Persistent pulmonary abnormalities after 18 months of SARS-CoV-2 pneumonia

OBJECTIVE

To describe persistent pulmonary abnormalities detected on HRCT after 18 months of SARS-CoV-2 pneumonia, and to determine their extension and correlation with pulmonary function.

PATIENTS AND METHODS

A prospective cross-sectional study with an initial cohort of 90 patients in follow-up due to persisting lung abnormalities on imaging, functional respiratory impairment and/or respiratory symptoms. Of these, 31 (34%) were selected for analysis due to the persistence of their lung abnormalities on HRCT at 18 months after infection. A double reading was performed for each HRCT (62 observations).

RESULTS

Of the 31 patients included: 20 (65%) were men; mean age was 67 years; 17 (55%) were smokers/ex-smokers. The mean hospitalisation time was 38 days. Eighteen (58%) patients were admitted to intensive care units. Five patients (16%) suffered an acute pulmonary thromboembolism and three (9.7%) had a pneumothorax. The mean time between the onset of pneumonia and the follow-up HRCT was 20.34 months. Nineteen percent of patients suffered from total lung function abnormalities; and ground-glass opacities and reticulation were present in 12% and 4.5% respectively. The findings of the 62 readings were: ground-glass opacities (100%), reticulation (83%), subpleural curvilinear lines (62%), parenchymal bands (34%), traction bronchiectasis (69%), displacement of vessels/fissures (46%) and honeycombing (4.9%). Pulmonary function 18 months after the acute episode revealed a mean FVC of 92% of predicted value, with an FVC < 80% of predicted value in 11 patients (35.4%). Mean DLCO was 71% of predicted value, with a DLCO < 80% in 22 patients (70%). We observed a statistically significant relationship between total lung function abnormalities on HRCT and FVC (P < 0.05), and a trend towards statistical significance with DLCO (P = 0.051); there was a statistically significant relationship between the presence of ground-glass opacities and FEV1/FVC (P < 0.01). The relationships between reticulation and FVC, FVC%, FEV1, FEV1% and DLCO% were also considered statistically significant (P < 0.05).

CONCLUSION

Persistent interstitial lung abnormalities are seen on HRCT for a subset of patients infected with SARS-CoV-2 pneumonia. Seventy percent of these patients suffered a slight decrease in DLCO.

Generation of LexA enhancer-trap lines in Drosophila by an international scholastic network

Conditional gene regulation in Drosophila through binary expression systems like the LexA-LexAop system provides a superb tool for investigating gene and tissue function. To increase the availability of defined LexA enhancer trap insertions, we present molecular, genetic, and tissue expression studies of 301 novel Stan-X LexA enhancer traps derived from mobilization of the index SX4 line. This includes insertions into distinct loci on the X, II, and III chromosomes that were not previously associated with enhancer traps or targeted LexA constructs, an insertion into ptc, and seventeen insertions into natural transposons. A subset of enhancer traps was expressed in CNS neurons known to produce and secrete insulin, an essential regulator of growth, development, and metabolism. Fly lines described here were generated and characterized through studies by students and teachers in an international network of genetics classes at public, independent high schools, and universities serving a diversity of students, including those underrepresented in science. Thus, a unique partnership between secondary schools and university-based programs has produced and characterized novel resources in Drosophila, establishing instructional paradigms devoted to unscripted experimental science.

Early-life nutrition interacts with developmental genes to shape the brain and sleep behavior in Drosophila melanogaster

The mechanisms by which the genotype interacts with nutrition during development to contribute to the variation of complex behaviors and brain morphology of adults are not well understood. Here we use the Drosophila Genetic Reference Panel to identify genes and pathways underlying these interactions in sleep behavior and mushroom body morphology. We show that early-life nutritional restriction effects on sleep behavior and brain morphology depends on the genotype. We mapped genes associated with sleep sensitivity to early-life nutrition, which were enriched for protein-protein interactions responsible for translation, endocytosis regulation, ubiquitination, lipid metabolism, and neural development. By manipulating the expression of candidate genes in the mushroom bodies and all neurons, we confirm that genes regulating neural development, translation and insulin signaling contribute to the variable response of sleep and brain morphology to early-life nutrition. We show that the interaction between differential expression of candidate genes with nutritional restriction in early life resides in the mushroom bodies or other neurons, and that these effects are sex specific. Natural variation in genes that control the systemic response to nutrition and brain development and function interact with early-life nutrition in different types of neurons to contribute to the variation of brain morphology and adult sleep behavior.

POS0795 EPIDEMIOLOGY, DIAGNOSIS AND CLINICAL CHARACTERISTICS OF GIANT CELL ARTERITIS IN PATIENTS INCLUDED IN THE ARTESER MULTICENTER STUDY

Background

Epidemiological information on Giant Cell Arteritis (GCA) comes mainly from the Scandinavian countries of northern Europe, which show a higher incidence than the countries of southern Europe. GCA clinical manifestations can be divided into cranial, extracranial, and general syndrome.

Objectives

In a large series of GCA from Spain, we studied a) the incidence of GCA, b) clinical manifestations, and c) comorbidities at the time of disease diagnosis.

