POS0422 A HISTORY OF CHLAMYDIAE INFECTION IN RHEUMATOID ARTHRITIS DEVELOPMENT

Background

Current hypotheses for the ethiopathogenesis of rheumatoid arthritis (RA) postulate an infectious agent initiating autoimmunity, which is thought to be at the mucosal level. Chlamydiae infections have been previously associated to development of an acute inflammatory arthritis, which can become chronic in some patients. Chlamydia trachomatis was detected in synovial fluid and tissue of RA patients, at least in early disease, suggesting that this organism could be involved in initiating RA onset, at least in a subset of patients.

Objectives

To investigate the association between Chlamydiae infection and the development of autoimmunity and pre-clinical manifestations associated with RA.

Methods

This study was performed in an ongoing prospective study of individuals genetically at risk of developing RA, namely first-degree relatives of RA patients (RA-FDR). Individuals without clinical evidence of RA are enrolled, and assessed yearly, clinically and biologically. We included all RA-FDRs who responded to a Chlamydiae infection questionnaire, and the exposure of interest was self-reported Chlamydiae infection. The primary outcome was autoimmunity associated with RA (seropositivity) defined by the presence of anti-citrullinated peptide antibodies (ACPA) and/or rheumatoid factors (RF) at the last visit. Seropositive inflammatory arthritis at the last visit was a secondary outcome. We used logistic regression to analyze univariable and multivariable associations, adjusting for age and gender as potential confounders.

Results

A total of 1254 RA-FDRs were analyzed, of which 168 (13.4%) had developed seropositivity. The prevalence of self-reported Chlamydia infection was significantly higher in seropositive individuals as compared to controls (17.9% versus 9.8%, P<0.01) (Table 1). A significant association between the self-reported history of Chlamydiae infection and the seropositivity was observed in both univariate and multivariate analyses (OR=2.00, 95% CI: 1.27-3.09; OR=1.91, 95% CI: 1.20-2.95, respectively). A sub-group of 48 RA-FDRs (4 %) presented inflammatory arthritis in conjunction with seropositivity. This subgroup, considered at highest risk for RA, reported significantly more often prior infections with Chlamydiae than the negative subgroup (20.8% versus 10.5%, P<0.05). The ORs for the association of self-reported history of Chlamydiae infection and inflammatory arthritis coupled to RA-associated autoimmunity were 2.23 (95% CI: 1.03-4.43, P<0.01, univariate analysis) and 1.91 (95% CI: 0.88-3.82, P=0.08, multivariate analysis).

Table 1.

A potential association between a self-reported history of Chlamydiae infection and RA development

RA-FDR with a self-reported chlamydia infection anamnesis (n=1254)Study GroupsSelf-reported “infection”Univariate analysisMultivariate analysis1OR (95% CI)OR (95% CI)Seropositive RA-FDR (n=168)30 (17.9%)2.00** (1.27 - 3.09)1.91** (1.20 – 2.95)Seronegative RA-FDR (n=1063)104 (9.8%)RA-FDR with seropositive inflammatory arthritis2 (n=48)10 (20.8%)2.23* (1.03 – 4.43)1.91 (0.88 – 3.82)RA-FDR without seropositive inflammatory arthritis (n = 1206)127 (10.5%)

1Logistic regression model adjusting for age and gender.

2Seropositive inflammatory arthritis was defined by being either: seropositive RA; seropositive “arthritis” (defined by at least one swollen joint at physical examination); seropositive with MSUS (musculoskeletal ultrasound) inflammatory activity.

* P-value < 0.05

** P-value < 0.01

Conclusion

Our results suggest that a history of Chlamydiae infection may be a risk factor for the development of RA in a subset of individuals at genetic risk for the disease. Serological analyses to assess the prevalence of antibodies to C. trachomatis major outer membrane protein (MOMP) are under way to confirm these preliminary data.

References

[1]Arleevskaya MI et al. Front Microbiol. 2016;7:1296;

[2]Inman RD et al. Curr Opin Rheumatol. 2000;12(4):254-262;

[3]Swanborg RH et al. Expert Rev Mol Med. 2006;8(29):1-23;

[4]Villareal C et al. Arthritis Res. 2002;4(1):5-9.

Disclosure of Interests

Céline Lamacchia: None declared, Romain Aymon: None declared, Benoit GILBERT: None declared, Olivia Studer: None declared, Kim Lauper Consultant of: KL reports consultant fees for Pfizer and speaker fees for Pfizer, Viatris and Celltrion, outside of the submitted work, Axel Finckh: None declared.

AB0018 SERUM ANTIBODIES AGAINST ORAL AND INTESTINAL BACTERIA IN INDIVIDUALS AT RISK FOR RHEUMATOID ARTHRITIS, CHRONIC RA PATIENTS, AND NEW ONSET PATIENTS WITH DIFFERENT RHEUMATIC DISEASES

Background

Evidence about the influence of microbes in autoimmune diseases such as rheumatoid arthritis (RA) has grown in recent years. However, the precise role of specific bacteria remains largely unknown. Previous investigations identified several oral pathobionts to be specifically targeted by serum antibodies in RA patients.1 In addition, Pianta et al.2 identified recognition of Prevotella copri by the immune system of RA patients. It has to be noted, however, that such findings have neither been reproduced, nor studied in different disease stages. Also, the assumptions made for P. copri relied on a single strain, the type strain DSM18205, isolated from a healthy individual.3 However, there is recent evidence suggesting P. copri to be a non-monotypic species, meaning it clusters into several subspecies displaying geno- and phenotypic differences4.

Objectives

This study aimed to quantify serum antibodies targeting different P. copri strains, as well as known oral pathobionts in patients with different rheumatic diseases or in various stages of RA development.

Methods

We used custom-made ELISA assays measuring pathogen-specific IgG levels in patient’s serum. Samples were tested against P. copri strains isolated from stool samples of healthy donors and RA patients, as well as the following oral pathobionts: Porphyromonas gingivalis, Prevotella intermedia and Prevotella melaninogenica. We analyzed 120 samples from a Swiss cohort of first-degree relatives, individuals in various pre-clinical RA stages (SCREEN-RA), and 45 samples of patients with established RA (SCQM cohort). These participants were categorized as asymptomatic seronegative individuals (FDR), individuals with ‘systemic autoimmunity associated with RA’ (ACPA and/or RF autoantibodies) (preRA 1), individuals with ’clinically suspect arthralgia’ or ‘undifferentiated arthritis’ with/without autoantibodies (preRA 2) and chronic RA patients (cRA). Additionally, we included 92 serum samples from new-onset patients diagnosed with RA, psoriatic arthritis (PsA) axial spondyloarthritis (SpA), or other non-rheumatic diseases (NRD) recruited via the german RheumaVOR cohort (Table 1).

Table 1.

