHC) in cognitive processes is not yet well understood in LOD.

Methods

The study was designed to examine the implicit coupling between the alteration of interhemispheric functional coordination and cognitive impairment in LOD. Thirty-one LOD patients and 37 matched healthy controls (HC) underwent neuropsychological tests and functional magnetic resonance imaging (fMRI) in this study.

Results

Compared to HC group, attenuated VMHC in superior frontal gyrus, superior temporal gyrus, posterior cerebellar lobe, postcentral and precentral gyrus was observed in LOD. Neuro-behavioral relevancy approach revealed that the imbalanced interhemispheric functional coordination in bilateral cerebellum was positively correlated with the performance of trail making test in LOD (r = 0.367, P = 0.040).

Conclusion

Altered linkage pattern of intrinsic homotopic connectivity and cognition was firstly investigated in LOD, and it would provide a novel clue to reveal the neural substrates underlying the cognitive dysfunction in LOD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Mutation analysis of four Chinese families with pure hereditary spastic paraplegia: pseudo- X-linked dominant inheritance and male lethality due to a novel ATL1 mutation

We studied four Chinese families with pure hereditary spastic paraplegia (HSP) to investigate the clinical features and associated genetic mutations. Linkage analysis was performed for all families to map the disease locus onto autosomal chromosomes, and related loci involved in HSP on the X chromosome were also examined. Polymerase chain reaction (PCR) sequencing was used to detect gene mutations. To confirm the influence of a splice-site mutation on mRNA, we used reverse transcription-PCR and direct sequencing. Linkage analysis and ATL1 gene sequencing of amniocytes were performed for prenatal genetic diagnosis. One missense variant (c.1517T>A) and a splice-site mutation (c.1245+1G>A) in SPAST, and two missense variants (c.715C>T, c.1204T>G) in ATL1 were identified. The c.1245+1G>A mutation caused a deletion of exon 9 in the SPAST gene. Prenatal genetic diagnosis showed that fetus did not carry the ALT1 c.1204T>G mutation. Follow-up was maintained for 5 years, and the negative result was confirmed by evidence of a healthy growing boy. We identified two novel mutations and two previously reported mutations in SPAST and ATL1, respectively. The family with the ATL1 c.1204T>G mutation exhibited male-lethality, female infancy-onset, and pseudo- X-linked dominant transmission, which had never been previously reported for HSP. Characteristic facial features were also noticed. The boy on whom prenatal gene diagnosis was performed is healthy and without unusual facies, suggesting that the c.1204T>G mutation might be related to these features. The results extend the genetic spectrum of HSP and suggest that linkage analysis remains a powerful tool in gene discovery studies.

Abstract P4-05-12: MultiOmyx™ screening for prognostic indicators of breast cancer

Over the last three decades, the incidence of early-stage breast cancer has doubled while the incidence of late stage breast cancer has slightly decreased; however, the standard treatment for both has not changed significantly in the last 10 years. Of those diagnosed with early-stage breast cancer, 30% will develop recurrent disease, though there is currently no diagnostic available to identify these cases. Conversely, identifying late stage patients with a low- risk for recurrence could spare them from post-surgical chemotherapy. We have developed a technology that allows in situ staining and analysis of up to 60 proteins on a single tissue slide. In this exploratory study we evaluated 25 known biomarkers on a cohort of more than 800 breast cancer cases assembled onto three tissue arrays. The cohort spans clinical grades and breast cancer subtypes, and is thus useful in novel associations of biomarker expression across a variety of clinical features. Twenty-five markers were chosen based on literature reports for marker association with disease recurrence and represent a range of biological features including signaling pathways and cell phenotypes. The slides were sequentially stained with antibodies that were directly conjugated to Cy3 and Cy5 dyes, imaged, evaluated for quality and subject inclusion, and subsequently analyzed for statistical correlations of expression values to clinical features. The images were then processed using a single cell analysis algorithm which allows for quantification of individual tumor cells and signal intensities for the markers to be extracted from sub-cellular domains (nucleus, cytoplasm, and membrane of each cell) allowing unique patterns of protein expression to be determined. Univariate Cox proportional hazards analysis was first applied to determine those features with strongest association with ‘death due to disease’. Of the 25 markers analyzed, several markers (e.g. API3, AMPH2, beta-catenin, CD44, CEACAM5, CK15, CK19, cMET, Her2, Ki67, TRIM29) were found to have strong association with poor outcome (FDR &lt; 0.05). After adjusting for clinical variables (stage, number of positive nodes, grade), a number of markers (e.g. CD44, CEACAM5, cMET, TRIM29) still show a strong association with poor clinical outcome (FDR &lt; 0.05, Cox proportional hazards model). CEACAM5 is part of the MammostratTM panel of markers used for determining prognosis in ER positive breast cancers after Tamoxifen® treatment. CD44, a cancer stem cell marker, and TRIM 29, a transcriptional regulatory factor involved in carcinogenesis, have been associated with basal-like breast cancers which have the worst prognosis of all the breast cancer subtypes. High levels of cMET have been associated with poor prognosis for all breast cancer subtypes and cMET is being explored as a therapeutic target. The MultiomyxTM methodology enabled us to verify a subset of biomarkers that are clinically relevant to breast cancer outcome. Using this technology could lead to identification of novel biosignatures that stratify patients and enable precision medicine that results in better treatment decisions and prognosis for patients.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-05-12.

