AB1339 MUSCLE ULTRASOUND FOR THE DIAGNOSIS OF SARCOPENIA IN RHEUMATOID ARTHRITIS (RA)

Background

Sarcopenia is a muscular disease characterized by a loss of muscle mass and function. The condition is associated with chronic diseases and ageing and predicts disability, hospitalization and death (1). Due to chronicity and disability produced by RA, it is convenient to see the relationship with sarcopenia.

Objectives

To assess the diagnostic utility of ultrasound (US) for sarcopenia.

Methods

Cases: Outpatients, 65 years old or more, with RA (ACR/EULAR 2010 criteria) from the rheumatology clinics of 4 Spanish University Hospitals were randomly selected consecutively from rheumatology consultation since May 2021 to September 2021. Controls: Control subjects without rheumatoid disease were selected from family members or friends of the cases, paired by age, gender and social status from May to September 2021.

Variable and measures:

The main evaluated outcome was sarcopenia as defined in 2019 by the European Working Group on Sarcopenia in Older People (EWGSOP). Crossectional Ultrasounds (US) of the third proximal forearm were evaluated for the perpendicular distance (milimetres) between superficial surface of subcutaneous celular tissue and the deep surface close to the ulnae with two different measures (66% and 75%).

Crossectional US images were also obtained of lower limbs, at an equidistant point between anterosuperior iliac spine and the upper border of the patella for measuring the distance between superficial surface of subcutaneous celular tissue and the deep interface of the femur with vastus medialis muscle with two different measures (50% and 75%).

Handheld dynamometer was used to measure the strength in upper limbs.

Body composition was evaluated using dual-energy X-ray densitometry.

Statistics: A descriptive analysis, chi square y T-student tests were done to compare the main characteristics and results between patients and controls. Correlations between forearm US and strength and between thigh US and total DEXA were calculated by Pearson’s test.

Results

76 patients and 76 controls were included in the study, 120 were women (78,9%), with media ± SD of age 74,7 ±6,98 of media and 32 (21,1%) were men, with age 70,1 ±3,78 of media. In comparation with controls, RA patients presented more frequency of sarcopenia (30 [19,53%] vs 6 [3,94%]; p=0,005) according to EWGSOP criteria.

From the point of view of ultrasound, RA patients presented less muscle mass in cubital forearm and thigh. Control group presented larger size of muscle (Table 1).

Table 1.

Results measirements case-control in milimeters

Control (m±ds)RA (m±ds)p-valorRight forearm 66% ulnar42,92±838,72±9,330,003Left forearm 66% ulnar41,17±8,9737,93±9,270,03Left forearm 75% cubital38,74±7,735,18±8,50,008Right Thigh 50% FR+VI30,9±7,4628,09±6,310,011Right Thigh 50%VI14,5±4,2613,08±4,270,042Right Thigh 50% FR15,26±3,613,5±3,280,002Right Thigh 50% area FR588±181,29481,49±140,560,001Lefth Thigh 50% FR+VI27,67±8,922,37±8,26<0,001

Ultrasound measurements in forearm which showed a positive correlation with strength were: right forearm: 66% ulnar (r=0,364, p=0,001), 75% ulnar (r=0,365, p=0,001); left forearm: 66% ulnar (r=0,348, p=0,002), 75% ulnar (r=0,337, p=0,003). In the other hand, ultrasound measurements in thigh which showed a positive correlation with DXA were: right thigh 50% femoral rectus (FR)-vastus intermedius (VI) (r=0,255, p=0,003), 50% VI (r=0,256,p=0,003), 50% FR (r=0,265, p=0,002), 50% area FR (r=0,280, p=0,003), 75% FR-VI (r=0,357,p<0,001), 75% VI (r=0,382,p<0,001), 75% FR (r=0,240, R2=0,006), 75% area FR (r=0,218,p=0,023); Left thigh: 50% FR-VI (r=0,251, p=0,004), 50% VI (r=0,293,p=0,001), 50% FR (r=0,214, p=0,015), 75% FR-VI (r=0,347,p<0,001), 75% VI (r=0,342, p<0,001), 75% FR (r=0,295, p=0,001).

Conclusion

Muscle Ultrasound is a useful diagnostic tool to detect sarcopenia. It can be cost-efficient and faster when compared with DEXA and the results correlate consistently with the strength in forearm. Patients with rheumatoid arthritis are in high risk of suffering sarcopenia and US could be used to control the evolution of this condition.

Disclosure of Interests

None declared

AB1545-HPR MALNUTRITION IN PATIENTS WITH RHEUMATOID ARTHRITIS OVER 65 YEARS OF AGE

Background

Malnutrition is one of the most important geriatric syndrome and fragility factor in older people. In adittion to being a disease sign, its presence is related with increasing of morbility, longer hospitalizations, institucionalization and mortality due to concomitant diseases.

Objectives

Describe prevalence of malnutrition risk and associated factor in patients with rheumatoid arthritis (RA) over 65 years of age.

Methods

Design:

A case-controls study.

Participants:

Cases: Recruitment was performed by random sampling between patients over 65 years of age with RA (ACR/EULAR 2010 criteria) attended at 4 Spanish University Hospitals. Controls: Recruitment of subjects without rheumatoid disease was performed asking for case patients who attended to medical center with a similar-age (age of range +/- 5 years) and same-gender person from same social or family environment.

Variables y measures:

The main variable was malnutrition risk, measured by screening of Mini Nutritional Assessment.

Other variables were: presence of sarcopenia, defined according to European Working Group on Sarcopenia in Older People (EWGSOP) 2019, economic status, dual-energy x-ray absorptiometry (DEXA) in spine and hip to osteoporose screening, toxic habits, comorbidities and Charlson index, physical activity measured with Global physical activity questionnaire (GPAQ) and Short Physical Performance Battery (SPPB), haemoglobin, calcium, D and B12 vitamins, total proteins, albumin, C reactive protein, body mass index (BMI), polimedication, quality of life measured with EQ-5D and RA related factors, activity disease measured with DAS28, SDAI and CDAI; physical function measured with HAQ (Health assessment questionnaire) and global functional status according ACR criteria.

Statistical analysis: Descriptive and multivariative analysis was performed to identify factors associated to sarcopenia in RA.

Results

152 subjects were included in the study, 76 RA and 76 controls.More patients than controls with malnutrition risk were found, although there were no significative difference (24 [31,6%] vs 17 [22,4%]; p=0,136). More women with RA were included (78,9%), with media ± SD of age 74,7 ± 3,78., sarcopenia was presented in 9/24 (37,5%) and Charlson index was 3 points in 11/24 patients (45,8%) and 4 points in 8/24 patients (33,3%). According to the treatment, almost a 40%, no DMARDs were taken and neither 25% biological DMARD. 58,3 % of patients received corticosteroids and mayority of them (95,8%) were polimedicated. RA patients who presented desnutrition risk, in comparison with the rest of patients, had a media of upper age (p=0,007), more frequency of sarcopenia (p=0,006), right tricipital skinfold thickness (p=0,043). Also, higher values were found in activity index like physical function and quality of life: DAS28 (p=0,003), HAQ (p=0,044), Vitamin D (p=0,035), IPAQ (p=0,003), SPPB (p=0,018), EQ5D (p=0,01), VAS EQ5D (p=0,044), SDAI (p= 0,006), CDAI (p=0,008). In multivariative análisis, factors associated by independent way to malnutrition risk were age (OR [CI 95%], 1,148 [1,020-1,291]; p=0,022) and inflammatory disease by DAS28 (OR [CI 95%], 2,043 [1,198-3,483]; p=0,009) (R2=0,252).

Conclusion

Even though frequency of malnutrition was similar in cases and controls, in RA was associated with inflammatory activity and older age. It´s important monitoring malnutrition risk in this kind of patients to perform correct interventions to prevent and improve nutrition.

