Dysbiosis of Skin Microbiota with Increased Fungal Diversity is Associated with Severity of Disease in Atopic Dermatitis

Background

Atopic dermatitis (AD) is a multifactorial inflammatory skin disease and an altered skin microbiota with an increase of Staphylococcus aureus has been reported. However, the role of fungi remains poorly investigated.

Objectives

We aimed to improve the understanding of the fungal skin microbiota, the mycobiota, in AD in relation to the bacterial colonization.

Methods

Skin swabs of 16 AD patients and 16 healthy controls (HC) from four different skin sites, that is antecubital crease, dorsal neck, glabella and vertex from multiple time points were analysed by DNA sequencing of the internal transcribed spacer region 1 (ITS1) and 16S rRNA gene for fungi and bacteria, respectively.

Results

Malassezia spp. were the predominant fungi in all subjects but with a decreased dominance in severe AD patients in favour of non‐Malassezia fungi, for example Candida spp. For bacteria, a decrease of Cutibacterium spp. in AD patients in favour of Staphylococcus spp., particularly S. aureus, was observed. Further, both bacterial and fungal community compositions of severe AD patients significantly differed from mild‐to‐moderate AD patients and HC with the latter two having overall similar microbiota showing some distinctions in bacterial communities.

Conclusions

We conclude that severe AD is associated with a pronounced dysbiosis of the microbiota with increased fungal diversity. Potentially infectious agents, for example Staphylococcus and Candida, were increased in severe AD.

OP0244 28 NEW AUTOANTIBODIES AGAINST GPCR, GROWTH FACTORS AND GROWTH FACTOR RECEPTORS ARE ASSOCIATED WITH DISEASE MANIFESTATIONS IN SYSTEMIC SCLEROSIS

Background:

The morbidity and mortality of systemic sclerosis (SSc) are largely determined by vascular and fibrotic pathologies. Levels of autoantibodies (ab) against G protein-coupled receptors (GPCR), growth factors (GF) and growth factor receptors (GFR) are altered in SSc compared to healthy controls (HC) 1. Thus, higher angiotensin II receptor type 1 - (AT1R) and endothelin receptor type A - (ETAR) ab levels are associated with severe disease and SSc-related mortality 2. CXC motiv chemokine receptor 3 - (CXCR3) and 4 - (CXCR4) ab have predictive value for deterioration of pulmonary fibrosis (PF) 3.

Objectives:

We used statistical methods to identify associations between disease manifestations and 28 new ab directed against GPCR, GF and GFR in SSc.

Methods:

Ab against the following targets were measured in sera from SSc patients (n = 177) and HC (n = 88): Adrenoceptors alpha-1 (ADRA1), alpha-2 (ADRA2), beta-1 (ADRB1), beta-2 (ADRB2); muscarinoceptors 1-5 (M1R - M5R); AT1R, ETAR, endothelin B receptor (ETBR); CXCR3, CXCR4; complement receptors 3a (C3aR) and 5a (C5aR); protease-activated receptors 1 (PAR1) and 2 (PAR2); vascular endothelial growth factor A (VEGFA) and its receptors 1 (VEGFR1) and 2 (VEGFR2), epithelial growth factor (EGF)/ - receptor (EGFR); hepatocyte growth factor (HGF)/ - receptor (HGFR), platelet-derived growth factor-AA (PDGFAA), placental growth factor (PlGF).

The organ involvement (PF, cardiac involvement, PAH, gastrointestinal tract) and quantitative markers (modified Rodnan skin score, SSc activity score, pulmonary function, cardiac enzymes and echocardiography, routine laboratory, autoimmune diagnostics) as well as demographic data were recorded retrospectively at the time of sample collection. Statistical analysis was performed using the Mann-Whitney U test (MWU), Pearson correlations, ROC analysis, and age-adjusted logistic regression models.

Results:

In SSc 20 of 28 measured ab levels are significantly altered compared to HC. According to the Pearson correlation matrix, the ab-levels are highly correlated and build a network that differs between HC and SSc. Furthermore, altered network signatures are formed in the differentiated analysis of several disease manifestations of SSc such as SSc-subtype or PF. Based on ROC analysis, FGF-ab, ADRB1-ab and PlGF-ab are well suited to predict SSc (Figure 1).