Methods

ARTESER is a retrospective epidemiological observational study of GCA promoted by the Spanish Society of Rheumatology in which 26 hospitals participate. The inclusion criteria were: all new patients diagnosed with GCA by a) ACR criteria, b) positive diagnostic test (temporal artery biopsy, temporal artery ultrasound or other relevant imaging techniques) and/or c) investigator’s clinical judgment. The patient recruitment period ranged from June 1, 2013 to March 29, 2019. The overall incidence of GCA per 100,000 people ≥50 years for the whole period and the mean annual incidence were evaluated. The clinical variables were collected by reviewing the patient’s medical history.

Results

1675 patients were included. The average annual incidence rate was 7.42 (95% CI: 6.57-8.27). All the cases were older than 50 years, and the age group with the highest annual incidence was that of 80 to 84 years, where it reached a value of 22.63 (95% CI: 22.04 -23.22). The mean annual incidence is higher in women than in men 10.07 (95% CI: 8.74-11.55) vs 4.81 (95% CI 3.84-5.93) (Table 1).

Table 1.

General characteristics, comorbidities and clinical manifestations

Epidemiologic, demographic and diagnosisMenWomenTotalGender, n (%)497 (29.7)1178 (70.3)1675Incidence annual rate (95% CI)4.81 (3.84-5.93)10.07 (8.74-11.55)7.42 (6.57-8.27)Age at diagnosis, years, mean (SD)76.9 (8.3)76.9 (8.0)76.9 (8.1)Diagnosis only by ACR Criteria89 (17.91)266 (22.58)355 (21.19)Diagnosis only with objective tests73 (14.69)140 (11.88)213 (12.72)Diagnosis ACR criteria + diagnosis objective tests311 (62.58)734 (62.31)1045 (62.39)Diagnosis by clinical judgment24 (4.8)38 (3.2)62 (3.7)Comorbidities at diagnosisArterial hypertension, n (%)330 (66.8)749 (63.7)1079 (64.6)Dyslipidemia, n (%)238 (48.3)563 (47.9)801 (48.0)Cranial clinical manifestationsNew-onset headache, n (%)382 (76.9)955 (81.1)1337 (79.9)Visual Clinic, n (%)194 (39.0)411 (34.9)605 (36.1)Extracranial manifestations and general syndromePolymyalgia rheumatica, n (%)178 (35.8)521 (44.3)699 (41.8)Asthenia, n (%)239 (48.1)634 (53.9)873 (52.2)Analysis at diagnosisErythrocyte sedimentation rate mm/h, mean (SD)72.3 (34.7)77.4 (33.0)75.9 (33.6)

The principal clinical characteristics of the population is shown in Table 1, the mean age at diagnosis was 76.9±8.1 years, 1178 (70.3%) were women. 1045 patients (62.39%) had ACR criteria and some positive objective test, 355 patients (21.9%) presented only ACR criteria and 213 (12.72%) only had a positive diagnostic test; 62 (3.7%) of the patients underwent diagnosis based on clinical judgment. The more frequent comorbidity was arterial hypertension (n=1079; 64.6%), followed by dyslipidemia (n=801, 48%). The predominant cranial manifestation was headache (n= 1337; 79.9%) and 605 patients experienced visual symptoms (36.1%). Polymyalgia rheumatica (n=699; 41.8%) and asthenia (n=837; 52.2%) were the most frequent extracranial and general syndrome manifestation, respectively. Regarding laboratory parameters, the most characteristic data was the increase of ESR (75.9±33.6 mm/1st h).

Conclusion

The mean annual incidence of GCA in Spain, 7.42 (95% CI: 6.57-8.27), is lower than that of the Scandinavian countries. It is higher in people older than 80 years. More than 60% of the patients met the ACR criteria and had a positive diagnostic test. Cranial manifestations constituted the most clinical features. The most frequent clinical manifestations are cranial. Up to a third of patients had visual manifestations.

Acknowledgements

This study has been funded by ROCHE Farma. The funder has not participated in the design, analysis, or interpretation of the results

Disclosure of Interests

None declared

POS0100 ACTIVATION OF THE CELLULAR INTEGRATED STRESS RESPONSE IN LABIAL SALIVARY GLANDS FROM SJÖGREN’S SYNDROME PATIENTS

Background

Sjögren’s syndrome (SS) is a chronic autoimmune disease characterized by inflammation of the exocrine glands and severe symptoms of eye and mouth dryness. Disorders in the saliva secretion process have been associated with oxidative and endoplasmic reticulum (ER) stress in combination with inflammatory responses. The integrated stress response (ISR) is a mechanism that allows cells to modify their gene expression program to restore homeostasis and promote their survival against various extrinsic and intrinsic stress signals, such as hypoxia, nutrient deprivation, viral infections, inflammatory factors (cytokines, chemokines, inflammasomes), and accumulation of unfolded proteins in the ER, among others (1). The ISR is regulated by four kinases: PERK, PKR, HRI and GCN2, that dimerize and autophosphorylate to become active and each one responds to different stress stimuli. The signaling pathways that are activated in response to stress factors stimulate the phosphorylation of eIF2α, which causes a transient inhibition of global protein synthesis and induction of synthesis of some specific genes like ATF4 and NRF2. ATF4 induces the transcription of genes involved in metabolism and nutrient uptake, redox status, and regulation of apoptosis. Dephosphorylation of eIF2α is the ISR termination signal to restore protein synthesis and is mediated by the PP1 complex, which recruits the catalytic subunit PP1c and one of its two regulatory subunits: GADD34 or CREP.