Disclosure of Interests

None declared

AB0562 POTENTIAL BIOMARKERS OF PERSONALIZED TREATMENT BASED ON CARDIOVASCULAR-RELATED COMORBIDITIES IN PSORIATIC ARTHRITIS

Background:

Psoriatic Arthritis (PsA) displays increased traditional cardiovascular (CV) risk factors, such as insulin resistance (IR), metabolic syndrome or obesity. Thus, it is an urgent need to treat and manage these cardiometabolic comorbidities associated. Some evidence points out that methotrexate could improve CV risk due to its anti-inflammatory properties, however the effect of PDE4 inhibitor treatment on CV risk have not been elucidated yet.

Objectives:

1) To evaluate the effect of conventional therapy and PDE4 inhibitor in PsA patients with high prevalence of cardiometabolic comorbidities. 2) To identify a molecular patient profile susceptible of being benefit from each therapy regarding disease activity and CV risk.

Methods:

Thirty biological-naïve patients with PsA were treated with the PDE4 inhibitor (Apremilast), Methotrexate or combined therapy (Apremilast and Methotrexate) following the clinical routine practice for 6 months. A cohort of 30 age and sex-matched healthy donors (HDs) was included. Plasma and peripheral blood mononuclear cells (PBMCs) were isolated from peripheral blood of patients and HDs. Different parameters related to the cardiometabolic risk were analyzed, including: atherogenic index, ratio apolipoprotein B (apo B)/apolipoprotein A (apo A), insulin resistance (IR), metabolic syndrome, obesity, arterial hypertension, and the SCORE. Clinical and analytical parameters were collected: lipid profile (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, apo A and apo B), glucose and insulin, body surface area (BSA) affected by psoriasis, number of tender and swollen joints, DAPSA, C-reactive protein and erythrocyte sedimentation rate. A panel of 92 proteins involved in cardiovascular disease (cardiovascular panel II, Olink) and an adipocytokine profile was measured in plasma and PBMCs. Hard cluster analysis was carried out in order to identify two distinctive molecular phenotypes depending on the treatment response related to the reduction of CV risk.

Results:

Among the 92 CV-related proteins, the higher levels of two molecules, CD163 and FABP4 observed in PsA patients compared to HDs, were strongly associated with elevated rates of CV risk factors such as apolipoprotein B/A and atherogenic risks, metabolic syndrome, obesity, IR, arterial hypertension and smoking. Thus, we could identify two clinical profiles of patients according to the plasma levels of these molecules: cluster 1 defined by 20 patients with low levels of CD163 and FABP4 and low prevalence of CV comorbidities and cluster 2 defined by 10 patients with high levels of CD163 and FABP4 and high prevalence of CVD comorbidities. Regarding cluster 2, those patients that were treated with Apremilast or combined therapy had a significant reduction of CD163 and FABP4 associated with a drop in total cholesterol, apo B, IR state and body mass index. In addition, both PDE4 inhibitor and combined treatment reduced activity disease. However, Methotrexate in monotherapy did not show a beneficial effect in PsA patients displaying higher levels of CD163, FABP4, total cholesterol and no changes in disease activity after treatment. In regard to cluster 1, the three therapy strategies reduced disease activity after 6 months. Even with low rates of comorbidities, those patients treated with Apremilast had reduced levels of total cholesterol and apolipoprotein B and body mass index after 6 months of therapy. However, no changes were observed in the treatment with Methotrexate or Methotrexate combined with Apremilast.

Conclusion:

1- CD163 and FABP4 could be considered as potential biomarkers of treatment efficacy regarding cardiometabolic comorbidities. 2- Apremilast might target metabolic alterations in PsA modulating lipid profile, insulin resistance and body mass index, decreasing the levels of surrogate CV-related molecules. 3- Apremilast treatment should be considered in PsA patients with higher rates of cardiometabolic comorbidities.

Funded by ISCIII (PI17/01316 and RIER RD16/0012/0015) co-funded with FEDER.

Disclosure of Interests:

None declared.

POS1001 CLINICAL AND SURROGATE CARDIOVASCULAR RISK ASSESSMENT AND ITS RELATIONSHIP WITH PSORIATIC ARTHRITIS PATHOGENESIS

Background:

Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with an increased prevalence of cardiovascular (CV) events. Traditional CV risk factors do not account for the increased CV disease mortality in PsA. Inflammation seems to have a key role in the development of this comorbidity, however the specific molecular mechanisms involved are not defined yet.

Objectives:

To evaluate clinical CV risk factors and surrogate markers and their relationship with inflammation, disease activity and metabolic comorbidities in PsA patients

Methods:

This is a cross-sectional study including 100 PsA patients without CV disease recruited in the routine clinical practice at the Rheumatology Department, Reina Sofia Hospital of Cordoba and 100 age-matched healthy donors (HDs). Different parameters related to the cardiometabolic risk were analyzed. Clinical and analytical parameters were collected: lipid profile (cholesterol, HDL, LDL, TG, ApoA and ApoB), glucose and insulin, body surface area (BSA) affected by psoriasis, number of tender and swollen joints, DAPSA, VAS, CRP and ESR. To measure the persistence of inflammation, CRP levels were recorded retrospectively once, twice, or three times during the 5 years prior to study and at the moment of the study. Increased levels of CRP in at least 50% of the determinations was considered as persistent inflammation. Plasma and peripheral blood mononuclear cells (PBMCs) were isolated from peripheral blood of patients and HDs. A panel of 92 proteins involved in CV disease and an adipocytokine profile was measured in plasma and PBMCs. In addition, activation of 18 intracellular pathways involved in cell activation was also measured in PBMCs. In vitro experiments in adipocytes treated with serum from PsA patients were also carried out.

Results:

Traditional CV risk factors including atherogenic risk, insulin resistance (IR), metabolic syndrome, smoking, obesity, arterial hypertension, apolipoprotein B/A risk, type 2 diabetes mellitus and the levels of SCORE were significantly increased in PsA patients. The presence of IR was associated with disease activity markers (DAPSA, ESR and CRP). In fact, the HOMA-IR index was related to the CRP persistence. PsA patients with obesity had significantly increased the number of tender and swollen joints, the levels of DAPSA and CRP. Twenty-eight proteins involved in CV disease and six adipocytokines were significantly elevated in the plasma of PsA patients. Several of these cardiovascular molecules were associated with higher levels of DAPSA (CTSD, GAL3, CD163, FABP4, IL6 and IL1RT2), acute phase reactants (GAL3, TNFα, Adiponectin, TNFR1 and IL6), affected body surface area (IL2RA, GAL3, CCL15, TRAP, CSTB, CD163, OPG and CNTN1) and onychopaty (TRAP, VWF, MCP-1, GAL3, LTBR, TFPI, CHI3L1, CTSZ and JAM-A). In addition, the mRNA expression of most of those 28 CV molecules were significantly increased in PBMCs from PsA patients. At intracellular level, the activation of 11 kinases (ERK1/2, AKT, S6 Ribosomal, mTOR, HSP27, Bad, p70 S6 kinase, PRAS40, p53 and caspase-3) involved in insulin signaling, inflammation, cell survival and apoptosis were altered in PBMCs. Finally, serum from PsA patients was able to modify the expression of these molecules in adipocytes.

Conclusion:

1) Disease activity and inflammatory burden are closely associated with the presence of metabolic alterations, specifically obesity and IR in patients with PsA. 2) The development of IR is extremely related to the persistence of CRP levels in the previous 5 years. 3) Inflammation is closely associated to the adipose tissue dysfunction in PsA and 4) FABP4, CD163 and GAL3 are surrogate CV markers commonly associated with clinical features of PsA, suggesting the role of these molecules linking CVD and PsA pathogenesis.