Overview human cohort studies

cohortSCREEN-RASCQMRheumaVORpatient groupFDRpreRA 1preRA 2cRANRDRAPsAaxSpAtotal numbers4240384532143016age median5454595643.551.550.533sex (F/M)32/1035/534/435/1019/139/515/1510/6ACPA positivity0259310700RF positivity0198340700

Results

Overall, there were no significant differences in the IgG reactivity profiles between the patient groups against the distinct P. copri strains or oral pathobionts (Figure 1). However, performing this assay with P. copri strains from distinct subspecies identified clear differences and revealed important variability in the IgG reactivity.

Figure 1.

Serum IgG responses against different microbes from individuals recruited via SCREEN-RA, SCQM or RheumaVOR cohort

Conclusion

Our study failed to reproduce previous results and could confirm neither P. copri nor the three oral pathobionts to be particularly targeted by systemic IgG immune reactions in RA patients. However, we identified strain-specific differences in the IgG reactivity against P. copri, regardless of disease type or state. The latter suggests that the overall immunostimulatory potential of P. copri might be dependent on its strain/subspecies level. Our findings underline the necessity of P. copri strain-level characterization when studying host-microbiota immune interactions.

References

[1]Ogrendik et al. MedGenMed (2005)

[2]Pianta et al. Arthritis Rheumatol. (2017)

[3]Hayashi et al. Int. J. Syst. Evol. Microbiol. (2007)

[4]Tett et al. Cell Host & Microbe (2019)

Disclosure of Interests

None declared

POS1420 DOUBLY ROBUST ESTIMATOR FOR AVERAGE TREATMENT EFFECT AS SENSITIVITY ANALYSIS FOR COMPARATIVE EFFECTIVENESS RESEARCH. AN EXAMPLE COMPARING DRUG MAINTENANCE BETWEEN BARICITINIB AND ALTERNATIVE BIOLOGIC DMARDS

Background

Drug maintenance is a common outcome measure of real world effectiveness studies, because it combines a measure of drug effectiveness and its tolerance / safety. Major hurdles of observational studies are potential selection biases and confounding. Cox proportional hazard ratio models address this issue by adjusting for potential confounders, but misspecification of the model may lead to biased estimates. ‘Augmented Inverse Probability Treatment Weighting’ (AIPTW) has the attractive property of being doubly robust, meaning that only one of the two underlying models has to be correctly specified to obtain consistent estimates. It can be used as a sensitivity analysis for Cox models, when analyzing time-to-event data.

Objectives

To evaluate AIPTW estimator and test the robustness of the results obtained by a Cox model.

Methods

Previous analyses in the Swiss rheumatoid arthritis (RA) registry (SCQM) had demonstrated that time to all-cause-discontinuation was significantly longer in RA patients on bariticinib (BARI, N = 273) compared to TNF-inhibitors (TNFi, N = 473); but not compared to other mode of actions biologics (OMA, N = 378) [1], in an adjusted Cox regression including age, gender, BMI, concomitant csDMARD, prednisone, CDAI score, disease duration, smoking status, line of therapy and seropositivity.

Here we repeat the same analysis using AIPTW, including the same potential confounders. We combine a propensity score using a logistic regression model and an inverse probability weighted Cox regression. Two implementations of the AIPTW estimator are considered. First we use the RiskRegression package in R, to obtain risk ratios. Then we implement the AIPTW manually to obtain the average treatment effect as the difference in median survival time.

Results

Time to treatment discontinuation measured with Cox model was significantly longer for RA patients on BARI compared to patients on TNFi according to the adjusted Cox model (HR = 1.79), and a similar non-significant trend existed when compared to OMA (HR = 1.29).

When considering 90-day treatment discontinuation measured with the AIPTW, the results were qualitatively very similar: the risk ratio between BARI and TNFi groups is statistically significant (RR = 2.51), while that of BARI against OMA is larger than one (RR = 1.47), but not statistically significant. Confidence intervals are larger with the AIPTW estimation.

Table 1.

Cox Regression HR and AIPTW risk ratios

Cox Regression Hazard Ratio (95% CI)AIPTW Estimate of 90-day risk ratio of treatment discontinuation (95% CI)BARI vs. TNFi1.79* (1.34-2.38)2.51* (1.19 – 3.83)BARI vs. OMA1.29 (0.96-1.73)1.47 (0.76 – 2.18)

Legend: BARI: baricitinib; TNFi: TNF-inhibitors; OMA: Other Mode of Actions biologics; AIPTW: Augmented Inverse Probability Treatment Weighting. 95% CI: 95% Confidence Interval. *: statistically significant result at the p<0.05 level.

Figure 1.

Absolute risk of treatment discontinuation over time between patients on baricitinib and patients on TNF inhibitors, estimated with AIPTW.

Conclusion

Time to treatment discontinuation measured with Cox model was significantly longer for RA patients on BARI compared to patients on TNFi according to the adjusted Cox model (HR = 1.79), and a similar non-significant trend existed when compared to OMA (HR = 1.29).

When considering 90-day treatment discontinuation measured with the AIPTW, the results were qualitatively very similar: the risk ratio between BARI and TNFi groups is statistically significant (RR = 2.51), while that of BARI against OMA is larger than one (RR = 1.47), but not statistically significant. Confidence intervals are larger with the AIPTW estimation.

Conflict of Interest:

This analysis has been made possible by financial support of Eli Lilly (Suisse) SA to the Geneva University Hospitals (HUG).

References

[1]Ann Rheum Dis, supplement 1, year 2021. DOI: 10.1136/annrheumdis-2021-eular.1781

Disclosure of Interests

Romain Aymon: None declared, Benoit GILBERT: None declared, Denis Mongin: None declared, Eric Nham: None declared, Cedric Laedermann Employee of: Eli Lilly, Rüdiger Müller Consultant of: Streuli Pharma, Gebro Pharma, AbbVie, Kim Lauper Speakers bureau: Pfizer, Viatris and Celltrion, Consultant of: Pfizer, Delphine Courvoisier: None declared, Axel Finckh: None declared

POS0435 IMPACT OF COMBINATION THERAPY WITH csDMARDs ON THE EFFECTIVENESS OF BIOLOGIC OR TARGETED SYNTHETIC DMARDs IN A REAL-LIFE SETTING: RESULTS FROM THE SWISS RHEUMATOID ARTHRITIS REGISTER (SCQM-RA)

Background

Management guidelines of RA suggest to administer biological or targeted synthetic DMARD (b/tsDMARD) in combination with conventional synthetic DMARD (csDMARD). Limited data exists about the impact of such csDMARD combination therapy (co-therapy) in real life settings, in particular for baricitinib use compared to other types of b/tsDMARD.

Objectives

To assess the impact of concomitant csDMARD prescription on b/tsDMARD maintenance, in a real-world setting.