Objectives

To evaluate the presence and functional state (phosphorylation) of the ISR sensing kinases: PERK, PKR, HRI and GCN2; the levels of eIF2α /p-eIF2α and the key ISR transcription factors ATF4 and NRF2, as well as subunits of the complex involved in the ISR termination: PP1c, GADD34 and CREP in labial salivary glands (LSG) of SS-patients.

Methods

Biopsies of LSG from 12 SS-patients and 11 control subjects were studied. The levels of mRNA, protein and phospho (p)-protein of the ISR components were determined by RT-qPCR and Western blotting.

Results

Our results show increased levels of p-PERK/PERK ratio (11/11), PKR (7/11), p-PKR (7/11), p-PKR/PKR ratio (7/11), eIF2α (5/11), p-eIF2α (5/11) and ATF4 (11/11) in LSG from SS-patients compared to control subjects. No significant changes were found in mRNA levels of HRI, GCN2, and GADD34 between LSG from SS-patients and control subjects. Decreased protein levels of HRI (8/12), p-GCN2 (6/11), eIF2α (6/11), p-eIF2α (6/11), NRF2 (11/12), and p-NRF2 (12/12) were found in LSG showing scarce parenchyma and high fibrosis and fat infiltration. On the other hand, PP1c and CREP showed decreased mRNA and protein levels in all SS-patients LSG. Interestingly, Ro autoantibodies and focus score were negatively correlated with PP1c and NRF2 mRNA and protein levels whereas positively correlated with PKR mRNA levels.

Conclusion

The overexpression and activation of some ISR kinases together with the decrease in the PP1c/CREP phosphatase complex suggests a continuous activation of ISR, resulting in p-eIF2α to remain activated in LSG from SS-patients. This would explain the high protein levels of ATF4 and of target genes involved in the antioxidant response in LSG from SS patients suggesting that ISR activation plays a key role in pro-survival response to cellular stress.

References

[1]Pakos-Zebrucka K, Koryga I, Mnich K, Ljujic M, Samali A, Gorman AM. The integrated stress response. EMBO Rep. 2016;17(10):1374-95.

Acknowledgements

This work was supported by Fondecyt-Chile 1210055; Enlace-VID Universidad de Chile [ENL04/20 to MJG]; Fondecyt Iniciacion 11201058 and PhD fellowship Conicyt Chile.

Disclosure of Interests

None declared

POS0455 TOFACITINIB DECREASES INFLAMMATORY MARKERS AND MITOCHONDRIAL MORPHOLOGICAL DAMAGE IN SALIVARY GLANDS OF A MURINE MODEL OF SJÖGREN’S SYNDROME

Background

Altered homeostasis of salivary gland (SG) epithelial cells in Sjögren’s syndrome (SS) patients could be the initiating factor that leads to inflammation, as well as secretory dysfunction. Mitochondria are important organelles involved in cellular metabolism and their dysfunction can induce a loss of homeostasis and inflammation. Altered mitochondrion can release mitochondrial components that can act as damage-associated molecular patterns (DAMPs) and induce an inflammatory response via pattern recognition receptors (PRRs) such as the NLRP3 inflammasome, TLR9, cGAS/STING, and ZBP1 (1). Previously we determined that SG from SS patients showed and altered autophagy, which is associated to an increased pro-inflammatory cytokines expression. Interestingly, increased expression of pro-inflammatory markers such as IL-6, was reversed by JAK inhibitor tofacitinib in three-dimensional (3D)-acini deficient in autophagy (2). It is not clear whether the alterations in autophagy found in SG patients include alterations in mitochondrial clearance (mitophagy) that may lead to the accumulation of damaged mitochondria and enhanced inflammation. In this context, recent results of our laboratory showed, for the first time, severe ultrastructural alterations of mitochondria in SG cells from SS patients (1). However, it remains to be determined if these alterations are related to inflammation and if an anti-inflammatory agent could regulate these processes.

Objectives

To analyze the effect of tofacitinib on the mitochondrial ultrastructure in submandibular glands of a murine model of SS. In addition, to evaluate the effect of tofacitinib on the expression and activation of some PRRs involved in the recognition of mitochondrial DAMPs in the same murine model.

Methods

Six-month-old female NOD.B10Sn-H2b/J mice (Jackson Laboratories, USA) were used with 4-5 mice per group. Procedures were approved by the Universidad de Chile Animal Care and Use Committee. 30 mg/kg/day tofacitinib citrate was administered by oral gavage. After 28 days of tofacitinib or vehicle administration, their submandibular glands were obtained, which were processed to evaluate the mitochondrial ultrastructure by electron microscopy or lysed in RIPA buffer to obtain proteins. The protein levels of PRRs: NLRP3, TLR9, ZBP-1, and cGAs, as well as molecules activated downstream of cGAS and ZBP-1 such as TBK1, pTBK1, pSTING, and STING were determined by Western blotting.