Funded by ISCIII (PI17/01316 and RIER RD16/0012/0015) co-funded with FEDER.

Disclosure of Interests:

None declared.

POS0475 INTEGRATIVE CLINICAL, MOLECULAR AND COMPUTATIONAL ANALYSES ALLOW THE IDENTIFICATION OF DISTINCTIVE PHENOTYPES OF RHEUMATOID ARTHRITIS PATIENTS RELATED TO THE CLINICAL INVOLVEMENT AND THE RESPONSE TO TNF INHIBITORS

Background:

TNF inhibitors (TNFi) represent an extraordinary advance in the management of Rheumatoid Arthritis (RA). Despite their benefits, there is a percentage of patients (20–40%) that do not achieve clinical improvement. Therefore, it is necessary to search for new and easily accessible biomarkers predictive of therapeutic response that might guide precision medicine.

Objectives:

1. To explore changes in the molecular profile of RA patients following TNFi therapy in serum samples. 2. To search for new and reliable biomarkers predictive of TNFi response, based on clinical and molecular profiles of RA patients, by using machine learning algorithms.

Methods:

In a prospective multicenter study, 79 RA patients undergoing TNFi and 29 healthy donors (HD) were enrolled. Twenty-two RA patients were further included as a validation cohort. Serum samples were obtained before and after 6 months of treatment, and therapeutic efficacy was evaluated. Patients’ response was determined following EULAR response criteria. Serum inflammatory profile was analyzed by a multiplex immunoassay, along with oxidative and NETotic profiles, evaluated by commercial kits. A circulating miRNA array was also performed by next-generation sequencing. Clustering analysis was carried out to identify groups of patients with distinctive molecular signatures. Then, clinical and molecular changes induced by TNFi were delineated after 6 months of therapy. Finally, integrative clinical and molecular signatures as predictors of response were assessed at baseline by supervised machine learning methods, using regularized logistic regressions.

Results:

Inflammatory, oxidative stress and NETosis-derived biomolecules were found altered in RA patients versus HD, closely interconnected and associated with several deregulated miRNAs. This altered molecular profile at baseline allowed the unsupervised division of three clusters of RA patients with distinctive clinical phenotypes, further linked to TNFi effectiveness. Cluster 1 included RA patients with low levels of pro-inflammatory cytokines, associated with a medium-low disease activity score and good clinical response. Clusters 2-3 comprised patients with high levels of pro-inflammatory cytokines, associated with a high disease activity and a non-response rate of 30%.

After 6 months of therapy the molecular profile found altered in RA patients was reversed in responder patients, who achieved a molecular phenotype similar to HDs. However, non-responder patients’ molecular profile remained significantly deregulated, including alterations in inflammatory mediators (IL-6, L-8, TNFα, VEGF, IL-1RA, IL-5, IL-15, GMCSF, GCSF, FGFb), oxidative stress markers (LPO) and NETosis-derived products (Elastase), along with specific miRNAs (miR-199a-5p). These molecular changes further correlated with changes in disease activity score. Machine-learning algorithms identified clinical (Creatinine, IgM, Vitamin D, Swollen Joints, C4, Disease Duration and Tryglicerides) and molecular (Nucleosomes, IL-10, miR-106a-5p, IL-13, IL-12p70, IL-15 and LPO) signatures as potential predictors of response to TNFi treatment with high accuracy. Furthermore, the integration of both features in a combined model increased the predictive value of these signatures (AUC: 0.91). These results were further confirmed in an independent validation cohort.

Conclusion:

1. RA patients display distinctive altered molecular profiles directly linked to their clinical status and associated with TNFi effectiveness. 2. Clinical response was associated with a specific modulation of the inflammatory profile, the reestablishment of the altered oxidative status, the reduction of NETosis and the reversion of related altered miRNAs. 3. The integrative analysis of the clinical and molecular profiles using machine learning allows the identification of novel signatures as potential predictors of therapeutic response to TNFi therapy.

Disclosure of Interests:

None declared

OP0038 SPLICEOSOME ALTERATIONS IN LEUCOCYTES FROM APS, SLE AND SLE+APS PATIENTS ARE CLOSELY RELATED TO THEIR MAIN CLINICAL FEATURES

Background:

To date, although multiple molecular approaches have illustrated the various aspects of Primary Antiphospholipid Syndrome (APS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome plus lupus (APS plus SLE), no study has so far fully characterized the potential role of posttranscriptional regulatory mechanisms such as the alternative splicing.

Objectives:

To identify shared and differential changes in the splicing machinery of immune cells from APS, SLE and APS plus SLE patients, and their involvement in the activity and clinical profile of these autoimmune disorders.

Methods:

Monocytes, lymphocytes and neutrophils from 80 patients (22 APS, 35 SLE and 23 APS plus SLE) and 50 healthy donors (HD) were purified by immunomagnetic selection. Then, selected elements of the splicing machinery were evaluated using a microfluidic qPCR array (Fluidigm). In parallel, extensive clinical/serological evaluation was performed, comprising disease activity, thrombosis and renal involvement, along with autoantibodies, acute phase reactants, complement and inflammatory molecules. Molecular clustering analyses and correlation/association studies were developed.

Results:

Patients with primary APS, SLE and APS plus SLE displayed significant and specific alterations in the splicing machinery components in comparison with HD, that were further specific for each leukocyte subset. Besides, these alterations were associated with distinctive clinical features.

Hence, in APS, clustering analysis allowed to identify two sets of patients representing different molecular profile groups with respect to the expression levels of splicing machinery components. Principal component analyses confirmed a clear separation between patients. Clinically, cluster 1 characterized patients with higher thrombotic episodes and recurrences than cluster 2 and displayed a higher adjusted global APS score (aGAPSS). Accordingly, these patients showed higher levels of inflammatory mediators than cluster 2.

Similarly, in patients with APS plus SLE, clustering analysis allowed to identify two sets of patients showing differential expression of splicing machinery components. Clinical and laboratory profiles showed that cluster 2 characterized patients that had suffered more thrombotic recurrences, most of them displaying an aGAPSS over 12 points and expressing higher levels of inflammatory mediators than cluster 1. The incidence of lupus nephropathy was similarly represented in both clusters.

Lastly, in SLE patients, molecular clustering analysis identified two sets of patients showing distinctive clinical features. One cluster characterized most of the patients positive for anti-dsDNA antibodies, further suffering lupus nephropathy, and a high proportion of them also presenting atheroma plaques and high levels of inflammatory mediators.

Correlation studies further demonstrated that several deranged splicing machinery components in immune cells (i.e. SF3B1tv1, PTBP1, PRP8 and RBM17) were linked to the autoimmune profile of the three autoimmune diseases, albeit in a specific way on each disorder. Accordingly, in vitro treatment of HD lymphocytes with aPL-IgG or anti-dsDNA-IgG changed the expression of spliceosome components also found altered in vivo in the three autoimmune diseases. Finally, the induced over/downregulated expression of selected spliceosome components in leukocytes modulated the expression of inflammatory cytokines, changed the procoagulant/adhesion activities of monocytes and regulated NETosis in neutrophils.

Conclusion:

1) The splicing machinery, profoundly altered in leukocytes from APS, APS plus SLE and SLE patients, is closely related to the activity of these diseases, their autoimmune and inflammatory profiles. 2) The analysis of the splicing machinery allows the segregation of APS, APS plus SLE and SLE, with specific components explaining the CV risk and renal involvement in these highly related autoimmune disorders.

Acknowledgements:

Funded by ISCIII, PI18/00837 and RIER RD16/0012/0015 co-funded with FEDER

Disclosure of Interests:

None declared

POS0419 ABERRANT SPLICEOSOME AND ALTERED EXPRESSION OF IFN-RESPONSE RELATED GENES ARE HALLMARKS OF MONOCYTES FROM LUPUS PATIENTS WITH RENAL DISEASE

Background:

To date, novel mechanisms such as the involvement of splicing machinery components in lupus nephropathy and its interplay with the transcriptome in innate immune cells have not been evaluated.

