Plasma MCP-1 and changes on cognitive function in community-dwelling older adults

Background

Monocyte Chemoattractant Protein-1 (MCP-1), a glial-derived chemokine, mediates neuroinflammation and may regulate memory outcomes among older adults. We aimed to explore the associations of plasma MCP-1 levels (alone and in combination with β-amyloid deposition—Aβ_42/40) with overall and domain-specific cognitive evolution among older adults.

Methods

Secondary analyses including 1097 subjects (mean age = 75.3 years ± 4.4; 63.8% women) from the Multidomain Alzheimer Preventive Trial (MAPT). MCP-1 (higher is worse) and Aβ_42/40 (lower is worse) were measured in plasma collected at year 1. MCP-1 in continuous and as a dichotomy (values in the highest quartile (MCP-1⁺)) were used, as well as a dichotomy of Aβ_42/40. Outcomes were measured annually over 4 years and included the following: cognitive composite z-score (CCS), the Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR) sum of boxes (overall cognitive function); composite executive function z-score, composite attention z-score, Free and Cued Selective Reminding Test (FCSRT - memory).

Results

Plasma MCP-1 as a continuous variable was associated with the worsening of episodic memory over 4 years of follow-up, specifically in measures of free and cued delayed recall. MCP-1⁺ was associated with worse evolution in the CCS (4-year between-group difference: β = −0.14, 95%CI = −0.26, −0.02) and the CDR sum of boxes (2-year: β = 0.19, 95%CI = 0.06, 0.32). In domain-specific analyses, MCP-1⁺ was associated with declines in the FCSRT delayed recall sub-domains. In the presence of low Aβ_42/40, MCP-1⁺ was not associated with greater declines in cognitive functions. The interaction with continuous biomarker values Aβ_42/40× MCP-1 × time was significant in models with CDR sum of boxes and FCSRT DTR as dependent variables.

Conclusions

Baseline plasma MCP-1 levels were associated with longitudinal declines in overall cognitive and episodic memory performance in older adults over a 4-year follow-up. How plasma MCP-1 interacts with Aβ_42/40 to determine cognitive decline at different stages of cognitive decline/dementia should be clarified by further research. The MCP-1 association on cognitive decline was strongest in those with amyloid plaques, as measured by blood plasma Aβ_42/40.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13195-021-00940-2.

Biomarkers of mitochondrial dysfunction and inflammaging in older adults and blood pressure variability

Most physiopathological mechanisms underlying blood pressure variability (BPV) are implicated in aging. Vascular aging is associated with chronic low-grade inflammation occurring in late life, known as "inflammaging" and the hallmark "mitochondrial dysfunction" due to age-related stress. We aimed to determine whether plasma levels of the pleiotropic stress-related mitokine growth/differentiation factor 15 (GDF-15) and two inflammatory biomarkers, interleukin 6 (IL-6) and tumor necrosis factor receptor 1 (TNFR-1), are associated with visit-to-visit BPV in a population of community-dwelling older adults. The study population consisted of 1096 community-dwelling participants [median age 75 (72-78) years; 699 females, 63.7%] aged ≥ 70 years from the MAPT study. Plasma blood sample was collected 12 months after enrolment and BP was assessed up to seven times over a 4-year period. Systolic (SBPV) and diastolic BPV (DBPV) were determined through several indicators taking into account BP change over time, the order of measurements and formulas independent of mean BP levels. Higher values of GDF-15 were significantly associated with increased SBPV (all indicators) after adjustment for relevant covariates [adjusted 1-SD increase in GDF-15: β (SE) = 0.07 (0.04), p < 0.044, for coefficient of variation%]. GDF-15 levels were not associated with DBPV. No significant associations were found between IL-6 and BPV, whereas TNFR1 was only partially related to DBPV. Unlike inflammation biomarkers, higher GDF-15 levels were associated with greater SBPV. Our findings support the age-related process of mitochondrial dysfunction underlying BP instability, suggesting that BPV might be a potential marker of aging.

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.

Dual-system Involvement: Exploring the Overlap Between Domestic and Family Violence and Child Maltreatment Perpetration

This longitudinal population-based study aimed to understand the dual-system involvement of males who engage in domestic and family violence (DFV) and child maltreatment perpetration. Specifically, this study investigates the prevalence of male perpetration of DFV, child maltreatment, and dual-system involvement, and compares the frequency and nature of perpetration by males with single-system contact and males with dual-system contact. The effect of race (Indigenous Australian/non-Indigenous Australian) and parental status on dual-system involvement is also examined. This study utilizes data from the Queensland Cross-sector Research Collaboration repository. These data contain each contact an individual male born in 1983 or 1984 had with the Queensland civil court system as a respondent to a domestic violence order (DVO) and the Queensland statutory child protection system, where, after an investigation, they were identified as the person responsible for substantiated harm to a child. The results from the study show a high level of overlap between males who perpetrate DFV and child maltreatment. Of males identified as being responsible for substantiated harm to a child, 58% have also been a respondent of a DVO, and approximately 16% of male DVO respondents were identified as being responsible for substantiated harm to a child. Differences were found in the frequency and nature of perpetration by males with dual-system involvement compared to those with single-system contact for either DFV or child maltreatment. Our results also show differences for Indigenous status, parental status, number of maltreatment events, harm type, number of DVOs, and number of breaches of a DVO. The implications of this study for both policy and practice are discussed.