Results

The results show that the mitochondria of the glandular epithelial cells of NOD.B10Sn-H2b/J mice treated with vehicle (control) present alterations such as swelling, disruption of membranes and crest disorganization that previously were reported in patients with SS (1). Interestingly, tofacitinib treatment improves the architecture of mitochondria. On the other hand, the protein levels of PRRs such as NLRP3 and cGAS decreased in mice treated with tofacitinib, as well as pTBK1.

Conclusion

The altered morphology of mitochondria together with the increased protein levels of PRRs and downstream markers of these PRRs suggests release of mitochondrial DAMPs in submandibular glands of NOD.B10Sn-H2b/J mice. The improvement in mitochondrial morphology as well as the decrease in PRRs activation under tofacitinib treatment suggest a potential use of this anti-inflammatory agent in mitochondrial alterations associated with inflammation. Many questions remain to be addressed, such as determining which mitochondrial DAMP might be being released and whether this is associated with impaired mitochondrial function in SS.

References

[1]Barrera, M. J., et al (2021). Dysfunctional mitochondria as critical players in the inflammation of autoimmune diseases: Potential role in Sjögren’s syndrome. Autoimmunity reviews, 20(8), 102867.

[2]Barrera, M. J., et al (2021). Tofacitinib counteracts IL-6 overexpression induced by deficient autophagy: implications in Sjögren’s syndrome. Rheumatology (Oxford, England), 60(4), 1951–1962.

Acknowledgements

This work was supported by Fondecyt Iniciación 11201058 and Fondecyt-Chile 1210055.

Disclosure of Interests

None declared.

POS0180 TYPE I INTERFERON DEPENDENT HSA-MIR-145-5P DOWNREGULATION MODULATES MUC1 AND TLR4 OVEREXPRESSION IN SALIVARY GLANDS FROM PRIMARY SJÖGREN’S SYNDROME PATIENTS

Background:

Primary Sjögren’s syndrome (pSS) is an autoimmune and inflammatory disease that mainly affects the salivary glands (SG) and is characterized by an overactivation of the type I interferon pathway (IFNs I). IFNs I are known to regulate the levels of microRNAs (miRNAs), non-coding RNAs whose levels are altered in pSS. IFNs I can decrease the levels of miR-145-5p, a miRNA with anti-inflammatory roles that has been reported downregulated in SG of from pSS patients [1]. This miRNA has TLR4 and MUC1 transcripts as predicted targets. MUC1 and TLR4 are two proteins overexpressed in SG of pSS patients that contribute, through various mechanisms, to the inflammatory state and glandular dysfunction [2-3]. Thus, we propose that IFNs I may contribute to a self-perpetuating inflammation loop through a hsa-miR-145-5p dependent MUC1 and TLR4 overexpression in the SG of pSS patients.

Objectives:

to evaluate whether mRNA levels of MUC1 and TLR4 are modulated by hsa-miR-145-5p in a IFNs I dependent manner.

Methods:

13 pSS patients and 9 controls SG biopsies were analyzed. hsa-miR-145-5p levels were determined by TaqMan assays and MUC1, TLR4, IFN-α and IFN-β mRNA levels by RT-qPCR. Additionally, in vitro assays using type I IFNs and chemically synthesized hsa-miR-145-5p mimics and inhibitors were performed to study its effect on MUC1 and TLR4 expression. JAK1 and STAT1 mRNA levels were also measured.

Results:

By Taqman assays we validated the decreased hsa-miR-145-5p levels (p=0.0001) in SG of pSS patients compared to controls. The decreased hsa-miR-145-5p levels correlated inversely with the increased mRNA levels of IFN-β (p=0.0192) in SG of pSS-patients. The hsa-miR-145-5p downregulation also correlated inversely with the overexpression of its predicted targets MUC1 (p=0.010) and TLR4 (p=0.0004). In vitro assays showed that IFN-β induces the overexpression of JAK1 (<p=0.0001) and STAT1 (p=<0.0001) leading to the downregulation of hsa-mir-145-5p (p=<0.0001) and increased MUC1 (p=<0.0001) and TLR4 mRNA levels (p=<0.0001). Functional assays suggest a regulation of hsa-miR-145-5p on MUC1 and TLR4 expression as MUC1 and TLR4 mRNA levels were decreased in HSG cells transfected with hsa-miR-513c-3p mimic and increased in HSG cells transfected with the miRNA inhibitor.

Conclusion:

Our findings suggest that IFNs I could induce the downregulation of hsa-miR-145-5p leading to the overexpression of MUC1 and TLR4 in SG from pSS patients. TLR4 is activated by ectopic mucins in the SG extracellular matrix from pSS patients which induces pro-inflammatory cytokines secretion [3]. Furthermore, the high levels of the MUC1-SEC and MUC1-Y isoforms observed in SG from pSS patients may favor cytokine synthesis through the immuno-enhancing peptide of MUC1-SEC or through the formation of a MUC1-SEC/MUC1-Y complex [4]. Therefore, IFNs I may contribute to the development of SS through amplification and perpetuation of inflammation due to a hsa-miR-145-5p dependent MUC1 and TLR4 overexpression.