Objectives:

1- To identify altered transcriptomic signatures associated with the immune response of monocytes from SLE patients and its association with clinical features. 2- To evaluate the role of the spliceosome linked to the transcriptomic profile of SLE monocytes. 3- To analyze mechanistically the impact of anti-dsDNA antibodies (Ab) and the modulation of the spliceosome in the SLE monocytes activity.

Methods:

Sixty SLE patients and forty healthy donors (HD) were included in the study. Infiltration rate of myeloid cells and its association with clinical features were analyzed in kidney biopsies by Immunohistochemistry. In parallel, circulating monocytes were purified from peripheral blood by immune-magnetic selection. The expression of a set of 770 genes related to autoimmune/inflammatory diseases was evaluated using NanoString Technologies. The levels of the main 45 components of the splicing machinery were further analyzed in these samples using a microfluidic qPCR array (Fluidigm). An extensive clinical/serological evaluation was also performed, comprising disease activity, renal involvement parameters, autoAb profile, and the systemic inflammatory status (27-plex Assay). Finally, in vitro studies involving anti-dsDNA-IgG Ab treatment and over/down-expression of splicing machinery components were carried out to analyze their effects in the monocyte activity.

Results:

Infiltration of CD68 expressing cells was confirmed in kidney biopsies and associated with parameters of kidney failure (C3/C4, chronic index), highlighting the key role of the myeloid compartment in lupus nephropathy. Gene expression profiling recognized 156 genes differentially expressed in SLE monocytes compared with HDs, including 87 genes up-regulated and 69 down-regulated. Functional analysis showed that most dysregulated genes were associated with the IFN response (i.e. IFIT1, IFI44, IFI44L, RSAD2). In parallel, the altered expression of 27 spliceosome components was demonstrated in SLE monocytes compared with HD, including 3 up-regulated and 24 down-regulated. Correlation studies demonstrated that the aberrant expression of splicing machinery components was linked to the altered interferon signature and the plasma inflammatory profile. This aberrant profile at molecular level was associated with the disease activity status, anti-dsDNA positivity and C3/C4 levels. Interestingly, SLE patients with renal disease displayed a simultaneous alteration of both, the IFN and the spliceosome signatures in monocytes, along with an enlarged pro-inflammatory profile in plasma. Logistic regression models that integrated the concomitant alteration of some splicing machinery components and IFNs genes identified lupus nephritis patients with high accuracy. Mechanistic studies showed that in vitro treatment of monocytes from HDs with anti-dsDNA promoted a concomitant deregulation of the IFN signature and the expression of several spliceosome components (i.e. PTB, RBM17, RNU6ATAC). Finally, the over/down-expression of selected spliceosome components (PTB and RBM17) in monocytes from SLE patients reduced the active release of inflammatory cytokines and their adhesion capacity.

Conclusion:

1) Monocytes from SLE patients with renal involvement exhibit a remarkable alteration of genes associated with the IFN response, further linked with the aberrant expression of several splicing machinery components. 2) Anti-dsDNA promoted the dysregulation in monocytes of both the IFN and spliceosome signatures, along with an active release of pro-inflammatory mediators. 3) The modulation of key splicing components in monocytes from SLE patients reduce their pro-inflammatory status and migration capacity. Ongoing studies may provide novel biomarkers and therapeutic tools to treat lupus nephropathy.

Acknowledgements:

Funded by ISCIII, PI18/00837 and RIER RD16/0012/0015 co-funded with FEDER

Disclosure of Interests:

None declared

THU0381 MANAGEMENT OF CARDIOVASCULAR COMORBIDITY IN PSORIATIC ARTHRITIS IN THE ROUTINE CLINICAL PRACTICE: A COMPARATIVE STUDY OF METHOTREXATE OR APREMILAST AS MONOTHERAPY AND COMBINED

Background:

The presence of cardiovascular disease in psoriatic arthritis (PsA) is of particular concern, as it is considered the leading cause of mortality in PsA. Thus, it is essential to recognize those appropriate therapies that could target this comorbidity, reducing the risk of cardiovascular disease and metabolic alterations.

Objectives:

To evaluate the efficacy of methotrexate (MTX) and apremilast as monotherapies or in combination, in the clinical manifestations of the disease and the reduction of cardiovascular risk factors in PsA.

Methods:

Prospective longitudinal study in 30 PsA patients diagnosed according to CASPAR criteria: 10 patients were treated with MTX (12 ± 2,58 mg/week), 10 patients with apremilast (60 mg/day) and 10 were treated with combined therapy for 6 months, recruited in the routine clinical practice at the Reina Sofia Hospital of Cordoba and University Hospital of Jaen, Spain. Clinical and analytical parameters were collected at baseline and after 6 months of treatment: lipid profile (cholesterol, HDL, LDL, TG, ApoA and ApoB), glucose and insulin, body surface area (BSA) affected by psoriasis, number of tender and swollen joints, DAS28, DAPSA, VAS, CRP and ESR.

The presence of cardiometabolic risk factors such as metabolic syndrome (MetSyn) was evaluated according to National Cholesterol Education Program (NCEP) adult treatment panel III (ATP III) criteria, meeting 3 of the following characteristics: abdominal obesity (men (>102 cm); women (>88 cm), TG > 150 mg/dL, HDL (men (<40 mg/dL); women (<50 mg/dL), blood pressure > 130/85 mmHg, glucose levels > 110 mg/dL). Insulin resistance (HOMA-IR > 2,5), body mass index (BMI), ApoB/ApoA ratio, atherogenic index (AI) and SCORE (age, gender, cholesterol, HDL, smoking habit and diabetes) were also studied.

Results:

Apremilast or MTX monotherapies caused a moderate reduction of the clinical inflammatory markers (CRP and ESR) and disease activity (VAS, DAPSA and DAS28) after 6 months of treatment. On the other hand, while apremilast significantly reduced the affected BSA, MTX had no significant effect. All those parameters were more significantly reduced after the combined treatment (MTX+ apremilast).

Apremilast monotherapy significantly improved alterations in the lipid profile (reducing cholesterol and LDL levels, ApoB/ApoA ratio and AI), insulin resistance and decreased BMI, thus reducing the number of patients with MetSyn. MTX monotherapy treatment had no positive effect on these parameters. None of the treatments had significant effects on SCORE values.

The beneficial effects of apremilast on the lipid profile were mitigated after the combination with MTX. Nevertheless, the number of patients with MetSyn decreased even more after the combined therapy of MTX with apremilast compared to apremilast monotherapy.

Conclusion:

1) In patients with moderate disease activity, treatment with apremilast monotherapy might have some advantages compared to the MTX monotherapy, since it can decrease the percentage of BSA with psoriasis, the lipid profile alteration, IR and weight, thus improving the cardiovascular risk profile. 2) Combined therapy (MTX+ apremilast) can induce a deeper reduction in the disease activity compared to the monotherapies, maintaining, in turn, the positive effects of apremilast on the cardiovascular risk.

Funded by ISCIII (PI17/01316 and RIER RD16/0012/0015) co-funded with FEDER.