In addition, limited cutaneous SSc (lSSc) patients displayed lower levels of most ab than diffuse cutaneous SSc patients, whereas cardiac and pulmonary involvement are associated with higher ab levels. In the logistic regression lSSc is associated with lower levels of ab against M1R, M2R, C5aR, ETAR, AT1R, PAR1, EGFR. Higher levels for ab against M1R, M2R, ETBR, C5aR are associated with PF, higher levels of ab against complement receptors, adrenoreceptors and EGF with NT-proBNP elevation.

Conclusion:

The newly described antibodies against GPCR, GF and GFR are highly correlated. Associations with morbidity- and mortality-determining organ involvement indicate their possible functional relevance and novel pathophysiological mechanisms. As new biomarkers, some of the ab have prognostic value for SSc; for other manifestations, their value should be evaluated in further studies.

References:

[1]Cabral-Marques, O., Marques, A., Giil, L.M. et al. GPCR-specific autoantibody signatures are associated with physiological and pathological immune homeostasis. Nat Commun9, 5224 (2018). https://doi.org/10.1038/s41467-018-07598-9

[2]Riemekasten G, Philippe A, Näther M, et al. Involvement of functional autoantibodies against vascular receptors in systemic sclerosis Annals of the Rheumatic Diseases 2011;70:530-536.

[3]Weigold, F., Günther, J., Pfeiffenberger, M. et al. Antibodies against chemokine receptors CXCR3 and CXCR4 predict progressive deterioration of lung function in patients with systemic sclerosis. Arthritis Res Ther 20, 52 (2018). https://doi.org/10.1186/s13075-018-1545-8

Disclosure of Interests:

Kristina Sterner: None declared, Césaire J. K. Fouodo: None declared, Inke König: None declared, Axel Künstner: None declared, Hauke Busch: None declared, Harald Heidecke Shareholder of: Owner of CellTrend, Anja Schumann: None declared, Antje Müller: None declared, Gabriela Riemekasten: None declared, Susanne Schinke Grant/research support from: UCB sponsors EULAR registration fees

AB0166 IMMUNOGLOBULIN G DERIVED FROM PATIENTS WITH SYSTEMIC SCLEROSIS IMPRINTS A PRO-INFLAMMATORY AND PRO-FIBROTIC PHENOTYPE IN MONOCYTE-LIKE THP-1 CELLS

Background:

Regulatory IgG autoantibodies directed against diverse G protein-coupled receptors (GPCR),i.e.antibodies with agonistic or antagonistic activity are abundant in human serum. The serum titers of autoantibodies targeting angiotensin II receptor 1 (AT1) and endothelin receptor A (ETA) are specifically altered in autoimmune diseases such as systemic sclerosis (SSc). Disease-promoting mechanisms regulated by anti-AT1and anti-ETAIgG are still elusive, but induction of pro-inflammatory and pro-fibrotic chemokines (CXCL8, CCL18) has been suggested to be one of them.

Objectives:

To determine the cytokine and phospho-kinase profiles induced in monocyte-like cells by IgG derived from SSc patients (SSc-IgG) enriched with anti-AT1and anti-ETAantibodies in comparison to IgG derived from healthy donors (IgG-HD).

Methods:

A monocyte-like cell line (THP-1) was culturedin vitroand stimulated with IgG (1 mg/ml) derived from SSc patients or HD in the presence of various inhibitors/blockers for 24h. Then, supernatants were analyzed by a human cytokine/chemokine array. Data were analyzed using bio-mathematical tools such as generalized t-test including the robust regression method from R/Bioconductor package LIMMA. In addition, THP-1 cells were culturedin vitroand stimulated with IgG (1 mg/ml) derived from SSc patients or HD for up to 30 minutes. Thereafter, cell lysates were assayed for the kinome employing a human phospho-kinase array. To validate potential effects of transcription factor inhibition, release of CXCL8 and CCL18 into the supernatant was measured by Elisa.

Results:

In general, SSc-IgG induced the release of most cytokines by THP-1 cells more pronouncedly than HD-IgG. The bio-mathematical analysis suggested that stimuli, responsible for the shift of the THP-1 cell cytokine profile, are more abundant in SSc-IgG than in HD-IgG. Based upon these findings a gene set enrichment analysis for transcription factors yielded the transcription factors NF-κB, AP-1, and PRDM1 (Blimp-1) as putative major regulatory hubs for the response of THP-1 cells to SSc-IgG. Further, SSc-IgG altered the phosphorylation status of several proteins, indicative of an involvement of MAPK and/or JAK/STAT pathways. Interestingly, a role for AP-1 was also proposed by the inhibition of CXCL8 and CCL18 release following pretreatment of THP-1 cells with an AP-1 blocker.