References:

[1]I. Alevizos, et al,. Arthritis Rheum, 2011;63:535-44.

[2]HH. Sung, et al,. Oral Dis. 2015;21(6):730-8.

[3]MJ. Barrera, et al,. Rheumatology (Oxford). 2015;54(8):1518-27

[4]LM. Herbert, et al,. Cancer Res. 2004;64(21):8077-84.

Acknowledgements:

Fondecyt 1210055, Fondecyt 1160015, Fondecyt Iniciación 11170049, Fondecyt Iniciación 11201058, CONICYT fellowship (DJ, PC)

Disclosure of Interests:

None declared

[Optimizing the detection of subclinical atrial fibrillation after ESUS]

INTRODUCTION

It has been estimated that approximately 20% of ischemic strokes have a cardioembolic origin and the cause is not detected or there are more than one in 9-25% of ischemic strokes. An adequate diagnostic approach of ESUS would allow an optimization of antithrombotic treatment.

OBJECTIVE

Narrative update about the available evidence on the best diagnostic and therapeutic approach among patients with ESUS and how to optimize the detection of atrial fibrillation as a potential cause is reviewed.

DEVELOPMENT

A search was conducted on PubMed (MEDLINE), using the MeSH terms [ESUS] + [atrial fibrillation] + [diagnosis] + [treatment]. Original data from clinical trials, prospective and retrospective studies and reviews were selected.

CONCLUSIONS

The detection of atrial fibrillation after ESUS is mandatory to optimize the treatment. However, not all patients have the same risk of developing silent atrial fibrillation. There are some factors that increase this risk (left atrium enlargement, elderly, frequent premature supraventricular complexes). In these patients, a more prolonged monitorization could increase the possibility of detecting atrial fibrillation, and consequently, to benefit more from anticoagulant treatment.

AB0698 REAL CLINICAL PRACTICE IN THE CONTROL OF REPORTED OUTCOMES BY THE PATIENT (PROS) DIAGNOSED WITH PSORIATIC ARTHRITIS AND/OR ANKYLOSING SPONDYLITIS WHO BEGIN TREATMENT WITH SECUKINUMAB. A PROSPECTIVE MULTICENTRIC STUDY

Background:

Objectives:

Analyse the effect of secukinumab in terms of the patient´s own variables, specifically: fatigue, sleep, pain and quality of life in patients with psoriatic arthritis or spondyloarthritis.

Methods:

A multicentric longtitudinal observational prospective study was carried out at 6 months in patients who begin treatment with secukinumab. At the start and after 6 months the following data was collected on the outcome: pain through an visual analogue scale (VAS), fatigue using the FACIT-fatigue scale, sleeping problems using the insomnia severity index (ISI) and quality of life with the EuroQol-3L-5D and the PsAQoL.

The sample can be described in terms of the distribution of the variables through measures of central tendency.It was analysed if the change after 6 months was statistically relevant using Student´s t-test for paired data in the case of FACIT, VAS, PsAQoL and ISI and chi-squared for the dimensions of the EQ-5D. The size of the effect of each of the measurements taken was calculated using Cohen’s D. the results are given grouped by disease and globally. The analysis was carried out using Stata v12 (College Station Tx, USA)

Results:

In table 1, the changes in the scales of normal distribution can be seen. Apart from general VAS, all the scales experience significant relevant changes. The PROs preferred by the patient with the best therapeutic response is the quality of sleep. The adjustment of the regression models does not produce changes in the results, apart from small adjustments to the condidence intervals (final column table 1). The subdomain in which the most significant change in the EQ-5D is produced is in that of pain and discomfort.

Conclusion:

After 6 months patients who begin treatment with secukinumab, present with improvements in all sizes of the effects of the treatment in the various studied scales. The improvement achieves global and generalised statistical significance after 6 months of study. The greatest effect is on sleep, quality of life and fatigue.

The measurements of the outcomes reported by the patients are a clinical value added to our objective evaluations of the health and activity of the disease, and allow us, in a more integrated and comprehensive manner, to undertake a more exact and close evaluation of their state of health and wellbeing.