Disclosure of Interests:

Nuria Barbarroja Puerto Grant/research support from: ROCHE and Pfizer., Speakers bureau: ROCHE and Celgene., Iván Arias de la Rosa: None declared, Carmen Torres-Granados: None declared, Maria del Carmen Abalos-Aguilera: None declared, Gómez García Ignacio: None declared, Isabel Añón Oñate: None declared, María José Pérez Galán: None declared, Desiree Ruiz: None declared, Alejandra M. Patiño-Trives: None declared, María Luque-Tévar: None declared, Eduardo Collantes Estevez Grant/research support from: ROCHE and Pfizer, Speakers bureau: ROCHE, Lilly, Bristol and Celgene, Chary Lopez-Pedrera Grant/research support from: ROCHE and Pfizer., Alejandro Escudero Contreras Grant/research support from: ROCHE and Pfizer, Speakers bureau: ROCHE, Lilly, Bristol and Celgene., María Dolores López Montilla Speakers bureau: Celgene

THU0003 ALTERED DNA METHYLATION AND DIFFERENTIAL EXPRESSION OF GENES INFLUENCING CARDIOVASCULAR RISK AND IMMUNITY IN CD4+ T CELLS FROM SUBJECTS WITH PSORIATIC ARTHRITIS

Background:

Cardiovascular risk factors are increased in Psoriatic Arthritis (PsA). In fact, around 60% out of PsA patients display insulin resistance (IR), a hallmark of metabolic syndrome, which might significantly contribute to the cardiovascular disease. Latest studies suggested that inflammatory and metabolic disorders may be under epigenetic control, including DNA methylation. DNA methylation is an unexplored area in the field of PsA.

Objectives:

To study the alterations in the genome-wide DNA methylation profile of CD4+T cells from PsA patients and its relationship with its pathology and the risk of cardiovascular comorbidity.

Methods:

Twenty healthy controls (HC) and 20 PsA patients were included in the study. PsA patients were classified into insulin resistant and non-insulin resistant according to HOMA-IR index. CD4+T lymphocytes were isolated from peripheral blood by positive immunomagnetic selection. The Illumina Infinium MethylationEPIC Beadchip was used to obtain DNA methylation profiles across approximately 850,000 CpGs (TSS1500, TSS200, 5UTR, 3UTR, first exon, gene body). Beta values (β) estimating methylation levels were obtained at each CpG site, and differentially methylated genes (DMG) between PsA and HC were identified. Functional classification of these genes was carried out through gene ontology analysis (PANTHER database). Gene expression analysis of the selected genes was also evaluated by RT-PCR. Vascular parameters including carotid intima-media thickness (cIMT) and endothelial function was analyzed by ecodoppler and periflux respectively.

Results:

The genome-wide methylation analysis identified 112 DMGs including 41 hypomethylated and 71 hypermethylated. These differentially methylated genes were enriched with several signaling pathways and disease categories including immune response, metabolic processes, oxidative stress, vascular and inflammatory pathways. The altered gene expression of selected genes with altered methylation levels in PsA was also validated. Correlation and association analysis of these DMGs with clinical and analytical variables, cardiovascular risk factors and endothelial microvascular function revealed that the degree of methylation of these genes was significantly associated with cIMT (IGF1R, NDRG3, SMYD3, HLA-DRB1, WDR70), arterial pressure (METT5D1, NRDG3, ADAM17, SMYD3, WNK1, CBX1), insulin resistance (AKAP13, SEMA6D, PLCB1), altered lipid profile and atherogenic index (MYBL1, METT5D1, MAN2A1, SLC1A7, SEMA6D, PLCB1, TLK1, SDK1, CBX1), inflammation (MYBL1, NDUFA5, METT5D1, SEMA6D, PLCB1, TLK1), and endothelial dysfunction (ADAMST10, GPCPD1, CCDC88A). In addition, this analysis also identified 435 DMGs including 280 hypomethylated and 155 hypermethylated in CD4+T cells from IR-PsA vs non IR-PsA patients. Between these two groups of PsA patients, CHUK, SERINC1, RUNX1, TTYH2, TXNDC11, FAF1, BICD1, SCD5, PDE5A, FAS, NFIA and GRP75 displayed the most significantly altered methylation, suggesting the role of these genes in the metabolic complications associated with PsA.

Conclusion:

These findings help our understanding of the pathogenesis of PsA and advance epigenetic studies in regards to this disease and the cardiometabolic comorbidities associated. Funded by ISCIII (PI17/01316 and RIER RD16/0012/0015) co-funded with FEDER.

Disclosure of Interests:

Iván Arias de la Rosa: None declared, María Dolores López Montilla Speakers bureau: Celgene, Javier Rodríguez: None declared, Esteban Ballester: None declared, Carmen Torres-Granados: None declared, Carlos Perez-Sanchez: None declared, Maria del Carmen Abalos-Aguilera: None declared, Gómez García Ignacio: None declared, Desiree Ruiz: None declared, Alejandra M. Patiño-Trives: None declared, María Luque-Tévar: None declared, Eduardo Collantes-Estévez Grant/research support from: ROCHE and Pfizer., Speakers bureau: ROCHE, Lilly, Bristol and Celgene., Chary Lopez-Pedrera Grant/research support from: ROCHE and Pfizer., Alejandro Escudero Contreras Grant/research support from: ROCHE and Pfizer, Speakers bureau: ROCHE, Lilly, Bristol and Celgene., Nuria Barbarroja Puerto Grant/research support from: ROCHE and Pfizer., Speakers bureau: ROCHE and Celgene.

SAT0043 SERUM BIOMOLECULES AS POTENTIAL BIOMARKERS OF CLINICAL EFFICACY AND PREDICTORS OF RESPONSE TO BIOLOGIC DISEASE MODIFYING ANTI-RHEUMATIC DRUGS IN RHEUMATOID ARTHRITIS PATIENTS

Objectives:

To evaluate the changes promoted in levels of circulating inflammatory mediators in RA patients in response to TNF-α inhibitors (TNFi) and anti-CD20 therapies, in order to identify biomarkers of clinical efficacy and potential predictors of therapeutic response to these drugs.

Methods:

In a prospective RA cohort multicenter study, we collected serum from RA patients with moderate or high disease activity prior and after 6 months of treatment with TNFi or rituximab (RTX), and analyzed levels of 27 proteins that constitute a multi-biomarker test of the inflammatory profile of these samples, using a multiplex immunoassay. Patients’ response was determined according to the EULAR response criteria (good/moderate/no). We compared basal levels of inflammatory molecules between the differential response patient groups and analyzed their discriminative ability. Logistic prediction models were created to assess the added value of potential inflammatory predictors.

Results:

Among 111 total RA patients, 50 of 85 (59%) patients in the TNFi group and 18 of 26 patients in the RTX group (69%) responded to the biologic treatment. High DAS28 or SDAI scores, or titers of auto-antibodies (RF or ACPA) at baseline were not predictive of response to any treatment. Instead, smoking habit and hyperlipidemia at baseline were predictors of a worse response to any of these bDMARDs.

Of the molecules analyzed by the multiplex assay, 14 inflammatory mediators showed a significant downregulation on patients’ responders to TNFi therapy. Moreover, the decline on 7 biomolecules was related to reduced DAS28. After RTX treatment, 15 inflammatory mediators were reduced in patients with good clinical response; downregulation in 4 of those biomolecules correlated with reduced DAS28.

In the search for predictors of response to each bDMARD, by using the MetaboAnalyst software, we could classify patients with distinctive therapeutic response based on the baseline levels of the inflammatory molecules analyzed. Receiver operating characteristic (ROC) analyses for those multiple biomarkers allowed us to further identify specific signatures of inflammatory biomolecules that may serve as predictors of response to each bDMARD therapy with high sensitivity and specificity. Thus, a signature of five molecules was identified as potential predictor of TNFi response [Vascular endothelial growth factor (VEGF), Eotaxin, RANTES, IL7 and IL-17]. Indeed, a signature including three highly expressed cytokines/chemokines in RA serum were identified as predictors of RTX response [interferon-inducible protein 10 (IP10), Eotaxin and monocyte chemotactic protein 1 (MCP-1)].

Conclusion:

The extensive analysis of serum inflammatory profile allowed to identify specific and distinctive signatures of biomolecules that, in coordination with known clinical and serological profiles, might predict the response of RA patients to TNFi or RTX treatments.