Exploring dual-system involvement for domestic violence victimisation and child maltreatment perpetration: An exploration by gender and race/ethnicity

BACKGROUND

There is an historical separation between system responses to domestic violence (DV) and child maltreatment. Concerns have been noted that DV victims may be over-represented as parents responsible for harm to children in the child protection system. Although there is a growing acknowledgement of the high overlap between DV and child maltreatment within families, little empirical research has been conducted on this relationship.

OBJECTIVE

This study aims to longitudinally examine the overlap of being a victim of DV and a perpetrator of child maltreatment, along with the impact of dual-system involvement on the nature and frequency of the violence experienced.

METHODS

The data are linked longitudinal administrative data from the Queensland Cross-sector Research Collaboration (QCRC) repository. These data contain each contact every individual born in Queensland in 1983 or 1984 had with the Queensland DV civil court system and the Queensland statutory child protection system.

RESULTS

Of individuals identified as a perpetrator of child maltreatment, 45% have also been a victim of DV and approximately 22% of DV victims were identified as a perpetrator of child maltreatment. Our results also show differences based on Indigenous status, gender, parental status, number of substantiations, frequency of violence, harm type, and number of domestic violence orders.

CONCLUSIONS

There is considerable overlap between individuals who are victims of DV and individuals who perpetrate child maltreatment. This overlap was influenced by both gender and race/ethnicity. The implications of this study for both policy and practice are discussed.

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.

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.

MEMO+: Efficacy, Durability and Effect of Cognitive Training and Psychosocial Intervention in Individuals with Mild Cognitive Impairment

BACKGROUND/OBJECTIVES

There is no consensus on the efficacy of cognitive training in persons with mild cognitive impairment (MCI) because of the paucity of well-designed randomized controlled trials. The objective was to assess the effect of memory training on the cognitive functioning of persons with MCI and its durability and to evaluate whether this effect generalizes to daily life and whether positive effects could be obtained from psychosocial intervention.

DESIGN

Single-blind randomized controlled trial.

SETTING

Research centers of the Institut Universitaire de Gériatrie de Montréal and Institut Universitaire en Santé Mentale de Québec.

PARTICIPANTS

Older adults meeting criteria for amnestic MCI (N = 145).

INTERVENTION

Participants were randomized to cognitive training, a psychosocial intervention, or a no-contact control condition. Interventions were provided in small groups in eight 2-hour sessions.

MEASUREMENT

Outcome measures were immediate and delayed composite performance memory scores, psychological health (depression, anxiety, well-being), and generalization effects of the intervention (strategy use in everyday life, difficulties in complex activities of daily living, memory complaints). Testing was administered before training and immediately, 3 months, and 6 months after training.

RESULTS

Participants in the cognitive training condition improved on the delayed composite memory score and on strategy use in everyday life. Improvement was maintained at the 3- and 6-month follow-up assessments. Participants in the psychosocial and no-contact conditions did not show any significant improvement.

CONCLUSION

Cognitive training improves the memory of persons with amnestic MCI. The effect persists over a 6-month period, and learned strategies are used in everyday life. Cognitive training is a valid way to promote cognition in MCI.

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.

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).

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.

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.

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.

Cerebral abscesses in hereditary haemorrhagic telangiectasia: a clinical and microbiological evaluation

OBJECTIVES

Hereditary haemorrhagic telangiectasia (HHT) is a rare autosomal dominant disorder that can lead to neurological manifestations including strokes and cerebral abscesses. Our objectives were to describe clinical, radiological, bacteriological, and outcome characteristics of patients with cerebral abscess and HHT, and to concurrently compare this group with a control group with cerebral abscess, but without HHT.

PATIENTS AND METHODS

Patients with HHT and cerebral abscess in 5 French medical centers were included. Their clinical, radiological, biological data and prognosis were compared to the data of unselected patients with cerebral abscesses but without HHT included during the same period of time.