Disclosure of Interests:

JUAN JOSE LERMA: None declared, Antonio Gracia: None declared, Antonio Perez: None declared, Amalia Rueda: None declared, Clara Molina: None declared, M. Dolores Pastor: None declared, Isabel Balaguer Trull: None declared, Inmaculada Valiente: None declared, Cristina Campos Fernández: None declared, Javier Calvo: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)

THU0229 HSA-MIR-513C-3P OVEREXPRESSION DECREASES XBP-1S CORRELATING WITH INCREASED INFLAMMATION AND AUTOANTIBODIES IN SALIVARY GLANDS FROM SJÖGREN’S SYNDROME PATIENTS

Background:

Endoplasmic reticulum (ER) stress and the Unfolded Protein Response (UPR) are linked to inflammation in a variety of human pathologies including autoimmune diseases. Salivary glands (SG) from Sjögren’s syndrome (SS) patients have high levels of IFN-gamma among other cytokines, which trigger or exacerbate protein unfolding or misfolding, inducing ER stress. In this study, we focused on the IRE1α/XBP-1 pathway of the UPR, whose transcription factor is XBP-1s, which induces genes linked to regulation of the secretory pathway. We recently found that SG of SS patients have reduced levels of XBP-1s transcripts associated with an increased DNA methylation of XBP-1 promoter [1]. We postulate that other epigenetic mechanisms, such as miRNAs, could coexist with promoter DNA hyper-methylation to regulate XBP-1s expression.

Objectives:

Due to hsa-miR-513c-3p overexpression has been reported in SG from SS patients [2] and that XBP-1 is a predicted target of hsa-miR-513c-3p, the aim of this study was to evaluate whether mRNA levels of XBP-1s is modulated by hsa-miR-513c-3p and also if IFN-gamma modify the expression hsa-miR-513c-3p and XBP-1s.

Methods:

SG biopsies from 16 SS-patients with low and high focus score and 5 controls were analyzed. hsa-miR-513c-3p levels were measured by Taqman miRNA assays, whereas XBP-1s mRNA levels were determined by qRT-PCR. Additionally,in vitroassays using IFN-gamma and chemically synthesized hsa-miR-513c-3p mimics and inhibitors were performed to study its effect on XBP-1s expression.

Results:

By Taqman assays we validated the overexpression of hsa-miR-513c-3p in SG from 8 SS patients with low (p=0.03) and 8 SS-patients with high (p=0.003) focus score, compared with SG from 5 controls. In the same samples, a decrease of XBP-1s transcript levels was observed in SG from SS-patients with low (p=0.002) and high (p=0.026) focus score. XBP1s transcript levels were negatively correlated with hsa-miR-513c-3p (r=-0.47, p=0.014), Ro (r=-0.73, p=0.0009), ANA (r=-0.7, p=0.0033) and focus score (r=-0.72, p=0.001). Stimulation of 3D-acini with 1 ng/mL IFN-gamma increase the hsa-miR-513c-3p levels (p=0.014) and decrease the XBP-1s transcript levels (p=0.027). A negative correlation was found between hsa-miR-513c-3p and XBP-1s transcript levels in 3D-acini stimulated with IFN-gamma (r=-0.87, p=0.0001). The XBP-1s transcript levels were decreased in HSG cells transfected with hsa-miR-513c-3p mimic and increased in HSG cells transfected with the miRNA inhibitor.

Conclusion:

IFN-gamma-induced upregulation of hsa-miR-513c-3p is consistent with the presence of STAT1-binding elements in its promoter region. Our findings suggest that the combined action of miRNAs and DNA methylation modulated by IFN-gamma could explain the altered expression of XBP-1s, a key transcription factor involved in cellular proteostasis, affecting secretory function in LSG from SS-patients. Our results confirm previous correlations found between XBP-1s protein levels and clinical parameters of SS-patients, suggesting an association of XBP-1s with inflammation and impaired SG function.

References:

[1]D. Sepúlveda,et al, Rheumatology (Oxford), 2018;57:1021-32.

[2]I. Alevizos,et al,. Arthritis Rheum, 2011;63:535-44.

Acknowledgments :

Fondecyt 1160015, Fondecyt Iniciación 11170049, Fondecyt Postdoctorado 3170023, CONICYT fellowship (PC, DJ).

Disclosure of Interests: :

None declared

Development of an Isavirus minigenome system to study the function of the pocket RNA-binding domain of the viral nucleoprotein (NP) in salmon cells

The Isavirus is an orthomyxovirus with a genome composed of eight segments of negative single-strand RNA (-ssRNA). It has been proposed that the eight genomic segments of the Isavirus are organized as a ribonucleoprotein (RNP) complex called a minigenome, which contains all the viral RNA segments, a viral heterotrimeric polymerase and multiple copies of the viral nucleoprotein (NP). Here, we develop an Isavirus minigenome system and show the importance of the formation of active RNPs and the role of viral NP R189, R194, R302 and K325 residues in the NP RNA-binding domain in the context of RNPs. The results indicate it is possible to generate a minigenome in salmon cells, a composite ISAV RNPs with EGFP-based chimeric vRNA with heterotrimeric polymerase (PB1, PB2, PA) and NP protein using CMV-based auxiliary plasmids. It was also shown that NP R189, R194, R302 and K325 residues are important to generate viral mRNA from the constituted RNPs and a detectable reporter protein. This work is the first salmon cell-based minigenome assay for the Isavirus, which was evaluated by a bioinformatic and functional study of the NP protein in viral RNPs, which showed that correct NP-vRNA interaction is key to the functioning of RNPs.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Disturbed testicular expression of the estrogen-metabolizing enzymes CYP1A1 and COMT in infertile men with primary spermatogenic failure: possible negative implications on Sertoli cells