Conclusion:

Herein, we demonstrate that IgG of SSc patients, enriched with anti-AT1and anti-ETAautoantibodies drives THP-1 cells towards a general pro-inflammatory and pro-fibrotic phenotype, which is reflected by broad changes in the secretome and kinome of these cells. Furthermore, our results highlight AP-1 as critical regulator of gene transcription of CXCL8 and CCL18 in a monocyte-like cell line.

References:

[1]Cabral-Marques O, Marques A, Giil LM, De Vito R, Rademacher J, Günther J, Lange T, Humrich JY, Klapa S, Schinke S, et al. GPCR-specific autoantibody signatures are associated with physiological and pathological immune homeostasis.Nat Commun(2018)9:5224. doi:10.1038/s41467-018-07598-9

[2]Günther J, Kill A, Becker MO, Heidecke H, Rademacher J, Siegert E, Radi M, Burmester G-R, Dragun D, Riemekasten G. Angiotensin receptor type 1 and endothelin receptor type A on immune cells mediate migration and the expression of IL-8 and CCL18 when stimulated by autoantibodies from systemic sclerosis patients.Arthritis Res Ther(2014)16:R65. doi:10.1186/ar4503

Disclosure of Interests:

Anja Dalmann: None declared, Sripriya Murthy: None declared, Melanie Wannick: None declared, Georgios Eleftheriadis: None declared, Antje Müller: None declared, Detlef Zillikens: None declared, Hauke Busch: None declared, Christian Sadik: None declared, Gabriela Riemekasten Consultant of: Cell Trend GmbH, Janssen, Actelion, Boehringer Ingelheim, Speakers bureau: Actelion, Novartis, Janssen, Roche, GlaxoSmithKline, Boehringer Ingelheim, Pfizer

FRI0269 CHARACTERIZATION OF PATIENTS WITH ANKYLOSING SPONDYLITIS WHO INITIATED SECUKINUMAB: ELECTRONIC HEALTH RECORDS DATA FROM THE COLUMBUS REPOSITORY

Background:

Secukinumab was the first anti-interleukin 17A monoclonal antibody treatment approved by the FDA for ankylosing spondylitis (AS). There is scarce information on the characteristics of secukinumab vs other biologic initiators with AS.

Objectives:

To describe real-world physician and patient characteristics, and treatment patterns of secukinumab and tumor necrosis factor inhibitor (TNFi) initiators.

Methods:

Electronic health records (EHR) data from adult patients with AS who initiated a biologic therapy between January 2018 and March 2019 (index date) were included from the Columbus Repository, a network capturing EHR data from 120 US rheumatology providers. Physician and patient characteristics, and treatment patterns were reported for patients who were prescribed secukinumab and TNFis (adalimumab, etanercept, certolizumab pegol, infliximab, infliximab-abda, and golimumab). Categorical variables were summarized using frequency counts and percentages and continuous variables were presented using means and standard deviations. Standardized mean differences andPvalues were used to compare treatment groups.

Results:

As of March 2019, AS treatment data were available for 82 secukinumab initiators and 160 TNFi initiators. Regarding overall practice size, 33% of practices had a single physician, and 65% of physicians were located in the South US region. Secukinumab initiators were younger than TNFi initiators (47.4 vs 49.8 years) and had a similar prevalence of HLA-B27 positivity (≈ 55%; Table 1). Comorbid psoriatic arthritis (PsA) was more commonly reported among secukinumab initiators vs TNFi initiators (17% vs 9%), while hypertension (5% vs 11%), obesity (2% vs 11%), and uveitis (2% vs 9%) were less common (Figure 1). Secukinumab initiators were more likely to have prior opioid use vs TNFi initiators but were less likely to have prior methotrexate use (Figure 2A); 67% of secukinumab initiators and 49% of TNFi initiators were biologic experienced, of whom 73% and 76%, respectively, used 1 prior biologic, 25% and 20% used 2 prior biologics, and 2% and 4% used ≥ 3 prior biologics (Figure 2B). The most common reasons for discontinuation of prior biologics among secukinumab and TNFi initiators were because the biologic was no longer required (47% vs 41%) and lack of efficacy (20% vs 24%) (Figure 2C).

