Progranulin and chemerin plasma level in obese patients with type 2 diabetes treated with a long-acting insulin analogue and premixed insulin analogue

Diabetes, referred to as the first non-infectious epidemic, covers a heterogenous group of metabolic diseases marked by hyperglycemia resulting from a defect of insulin secretion and/or insulin resistance. Highly endocrine active adipocytes, particularly those located in white adipose tissue, constitute a source of cytokines, growth factors and complement component as well as adipocytokines including chemerin and progranulin could be the key molecules in the pathomechanism of hypertension, dyslipidemia, metabolic disorders or diabetes type 2. In this study, it was decided to verify the existence of possible relationships between the plasma concentration of progranulin and chemerin and the values of intermediate indices of insulin sensitivity and insulin resistance in patients, both before and after the 6-month insulin therapy by long-acting insulin analogue and premixed insulin analogue. The level of laboratory parameters in blood plasma collected from the control group and from obese individuals with type 2 diabetes mellitus was estimated with the test kits using enzyme-linked immunosorbent assay (ELISA): the test of Mediagnost E103 GmbH GmbH, Reutlingen, Germany for progranulin; the test of BioVendor R&D, Brno, Czech Republic for chemerin. The aim of this study was to assess the progranulin and chemerin plasma level in obese individuals with type 2 diabetes, before and after 6 months of pharmacological treatment with a long-acting analogue human insulin or premixed insulin. In the blood plasma of untreated diabetics - in contrary to progranulin plasma concentration in diabetic patients after management implementation - progranulin was found to occur in a significantly higher concentration in relation to the level of this protein in the blood plasma of control group individuals. Despite the fact that 6-month therapy, both with the insulin mixture and with the long-acting analogue in people with diabetes, does not significantly affect the plasma chemerin concentration, the high, negative correlation between the progranulin and chemerin levels in the blood of individuals of the control group, and a positive one between the levels of progranulin and chemerin in people with diabetes before and after treatment was found. The conducted studies indicated the modified, in the course of diabetes type 2, mutual quantitative relations between progranulin and chemerin - the biological mediators of systemic metabolism, reflecting their active participation in the pathogenetic changes underlying type 2 diabetes. The obtained study results indicate a modification of mutual relationships of the adipocytokines assessed in the paper - progranulin and chemerin, associated with the development of the systemic inflammatory response occurring in the course of obesity which, by inducing insulin resistance, may consequently lead to type 2 diabetes. Taking into consideration the fact that the plasma progranulin and chemerin concentrations in obese patients with type 2 diabetes subjected to pharmacotherapy have not been assessed so far, it is possible that the obtained study results may cast light on the potential influence of the applied treatment on the systemic changes of the both adipocytokines involved in the pathomechanism of the mentioned disorder and thus create the possibility of implementing new therapeutic strategies in the management of patients with diabetes, which is an increasingly common, fast-spreading metabolic disease considered as a non-infectious epidemic of the 21^st century.

The antimalaria drug artemisinin displays strong cytotoxic effect on leukaemia lymphocytes in combination with vitamin C and pro-vitamin K3

This study investigated the anticancer effect of the anti-parasitic drug artemisinin in combination with two redox modulators: vitamin C and pro-vitamin K3 (C/K3) The experiments were conducted on leukaemia cells Jurkat. Cells were treated with either artemisinin or C/K3 alone and with all three compounds. Cell proliferation and viability were analysed using trypan blue stating and automated cell counting. The results showed that artemisinin (>10 mM) suppressed cell proliferation activity, but did not induce cell death up to 500 mM. The drug demonstrated a clear cytostatic effect at concentrations 250- 500 mM – Jurkat cells did not proliferate, but were alive. The combination C/K3 (200:2, 300:3 mM/mM) applied alone did not affect cell proliferation and viability. Vitamins C/K3 in concentration ratio 500:5 (μM/mM) decreased cell proliferation activity by ~10%. The triple combination artemisinin/C/K3 manifested synergistic anti-proliferative effects at all concentration ratios analysed. This synergistic effect increased with increasing C/K3 concentration. Based on literature data, it was assumed that the anti-proliferative effect of the triple combination was mediated by changes in the redox-homeostasis of cancer cells. The C/K3 redox system likely acted on cancer mitochondria and increased superoxide production and activation of pro-apoptotic signals, specific for cancer cells. On the other hand, artemisinin could generate hydroxyl radicals as a result of activation of Fenton reactions, depleting intracellular reducing equivalents. Both redox mechanisms lead to activation of signal pathways for induction of cancer cell death.