Estradiol (E₂ ) is normally metabolized to hydroxyestradiols and methoxyestradiols by CYP1A1, CYP1B1 and COMT. However, an altered production of these metabolites by a disturbed expression of these enzymes is associated with reproductive and non-reproductive pathologies. In vitro studies suggest that increased hydroxyestradiols and methoxyestradiols intratesticular generation is related to male infertility, but no studies have explored whether infertile men have a disturbed testicular expression of the enzymes that generate these E₂ metabolites. The aim of this study was to assess CYP1A1, CYP1B1 and COMT testicular expression at mRNA and protein level in men with spermatogenic impairment. Seventeen men with primary spermatogenic failure (13 with Sertoli cell-only syndrome and four with maturation arrest) and nine controls with normal spermatogenesis were subjected to testicular biopsy. mRNA was quantified using real-time RT-PCR and protein expression was evaluated using western blot and immunohistochemistry followed by integrated optic density analysis. Besides, the effects of hydroxyestradiols and methoxyestradiols on testosterone-induced transcriptional activity were evaluated in TM4 cells using a luciferase reporter assay system. Our results show that patients with Sertoli cell-only syndrome had significantly elevated COMT expression at the mRNA level, higher COMT immunoreactivity in their seminiferous tubules and increased protein expression of the soluble COMT isoform (S-COMT), whereas patients with maturation arrest had significantly elevated CYP1A1 mRNA levels and higher CYP1A1 immunoreactivity in interstitial space. Finally, 2-hydroxyestradiol decreased testosterone-induced transcriptional activity in Sertoli cells in vitro. In conclusion, male infertility is related to disturbed testicular expression of the enzymes responsible for producing hydroxyestradiols and/or methoxyestradiols. If these changes are related with increased intratesticular hydroxyestradiols and methoxyestradiols concentrations, they could elicit an impaired Sertoli cell function. Our results suggest CYP1A1 and COMT as new potential targets in treating male infertility.

Outcomes After Direct Thrombectomy or Combined Intravenous and Endovascular Treatment Are Not Different

Background and Purpose—

Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients.

Methods—

Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score. The average odds ratios for the association of treatment with good outcome and death at 3 months and symptomatic bleedings at 24 hours were calculated with the Mantel–Haenszel test statistic.

Results—

We included 599 direct EVT patients and 567 patients with combined treatment. Stratification through propensity score achieved balance of baseline characteristics across treatment groups. There was no association between treatment modality and good outcome (odds ratio, 0.97; 95% confidence interval, 0.74–1.27), death (odds ratio, 1.07; 95% confidence interval, 0.74–1.54), or symptomatic bleedings (odds ratio, 0.56; 95% confidence interval, 0.25–1.27).

Conclusions—

This observational study suggests that outcomes after direct EVT or combined intravenous thrombolysis+EVT are not different. If confirmed by a randomized controlled trial, it may have a significant impact on organization of stroke systems of care.

Abstract WP372: The Acute ICH Growth Score: Simple and Accurate Predictor of Hematoma Expansion in Patients with Acute Intracerebral Hemorrhage

Background and Purpose: Acute intracerebral hemorrhage (ICH) hematoma expansion predicts high mortality and morbidity, occurring in a third of patients presenting with this condition. Recent studies correlated ultra-early hematoma growth and hematoma morphologic appearance with ICH expansion. Our purpose was to develop simple and clinically useful score that would predict ICH hematoma expansion accurately.

Methods: This cohort included patients with primary or anticoagulation-associated ICH patients presenting <6 hours post ictus prospectively enrolled in the PREDICT study. Patients underwent baseline CT, CT angiography and 24-hour CT for hematoma expansion analysis. A risk score model was developed for predicting hematoma expansion (> 6 ml or > 33%). A 7-point acute ICH growth score was based on ultra-early hematoma growth > 5 mL/hour (yes=1), irregular morphology (yes=1), density heterogeneity (yes=1), presence of fluid-blood levels (yes=1), spot sign (yes=1), and use of anticoagulation (yes=2). Discrimination of the expansion score was assessed.

Results: We retrospectively studied 301 primary or anticoagulation-associated intracerebral hemorrhage patients. The 7-point acute ICH growth score demonstrated good discrimination for hematoma expansion>6 mL or 33% (area under the curve of 0.76). Median and significant HE are shown in the table below (p<0.001).

Conclusions: In a multicenter prospective study, the ICH expansion score demonstrate good correlation with hematoma expansion, and included recently reported variables such as morphology and ultraearly growth.