Table 1.

Baseline Demographics and Disease Characteristics Among Patients With AS at the Index Date.

.CharacteristicSecukinumab(N = 82)TNFi(N = 160)SMD*PValueAge, mean (SD), years47.4 (12.8)49.8 (14.6)0.170.21Female, n (%)43 (52)90 (56)0.080.57Race/ethnicity, n (%)N = 65N = 1290.200.66White52 (80)106 (82)Hispanic8 (12)13 (10)Black3 (5)8 (6)Asian1 (2)2 (2)Other1 (2)0Geographic distribution, n (%)0.370.05South49 (60)113 (71)Midwest27 (33)28 (18)West5 (6)16 (10)Northeast1 (1)3 (2)Health insurance, n (%)N = 79N = 1560.410.39Commercial57 (72)94 (60)Medicare8 (10)33 (21)Medicaid2 (3)4 (3)Other12 (15)25 (16)HLA-B27 positivity, n (%) [N]14 (54) [N = 26]31 (56) [N = 55]0.051.00Body mass index, mean (SD), kg/m230.6 (6.1)30.9 (7.7)0.030.82

SMD, standardized mean difference.

* Comparisons with SMD > 0.1 were suggestive of clinically relevant differences.

Conclusion:

Secukinumab initiators with AS were younger and more opioid and biologic experienced, were more likely to have a PsA diagnosis, and were more likely to discontinue their previous biologic because the biologic was no longer required compared to patients who initiated TNFis.

Acknowledgments:

This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ. Support for third-party writing assistance for this abstract, furnished by Kheng Bekdache, PhD, of Health Interactions, Inc, was provided by Novartis Pharmaceuticals Corporation, East Hanover, NJ.

Disclosure of Interests:

Howard Busch Speakers bureau: AbbVie, Amgen, Crescendo, Exagen, Genentech, Mallinckrodt, Novartis, Primus, Sanofi/Regeneron, and UCB, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Peter Hur Employee of: Novartis Pharmaceuticals Corporation, Esther Yi Employee of: Novartis Pharmaceuticals Corporation

AB0750 CLINICAL CHARACTERISTICS AND TREATMENT PATTERNS OF PATIENTS WITH PSORIATIC ARTHRITIS WHO WERE PRESCRIBED BIOLOGICS: DATA FROM THE COLUMBUS REPOSITORY

Background:

Real-world data from electronic health records (EHR) allow examination of treatment patterns and clinical practice behaviors for psoriatic arthritis (PsA).

Objectives:

To describe physician and patient characteristics, and treatment patterns of patients with PsA who initiated secukinumab and other biologics using data from the Columbus Repository.

Methods:

EHR data from adult patients with PsA who were prescribed a new biologic therapy between January 2018 and March 2019 (index date) were included from the Columbus Repository, which collects clinical records from a network of US rheumatology providers. Demographics, disease characteristics, and treatment patterns, as well as physicians’ characteristics, were reported for patients who were prescribed secukinumab vs other biologics (abatacept, adalimumab, etanercept, certolizumab pegol, golimumab, infliximab, infliximab-dyyb, infliximab-abda, ustekinumab, and ixekizumab). Treatment groups were mutually exclusive and only the most recently prescribed biologic was represented. Categorical variables were summarized using frequency counts and percentages and continuous variables were presented using means and standard deviations.

Results:

As of March 2019, 234 patients initiated secukinumab and 806 initiated other biologics for PsA treatment; 62 physicians prescribed biologics for PsA. Overall, 73% of physicians’ offices had a single provider contributing patients to the analysis, and 76% of physicians were located in the South US region. Secukinumab initiators were younger (55.2 vs 57.3 years), more likely to be male (44% vs 31%), and had higher BMI (34.0 vs 31.9 kg/m2) vs other biologic initiators. Almost all disease activity measures evaluated had a large proportion (> 80%) of missing data; among those with nonmissing data, secukinumab initiators had numerically higher mean (SD) RAPID3 score vs other biologic initiators (12.6 [6.5] vs 11.6 [7.1]). Overall, 70% of secukinumab initiators and 48% of other biologic initiators were biologic experienced (Figure 1). Comorbidities were similar between groups (Figure 2). The most common reasons for discontinuation of prior biologic were the biologic was no longer required and lack of efficacy (Table 1).