Methods

This is a nested cohort study within the Swiss registry of RA patients (Swiss Clinical Quality Management (SCQM-RA)), of treatment courses with bDMARDs or baricitinib (BARI) initiated between 2017-09-01 and 2020-06-01, with at least one follow-up visit. We compared the time-to-drug-discontinuation (drug maintenance), as a measure of drug effectiveness of b/tsDMARDs, with or without csDMARD co-therapy. Our exposure of interest was the impact of csDMARD co-therapy compared to monotherapy in 3 categories of b/tsDMARDs: baricitinib (BARI), TNFi inhibitors (TNFi) and other modes of action bDMARDs (OMA). Co-therapy was defined as receiving at least one csDMARD during at least 40% of the b/tsDMARD treatment courses (TC) duration.

Baseline characteristics were compared using t-tests or χ2. Survival Kaplan-Meier curves, with Log-rank test, were used to assess time-to-discontinuation. Cox models were applied to obtain adjusted hazard ratios (HR) using age, BMI, corticosteroid treatment, CDAI score, disease duration, smoking, line of therapy, seropositivity, gender as covariates. Missing baseline CDAI values were imputed using linear model with quadratic regression time.

Results

1065 TC were included (273 BARI, 319 OMA, 473 TNFi), about half of which were initiated with csDMARD co-therapy (Table 1). In the co-therapy groups, csDMARD were taken on average 98% of the TC duration. Methotrexate was the most prescribed csDMARD (Table 1).

Table 1.

Baseline characteristics of studied population

VariableBARIOMATNFiBARIBARI + csDMARDp valuesOMAOMA + csDMARDp valuesTNFiTNFi + csDMARDp valuesn = 164n = 109n = 170n = 149n = 183n = 290Mean (SD)Mean (SD)Mean (SD)Otherwise: %*Otherwise: %*Otherwise: %*Prednisone21 %24 %0.7322 %29 %0.1820 %20 %1.00Line of Therapy- 1st (= bio-naive)17 %18 %0.0419 %22 %0.5142 %51 %0.15-2nd17 %24 %24 %22 %26 %20 %-3rd24 %11 %27 %20 %14 %10 %-4th or later42 %48 %31 %36 %19 %18 %Female82 %73 %0.1475 %71 %0.4281 %70 %0.01Age60 (15)57 (11)0.0560 (13)57 (12)0.0352 (16)53 (14)0.66Disease duration (years)13 (10)12 (9)0.8211 (9)11 (10)0.589 (10)8 (8)0.36CDAI baseline19 (10)18 (8)0.5320 (14)21 (12)0.5318 (10)18 (11)0.64Seropositivity77 %72 %0.3574 %75 %0.9668 %71 %0.64csDMARD type- MTX-48 %--50 %--60 %-- MTX + other-2 %-5 %-4 %-- Other-50 %-45 %-36 %-

TC = treatment course, BARI = baricitinib, TNFi = TNF inhibitors, OMA = Other Mode of Action drugs, DMARDs = Disease Modifying Anti-Rheumatic Drugs, csDMARDs = classical synthetic DMARDs, SD = standard deviation. CDAI = Clinical Disease Activity Index. csDMARD = conventional synthetic DMARD. MTX = Methotrexate. Other: Other csDMARD. * Percentages relate to total n treatment courses. p values in bold highlight statistically significant difference between respective groups. All % mean and SD values are rounded to integers.

Even after adjustment, we found no difference in drug maintenance with and without concomitant csDMARD in the BARI group (crude p = 0.67; HR co-therapy 2.17, 95% CI [0.61;7.77], p = 0.16) and in the TNFi group (crude p = 0.13; HR co-therapy 1.24, 95% CI [0.56;2.74], p = 0.60). Adjusted drug maintenance with or without csDMARD was also similar in the OMA group, despite non-adjusted p-value in favor of monotherapy (Figure 1) (crude p = 0.007; HR co-therapy 0.66, 95% CI [0.25;1.80], p = 0.39).

Figure 1.

Drug maintenance of monotherapy vs csDMARD co-therapy (Non-adjusted Kaplan-Meier).

Conclusion

Our data suggest that drug maintenance of BARI, OMA and TNFi, were not significantly modified by concomitant csDMARD therapy.

Disclosure of Interests

Benoit GILBERT Speakers bureau: Once for Lilly, outside of the presented work., Denis Mongin: None declared, Eric Nham: None declared, Delphine Courvoisier: None declared, Kim Lauper Speakers bureau: for Pfizer, Viatris and Celltrion, outside of the submitted work., Consultant of: for Pfizer, outside of the submitted work., Cedric Laedermann Employee of: Currently employed by Eli Lilly., Rüdiger Müller: None declared, Axel Finckh Speakers bureau: Lilly, Grant/research support from: Research Grant by Lilly, to the rheumatology division.

POS0668 REAL WORLD EFFECTIVENESS OF BARICITINIB IN THE SWISS RHEUMATOID ARTHRITIS REGISTER (SCQM-RA)

Background:

When not responding to conventional synthetic DMARDs (csDMARDs), rheumatoid arthritis (RA) patients may receive biological DMARDs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs) including baricitinib (BARI). While BARI has demonstrated efficacy in randomized controlled trials, limited studies have established comparative effectiveness in real world settings, in particular when used in b/tsDMARD-naïve patients.

Objectives:

To analyze the effectiveness of BARI versus alternative bDMARDs, as assessed by drug maintenance over time and by response rates at 12 months.

Methods:

This is a nested study of RA patients, within the prospective Swiss Clinical Quality Management (SCQM) observational cohort.

All treatment courses (TC) with BARI or alternative bDMARDs initiated between 2017-09-01 and 2020-06-01, with at least one follow-up visit, were included. TC with BARI were compared to TC with alternative bDMARDs (non-BARI), including all b/tsDMARDs except rituximab. The non-BARI group was then subdivided into TNF inhibitors (TNFi) and other mode of action bDMARDs (OMA), excluding tsDMARDs. A secondary analysis focusing specifically on b/tsDMARD naïve patients was conducted.

Baseline characteristics were compared using ANOVA or χ2 tests. A Cox-model survival analysis assessed drug maintenance. 12-month response rates were estimated using an attrition-corrected, confounder-adjusted approach (1). CDAI score ≤10 defined low disease activity state (LDA), and CDAI score ≤2.8 defined remission.

Results:

Overall, 1218 eligible TC (from 1028 patients) were initiated during the study period (273 in BARI, 154 other tsDMARD, 473 in TNFi and 318 in OMA). Drug maintenance was significantly shorter for TNFi compared to BARI, even after adjustment for potential confounders (Hazard ratio (HR) for drug discontinuation 1.85 (95% CI [1,40 – 2,43]); p < 0.001). Drug maintenance was also numerically shorter for the OMA group compared to BARI, but the difference was not significant (HR 1.18 (95% CI [0.87 – 1.60]); p = 0.28). These differences were larger when analysing only bDMARD-naïve patients (Figure 1a).