Acknowledgments :

Funded by Junta de Andalucía (PI-0285-2017), ISCIII, (PI18/00837 and RIER RD16/0012/0015) co-funded with FEDER

Disclosure of Interests:

María Luque-Tévar: None declared, Carlos Perez-Sanchez: None declared, Font Ugalde Pilar: None declared, Montserrat Romero-Gómez: None declared, Alejandra M. Patiño-Trives: None declared, Desiree Ruiz: None declared, Iván Arias de la Rosa: None declared, Maria del Carmen Abalos-Aguilera: None declared, Rafaela Ortega Castro: None declared, Alejandro Escudero Contreras: None declared, Carlos Rodríguez-Escalera Speakers bureau: Lilly, GSK, Novartis and Sanofi, José Javier Pérez Venegas: None declared, María Dolores Ruiz Montesinos: None declared, Carmen Dominguez: None declared, Carmen Romero Barco: None declared, Antonio Fernandez-Nebro: None declared, Natalia Mena-Vázquez: None declared, Jose Luis Marenco Speakers bureau: ABbvie, Pfzer, lilly, Julia Uceda: None declared, Mª Dolores Toledo-Coello: None declared, Nuria Barbarroja Puerto Grant/research support from: ROCHE and Pfizer., Speakers bureau: ROCHE and Celgene., Maria A Aguirre: None declared, Chary Lopez-Pedrera Grant/research support from: ROCHE and Pfizer., Eduardo Collantes-Estévez Grant/research support from: ROCHE and Pfizer., Speakers bureau: ROCHE, Lilly, Bristol and Celgene.

Effectiveness of a multimodal training programme to improve general practitioners' burnout, job satisfaction and psychological well-being

BACKGROUND

The changes in the models of care for mental disorders towards a community focus and deinstitutionalisation might have risen General practitioners' (GPs) workload, increasing their mental health concerns and the need for solutions. Pragmatic research into improving GPs' work-related health and psychological well-being is limited by focusing mainly on stressors and through not providing systematic attention to the development of positive mental health via interventions that develop psychological resources and capacities. The aim of this study was twofold: a) to determine the effectiveness of an intensive multimodal training programme for GPs designed to improve their management of mental-health patients; and b) to ascertain if the program could be also useful to improve the GPs management of their own burnout, job satisfaction and psychological well-being.

METHOD

Eighteen GPs constituted a control group that underwent the routine clinical Mental health support programme for primary care. An experimental group (N = 20) additionally received a Multimodal training programme (MTP) with an Integrated Brief Systemic Therapy (IBST) approach. Through questionnaires and a clinical interview, level of burnout, professional satisfaction, psychopathological state and various indicators of the quality of administrative and healthcare management were analysed at baseline and 10 months after the programme.

RESULTS

In relation to government of mental-health patients indicators, on the one hand MTP group showed statistically significant improvements in certain administrative health parameters, but on the other it did not improve opinions and attitudes towards mental illness. Regarding GPs management of their own burnout, job satisfaction and psychological well-being assessments, the MTP presented better scores on global psychopathological state and better evolution of satisfaction at work; psychopharmacology use dropped in both groups; in contrast, the MTP did not improve burnout levels.

CONCLUSIONS

Findings of this preliminary study are promising for the MTP (with an IBST approach) practice in primary care. More research evidence is required from larger samples and randomized controlled trials to support both the hypothetical adoption of MTP (with an IBST approach) as a part of a continuing professional-training programme for GPs' management of mental-health patients and its positive effects on work-related health factors.

Environmental and economic analysis of power generation in a thermophilic biogas plant

This paper investigates the environmental and economic performance of the power production from biogas using Life Cycle Assessment, Life Cycle Costing and Cost Benefit Analysis methodologies. The analysis is based on a commercial thermophilic biogas plant located in Spain where is installed a Combined Heat and Power system that produces electricity that is sold to the grid. Power generation has been assumed as the only function of the biogas system, expanding the system boundaries to include the additional function related to the end-of-life management of the biowastes. Thus environmental burdens from the conventional management of residues were calculated separately and subtracted. The base scenario involves using agri-food waste, sewage sludge and pig/cow manure as substrates. This situation is compared against an alternative scenario where the production of synthetic fertilizer is surrogated by the digestate. The results have shown that the most impacting activities in all impacts categories of power production are primarily attributable to the operation and maintenance of the biogas plant except for water resource depletion and climate change. The avoided emissions associated with the conventional management of pig/cow manure more than offset GHG emissions of the biogas system resulting in a negative impact value of -73.9gCO₂eq/kWh in the base case scenario. The normalized results show that local impact categories such as primarily human toxicity, fresh water ecotoxicity and particulate matter are the most significantly affected by the biogas system while global impact categories as climate change and ozone depletion are less severely affected. The operation and maintenance phase is also shown to be the largest contributor after the life cycle cost analysis, followed by the construction and dismantling of the biogas plant and the profitability of the project is primarily related to the income obtained from the management of the biowastes used as substrates.

[Long-term effect of policosanol on the functional recovery of non-cardioembolic ischemic stroke patients: a one year study]

INTRODUCTION

Stroke is a leading cause of mortality and disability. Policosanol has been effective in brain ischemia models. The aim of this study is to investigate whether policosanol, added to aspirin therapy within 30 days of stroke onset, is better than placebo + aspirine for the long-term recovery of non-cardioembolic ischemic stroke subjects.

PATIENTS AND METHODS

Randomized, double-blind, placebo-controlled study. Eighty patients (mean age: 69 years) within 30 days of onset, with a modified Rankin Scale score (mRS) 2 to 4, were included. They were randomized in two groups (policosanol + aspirine or placebo + aspirine) for 12 months.

RESULTS

Policosanol + aspirine decreased significantly mean mRS from the first interim check-up (1.5 months). The treatment even improved after long-term therapy. More policosanol + aspirin (87.5%) than placebo + aspirine (0%) patients achieved mRSs <= 1. Policosanol + aspirine increased significantly Barthel Index, lowered LDL-cholesterol and increased HDL-cholesterol versus placebo + aspirin.

CONCLUSIONS

Long-term (12 months) administration of policosanol + aspirin given after suffering non-cardioembolic ischemic stroke was shown to be better than placebo + aspirin in improving functional outcomes when used among patients with non-cardioembolic ischemic stroke of moderate severity.

Time resolved spectroscopy of infrared emitting Ag2S nanocrystals for subcutaneous thermometry

We report a systematic investigation on the temperature dependence of fluorescence decay dynamics of infrared emitting colloidal Ag₂S nanocrystals (NCs) with different surface coatings. The drastic lifetime reduction in the biological temperature range (20-50 °C) makes Ag₂S NCs outstanding candidates for high sensitivity subcutaneous lifetime-based thermal sensing in the second biological window (1000-1400 nm). Indeed, the lifetime thermal sensitivity of Ag₂S NCs has been found to be as large as 3-4% °C^-1 at an operating wavelength of 1250 nm. Their application for lifetime-based luminescence nanothermometry has been demonstrated through simple ex vivo experiments specially designed to elucidate the magnitude of subcutaneous thermal gradients. Experimental data were found to be in excellent agreement with numerical simulations.

Cut-off Points for Muscle Mass - Not Grip Strength or Gait Speed - Determine Variations in Sarcopenia Prevalence

OBJECTIVES

The European Working Group on Sarcopenia in Older People (EWGSOP) has proposed different methods and cut-off points for the three parameters that define sarcopenia: muscle mass, muscle strength and physical performance. Although this facilitates clinical practice, it limits comparability between studies and leads to wide differences in published prevalence rates. The aim of this study was to assess how changes in cut-off points for muscle mass, gait speed and grip strength affected sarcopenia prevalence according to EWGSOP criteria.