Table 1.

Treatment Patterns Among Patients With PsA at the Index Date

Secukinumab(N = 234)Other Biologic(N = 806)SMD*PValueReason for discontinuing prior biologic treatment, n (%)N = 164N = 3850.200.67No longer required64 (39)136 (35)Lack of efficacy28 (17)75 (19)Cost or administrative5 (3)10 (3)Side effects5 (3)9 (2)Lack of tolerability03 (1)Patient fear of side effects1 (1)0Other25 (15)63 (16)Missing36 (22)89 (23)Prior medication use, n (%)NSAIDs109 (47)365 (45)0.030.78Opioids89 (38)252 (31)0.140.06Steroids68 (29)265 (33)0.080.31DMARDsMethotrexate83 (35)340 (42)0.140.08Sulfasalazine25 (11)93 (12)0.030.81Apremilast53 (23)104 (13)0.26< 0.01Tofacitinib10 (4)36 (4)0.011.00No. of prior biologics, mean (SD)0.95 (0.82)0.62 (0.77)0.41< 0.01

SMD, standardized mean difference.

* Comparisons with SMD > 0.1 were suggestive of clinically relevant differences.

Conclusion:

Secukinumab initiators with PsA were more likely to be male and biologic experienced, have a higher BMI and higher RAPID3 scores indicative of more active disease vs those initiating other biologics. Additional structured and unstructured elements may need to be captured on EHR platforms to gain clarity on disease activity and treatment decisions.

Acknowledgments:

This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ. Support for third-party writing assistance for this abstract, furnished by Kheng Bekdache, PhD, of Health Interactions, Inc, was provided by Novartis Pharmaceuticals Corporation, East Hanover, NJ.

Disclosure of Interests:

Howard Busch Speakers bureau: AbbVie, Amgen, Crescendo, Exagen, Genentech, Mallinckrodt, Novartis, Primus, Sanofi/Regeneron, and UCB, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Peter Hur Employee of: Novartis Pharmaceuticals Corporation

Klinik für Dermatologie, Allergologie und Venerologie der Universität zu Lübeck: Interaktion von Forschung und klinischer Versorgung

Die Ursprünge der Lübecker Universitäts-Hautklinik reichen in die 30er-Jahre des letzten Jahrhunderts zurück. Die Klinik hat in den letzten Jahrzehnten eine konsequente bauliche und inhaltliche Weiterentwicklung erfahren und verfügt heute über 85 Betten auf 2 Stationen und in einer Tagesklinik. Ein modernes Weiterbildungsprogramm, das auf einem Rotationsprinzip durch 5 verschiedene stationäre und ambulante Teams beruht, vermittelt alle wesentlichen Lerninhalte der Dermatologie. Die Erweiterung der Klinik in den letzten Jahren beruhte auf einer engen Interaktion von Grundlagenforschung und klinischer Tätigkeit, insbesondere auf dem Gebiet kutaner Autoimmunerkrankungen und entzündlicher Dermatosen. Die wissenschaftliche Entwicklung der Hautklinik profitierte seit 2007 insbesondere von der Förderung durch die Exzellenzinitiative des Bundes (Exzellenzcluster Inflammation at Interfaces). Daneben wurde durch die Deutsche Forschungsgemeinschaft (DFG) seit 2011 unter Federführung der Hautklinik ein Graduiertenkolleg Modulation of Autoimmunity gefördert, das zur Entwicklung des wissenschaftlichen Nachwuchses und zur Ausbildung zahlreicher naturwissenschaftlicher und medizinischer Doktoranden/Doktorandinnen1 beitrug. Seit 2015 besteht an der Klinik auch eine Klinische Forschungsgruppe der DFG zum Thema Pemphigoid Diseases – Molecular Pathways and their Therapeutic Potential. Im Jahr 2018 haben Mitarbeiter der Klinik wesentlich zur Einwerbung eines Clinician Scientist-Programms der DFG beigetragen, das die wissenschaftliche Ausbildung forschender Kliniker verbessern soll. In den letzten Jahren haben sich aus der Lübecker Hautklinik heraus 2 eigenständige Institute neu etabliert. Hierzu zählen das Institut für Entzündungsmedizin unter der Leitung von Prof. Diamant Thaçi, in dem klinische Studien zu entzündlichen Hauterkrankungen initiiert und koordiniert werden und die Versorgung von Patienten mit entzündlichen Dermatosen stattfindet. Daneben ist aus der Hautklinik heraus das Lübecker Institut für Experimentelle Dermatologie (LIED) entstanden, in dem derzeit 5 Professoren mit ihren jeweiligen Arbeitsgruppen zu unterschiedlichen Themen der Entzündung an der Haut forschen. Die interdisziplinären wissenschaftlichen Aktivitäten zur Entzündung an der Haut am Lübecker Campus werden seit 2015 in einem Center for Research on Inflammation of the Skin (CRIS) gebündelt. CRIS erhielt kürzlich die Zusage für ein eigenständiges Forschungsgebäude, das nach § 91 Grundgesetz durch Bund und Land finanziert wird und derzeit im Zentrum des Lübecker Campus entsteht. Der Ausbau der Forschungsstrukturen der Klinik ging mit der Einrichtung von Spezialambulanzen für verschiedene entzündliche Hauterkrankungen, aber auch für die Versorgung von Hautkrebs und chronischen Wunden einher. Die Klinik verfügt über ein zertifiziertes Hautkrebszentrum und ist Teil der Lübecker universitären Gefäß- und Krebszentren. Weitere wichtige Pfeiler der klinischen Versorgung sind zertifizierte diagnostische Einsendelabore für Dermato-Histopathologie und kutane Autoimmunerkrankungen.