THU0186 CLINICAL EVALUATION OF THE IMMUNOGENICITY TO CT-P13 FOR SUBCUTANEOUS USE IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS: 1-YEAR CLINICAL RESULTS FROM A MULTICENTER, RANDOMIZED CONTROLLED PIVOTAL TRIAL

Background:

Novel subcutaneous infliximab (CT-P13 SC) was developed to augment the flexibility in therapeutic use of infliximab and noninferiority (NI) of CT-P13 SC versus CT-P13 intravenous (IV) was demonstrated for efficacy in patients with rheumatoid arthritis (RA) [1]. CT-P13 SC 120mg biweekly showed consistent higher therapeutic trough levels during the treatment period, which helps in maintaining efficacy over time. Since immunogenicity has clinical importance in patients using anti-TNF alpha agents and there is a general presumption that SC route is more immunogenic than IV route, this needs careful assessment.

Objectives:

Immunogenicity assessment of CT-P13 SC with further impact analysis has been performed on the pivotal data set [1] to determine whether there was any correlation between the magnitude of anti-drug antibody (ADA) positivity and clinical outcomes in RA patients.

Methods:

The immune response against CT-P13 in human serum was detected using an electrochemiluminescence (ECL) platform with an Affinity Capture Elution (ACE) step. An ADA ECL ACE assay showed ability to detect ADA at low levels in all samples regardless of residual drug in serum (25 ng/mL ADA in the presence of 80 μg/mL of CT-P13 in RA serum). To investigate the impact of ADA titer on PK, efficacy and safety, key clinical parameters were assessed by visit based ADA titer quartile. All patients who had ‘Positive’ ADA status result at each visit were included in the analysis and categorized into 4 groups using the 25th, 50th, 75th percentiles of ADA titer result, respectively.

Results:

The four subgroups categorized by quartiles at each visit from week 22 to week 54 were: 1st (ADA titer ≤ 3), 2nd (3 < ADA titer ≤ 9), 3rd (9 < ADA titer ≤ 27) and 4th (27 < ADA titer). There was a trend for pre-dose concentration to decrease as ADA titer increases for both CT-P13 SC and CT-P13 IV arms as expected (Figure 1). Patients in the 1st and 2nd subgroup maintained the sufficient therapeutic drug concentration level. Figure 2 shows the correlation between ADA titer and efficacy outcomes where the change from baseline of DAS28 (CRP) and the proportion of patients achieving ACR20 were lower in the 3rd and 4th subgroups. The ADA impact was especially apparent in the 4th subgroup where the mean pre-dose concentration of the patients was below the therapeutic drug concentration level (1 μg/mL), which led to worse efficacy outcomes in both arms, IV as well as SC. Nevertheless, no impact of ADA on safety profile in both arms was observed. A neutralizing antibody (NAb) method with enhanced drug tolerance but limited performance was also developed and clinical consequences of NAb titer in terms of PK, efficacy and safety were not different from the results with ADA.

Conclusion:

The analysis of both ADA positivity and titer is clinically meaningful in the prediction of PK profile and clinical response. CT-P13 SC administration did not result in a greater incidence of ADA compared to the CT-P13 IV and there were no clinical differences depending on the formulation.

References:

[1]Westhovens R, et al. Annals of the Rheumatic Diseases 2019;78:1158-1159.

Disclosure of Interests:

Rene Westhovens Grant/research support from: Celltrion Inc, Galapagos, Gilead, Consultant of: Celltrion Inc, Galapagos, Gilead, Speakers bureau: Celltrion Inc, Galapagos, Gilead, DaeHyun Yoo Grant/research support from: Celltrion, Inc, Consultant of: Celltrion, Inc, Speakers bureau: Celltrion Healthcare, Inc, Piotr Wiland Grant/research support from: Celltrion, Inc, Speakers bureau: Novartis, Pfizer, Abbvie, Gedeon-Richter, Lilly, Roche, Sandoz, Marek Zawadzki Grant/research support from: Celltrion, Inc, Delina Ivanova Grant/research support from: Celltrion, Inc, Alfredo Berrocal Grant/research support from: Celltrion, Inc, Speakers bureau: Pfizer, Elias Chalouhi Grant/research support from: Celltrion, Inc, Éva Balázs Grant/research support from: Celltrion, Inc, Consultant of: Amgen, Sergii Shevchuk Grant/research support from: Celltrion, Inc, Sang Joon Lee Shareholder of: Celltrion, Inc, Employee of: Celltrion, Inc, Sung Hyun Kim Shareholder of: Celltrion, Inc, Employee of: Celltrion, Inc, JeeHye Suh Employee of: Celltrion, Inc, Chankyoung Hwang Employee of: Celltrion, Inc, Dae Seok Choi Shareholder of: Celltrion, Inc, Employee of: Celltrion, Inc