All TC taken together, the rates of LDA and remission did not differ significantly between the 3 groups at 12 months. LDA ranged from 63% to 67% (BARI vs OMA p = 0.87; BARI vs TNFi p = 0.81) and remission from 19% to 23% (BARI vs OMA p = 0.30; BARI vs TNFi p = 0.77; Figure 1b).

Conclusion:

BARI demonstrated a significantly higher overall drug maintenance than TNFi, and a similar drug maintenance to OMA, both in a bDMARD-naïve population and in the overall population. The adjusted 12-month response rates did not differ between BARI, TNFi and OMA groups. These results suggest that prescription of BARI after csDMARD has at least similar outcomes as alternative bDMARDs.

References:

[1]Lauper, K., et al. Sat0588. Annals of the Rheumatic Diseases 78 (2019).

Table 1.

Baseline characteristics of studied population

VariableOverall comparison:BARI vs non-BARISubgroup analysis 1:by bDMARD type (tsDMARD excluded)Subgroup analysis 2:In b/tsDMARD-naïve patientsBARI(TC = 273; 273 patients)Non-BARI(altogether)(TC = 945; 755 patients)p valuesTNFi(TC = 473; 408 patients)OMA(TC = 318; 298 patients)p values(vs BARI)BARI(n = 46)TNFi(n = 225)OMA(n = 65)p valuesMean (SD)Otherwise: n %Mean (SD)Otherwise: n %Mean (SD)Otherwise: n %Concomitant csDMARD41 %46 %0.1754 %41 %<0.0150 %61 %48 %0.1Line of Therapy-1st (= bio-naive)17 %35 %<0.0148 %20 %<0.01100 %100 %100 %-2nd20 %23 %23 %23 %-3rd19 %16 %11 %24 %-4th or later44 %26 %18 %33 %Female78%74 %<0.2174 %73 %0.2870 %71 %74 %0.88Age59 (14)56 (14)0.0152 (15)58 (13)<0.0157 (15)51 (14)57 (16)<0.01Disease duration (years)13 (10)10 (9)<0.018 (9)11 (9)<0.015.5 (6.45)5 (7)6.5 (9)0.243CDAI baseline15 (9)15 (10)0.914 (9)16 (11)0.0513 (7)14 (9)14 (10)0.72Previous tsDMARD (non-BARI)33 %8 %<0.014 %11 %<0.010 %0 %0 %TC duration > 12-months37 %29 %0.0127 %30 %0.0237 %29 %34 %0.52

BARI = baricitinib, TNFi = TNF inhibitors, OMA = other mode of action, Non-BARI = TNFi + OMA + other tsDMARDs, SD = standard deviation.

Disclosure of Interests:

Benoit GILBERT: None declared, Delphine Courvoisier: None declared, Denis Mongin: None declared, Kim Lauper Consultant of: Gilead Galapagos, Grant/research support from: AbbVie, Clementine Perrier Shareholder of: Eli Lilly, Employee of: Eli Lilly, Rudiger Muller Consultant of: AbbVie, Novartis, Grant/research support from: GEBRO Pharma, Axel Finckh Speakers bureau: AbbVie, BMS, Pfizer, Eli-Lilly, Consultant of: AbbVie, BMS, Pfizer, Eli-Lilly, Grant/research support from: BMS, Pfizer, Eli-Lilly

POS1168 SELF-REPORTED SARS-CoV2 TESTING AND COVID-19 DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS, AXIAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS IN A SWISS OBSERVATIONAL COHORT

Background:

Since the beginning of the pandemic in Switzerland, immunosuppressed people were strongly advised to be tested for SARS-CoV2 when symptomatic as it was conjectured that they might be more at risk for infection and/or severe disease. While patients with autoimmune diseases might be indeed more at risk of death from COVID-191, it remains unknown, whether there are differences in infection or complication rates between patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA), and whether this relates to their disease or their treatment. Additionally, the prevalence of SARS-CoV2 testing in this population is not known.

Objectives:

This study aimed to assess and compare the rate of COVID-19 and SARS-CoV2 testing in patients with RA, AxSpA and PsA, the potential association with their treatment and, for testing, the number of symptoms.

Methods:

We included patients with RA, AxSpA and PsA from the Swiss Clinical Quality Management register (SCQM) using a smartphone app (mySCQM) to record information between March and December 2020. The outcomes of interest were self-reported SARS-CoV2 testing, symptoms compatible with COVID-19 during the previous month and confirmed COVID-19 through PCR nasopharyngeal swab. Outcomes were evaluated over the complete length of the aforementioned period (i.e. the outcome has been reported at least once during the period). Outcomes were compared between diseases groups, using logistic regression. We also evaluated the association of baseline treatment (TNF-inhibitors, b/tsDMARDs with other modes of action (OMA), no b/tsDMARDs) on the odds of symptoms and testing and the association of the number of symptoms (0-9) on the odds of testing. The analyses of SARS-CoV2 testing and COVID-19 symptoms were additionally adjusted for age, gender, glucocorticoids and csDMARDs. Confirmed cases were not adjusted for treatment and other covariates considering the low number of events.

Results:

We included 927 patients with RA, 805 with AxSpa and 453 with PsA (Table 1). 1010 patients reported COVID-19-like symptoms (mostly fever, runny nose and cough), but only 455 of them (45%) reported being tested. 151 patients were tested without symptoms. In between March and December 2020, 7.6% of RA, 8.5% of AxSpA and 10.5% of PsA patients were tested positive for COVID-19 (p=0.678). The odds of testing, symptoms and confirmed COVID-19 were similar between diseases and not associated with treatment for testing and symptoms (Figure 1). The number of symptoms was associated with the odds of testing (OR 1.43, 95%CI 1.37-1.50 by symptom).

Table 1.RAaxSpAPsApn 927 805 453Age (mean, SD)56.4 (13)47.1 (12)52.7 (11)<0.001Genderfemale 705 (76) 403 (50) 230 (51)<0.001TreatmentTNFi 272 (29) 498 (62) 174 (38)<0.001OMA 355 (38) 71 (9) 137 (30)No b/tsDMARDs 300 (32) 236 (29) 142 (31)csDMARDs use 476 (51) 111 (14) 147 (33)<0.001Steroids use 93 (10) 11 (1) 19 (4)<0.001Disease duration14.2 (10)17.4 (11)14.8 (12)<0.001Testing for COVID-19All patients258 (28)231 (29)117 (26) 0.550Patients with symptoms189/427 (44)179/392 (46)87/191 (46) 0.911Presence of COVID-19 symptoms427 (46)392 (49)191 (42) 0.082Positive COVID-19 test* 18/237 (8) 19/223 (9) 11/105 (11) 0.678

N, % when not specified otherwise. *Missing data on test results in 41 patients χ2 test for categorical and t-test for continuous variables.

Figure 1.

Conclusion:

Prevalence of COVID-19 symptoms and confirmed cases was similar between diseases, and for symptoms, was not associated with treatment. Despite strong advice from health authorities, less than 50% of patients with inflammatory rheumatic diseases and COVID-19 symptoms were tested. This proportion was not significantly different between diseases and not influenced by type of treatment. Efforts should be made to improve rates of SARS-CoV2 testing in patients with rheumatic diseases.