RESULTS

Twenty-six patients (13 men and 13 women; 44.7±17.2; range 12-79 years), with HHT and cerebral abscess were included. A pulmonary arteriovenous malformation (AVM) was present in all cases. Cerebral abscesses were solitary, supratentorial, and mostly lobar. In all cases, pathogens were anaerobic or facultative anaerobic germs (particularly streptococcus). No death was observed, but various sequels were present in up to two-thirds of the patients. We observed a recurrence of the cerebral abscess in 4 patients with a mean delay of 81 months. In comparison with the control group, cerebral abscesses were generally of later recurrence and significantly more often unique and less often due to staphylococcus.

CONCLUSION

HHT cerebral abscesses are particularly linked to pulmonary arteriovenous malformations and anaerobic germs. Their clinical, radiological and bacteriological characteristics are quite different than in a control group with more solitary brain localizations, no staphylococcus infection and a significantly longer interval to recurrence.

Training-related brain plasticity in subjects at risk of developing Alzheimer's disease

Subjects with mild cognitive impairment are at risk of developing Alzheimer's disease. Cognitive stimulation is an emerging intervention in the field of neurology and allied sciences, having already been shown to improve cognition in subjects with mild cognitive impairment. Yet no studies have attempted to unravel the brain mechanisms that support such improvement. This study uses functional magnetic resonance imaging to measure the effect of memory training on brain activation in older adults with mild cognitive impairment and to assess whether it can reverse the brain changes associated with mild cognitive impairment. Brain activation associated with verbal encoding and retrieval was recorded twice prior to training and once after training. In subjects with mild cognitive impairment, increased activation was found after training within a large network that included the frontal, temporal and parietal areas. Healthy controls showed mostly areas of decreased activation following training. Comparison with pre-training indicated that subjects with mild cognitive impairment used a combination of specialized areas; that is, areas activated prior to training and new alternative areas activated following training. However, only activation of the right inferior parietal lobule, a new area of activation, correlated with performance. Furthermore, the differences between the brain activation patterns of subjects with mild cognitive impairment and those of healthy controls were attenuated by training in a number of brain regions. These results indicate that memory training can result in significant neural changes that are measurable with brain imaging. They also show that the brains of people with mild cognitive impairment remain highly plastic.

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.

Executive functions in frontotemporal dementia and Lewy body dementia

Diagnosis of different types of dementia is often based on clinical symptomatology rather than underlying pathology; therefore, accurate diagnosis depends on a thorough description of cognitive functioning in different dementias. Furthermore, direct comparison of cognitive functions between different types of dementia is necessary for differential diagnosis. Executive dysfunction is common in several types of dementia, including frontotemporal dementia (FTD) and Lewy body dementia (LBD); however, FTD and LBD patients have never been directly compared on measures of executive functioning. The authors compared the performance of 17 FTD and 15 LBD patients on 6 measures of executive functioning in terms of statistical group differences, mean severity of clinical impairment in comparison to normal controls, and frequency of impairment. Results indicated a remarkably similar pattern of performance across all areas examined in terms of mean performance, as well as degree and frequency of impairment. Only the Stroop test produced results that could potentially differentiate the patient groups. These findings suggest that both FTD and LBD should be considered disorders involving executive dysfunction.

Improvement of episodic memory in persons with mild cognitive impairment and healthy older adults: evidence from a cognitive intervention program

The efficacy of cognitive training was assessed in persons with mild cognitive impairment (MCI) and persons with normal cognitive aging. Forty-seven participants were included in this study: 28 with MCI and 17 controls. Twenty-one participants received intervention (20 MCI and 9 controls) and 16 participants (8 MCI and 8 controls) received no intervention (waiting-list group). The intervention focused on teaching episodic memory strategies. Three tasks of episodic memory (list recall, face-name association, text memory) were used as primary outcome measures. Results were analyzed using analyses of variance. The intervention effect (pre- and post-intervention difference) was significant on two of the primary outcome measures (delayed list recall and face-name association). A significant pre-post-effect was also found on measures of subjective memory and well-being. There was no improvement in the performance of groups of individuals with MCI and normal elderly persons who did not receive the intervention. These results suggest that persons with MCI can improve their performance on episodic memory when provided with cognitive training.

Ataxie cérébelleuse révélant un syndrome de Wolfram

INTRODUCTION

Wolfram syndrome is a genetic disease with recessive autosomic transmission, associating early-onset diabetes mellitus and bilateral optical atrophy.

CASE REPORT

We report the case of a 47-year-old patient for whom we diagnosed a Wolfram syndrome in view of a late neurological syndrome in association with ataxia and bilateral horizontal nystagmus. The brain resonance magnetic imaging revealed a major atrophy of the brainstem and cerebellum.

CONCLUSION

Wolfram syndrome is a rare pathology, with fatal consequences before the age of 50. The association of diabetes mellitus and optical atrophy, especially when there are other symptoms (ataxia, deafness, diabetes insipidus, neuropsychiatric manifestations or urinary tract disorders) should lead to this diagnosis and to carry out a genetic confirmation.