Clinical and functional consequences of anti-properdin autoantibodies in patients with lupus nephritis

Properdin is the only positive regulator of the complement system. In this study, we characterize the prevalence, functional consequences and disease associations of autoantibodies against properdin in a cohort of patients with autoimmune disease systemic lupus erythematosus (SLE) suffering from lupus nephritis (LN). We detected autoantibodies against properdin in plasma of 22·5% of the LN patients (16 of 71) by enzyme-linked immunosorbent assay (ELISA). The binding of these autoantibodies to properdin was dose-dependent and was validated by surface plasmon resonance. Higher levels of anti-properdin were related to high levels of anti-dsDNA and anti-nuclear antibodies and low concentrations of C3 and C4 in patients, and also with histological signs of LN activity and chronicity. The high negative predictive value (NPV) of anti-properdin and anti-dsDNA combination suggested that patients who are negative for both anti-properdin and anti-dsDNA will not have severe nephritis. Immunoglobulin G from anti-properdin-positive patients' plasma increased the C3b deposition on late apoptotic cells by flow cytometry. Nevertheless, these IgGs did not modify substantially the binding of properdin to C3b, the C3 convertase C3bBb and the pro-convertase C3bB, evaluated by surface plasmon resonance. In conclusion, anti-properdin autoantibodies exist in LN patients. They have weak but relevant functional consequences, which could have pathological significance.

Does comorbid depression and alcoholic dependence influence cognition in Bulgarian womеn?

Introduction

Previous research on the impact of alcohol intake on human behavior and cognition has revealed the detrimental effects of alcohol dependence. Especially in women, depression is often associated with the initiation of alcohol abuse that provokes new episodes of depression and this cycle tends to chronify.

Objective

Although the co-occurrence of depression and alcoholism is well documented, there is still scarce data on the cognition of depressed alcohol-depended women. The aim of the present study is to examine the cognitive function in women who demonstrate both depression and alcohol dependence.

Method

A group of fifty-three Bulgarian women with a formal diagnosis of alcohol dependence (Mage = 43.89, SDage = 9.48; level of education: all with high school education) and varying levels of depressive symptomatology were examined at the Municipal Council on Drug Addiction Blagoevgrad. Information were collected from personal history taking (anamnesis), self-reports and the Lesch Alcoholism Typology–Questionnaire (LAT online program). The women were grouped according to their age (27–45 and 46–71).

Results

Results indicated that there is a significant influence of depression (P = .032), a slightly above the statistical significance level non-influence of age (P = .056), and an interaction of the influence of depression*age (P = .048) on self-reported cognitive performance.

Conclusions

The present research suggests that future researchers should further clarify in a more systematic way the factors that influence cognition in this special population with comorbid depression and alcoholic dependence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Codependency in mothers of addicted persons: Cross-cultural differences between Greece and Bulgaria

Introduction

The people who maintain close relationships with relatives suffering from addiction to psychoactive substances may become more sensitive to develop a physical, mental and emotional state, similar to an emotional addiction.

Objective

The aim of this study is to give a cross-cultural perspective to codependence and reveal the profile of female relatives of addicted persons in Greece and Bulgaria.

Method

Thirty-nine Greek mothers of addicted persons from Greece (Mage = 43.97, SDage = 18.34, all high school graduates), a similar group of forty Greek female participants (32 mothers of non-addicted persons, Mage = 40.97, SDage = 17.22, all high school graduates), and thirty Bulgarian women (all mothers of addicted persons, Mage = 53.55, SDage = 5.58, all high school graduates) were examined with the STAI-state questionnaire, the ZUNG Self Rating Depression Scale and the Questionnaire of Establishment of Codependency.