References:

[1]Williamson, E. J. et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 584, 430–436 (2020).

Acknowledgements:

This study was supported by Pfizer, Sanofi, Novartis, Gilead, Biogen and Bristol-Myers Squibb.

We thank all the patients and health professionals contributing to SCQM.

Disclosure of Interests:

Eleftherios Papagiannoulis: None declared, Adrian Ciurea Speakers bureau: Abbvie, Eli Lilly, MSD, Novartis, Pfizer, Diana Dan: None declared, Axel Finckh: None declared, Benoit GILBERT: None declared, Isabell von Loga Consultant of: Deloitte Consulting AG., Cathy Melong Pianta Taleng: None declared, Almut Scherer Consultant of: Pfizer, Employee of: BMS (2007-2008), Kim Lauper Consultant of: Gilead Galapagos, Grant/research support from: AbbVie. The SCQM foundation is supported by different companies https://www.scqm.ch/en/sponsoren/.

THU0203 REAL WORLD EFFECTIVENESS OF BARICITINIB IN THE SWISS RHEUMATOID ARTHRITIS REGISTER (SCQM-RA)

Background:

Patients with rheumatoid arthritis (RA) intolerant or not responding adequately to conventional synthetic DMARD (csDMARD) usually receive biological DMARDs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs) as 2ndline. Baricitinib (BARI), a once-daily oral selective Janus kinase inhibitor, is efficient in randomised controlled trials but still lacks evidence for effectiveness in real world settings.

Objectives:

To characterise patients initiating treatment with BARI or other alternative bDMARDs, and to perform an analysis of drug maintenance.

Methods:

This is an observational, prospective, cohort study, within the Swiss Clinical Quality Management (SCQM) register.

All treatment courses (TC) initiated between 2017-09-01 and 2019-10-01 were considered, comparing TC with BARI (BARI group) to TC with alternative bDMARDs, either TNF inhibitors (TNFi group) or other mode of action bDMARDs (OMA group), excluding rituximab.

Baseline characteristics were compared using ANOVA or χ2 tests. The crude drug maintenance was assessed by survival analysis (Kaplan-Meier). To correct for potential confounding factors, a Cox proportional hazard model was used. Missing values were imputed using multiple imputation with chained equations.

Results:

During the study period, 979 TC were initiated (240 in BARI group, 461 in TNFi group and 278 in OMA group). BARI was prescribed to significantly older patients, with longer disease durations and more previous treatment failures (Table 1). Unadjusted drug maintenance was significantly shorter in the TNFi compared to the BARI group (log rank p = 0.019). After adjustment for potential confounding factors, the hazard of TNFi discontinuation remained higher than for BARI (Hazard Ratio (HR) 1.48 (95% CI = [1.05 – 2.09]; p = 0.02)). A similar trend was observed when comparing the OMA drugs to BARI, with a HR for discontinuation of 1.42 (95% CI = [0.98 – 2.05]; p = 0.06) (Figure 2). Covariates significantly associated with decreased drug maintenance were concomitant csDMARD and concomitant glucocorticoids (Figure 2).

Table 1.

Baseline characteristics of studied population

VariableCategoriesBaricitinib(TC = 240; 240 patients)Mean (SD)Otherwise: n %TNFi(TC = 461; 397 patients)Mean (SD)Otherwise: n %OMA bDMARDs(TC = 278; 253 patients)Mean (SD)Otherwise: n %P valuesConcomitant csDMARD at baseline45 %54 %46 %0.02Line of Therapy1st20 %46 %22 %<0.012nd22 %25 %26 %3rd14 %14 %26 %4thor later43 %16 %27 %Gender (female)80 %71 %74 %0.05Age59 (13)53 (14)59 (13)<0.01Seropositivity (ACPA and/or RF)75 %71 %79 %0.04HAQ-DI Score0.9 (0.7)0.7 (0.6)0.8 (0.6)0.02Disease duration (years)12 (10)9 (10)11 (9)<0.01CDAI baseline19 (10)15 (12)19 (14)0.09

Legend

TC = Treatment Courses. SD = Standard Deviation. TNFi = TNF inhibitors. OMA bDMARDs = Other Mode of Action biological DMARDs. csDMARD = conventional synthetic DMARD. ACPA = Anti Citrullinated Peptide Antibodies. RF = Rheumatoid Factor. HAQ-DI= Health Assessment Questionnaire Disability Index. CDAI = Clinical Disease Activity Index.

Conclusion:

In this preliminary analysis, baricitinib was prescribed to older patients, with longer disease durations, and more previous treatment failures compared to alternative bDMARDs. Baricitinib demonstrated a significantly higher drug maintenance than TNFi, while similar trend was observed in comparison to OMA drugs.

Conflict of interest:

This analysis has been made possible by financial support of Eli Lilly (Suisse) SA to the Geneva University Hospitals (HUG).

Disclosure of Interests: :

Benoit GILBERT: None declared, Kim Lauper: None declared, Delphine Courvoisier: None declared, Clementine Perrier Shareholder of: Share of Eli Lilly Company, Employee of: I am currently an employee of Eli Lilly Suisse SA, Rudiger Muller Consultant of: AbbVie, Nordic, Sandoz, Axel Finckh Grant/research support from: Pfizer: Unrestricted research grant, Eli-Lilly: Unrestricted research grant, Consultant of: Sanofi, AB2BIO, Abbvie, Pfizer, MSD, Speakers bureau: Sanofi, Pfizer, Roche, Thermo Fisher Scientific

Rationale and protocol of the ENGAGE study: a double-blind randomized controlled preference trial using a comprehensive cohort design to measure the effect of a cognitive and leisure-based intervention in older adults with a memory complaint

BACKGROUND

Leisure activities can be both enjoyable and cognitively stimulating, and participation in such activities has been associated with reduced age-related cognitive decline. Thus, integrating stimulating leisure activities in cognitive training programs may represent a powerful and innovative approach to promote cognition in older adults at risk of dementia. The ENGAGE study is a randomized controlled, double-blind preference trial with a comprehensive cohort design that will test the efficacy and long-term impact of an intervention that combines cognitive training and cognitively stimulating leisure activities.