Three-dimensional dynamics of oblate and prolate capsules in shear flow

We study computationally the dynamics of oblate and prolate spheroidal capsules in simple shear flow with small inertia for a range of dimensionless shear rates. The capsule is modelled as a liquid droplet enclosed by a hyperelastic membrane, and its equatorial plane is initially tilted out of the plane of shear. We find, at low shear rates, the well-accepted tumbling motion is not always stable for both oblate and prolate capsules. For an oblate capsule, the dominant stable modes for increasing dimensionless shear rate are as follows: rolling with the equatorial plane staying in the plane of shear, precessing following Jeffery's orbit [Proc. R. Soc. London A 102, 161 (1922)], and tumbling. Interestingly, the order of modes is reversed for a prolate capsule: tumbling, precessing, and rolling with increasing dimensionless shear rate. At transitional regimes, we find the stable motion of a capsule can depend on its initial titled angle, even at the same shear rate. At high dimensionless shear rates, a spheroidal capsule undergoes a complicated oscillating-swinging motion: Its major axis oscillates about the plane of shear in addition to the swinging about a mean angle with flow direction found previously, and the amplitudes of both oscillations decrease when increasing the dimensionless shear rate towards a steady tank treading motion asymptotically. We summarize the results in phase diagrams and discuss the reorientation of both oblate and prolate capsules in a wide range of dimensionless shear rates.

Detrusor botulinum toxin A injection significantly decreased urinary tract infection in patients with traumatic spinal cord injury

STUDY DESIGN

The study was designed as a single-arm clinical trial.

OBJECTIVES

To investigate the effect of detrusor botulinum toxin A (BoNTA) injection on urinary tract infection (UTI) in patients with spinal cord injury (SCI).

SETTING

The study was performed in a national rehabilitation research center of China.

METHODS

Between September 2010 and May 2012, 41 male inpatients with neurogenic detrusor overactivity (NDO) caused by traumatic SCI, mean age 36.0±8.8 years, duration of SCI since inclusion 21.5±17.3 months, received an injection of 300 U BoNTA into detrusor. Before and 3 months after injection, each patient kept a bladder diary, underwent video-urodynamic investigation and urine culture. All UTIs occurring in the 6 months before and the 6 months after injection were recorded.

RESULTS

Before injection, the mean number of UTI over 6 months was 1.39±1.36. After injection, the mean significantly decreased to 0.78±0.96 (P=0.023). The mean maximum detrusor pressure during filling decreased significantly in the patients of detrusor overactivity (n=24) compared with patients of normo-active detrusor (n=17) after injection (35.4±12.2 vs 20.9±7.9 cmH(2)O, P=0.000), meantime, the decrease of UTI was significant in the former (1.29±1.21 vs 0.41±0.62 cmH(2)O, P=0.015) while no significant in the latter (1.46±1.47 vs 1.04±1.08, P=0.319).

CONCLUSION

Detrusor BoNTA injection significantly decreased UTI in SCI patients with NDO. This effect seems to be related to the decrease of detrusor pressure.

Numerical simulations of deformation and aggregation of red blood cells in shear flow

This article reviews numerical simulations of red blood cells (RBCs) mainly using the lattice Boltzmann method (LBM), focusing on the 2-dimensional deformation and aggregation of the cells in simple shear flow. We outline the incorporation of the immersed boundary method into the LBM, in which the membrane forces are obtained from the membrane model. The RBCs are simulated as a single biconcave capsule and as a doublet of biconcave capsules. The transition from swinging to tumbling motions of the RBCs, as induced by reducing the shear rate or increasing the membrane bending stiffness, is discussed. Also discussed is the aggregation tendency of the doublet of RBCs, for which homogenous deformability maintained RBC aggregation, whereas an increased deformability difference resulted in RBC dissociation.