2-hydroxyoestradiol and 2-methoxyoestradiol, two endogenous oestradiol metabolites, induce DNA fragmentation in Sertoli cells

Elevated intratesticular levels of hydroxyoestradiols and methoxyoestradiols, two classes of endogenous oestradiol metabolites, have been associated with male infertility. The aim of this study was to explore the effects of 2-hydroxyoestradiol (2OHE₂ ), 4-hydroxyoestradiol (4OHE₂ ), 2-methoxyoestradiol (2ME₂ ) and 4-methoxyoestradiol (4ME₂ ) on Sertoli cell viability. For this, TM4 cells were incubated with different concentrations of these metabolites for 24 h to then evaluate the viability and DNA integrity by MTS and TUNEL assay respectively. The participation of classical oestrogen receptors and the involvement of oxidative stress and apoptotic mechanisms were also evaluated co-incubating TM4 cells with these estradiol metabolites and with the drugs ICI182780, N-acetylcysteine and Z-VAD-FMK respectively. Only high concentrations of 2OHE₂ and 2ME₂ decreased cell viability inducing DNA fragmentation. In addition, ICI182780 did not block the effect of 2OHE₂ and 2ME₂ , while N-Acetylcysteine and Z-VAD-FMK only blocked the effect of 2OHE₂ . Moreover, 2OHE₂ but not 2ME₂ induced PARP and caspase-3 cleavage. Finally, lower 2OHE₂ and 2ME₂ concentrations (0.01-0.1-1.0 μmol l^-1 ) decreased Sertoli cell viability 48 h post-treatment. Our results support the hypothesis that elevated intratesticular 2OHE₂ or 2ME₂ concentrations could be related to male infertility since 2OHE₂ by apoptosis and 2ME₂ by undetermined mechanisms induce DNA fragmentation in Sertoli cells.

[Medication errors related to computerized physician order entry at the hospital: Record and analysis over a period of 4 years]

OBJECTIVES

Computerized physician order entry (CPOE) can generate medication errors. It is necessary to identify them and analyse their causes in order to secure the medication use system.

METHODS

Errors were recorded during the pharmaceutical analysis of prescriptions over a period of 4 years on 425 beds. A code frame was provided. Errors were classified according to type, causes and time of detection. The most often drug implicated and the error correction rate were studied. Deep causes were determined and contributing factors were listed.

RESULTS

Among 99,536 prescriptions analyzed, 2636 errors were detected (2.65 errors per 100 orders analyzed). The most common error was omission (31.49%). The most represented cause was redundancy requirement (11.34%). Antibacterials were most commonly involved (224 errors). Exactly 65.9% of the prescriptions were modified by physicians. Three root causes were identified: (1) configuration issues; (2) misuse; (3) design problem. Three types of contributing factors have also been detailed: economic, human and technical factors.

CONCLUSIONS

Identifying root causes has targeted three types of improvement actions: (1) software settings; (2) training of users; (3) requests for improvements. Contributing factors have to be identified to control the generated risk. Some errors related to CPOE may lead to serious side effects for the patient. That is why it is necessary to identify these errors and analyze them in order to implement improvement actions and prevention to secure the prescription.

MUC1/SEC and MUC1/Y overexpression is associated with inflammation in Sjögren's syndrome

OBJECTIVES

To evaluate the expression and localization of MUC1/SEC and MUC1/Y isoforms in labial salivary glands (LSG) from Sjögren's syndrome patients (SS patients), as well as their in vitro expression induced by cytokines.

SUBJECTS AND METHODS

Labial salivary gland from 27 primary SS patients and 22 non-SS sicca subjects were studied. Relative MUC1/SEC and MUC1/Y mRNA levels were determined by qPCR and protein levels by Western blotting. Induction of mucin mRNAs was assayed in vitro. Immunohistochemistry was used for localization.

RESULTS

Relative MUC1/SEC and MUC1/Y mRNA and protein levels were significantly higher in LSG from SS patients. These mRNAs were induced by cytokines. MUC1/SEC and MUC1/Y were detected in acini apical region of control LSGs, and significant cytoplasmic accumulation was observed in acini of SS patients. MUC1/Y localized in acinar nuclei and cytoplasm of inflammatory cells of LSG from SS patients. A strong positive correlation was observed between cellular MUC1/SEC levels and glandular function determined by scintigraphy.

CONCLUSIONS

We show for the first time that MUC1/SEC and MUC1/Y are expressed in LSG of both SS patients and non-SS sicca subjects. The observed overexpression and aberrant localization of MUC1/SEC and MUC1/Y and their induction by pro-inflammatory cytokines may favor the perpetuation of the inflammatory environment that disrupts the salivary glandular homeostasis in SS patients.

Next-generation transcriptome characterization in three Nacella species (Patellogastropoda: Nacellidae) from South America and Antarctica

The southern tip of South America and Antarctica are particularly interesting due to many genera and also species currently sharing between both areas. The genus Nacella (Patellogastropoda: Nacellidae) is distributed in different regions of South America and Antarctica living preferentially on rocks and boulders and grazing on algae, diatoms and bacterial films. We described the transcriptomes of three Nacella species, Nacella concinna (Strebel, 1908), inhabiting the Antarctic Peninsula; Nacella magallanica (Gmelin, 1791), from Patagonia and Nacella clypeater (Lesson, 1831), from central Chile. In total, we obtained over 20,000 contigs with an average length of 583bp. Homologous protein coding genes (PCGs) for mitochondrial genome of the three species were characterized and a database of molecular markers was also generated. This study represents the first publicly available report on pyrosequencing data for patellogastropod species, and provides an important comparative resource for studies in ecophysiology and evolutionary adaptation in marine invertebrate species.