METHODS

One hundred and forty-four older adults with a memory complaint will be recruited in Montreal and Toronto. A particular effort will be made to reach persons with low cognitive reserve. Participants will be randomly assigned to one of two conditions: cognitive + leisure training (ENGAGE-MUSIC/SPANISH) or active control (ENGAGE-DISCOVERY). The ENGAGE-MUSIC/SPANISH training will include teaching of mnemonic and attentional control strategies, casual videogames selected to train attention, and classes in music or Spanish as a second language. The ENGAGE-DISCOVERY condition will comprise psychoeducation on cognition and the brain, low-stimulating casual videogames and documentary viewing with discussions. To retain the leisure aspect of the activities, participants will be allowed to exclude either music or Spanish at study entry if they strongly dislike one of these activities. Participants randomized to ENGAGE-MUSIC/SPANISH who did not exclude any activity will be assigned to music or Spanish based on a second random assignment. Training will be provided in 24 2-h sessions over 4 months. Outcomes will be measured at baseline, at 4-month follow-up, and at 24-month follow-up. The primary outcome will be cognitive performance on a composite measure of episodic memory (delayed recall scores for words and face-name associations) measured at baseline and at the 4-month follow-up. Secondary outcomes will include a composite measure of attention (speed of processing, inhibition, dual tasking, and shifting), psychological health, activities of daily living, and brain structure and function and long-term maintenance measured at the 24-month follow-up. Information on cognitive reserve proxies (education and lifestyle questionnaires), sex and genotype (apolipoprotein (Apo)E4, brain-derived neurotrophic factor (BDNF), and catechol-O-methyltransferase (COMT)) will be collected and considered as moderators of training efficacy.

DISCUSSION

This study will test whether a program combining cognitive training with stimulating leisure activities can increase cognition and reduce cognitive decline in persons at risk of dementia.

TRIAL REGISTRATION

NCT03271190 . Registered on 5 September 2017.

Anthropogenic particles in the stomach contents and liver of the freshwater fish Squalius cephalus

Anthropogenic particles (APs) are a very broad category of particles produced directly or indirectly by human activities. Their ingestion by biota is well studied in the marine environment. In contrast, studies on AP ingestion in wild freshwater organisms are scarce despite high contamination levels in some rivers and lakes. In this study, we aimed to evaluate the ingestion of APs and the possible occurrence of APs in the liver and muscle of a freshwater fish, Squalius cephalus, from the Parisian conurbation. After isolation, the particles were analyzed using Raman spectroscopy. In sixty stomachs, eighteen APs were found, half of which were plastics and the other half were dyed particles. Twenty-five percent of sampled individuals had ingested at least one AP. The mean length of the APs was 2.41 mm. No significant difference was found between the sites upstream and downstream of Paris. Additionally, 5% of sampled livers contained one or more APs, which were characterized as microplastics (MPs). No APs were found in the muscle tissue. The majority of APs isolated from stomach contents were fibers, which is similar to the findings of a previous river contamination study. This highlights that fish could be more exposed to fibers than previously thought and that more studies on the impacts of fiber ingestion are required. Despite their low occurrence, MPs are reported, for the first time, in the liver of a wild freshwater fish species. While the pathways and impacts are still unknown, MPs also occur in liver of marine mollusks and fish. Physiological in vitro studies are needed to better evaluate the impacts of such phenomena.

Positive correlation between dispersal and body size in Green Frogs (Rana clamitans) naturally colonizing an experimental landscape

Dispersers are often assumed to have the mean phenotype observed across the entire metapopulation, despite growing evidence of dispersal–phenotype correlations. We examined three dispersal–phenotype correlations in Green Frogs (Rana clamitans Latreille, 1801 = Lithobates clamitans (Latreille, 1801)). Two were in traits that have been previously tied to fitness (body size and body condition), while a third (relative hindlimb length) has been linked to movement performance. We constructed a spatially dispersed array of experimental ponds in close proximity to source ponds known to support Green Frog breeding populations. Over the course of two breeding seasons (four sampling periods), we measured phenotypes of all Green Frogs that had colonized the experimental ponds and a sample of individuals from the source ponds. After only 1 month, a positive correlation was detected between dispersal and body size within the population of dispersers occupying the experimental ponds. After a 2nd month, this positive dispersal – body size correlation was also present when comparing the population of dispersers to the population of nondispersers remaining at the source ponds. Even if generated solely by plasticity, a positive correlation between dispersal and body size (a trait tightly linked to fitness) has the ability to alter metapopulation capacity and thus the probability of regional species persistence.

On the Habitability of Desert Varnish: A Combined Study by Micro-Raman Spectroscopy, X-ray Diffraction, and Methylated Pyrolysis-Gas Chromatography-Mass Spectrometry

In 2020, the ESA ExoMars and NASA Mars 2020 missions will be launched to Mars to search for evidence of past and present life. In preparation for these missions, terrestrial analog samples of rock formations on Mars are studied in detail in order to optimize the scientific information that the analytical instrumentation will return. Desert varnishes are thin mineral coatings found on rocks in arid and semi-arid environments on Earth that are recognized as analog samples. During the formation of desert varnishes (which takes many hundreds of years), organic matter is incorporated, and microorganisms may also play an active role in the formation process. During this study, four complementary analytical techniques proposed for Mars missions (X-ray diffraction [XRD], Raman spectroscopy, elemental analysis, and pyrolysis-gas chromatography-mass spectrometry [Py-GC-MS]) were used to interrogate samples of desert varnish and describe their capacity to sustain life under extreme scenarios. For the first time, both the geochemistry and the organic compounds associated with desert varnish are described with the use of identical sets of samples. XRD and Raman spectroscopy measurements were used to nondestructively interrogate the mineralogy of the samples. In addition, the use of Raman spectroscopy instruments enabled the detection of β-carotene, a highly Raman-active biomarker. The content and the nature of the organic material in the samples were further investigated with elemental analysis and methylated Py-GC-MS, and a bacterial origin was determined to be likely. In the context of planetary exploration, we describe the habitable nature of desert varnish based on the biogeochemical composition of the samples. Possible interference of the geological substrate on the detectability of pyrolysis products is also suggested. Key Words: Desert varnish-Habitability-Raman spectroscopy-Py-GC-MS-XRD-ExoMars-Planetary science. Astrobiology 17, 1123-1137.

Microplastics in livers of European anchovies (Engraulis encrasicolus, L.)

Microplastics (MPs) are thought to be ingested by a wide range of marine organisms before being excreted. However, several studies in marine organisms from different taxa have shown that MPs and nanoplastics could be translocated in other organs. In this study, we investigated the presence of MPs in the livers of commercial zooplanktivorous fishes collected in the field. The study focuses mainly on the European anchovy Engraulis encrasicolus but concerns also the European pilchard Sardina pilchardus and the Atlantic herring Clupea harengus. Two complementary methodologies were used to attest the occurrence of MPs in the hepatic tissue and to exclude contamination. 1) MPs were isolated by degradation of the hepatic tissue. 2) Cryosections were made on the livers and observed in polarized light microscopy. Both methods separately revealed that MPs, mainly polyethylene (PE), were translocated into the livers of the three clupeid species. In anchovy, 80 per cent of livers contained relatively large MPs that ranged from 124 μm to 438 μm, showing a high level of contamination. Two translocation pathways are hypothesized: (i) large particles found in the liver resulted from the agglomeration of smaller pieces, and/or (ii) they simply pass through the intestinal barrier. Further studies are however required to understand the exact process.