A systematic review on use of Chinese medicine and acupuncture for treatment of obesity

Obesity is a major health hazard and despite lifestyle modification, many patients frequently regain any lost body weight. The use of western anti-obesity drugs has been limited by side effects including mood changes, suicidal thoughts, and gastrointestinal or cardiovascular complications. The effectiveness and safety of traditional Chinese medicine including Chinese herbal medicine (CHM) and acupuncture provide an alternative established therapy for this medical challenge. In this systematic review, we used standard methodologies to search, review, analyse and synthesize published data on the efficacy, safety and relapse of weight regain associated with use of CHM and acupuncture. We also examined the rationale, mechanisms and potential utility of these therapies. A total of 12 electronic databases, including Chinese, English, Korean and Japanese, were searched up to 28 February 2010. Randomized controlled trials (RCTs) for CHM and/or acupuncture with comparative controls were considered. We used the Jadad scale to assess methodological qualities, the random effect model in the pooled analysis of therapeutic efficacy to adjust for heterogeneity and funnel plots to explore publication bias. After screening 2,545 potential articles from the electronic databases, we identified 96 RCTs; comprising of 49 trials on CHM treatment, 44 trials on acupuncture treatment and 3 trials on combined therapy for appraisal. There were 4,861 subjects in the treatment groups and 3,821 in the control groups, with treatment duration ranging from 2 weeks to 4 months. Of the 77 publications written in Chinese, 75 had a Jadad score <3, while 16 of the 19 English publications had a Jadad score of >3. Efficacy was defined as body weight reduction ≥ 2 kg or body mass index (BMI) reduction ≥ 0.5 kg/m(2) . Compared with placebo or lifestyle modification, CHM and acupuncture exhibited respective 'risk ratio' (RR) of 1.84 (95% CI: 1.37-2.46) and 2.14 (95% CI: 1.58-2.90) in favour of body weight reduction, with a mean difference in body weight reduction of 4.03 kg (95% CI: 2.22-5.85) and 2.76 kg (95% CI: 1.61-3.83) and a mean difference in BMI reduction of 1.32 kg m(-2) (95% CI: 0.78-1.85) and 2.02 kg m(-2) (95% CI: 0.94-3.10), respectively. Compared with the pharmacological treatments of sibutramine, fenfluramine or orlistat, CHM and acupuncture exhibited an RR of 1.11 (95% CI: 0.96-1.28) and 1.14 (95% CI: 1.03-1.25) in body weight reduction, mean difference in body weight reduction of 0.08 kg (95% CI: -0.58 to 0.74) and 0.65 kg (95% CI: -0.61 to 1.91), and mean difference in BMI reduction of 0.18 kg m(-2) (95% CI: -0.39 to 0.75) and 0.83 kg m(-2) (95% CI: 0.29-1.37), respectively. There were fewer reports of adverse effects and relapses of weight regain in CHM intervention studies conducted in China than studies conducted outside China. CHM and acupuncture were more effective than placebo or lifestyle modification in reducing body weight. They had a similar efficacy as the Western anti-obesity drugs but with fewer reported adverse effects. However, these conclusions were limited by small sample size and low quality of methodologies.

Potential risk of zoonotic transmission from young swine to human: seroepidemiological and genetic characterization of hepatitis E virus in human and various animals in Beijing, China

The aim of this study was to further investigate the prevalence of infection and genotype of hepatitis E virus (HEV) among different species of animals, people whose works are related to pigs and the general population in the suburb of Beijing, China. Serum and faecal samples were collected from 10 animal species and humans. Anti-HEV was detected by enzyme immunoassays (EIA); HEV RNA was amplified by reverse transcription-nested polymerase chain reaction (RT-nPCR) method. PCR products were cloned and sequenced. The isolated swine HEV sequences were analysed phylogenetically. The positive rates of serum anti-HEV in swine, cattle, milk cow, horse, sheep, donkey, dog, duck, chicken, pig farm workers and slaughterhouse workers, and general population were 81.17% (802/988), 25.29% (66/261), 14.87% (40/269), 14.29% (40/280), 9.30% (53/514), 0 (0/25), 0 (0/20), 2.53% (8/316), 3.03% (7/231), 58.73% (37/63), 35.87% (66/184) and 20.06% (538/2682), respectively. The anti-HEV prevalence in adult swine (≥ 6 months) and younger swine (≤ 3 months) was 91.49% (591/646) and 61.7% (211/342), respectively. The positive rate of HEV RNA in young swine faeces was 47.94% (93/194). All 93 isolates from the younger swine shared 87.8-100% nucleotide homology with each other and had identities of 75.6-78.9%, 73.9-76.1%, 76.4-80.6% and 83.1-95.0% with the corresponding regions of genotypes 1-4 HEV, respectively. Phylogenetic analysis showed that all HEV isolates belong to genotype 4, subgenotype 4d. These results suggest a potential risk of zoonotic transmission of HEV from younger swine to farmers who rear pigs.