Results

Results indicated that there are statistically significant differences between the Greek and the Bulgarian female relatives of addicted persons on the scores ofZUNG (MGreek = 51.64, SDGreek = 2.07, MBulgarian = 73.63, SDBulgarian = 4.04) and STAI (MGreek = 53.89, SDGreek = 2.68, MBulgarian = 74.16, SDBulgarian = 4.84), but not for the Questionnaire of Establishment of Codependency. Statistically significant differences in all three questionnaires were found for the groups of Greek mothers of dependent and non-dependent persons (P < .005).

Conclusions

This research suggests that although there is more anxiety and depression reported by the Bulgarian mothers of addicted persons, no cross-cultural difference was found for codependence in mothers of addicted persons.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Tautomeric transformations of piroxicam in solution: a combined experimental and theoretical study

Piroxicam tautomerism was studied in solution. Enol-amide tautomer is presented mainly as a sandwich type dimer in ethanol and DMSO. The addition of water leads to gradual shift of the equilibrium towards the zwitterionic tautomer.

Association of rs172378 C1q gene cluster polymorphism with lupus nephritis in Bulgarian patients

Introduction

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that can affect substantially any organ in the body. One of its most severe manifestations is lupus nephritis. Hereditary C1q deficiency is strongly related to SLE but there are very few and inconsistent studies exploring the single nucleotide polymorphisms (SNPs) of the C1q gene cluster in relation to the pathogenesis of SLE. In the present study we evaluated the possible association of gene variants in complement C1q gene cluster with susceptibility to lupus nephritis in a Bulgarian population, focusing on five previously associated with SLE SNPs in other populations.

Materials and methods

Thirty-eight patients with lupus nephritis and 185 healthy controls, all from Bulgaria, were genotyped for the five C1q SNPs, rs587585, rs292001, rs172378, rs294179 and rs631090, by quantitive real-time PCR methods. We also determined C1q serum levels of C1q and haemolytic activity of C1q in relation to C1q genotypes.

Results

Lupus nephritis patients and healthy controls had statistically similar frequencies of genotypes and alleles of rs587585, rs292001, rs294179 and rs631090 SNPs. Nevertheless, minor G allele in rs172378 was significantly overrepresented in lupus nephritis patients when compared with healthy controls (36% vs. 23%, odds ratio = 1.80, 95% confidence interval = 1.06–3.06, p = 0.029). The SNP rs292001 showed a trend towards lower serum C1q levels in healthy controls. Two SNPs – rs294179 and rs292001 – were in a linkage disequilibrium in patients and healthy controls with different power (healthy controls: r2 = 0.6526, D′ = 0.842; lupus nephritis patients: r2 = 0.491, D′ = 0.686). The haplotype C-A-A-T-T in the patient group was associated with lupus nephritis: 7.7% vs. 0.8%, odds ratio = 10.81, 95% confidence interval = 1.45–80.57, p = 0.002.

Conclusions

These results support the implication of the G allele in rs172378 as a risk factor for lupus nephritis in a homozygous status, at least for a Bulgarian population.

[Screning study on pregnant women and neonatal infection with streptococcus agalactiae (group B streptococci)]

We report the results of a screening study on pregnant women and early onset neonatal group B streptococcal infections in Sofia, Bulgaria, July 2009-July 2010. Women were studied for risk factors at delivery, intrapartum antibiotic prophylaxis (lAP) and outcome for the newborns. All GBS positive women who had risk factors at delivery gave birth to newborns with neonatal infection despite the IAP given in 50% of the cases. The majority of the GBS positive women who had no risk factors at delivery gave birth to healthy newborns although only 32% of them received IAP However 11% of the GBS positive women without risk factors delivered children with neonatal infection. We consider that IAP should be given to all GBS positive women to prevent from neonatal infection. The dominant GBS serotypes were ll, 11 and la. The isolates were 100% susceptible to penicillin, cefazolin, cefotaxime, vancomycin and 91.66% susceptible to erythromycin and clindamycin, the resistant strains being from the MLSB phenotype.