METHODS

Cross-sectional analysis of elderly individuals recruited from outpatient clinics (n=298) and nursing homes (n=276). We measured muscle mass, grip strength and gait speed and assessed how changes in cut-off points changed sarcopenia prevalence in both populations.

RESULTS

An increase from 5.45 kg/m2 to 6.68 kg/m2 in the muscle mass index for female outpatients and nursing-home residents increased sarcopenia prevalence from 4% to 23% and from 9% to 47%, respectively; for men, for an increase from 7.25 kg/m2 to 8.87 kg/m2, the corresponding increases were from 1% to 22% and from 6% to 41%, respectively. Changes in gait speed and grip strength had a limited impact on sarcopenia prevalence.

CONCLUSION

The cut-off points used for muscle mass affect the reported prevalence rates for sarcopenia and, in turn, affect comparability between studies. The main factors influencing the magnitude of the change are muscle mass index distribution in the population and the absolute value of the cut-off points: the same difference between two references (e.g., 7.5 kg/m2 to 7.75 kg/m2 or 7.75 kg/m2 to 8 kg/m2) may produce different changes in prevalence. Changes in cut-off points for gait speed and grip strength had a limited impact on sarcopenia prevalence and on study comparability.

"Move on Against Frailty": Time to Raise Awareness about Frailty and Prevention of Disability in the Community

Frailty, a state of increased risk of progression towards disability, with particular vulnerability to internal or external stressors, is highly prevalent among older community-dwellers, and, together with disability, represents a burden for both older adults and the society. These reasons, in aging populations, place frailty in the public health agenda (1, 2).

Temperature efficiency for dormancy release in apricot varies when applied at different amounts of chill accumulation

Our aim was to assess the possible differential effect of increasing temperatures due to global warming on dormancy progression in apricot. The effect of a range of chilling temperatures on vegetative and reproductive bud dormancy progression in excised shoots was examined during two seasons. Temperature treatments were applied in different dormant stages to evaluate the possible interaction of date × temperature for dormancy release in apricot. During sampling, chill accumulated in the field ranged from 0 to 49 chill portions (CPs), corresponding to 0-100% of the chilling requirement (CR) of the apricot selection Z505-2. Forcing conditions were applied after a 60-day chill treatment on each sampling date, and rate to budbreak (1/mean time to bud break: MTB(-1) ) was established in vegetative (terminal and lateral) and reproductive buds to determine depth of dormancy. Results showed that the stage of dormancy has a strong influence on the effect of different temperatures on dormancy progression in apricot. For the first time, a non-linear effect of different chilling temperatures during the dormancy cycle in apricot was obtained, especially in the superior range of temperatures traditionally considered to release dormancy. Thus, introduction of this differential effect could help to improve the models to estimate dormancy release in the context of climate change.

Cognitive performance of GBA mutation carriers with early-onset PD: the CORE-PD study

OBJECTIVE

To assess the cognitive phenotype of glucocerebrosidase (GBA) mutation carriers with early-onset Parkinson disease (PD).

METHODS

We administered a neuropsychological battery and the University of Pennsylvania Smell Identification Test (UPSIT) to participants in the CORE-PD study who were tested for mutations in PARKIN, LRRK2, and GBA. Participants included 33 GBA mutation carriers and 60 noncarriers of any genetic mutation. Primary analyses were performed on 26 GBA heterozygous mutation carriers without additional mutations and 39 age- and PD duration-matched noncarriers. Five cognitive domains, psychomotor speed, attention, memory, visuospatial function, and executive function, were created from transformed z scores of individual neuropsychological tests. Clinical diagnoses (normal, mild cognitive impairment [MCI], dementia) were assigned blind to genotype based on neuropsychological performance and functional impairment as assessed by the Clinical Dementia Rating (CDR) score. The association between GBA mutation status and neuropsychological performance, CDR, and clinical diagnoses was assessed.

RESULTS

Demographics, UPSIT, and Unified Parkinson's Disease Rating Scale-III performance did not differ between GBA carriers and noncarriers. GBA mutation carriers performed more poorly than noncarriers on the Mini-Mental State Examination (p = 0.035), and on the memory (p = 0.017) and visuospatial (p = 0.028) domains. The most prominent differences were observed in nonverbal memory performance (p < 0.001). Carriers were more likely to receive scores of 0.5 or higher on the CDR (p < 0.001), and a clinical diagnosis of either MCI or dementia (p = 0.004).

CONCLUSION

GBA mutation status may be an independent risk factor for cognitive impairment in patients with PD.

Toxicity of medicinal plants used in traditional medicine in Northern Peru

ETHNOPHARMACOLOGICAL RELEVANCE

The plant species reported here are traditionally used in Northern Peru for a wide range of illnesses. Most remedies are prepared as ethanol or aqueous extracts and then ingested. The aim of this study was to evaluate the potential toxicity of these extracts.

MATERIALS AND METHODS

The toxicity of ethanolic and water extracts of 341 plant species was determined using a brine-shrimp assay.

RESULTS

Overall 24% of the species in water extract and 76% of the species in alcoholic extract showed elevated toxicity levels to brine-shrimp. Although in most cases multiple extracts of the same species showed very similar toxicity values, in some cases the toxicity of different extracts of the same species varied from non-toxic to highly toxic.

CONCLUSIONS

Traditional preparation methods take different toxicity levels in aqueous and ethanol extracts into account when choosing the appropriate solvent for the preparation of a remedy.

Olfaction in Parkin heterozygotes and compound heterozygotes: the CORE-PD study

BACKGROUND

While Parkinson disease (PD) is consistently associated with impaired olfaction, one study reported better olfaction among Parkin mutation carriers than noncarriers. Whether olfaction differs between Parkin mutation heterozygotes and carriers of 2 Parkin mutations (compound heterozygotes) is unknown.

OBJECTIVE

To assess the relationship between Parkin genotype and olfaction in PD probands and their unaffected relatives.

METHODS

We administered the University of Pennsylvania Smell Identification Test (UPSIT) to 44 probands in the Consortium on Risk for Early-Onset Parkinson Disease study with PD onset ≤50 years (10 Parkin mutation heterozygotes, 9 compound heterozygotes, 25 noncarriers) and 80 of their family members (18 heterozygotes, 2 compound heterozygotes, 60 noncarriers). In the probands, linear regression was used to assess the association between UPSIT score (outcome) and Parkin genotype (predictor), adjusting for covariates. Among family members without PD, we compared UPSIT performance in heterozygotes vs noncarriers using generalized estimating equations, adjusting for family membership, age, gender, and smoking.

RESULTS

Among probands with PD, compound heterozygotes had higher UPSIT scores (31.9) than heterozygotes (20.1) or noncarriers (19.9) (p < 0.001). These differences persisted after adjustment for age, gender, disease duration, and smoking. Among relatives without PD, UPSIT performance was similar in heterozygotes (32.5) vs noncarriers (32.4), and better than in heterozygotes with PD (p = 0.001).

CONCLUSION

Olfaction is significantly reduced among Parkin mutation heterozygotes with PD but not among their heterozygous relatives without PD. Compound heterozygotes with PD have olfaction within the normal range. Further research is required to assess whether these findings reflect different neuropathology in Parkin mutation heterozygotes and compound heterozygotes.