Transition from orbital liquid to Jahn-Teller insulator in orthorhombic perovskites RTiO3

Following the same strategy used for RVO3, thermal conductivity measurements have been made on a series of single-crystal perovskites RTiO3 (R=La,Nd,...,Yb). Results reveal explicitly a transition from an orbital liquid to an orbitally ordered phase at a magnetic transition temperature, which is common for both the antiferromagnetic and ferromagnetic phases in the phase diagram of RTiO3. This spin/orbital transition is consistent with the mode softening at T_{N} in antiferromagnetic LaTiO3 and is supported by an anomalous critical behavior at T_{c} in ferromagnetic YTiO3.

Pancreatic islet beta-cell deficit and glucose intolerance in rats with uninephrectomy

This study was performed to examine the effect of chronic renal impairment and renin-angiotensin system (RAS) activation induced by unilateral nephrectomy (UNX) on the development of pancreatic islet beta-cell deficit and glucose intolerance. Sprague-Dawley rats were randomized into three groups: untreated UNX (n=10), UNX treated with the angiotensin-converting enzyme inhibitor lisinopril (n=8) and sham operation (n=10). Blood glucose, serum insulin, renal function and histological changes of kidney and pancreas were examined 8 months postoperation. Compared with the sham rats, UNX rats developed renal impairment, insulin deficiency and glucose intolerance. Histological staining revealed an islet beta-cell deficit associated with increased immunoreactivity for angiotensin and angiotensin type 1 receptor in UNX rats. Treatment with lisinopril significantly improved renal dysfunction, hyperglycemia, insulin secretion and islet RAS expression. These data suggest that chronic renal impairment and RAS activation may contribute to islet beta-cell loss and glucose intolerance. RAS blockade may therefore prevent these disorders.

Tank-treading, swinging, and tumbling of liquid-filled elastic capsules in shear flow

The dynamic motion of three-dimensional (3D) capsules in a shear flow is investigated by direct numerical simulation. The capsules are modeled as Newtonian liquid droplets enclosed by elastic membranes, with or without considering the membrane-area incompressibility. The internal liquid of the capsules is the same as that outside. The dynamic motion of capsules with initially spherical and oblate spheroidal unstressed shapes is studied under various shear rates. The results show that spherical capsules deform to stationary configurations and then the membranes rotate around the liquid inside (steady tank-treading motion). Such a steady mode is not observed for oblate spheroidal capsules. It is shown that with the shear rate decreasing, the motion of oblate spheroidal capsules changes from the swinging mode (a capsule undergoes periodic shape deformation and inclination oscillation while its membrane is rotating around the liquid inside) to tumbling mode.

Orbital fluctuations and orbital flipping in RVO3 perovskites

The effect of the average R-site ionic radius IR and variance on the orbital and magnetic order in R3+-doped YVO3 was studied in Y1-xLaxVO3 and Y1-x(La0.2337Lu0.7663)xVO3 with fixed IR. The orbital flipping temperature T{CG} increases nonlinearly with increasing R-site variance, indicating that the V-O-V bond angle is not the primary driving force stabilizing the C-type orbitally ordered phase. The suppressed thermal conductivity in the G-type orbitally ordered phase signals some remaining orbital randomness that is enhanced by t{2} and et hybridization in {3}T{1g} site symmetry.