Biodegradation of phenol by immobilized Aspergillus awamori NRRL 3112 on modified polyacrylonitrile membrane

Covalent immobilization of Aspergillus awamori NRRL 3112 was conducted onto modified polyacrylonitrile membrane with glutaraldehyde as a coupling agent. The polymer carrier was preliminarily modified in an aqueous solution of NaOH and 1,2-diaminoethane. The content of amino groups was determined to be 0.58 mgeq g(-1). Two ways of immobilization were used-in the presence of 0.2 g l(-1) phenol and without phenol. The capability of two immobilized system to degrade phenol (concentration-0.5 g l(-1)) as a sole carbon and energy source was investigated in batch experiments. Seven cycles of phenol biodegradation were conducted. Better results were obtained with the immobilized system prepared in the presence of phenol, regarding degradation time and phenol biodegradation rate. Scanning electron micrographs of the polyacrylonitrile membrane/immobilized Aspergillus awamori NRRL at the beginning of repeated batch cultivation and after the 7th cycle were compared. After the 7th cycle of cultivation the observations showed large groups of cells. The results from the batch experiments with immobilized system were compared to the results produced by the free strain. Phenol biodegradation experiments were carried out also in a bioreactor with spirally wound membrane with bound Aspergillus awamori NRRL 3112 in a regime of recirculation. 10 cycles of 0.5 g l(-1) phenol biodegradation were run consecutively to determine the degradation time and rate for each cycle. The design of the bioreactor appeared to be quite effective, providing large membrane surface to bind the strain.

Polyphenols and antioxidant capacity of Bulgarian medicinal plants

Extracts of 21 plants used in Bulgarian phytotherapy for the treatment of respiratory, gastrointestinal and other inflammatory disorders were screened in vitro for antioxidant activity and phenolic compounds content. Plant extracts were prepared as herbal teas following the ethnic use. The water-phase TEAC (Trolox equivalent antioxidant capacity) of the teas were compared to that of the famous tea-like beverages mate, rooibos and honeybush, and to that of green and black tea, well known for their high antioxidant potential. The content of total phenolics in the teas was determined spectrometrically according to the Folin-Ciocalteu procedure and calculated as quercetin equivalents (QE). Seven Bulgarian medicinal plants were with high phenolics content and antioxidant properties: Pulmonaria officinalis L. (Boraginaceae) (TEAC 2.02+/-0.14 mM/QE 673.39+/-9.92 microM), Hypericum perforatum L. (Hypericaceae) (TEAC 3.75+/-0.14 mM/QE 881.93+/-6.68 microM), Agrimonia eupatoria L. (Rosaceae) (TEAC 3.76+/-0.5mM/QE 702.29+/-6.82 microM), Origanum vulgare L. (Lamiaceae) (TEAC 5.87+/-0.2mM/QE 1653.61+/-11.52 microM), Melissa officinalis L. (Lamiaceae) (TEAC 4.06+/-0.31 mM/QE 1370.09+/-41.38 microM), Rubus sp. diversa (Rosaceae) (TEAC 4.23+/-0,12 mM/QE 608.95+/-5.95 microM), Cotinus coggygria Scop. (Anacardiaceae) (TEAC 7.05+/-0.19 mM/QE 923.33+/-14.19 microM). Therefore, Bulgarian herbs can be considered to be a rich source of water-soluble antioxidants and/or phenolic compounds as compared to studied foreign plants.

[Changing susceptibility patterns of surgical site infection pathogens after the introduction of modern perioperative chemotherapy in the emergency surgery clinic]

993 surgical site infection aerobic pathogens are isolated over a six-year period (I.1994-I.2000) by the Microbiology Laboratory at University Hospital "Tzaritza Joana". 224 (22.6%) of them are isolated from patients undergoing abdominal surgery in the Emergency Surgery Clinic. The period covers 3 years before the introduction of current single-dose perioperative prophylaxis (i.e. under the conditions of long-term one) as well as the next 3 years following its introduction in the Emergency Surgery Clinic. The changes of pathogens susceptibility patterns to single-dose drug schemes in both hospital elective abdominal surgery and emergency surgery clinics are followed during the whole period. Our microbial susceptibility data support the ecological expedience of single-dose approach categorically.

RAR-RXR selectivity and biological activity of new retinoic acid analogues with heterocyclic or polycyclic aromatic systems

The cell biological activity of novel retinoids and rexinoids is described. The stereochemistry of the new compounds was analyzed and ligand docking experiments revealed the structural basis of their RAR binding characteristics. The new ligands activate nuclear retinoic acid receptors (RAR, RXR) with distinct selectivity patterns, as determined in genetically engineered 'reporter' cells. The biological activity of the novel retinoids was assessed by differentiation of NB4 acute promyelocytic leukemia cells.