408 HOLSTEIN DONORS RESPONSE USING OR NOT USING ESTRADIOL 17-β IN THE SUPEROVULATORY TREATMENT

Because of new regulations banning the use of estradiol in the European Union and other countries, the present study was designed to determine the efficacy of an alternative to the use of estradiol 17-β in superovulation of Holstein cows and heifers. A total of 61 lactating cows and 49 heifers (15-18 months old) were divided into 2 groups: Group A (32 cows and 22 heifers) and Group B (29 cows and 27 heifers). Animals in Group A received a CIDR device (Pfizer, Madrid, Spain) for 13 days. At the same time of CIDR insertion and 5 days later, all animals received 2 mL (0.15 mg) of d-cloprostenol (PGF; Veteglan®, Calier, Spain). Gonadotropin-releasing hormone (0.5 mg of gonadorelin; Fertagyl®, Schering-Plough, Carbajosa de la Sagrada, Spain) was administered twice, 36 h after the second PGF and 24 h after CIDR removal. Superovulation treatments were initiated 36 h after the first GnRH, with a total dose of 15 mL (750 IU) of FSH (Pluset®, Calier, Spain) for cows and 11.5 mL (575 IU) for heifers, given in 10 twice-daily injections that decreased in dose. Luteolysis was induced with 0.15 mg of PGF given twice, 12 h before and also at the time of CIDR removal. Animals in Group B received a CIDR device for 7 days. Twenty-four hours after CIDR insertion, all animals received 100 mg of progesterone (Smithkline, Tres Cantos, Spain) and 5 mg of estradiol 17-β (Sigma, St. Louis, MO, USA). Beginning on Day 5, animals were superovulated with similar doses of FSH to those used in Group A. Luteolysis was induced with 0.15 mg of PGF given twice, 12 h before CIDR removal and also at the time of removal. Gonadotropin-releasing hormone (0.5 mg) was administered at the time of AI. Animals from both groups were inseminated with frozen-thawed semen at 12 and 24 h after the onset of standing estrus. Embryos were recovered nonsurgically 7 days later. A total of 299 frozen-thawed embryos (Freeze Control® CL5500, Bioniche, Belleville, Ontario, Canada) from both groups were transferred in synchronized Holstein heifers. Pregnancy was confirmed by rectal palpation on Day 40 to 45 of gestation. Data were analyzed by two-way ANOVA and results are shown in the table. No significant differences were found between cows and heifers, nor was there a difference between groups. These results showed that the previous superovulatory treatment using progesterone and estradiol can be successfully replaced with the treatment protocol described herein. Table 1.Mean number of recovered ova/embryos, transferable embryos, and pregnancy rates after embryo transfer (ET) in Holstein cows and heifers superovulated with 2 treatment protocols

Characteristics of falls producing hip fractures in nonagenarians

OBJECTIVES

To evaluate the characteristics associated with falls causing hip fracture in patients 90 years of age or older (nonagenarians). A second objective was to compare these characteristics with those present in younger patients (65-79 year-olds).

DESIGN

Prospective, observational study.

SETTING

Six hospitals in Barcelona (Spain) and its surrounding area.

PARTICIPANTS

105 nonagenarians diagnosed with hip fracture after a fall. Most patients were women (78; 74%), with a mean age of 92.2+/-2 years. All of them were living in the community, except for eight institutionalized patients. 221 patients aged 65 to 79 composed the younger patient's comparison group.

MEASUREMENTS

Characteristics of falls causing hip fracture were analyzed: location, time and the risk factor for the fall, classified as intrinsic, extrinsic or combined.

RESULTS

The mean number of falls in the previous year was 1.5 - 22% of the patients reported having fallen two or more times. Falls usually happened while at home (70%) and during the day (64%). An intrinsic risk factor was considered the most likely cause in 37% of the cases, an extrinsic risk factor in 35%, and a combination in 28%. Multiple stepwise logistic regression analysis showed that nonagenarians were characterized by lower BI scores, more falls happening during night time, a higher use of, benzodiazepines and diuretics, and a lower use of non-benzodiazepinic hypnotics.

CONCLUSIONS

Most falls causing hip fracture in nonagenarians happen during the day and at home. Falls in nonagenarians happening more frequently during nighttime, and these oldest subjects had lower BI scores, and a higher use of benzodiazepines and diuretics and less use of non-benzodiazepines hypnotics compared with the younger patients.

[Circumstances associated to falls resulting in hip fracture in community-dwelling subjects older than 94 years old]

OBJECTIVE

To evaluate the circumstances associated with falls resulting in hip fracture in the 95 years of age or older community-dwelling patients.

MATERIAL AND METHODS

A prospective, observational study, was conducted in 6 hospitals in the Barcelona area on the characteristics associated with falls resulting in hip fracture in 30 patients aged > 94 years old. Location, time and the risk factor for the fall (classified as intrinsic, extrinsic or combined) were evaluated.

RESULTS

Mean number of falls in the previous year was 1.6, 5 (16.7%) of the patients reporting having fallen two or more times. Falls usually occurred while at home, a high percentage (46.7%) of which occurred during the night. When the differences were evaluated by sex, there was a high percentage of uncorrected auditory loss in men and high number of chronic drugs and psychotropic drugs in women.

CONCLUSIONS

Most falls causing hip fracture in community-dwelling very elderly subjects occur at home. Nearly half of the falls occur during the night.

A cooperative approach for the diagnosis of the melanoma

In this work we present a decision support system for the melanoma diagnosis using individual methods and the collaboration between these methods. The system designed uses a photograph of the lesion and it makes a preprocessing task to extract the region of interest. Then, several characteristics of the image are analyzed, studying with different methods the degree of malignity; the methods used are based in Bayesian rules and in neural networks. Finally, each individual decision from each method contributes in some way to the final decision. The classification rate obtained with the cooperative approach is above 92%.

Kinetics of antibodies in sera, saliva, and urine samples from adult patients with primary or secondary dengue 3 virus infections

OBJECTIVES

The kinetics of three serological markers (IgM, IgA, and IgG) in serum, saliva, and urine samples from adult patients with primary or secondary dengue infection were studied.

DESIGN

Serum, saliva, and urine samples were collected from 22 patients with clinical and confirmed dengue 3 virus infection during the outbreak in Havana City in 2001. They were tested by capture IgM (MAC-ELISA), IgA (AAC-ELISA), and IgE (EAC-ELISA) and IgG ELISA inhibition method (EIM) to detect specific dengue antibodies.

RESULTS

Similar kinetics were observed in IgM, IgA, and IgG antibodies in saliva and IgA and IgG in urine samples from secondary cases compared with kinetics in serum samples, although the values were lower. No IgG antibody was detected in saliva and urine samples in primary cases and IgM antibody was not detected in urine samples from either primary or secondary infection. All secondary cases were positive for IgG in saliva and urine samples at day 7. The kinetics of specific IgE antibodies in primary and secondary cases were different.

CONCLUSIONS

The kinetics of three serological markers (IgM, IgA, and IgG) in serum, saliva, and urine samples from adult patients with primary or secondary dengue 3 virus infection were studied for the first time, showing its behavior and usefulness in dengue virus diagnosis. The specific IgE could play a role as a serological marker in secondary infections.

Circunstancias asociadas a las caídas responsables de fractura de fémur en pacientes ancianos. Diferencias por grupo de edad y género

BACKGROUND

The majority of hip fractures are produced because of a fall. We examined the characteristics associated with falls causing hip fracture in elderly patients.

MATERIAL AND METHODS

Characteristics of falls owing to hip fracture were analyzed in 410 consecutive patients admitted in 6 hospitals during the 2004. We evaluated the location, time and the possible cause of fall: intrinsic risk factor, extrinsic or combined.

RESULTS

We evaluated 316 women (77%) and 94 men, mean age 81.9 years. Previous to the hip fracture, the mean BI was 77.5. The mean value of falls during the last year was 1.9. Previously to the fall that caused hip fracture, we found that 24% of the patients had fallen repeatedly (more than two falls). Usually falls were at home (68%) and during daytime (80%). In 45% of patients an intrinsic risk factor was considered the most likely cause, in 33% an extrinsic risk factor and in 22% a combination.

CONCLUSIONS

The majority of falls owing to hip fracture in elderly people happen in daytime, at home and due to intrinsic risk factors. Efforts to identify elderly people at risk of fall should be stressed in order to establish preventive measures.