Transient deformation of elastic capsules in shear flow: effect of membrane bending stiffness

The transient deformation of liquid capsules enclosed by elastic membranes with bending rigidity in shear flow has been studied numerically, using an improved immersed boundary-lattice Boltzmann method. The purpose of the present study is to investigate the effect of interfacial bending stiffness on the deformation of such capsules. Bending moments, accompanied by transverse shear tensions, usually develop due to a preferred membrane configuration or its nonzero thickness. The present model can simulate flow induced deformation of capsules with arbitrary resting shapes (concerning the in-plane tension) and arbitrary configurations at which the bending energy has a global minimum (minimum bending-energy configurations). The deformation of capsules with initially circular, elliptical, and biconcave resting shapes was studied; the capsules' minimum bending-energy configurations were considered as either uniform-curvature shapes (like circle or flat plate) or their initially resting shapes. The results show that for capsules with minimum bending-energy configurations having uniform curvature (circle or flat plate), the membrane carries out tank-treading motion, and the steady deformed shapes become more rounded if the bending stiffness is increased. For elliptical and biconcave capsules with resting shapes as minimum bending-energy configurations, it is quite interesting to find that with the bending stiffness increasing, the capsules' motion changes from tank-treading mode to flipping mode, and resembles Jeffery's flipping mode at large bending stiffness.

Gene amplification and associated loss of 5' regulatory sequences of CoAA in human cancers

CoAA is an RRM-containing transcriptional coactivator that stimulates transcriptional activation and regulates alternative splicing. We show that the CoAA gene is amplified at the chromosome 11q13 locus in a subset of primary human cancers including non-small cell lung carcinoma, squamous cell skin carcinoma and lymphoma. Analysis of 42 primary tumors suggests that CoAA amplifies independently from the CCND1 locus. Detailed mapping of three CoAA amplicons reveals that the amplified CoAA gene is consistently located at the 5' boundaries of the amplicons. The CoAA coding and basal promoter sequences are retained within the amplicons but upstream silencing sequences are lost. CoAA protein is overexpressed in tumors containing the amplified CoAA gene. RNA dot blot analysis of 100 cases of primary tumors suggests elevated CoAA mRNA expression. CoAA positively regulates its own basal promoter in transfection assays. Thus, gene amplification, loss of silencing sequence and positive feedback regulation may lead to drastic upregulation of CoAA protein. CoAA has transforming activities when tested in soft agar assays, and CoAA is homologous to oncoproteins EWS and TLS, which regulate alternative splicing. These data imply that CoAA may share a similar oncogenic mechanism with oncogene EWS and that CoAA deregulation may alter the alternative splicing of target genes.

Gene therapy by membrane-expressed superantigen for α-fetoprotein-producing hepatocellular carcinoma

Staphylococcus enterotoxin A (SEA) is a powerful immunostimulant, which can stimulate T cells bearing certain T-cell receptor beta-chain variable regions, when bound to major histocompatibility complex II molecules. In vivo administration of intact superantigen in sufficient therapeutic amounts risks unwanted cytotoxicity against normal cells. In this study, we used SEA fused with CD80 transmembrane region (named as SEAtm) driven by alpha-fetoprotein (AFP) enhancer/promoter to reduce toxicity and to improve safety and efficiency in the application of SEA. We demonstrated that SEAtm by adenovirus from the AFP enhancer/promoter (AdAFPSEA) could be expressed on the surface of AFP-producing cell line Hepa1-6 instead of non-AFP-producing cell lines. Hepa1-6 infected by recombinant adenovirus stimulated proliferation of splenocytes and activated CD4(+) and CD8(+) T cells in vitro. After AdAFPSEA was injected into the subcutaneously established hepatoma in vivo, the expression of SEA was detected in tumor tissues, which subsequently induced tumor-specific cytotoxic T cells in spleen. Moreover, hepatocellular carcinoma (HCC) xenografts were suppressed by treatment with AdAFPSEA and the survival time of treated mice was prolonged. These findings suggest that membrane-expressed SEA by adenovirus from AdAFPSEA can generate stronger local and systemic antitumor responses against HCC.

Specific heat of single-crystal PrMnO3

The specific heat of single-crystal PrMnO₃ was investigated from 2 to 200 K under different magnetic fields up to 8 T. A Schottky-like anomaly observed at low temperature was gradually shifted to higher temperatures by magnetic fields. The first four singlets of the Pr^3+ 3H₄ ground multiplet in PrMnO₃ are given for the first time by fitting the specific heat of Pr³⁺ ions below 40 K under zero field. By analysing the field dependence of the first singlet of Pr³⁺ ions, the Pr-Mn exchange field is found to be negligible, which is consistent with the magnetic anisotropy of Pr³⁺ ions revealed in the magnetic measurement. At T_N, the cooperative antiferromagnetic ordering of Mn³⁺ spins shows up as λ-shaped anomaly, which is lowered and broadened in magnetic fields. The magnetic entropy near T_N is estimated by subtracting the contributions to specific heat from Pr³⁺ ions and lattice vibrations. It was found that the fraction of entropy above T_N in the total entropy increases with the fields due to the enhancement of spin fluctuations by magnetic field.