Morphology of the filtration apparatus of three planktivorous fishes and relation with ingested anthropogenic particles

Anthropogenic particles (APs), including microplastics, are ingested by a wide variety of marine organisms. Exposure of Clupeiformes (e.g. herrings, anchovies, sardines) is poorly studied despite their economic and ecological importance. This study aims to describe the morphology of the filtration apparatus of three wild-caught Clupeiformes (Sardina pilchardus, Clupea harengus and Engraulis encrasicolus) and to relate the results to ingested APs. Consequently, the species with the more efficient filtration apparatus will be more likely to ingest APs. We hypothesized that sardines were the most exposed species. The filtration area and particle retention threshold were determined in the three species, with sardines displaying the highest filtration area and the closest gill rakers. Sardines ingested more fibers and smaller fragments, confirming that it is the most efficient filtering species. These two results lead to the conclusion that, among the three studied, the sardine is the species most exposed to APs.

Reversal of intramyocellular lipid accumulation by lipophagy and a p62-mediated pathway

We have previously observed the reversal of lipid droplet deposition in skeletal muscle of morbidly obese patients following bariatric surgery. We now investigated whether activation of autophagy is the mechanism underlying this observation. For this purpose, we incubated rat L6 myocytes over a period of 6 days with long-chain fatty acids (an equimolar, 1.0 mM, mixture of oleate and palmitate in the incubation medium). At day 6, the autophagic inhibitor (bafilomycin A1, 200 nM) and the autophagic activator (rapamycin, 1 μM) were added separately or in combination for 48 h. Intracellular triglyceride (TG) accumulation was visualized and quantified colorimetrically. Protein markers of autophagic flux (LC3 and p62) and cell death (caspase-3 cleavage) were measured by immunoblotting. Inhibition of autophagy by bafilomycin increased TG accumulation and also increased lipid-mediated cell death. Conversely, activation of autophagy by rapamycin reduced both intracellular lipid accumulation and cell death. Unexpectedly, treatment with both drugs added simultaneously resulted in decreased lipid accumulation. In this treatment group, immunoblotting revealed p62 degradation (autophagic flux), immunofluorescence revealed the colocalization of p62 with lipid droplets, and co-immunoprecipitation confirmed the interaction of p62 with ADRP (adipose differentiation-related protein), a lipid droplet membrane protein. Thus the association of p62 with lipid droplet turnover suggests a novel pathway for the breakdown of lipid droplets in muscle cells. In addition, treatment with rapamycin and bafilomycin together also suggested the export of TG into the extracellular space. We conclude that lipophagy promotes the clearance of lipids from myocytes and switches to an alternative, p62-mediated, lysosomal-independent pathway in the context of chronic lipid overload (*P<0.05, **P<0.01, ***P<0.001, ****P<0.0001).

Detection of Anthropogenic Particles in Fish Stomachs: An Isolation Method Adapted to Identification by Raman Spectroscopy

Microplastic particles (MP) contaminate oceans and affect marine organisms in several ways. Ingestion combined with food intake is generally reported. However, data interpretation often is circumvented by the difficulty to separate MP from bulk samples. Visual examination often is used as one or the only step to sort these particles. However, color, size, and shape are insufficient and often unreliable criteria. We present an extraction method based on hypochlorite digestion and isolation of MP from the membrane by sonication. The protocol is especially well adapted to a subsequent analysis by Raman spectroscopy. The method avoids fluorescence problems, allowing better identification of anthropogenic particles (AP) from stomach contents of fish by Raman spectroscopy. It was developed with commercial samples of microplastics and cotton along with stomach contents from three different Clupeiformes fishes: Clupea harengus, Sardina pilchardus, and Engraulis encrasicolus. The optimized digestion and isolation protocol showed no visible impact on microplastics and cotton particles while the Raman spectroscopic spectrum allowed the precise identification of microplastics and textile fibers. Thirty-five particles were isolated from nine fish stomach contents. Raman analysis has confirmed 11 microplastics and 13 fibers mainly made of cellulose or lignin. Some particles were not completely identified but contained artificial dyes. The novel approach developed in this manuscript should help to assess the presence, quantity, and composition of AP in planktivorous fish stomachs.

When Microplastic Is Not Plastic: The Ingestion of Artificial Cellulose Fibers by Macrofauna Living in Seagrass Macrophytodetritus

Dead leaves of the Neptune grass, Posidonia oceanica (L.) Delile, in the Mediterranean coastal zone, are colonized by an abundant "detritivorous" invertebrate community that is heavily predated by fishes. This community was sampled in August 2011, November 2011, and March 2012 at two different sites in the Calvi Bay (Corsica). Ingested artificial fibers (AFs) of various sizes and colors were found in 27.6% of the digestive tracts of the nine dominant species regardless of their trophic level or taxon. No seasonal, spatial, size, or species-specific significant differences were revealed; suggesting that invertebrates ingest AFs at constant rates. Results showed that, in the gut contents of invertebrates, varying by trophic level, and across trophic levels, the overall ingestion of AFs was low (approximately 1 fiber per organism). Raman spectroscopy revealed that the ingested AFs were composed of viscose, an artificial, cellulose-based polymer. Most of these AFs also appeared to have been colored by industrial dyes. Two dyes were identified: Direct Blue 22 and Direct Red 28. The latter is known for being carcinogenic for vertebrates, potentially causing environmental problems for the P. oceanica litter community. Techniques such as Raman spectroscopy are necessary to investigate the particles composition, instead of relying on fragment size or color to identify the particles ingested by animals.

Fluorinated Alcohols as Activators for the Solvent-Free Chemical Fixation of Carbon Dioxide into Epoxides

The addition of fluorinated alcohols to onium salts provides highly efficient organocatalysts for the chemical fixation of CO2 into epoxides under mild experimental conditions. The combination of online kinetic studies, NMR titrations and DFT calculations allows understanding this synergistic effect that provides an active organocatalyst for CO2 /epoxides coupling.