[Influence of staphylococcal enterotoxin A on immunogenicity of hepatocellular carcinoma cells]

OBJECTIVE

To transduce the gene of staphylococcal enterotoxin A (SEA) into a HCC cell line HHCC and to make the cells to express the molecules of SEA for the purpose of improving the immunogenicity and inducing immune rejection of HCC.

METHODS

Construct retroviral vector containing the gene of SEA and transduce it into HHCC cells. Then the integration, transcription and expression of recombinant were analyzed. At last cytotoxicity test of peripheral blood mixed lymphocytes was carried out.

RESULTS

We obtained the retroviral vector pLXSN-SEA, transduced into HHCC cells and obtained the HCC cell line that expressed SEA toxin protein. The content of SEA in supernatant was at the level of pg. The cytotoxicity of HHCC transduced with SEA by T lymphocytes was 45.6%, which was higher than that of HHCC (20.7%). The Km value of T lymphocytes against HHCC transduced with SEA and without SEA was 5.18 x 10(4) and 2.92 x 10(5), separately. The difference had statistical significance.

CONCLUSIONS

After transducing the SEA gene, although tiny quantity of expression is detected, the cytotoxicity assay proves that the expression of SEA lead to a robust immune response.

Reconstruction of SEA-B7.1 double signals on human hepatocellular carcinoma cells and analysis of its immunological effect

Since transfection of established tumors with immunostimulatory genes, such as superantigens (SAg), a family of bacterial and viral proteins with strong immunostimulatory properties, can elicit antitumor immunity, direct transfection of tumors with genes of staphylococcal enterotoxin A (SEA) could probably set up a new way of immunological pathway. In our study, human hepatocellular carcinoma (HCC) cell lines stably transduced with SEA and B7.1/SEA fused genes, HHCCSEA and HHCCBS, were obtained by using the method of retroviral mediated gene transduction. The results showed that human HCC cells could express SEA gene. Although a tiny quantity of expression was detected, a robust immune response was promoted. The cytotoxicity of CTL on HHCCBS was the same as that on HHCCSEA. But the K(m) value of the reaction of the former was lower than that of HHCCSEA. Furthermore, the activity assay of T cells by ELISPOT demonstrated that HHCCBS could elicit more CTL activity than HHCCSEA and HHCCB7.1. It suggested that the affinity of T cells to HHCCBS was higher and the maxim velocity of reaction could be attained at an early stage of the reaction. Transduced HCC cells were also analyzed for HLA expression, and it was found that a majority of the cells expressed HLA-I molecules but no HLA-DR molecules. After blocking the HLA-I molecules by HLA-I mAb, the cytotoxicity of T lymphocytes dropped remarkably. The results suggested that SEA were mainly presented by HLA-I molecules, and that B7.1 and SEA could have synergistic action at the early stage of the reaction, but the relationship between them in the consequent process needs to be clarified.

[A retrospective analysis of therapeutic outcome of various types of severe virus hepatitis]

OBJECTIVE

To explore combined therapeutic schemes for severe virus hepatitis and to raise survival rate.

METHODS

The therapeutic outcomes of different schemes were analyzed in 1020 cases of severe viral hepatitis treated in our hospital in recent twenty years. The treatments were classified as basic and combination of Chinese traditional and Western medicine therapies in which embryonic liver cell suspend liquid or hepatic growth factor, or/and artificial liver as blood cleaner were also used for the latter.

RESULTS

The survival rate was 30.28% (33/109) treated by basic procedures and 60.15% (548/911) by combined procedures. There was obvious statistical difference in survival rate between the two groups (P<0.001). Among all the patients, 219 (21.47%) suffered from acute or sub-acute severe hepatitis, 801 (78.53%) chronic severe hepatitis; 446 started their treatment at the early stage of the disease and the survival rate was 77.13% (344/446); 404 at the mid stage and 170 at the late stage and the survival rates were 52.72% (213/404) and 14.12% (24/170), respectively. The survival rate for the patients treated at the early or the mid stage was much higher than that at the late stage (P<0.001), and had a positive correlation with the activity of prothrombin.

CONCLUSION

The combined therapies used in present study are effective to raise the survival rate of the patients with severe virus hepatitis. Early treatment is extremely important for the patients' prognosis.