Organic and mineral imprints in fossil photosynthetic mats of an East Antarctic lake

Lacustrine microbial mats in Antarctic ice-free oases are considered modern analogues of early microbial ecosystems as their primary production is generally dominated by cyanobacteria, the heterotrophic food chain typically truncated due to extreme environmental conditions, and they are geographically isolated. To better understand early fossilization and mineralization processes in this context, we studied the microstructure and chemistry of organo-mineral associations in a suite of sediments 50-4530 cal. years old from a lake in Skarvsnes, Lützow Holm Bay, East Antarctica. First, we report an exceptional preservation of fossil autotrophs and their biomolecules on millennial timescales. The pigment scytonemin is preserved inside cyanobacterial sheaths. As non-pigmented sheaths are also preserved, scytonemin likely played little role in the preservation of sheath polysaccharides, which have been cross-linked by ether bonds. Coccoids preserved thylakoids and autofluorescence of pigments such as carotenoids. This exceptional preservation of autotrophs in the fossil mats argues for limited biodegradation during and after deposition. Moreover, cell-shaped aggregates preserved sulfur-rich nanoglobules, supporting fossilization of instable intracellular byproducts of chemotrophic or phototrophic S-oxidizers. Second, we report a diversity of micro- to nanostructured CaCO3 precipitates intimately associated with extracellular polymeric substances, cyanobacteria, and/or other prokaryotes. Micro-peloids Type 1 display features that distinguish them from known carbonates crystallized in inorganic conditions: (i) Type 1A are often filled with globular nanocarbonates and/or surrounded by a fibrous fringe, (ii) Type 1B are empty and display ovoid to wrinkled fringes of nanocrystallites that can be radially oriented (fibrous or triangular) or multilayered, and (iii) all show small-size variations. Type 2 rounded carbonates 1-2 μm in diameter occurring inside autofluorescent spheres interpreted as coccoidal bacteria may represent fossils of intracellular calcification. These organo-mineral associations support organically driven nanocarbonate crystallization and stabilization, hence providing potential markers for microbial calcification in ancient rocks.

Determination of the Al2O3 content in NaF-AlF3-CaF2-Al2O3 melts at 950 °C by Raman spectroscopy

The in situ control of the chemical composition of industrial aluminum smelter is a challenge mainly for physicochemical reasons: high temperature, high surrounding electromagnetic field, and the highly corrosive molten salt electrolyte to deal with. In previous works, we proposed that Raman spectroscopy is a method of choice that could be adapted to real smelters. The laboratory study presented here relies on reproducible Raman spectra recorded on molten mixtures whose compositions are identical to those used during the production of aluminum. A normalization procedure for the Raman spectra is proposed based on the equilibria taking place in the bath. In addition, we discuss two quantitative models to determine the alumina content from the Raman spectra of the molten NaF-AlF3-CaF2-Al2O3 electrolytes. Univariate and multivariate approaches are applied to determine both the COx (alumina content) and the CR (NaF/AlF3 molar ratio) by Raman spectroscopy without referring to an additional internal reference of intensity. The procedure was successfully tested and validated on industrial samples.

Structural and Dynamic Approaches of Molten Salts by High Temperature Spectroscopies

The combination of 27AI NMR expriments and Molecular Dynamics simulation confirms the exis-tence of penta-coordinated Aluminium in several molten aluminium oxides. In the case of fluoroalumi-nate molten salts, NMR and Raman spectroscopies provide complementary approaches leading to a structural description in term of AIF− 4, AlF5 2-and AlF6 3−species.

Direct determination of the NaF/AlF3 molar ratio by Raman spectroscopy in NaF-AlF3-CaF2 melts at 1000 °C

For the last 40 years, Raman spectroscopy has been very useful in investigating the structure of corrosive molten salts, such as the cryolite-based melts widely used as electrolyte in the Hall-Heroult process. Even if this process remains the most economically efficient for metallic aluminum electro-production, it suffers from a high energy loss, which is dependent on the melt composition. Therefore, controlling the chemical composition of the electrolyte is essential. The present paper proposes to apply Raman spectroscopy for the direct determination of the NaF-AlF3 molar ratio in NaF-AlF3-CaF2-based melts. Despite the experimental difficulties, a calibration curve based on equilibria taking place in the melt has been developed and the procedure has been successfully compared to industrial samples of known compositions. The possible exportation of the laboratory scale procedure to an industrial environment application for the control of the Hall-Heroult process is finally discussed.

Systematic molecular and cytogenetic screening of 100 patients with marfanoid syndromes and intellectual disability

The association of marfanoid habitus (MH) and intellectual disability (ID) has been reported in the literature, with overlapping presentations and genetic heterogeneity. A hundred patients (71 males and 29 females) with a MH and ID were recruited. Custom-designed 244K array-CGH (Agilent®; Agilent Technologies Inc., Santa Clara, CA) and MED12, ZDHHC9, UPF3B, FBN1, TGFBR1 and TGFBR2 sequencing analyses were performed. Eighty patients could be classified as isolated MH and ID: 12 chromosomal imbalances, 1 FBN1 mutation and 1 possibly pathogenic MED12 mutation were found (17%). Twenty patients could be classified as ID with other extra-skeletal features of the Marfan syndrome (MFS) spectrum: 4 pathogenic FBN1 mutations and 4 chromosomal imbalances were found (2 patients with both FBN1 mutation and chromosomal rearrangement) (29%). These results suggest either that there are more loci with genes yet to be discovered or that MH can also be a relatively non-specific feature of patients with ID. The search for aortic complications is mandatory even if MH is associated with ID since FBN1 mutations or rearrangements were found in some patients. The excess of males is in favour of the involvement of other X-linked genes. Although it was impossible to make a diagnosis in 80% of patients, these results will improve genetic counselling in families.

Tricking the guard: exploiting plant defense for disease susceptibility

Typically, pathogens deploy virulence effectors to disable defense. Plants defeat effectors with resistance proteins that guard effector targets. We found that a pathogen exploits a resistance protein by activating it to confer susceptibility in Arabidopsis. The guard mechanism of plant defense is recapitulated by interactions among victorin (an effector produced by the necrotrophic fungus Cochliobolus victoriae), TRX-h5 (a defense-associated thioredoxin), and LOV1 (an Arabidopsis susceptibility protein). In LOV1's absence, victorin inhibits TRX-h5, resulting in compromised defense but not disease by C. victoriae. In LOV1's presence, victorin binding to TRX-h5 activates LOV1 and elicits a resistance-like response that confers disease susceptibility. We propose that victorin is, or mimics, a conventional pathogen virulence effector that was defeated by LOV1 and confers virulence to C. victoriae solely because it incites defense.

Multistrain influenza protection induced by a nanoparticulate mucosal immunotherapeutic

All commercial influenza vaccines elicit antibody responses that protect against seasonal infection, but this approach is limited by the need for annual vaccine reformulation that precludes efficient responses against epidemic and pandemic disease. In this study we describe a novel vaccination approach in which a nanoparticulate, liposome-based agent containing short, highly conserved influenza-derived peptides is delivered to the respiratory tract to elicit potent innate and selective T cell-based adaptive immune responses. Prepared without virus-specific peptides, mucosal immunostimulatory therapeutic (MIT) provided robust, but short-lived, protection against multiple, highly lethal strains of influenza in mice of diverse genetic backgrounds. MIT prepared with three highly conserved epitopes that elicited virus-specific memory T-cell responses but not neutralizing antibodies, termed MITpep, provided equivalent, but more durable, protection relative to MIT. Alveolar macrophages were more important than dendritic cells in determining the protective efficacy of MIT, which induced both canonical and non-canonical antiviral immune pathways. Through activation of airway mucosal innate and highly specific T-cell responses, MIT and MITpep represent novel approaches to antiviral protection that offer the possibility of universal protection against epidemic and pandemic influenza.