Income-related inequalities in mental health in Sweden and the role of social determinants

Background

Mental health is an increasing concern in all European countries as the burden of mental disorders continue to grow and cause substantial suffering and costs to societies. Furthermore, research shows there are social inequalities in the distribution of mental illness. This study aims to increase knowledge on income-related inequalities in mental health in Sweden and the role of social determinants.

Methods

Drawing on a national survey (Health on Equal Terms) representative of the population aged 16-84, years 2010-2015 (n = 57107) we quantify the income-related inequality in mental health and estimate the contribution of social determinants of the inequality. Poor mental health is defined as a value of at least 3, based on the general health questionnaire (GHQ)-12. Income is measured as yearly disposable income. Income related inequalities in mental health are quantified by the concentration index and decomposed using the Wagstaff-type decomposition analysis.

Results

Preliminary results show that the income inequalities in mental health, as measured by the overall concentration index in mental health was - 0,16 (95% CI -0.17 to -0.15), indicating income inequalities to the disadvantage of those less affluent. The determinants that contributed most to the inequalities were employment, financial strain and experiencing harassment. Together they explained 43 % of the income inequalities in mental health. Generally, socio-economic factors had highest importance for the inequalities found, while demographic factors and psychosocial factors were of smaller importance.

Conclusions

The income related inequalities in mental health are substantial in Sweden. Recently, a national target of reducing the preventable inequalities in health within a generation was adopted. To improve surveillance of inequalities and inform policy we need to closely follow the development of inequalities in mental health and to disentangle the contribution of specific social determinants.

Key messages

Income-related inequalities in mental health in Sweden are considerable. Socio-economic factors had highest importance for the inequalities found, while demographic factors and psychosocial factors were of smaller importance.

TGFβ-induced cytoskeletal remodeling mediates elevation of cell stiffness and invasiveness in NSCLC

Importance of growth factor (GF) signaling in cancer progression is widely acknowledged. Transforming growth factor beta (TGFβ) is known to play a key role in epithelial-to-mesenchymal transition (EMT) and metastatic cell transformation that are characterized by alterations in cell mechanical architecture and behavior towards a more robust and motile single cell phenotype. However, mechanisms mediating cancer type specific enhancement of cell mechanical phenotype in response to TGFβ remain poorly understood. Here, we combine high-throughput mechanical cell phenotyping, microarray analysis and gene-silencing to dissect cytoskeletal mediators of TGFβ-induced changes in mechanical properties of on-small-cell lung carcinoma (NSCLC) cells. Our experimental results show that elevation of rigidity and invasiveness of TGFβ-stimulated NSCLC cells correlates with upregulation of several cytoskeletal and motor proteins including vimentin, a canonical marker of EMT, and less-known unconventional myosins. Selective probing of gene-silenced cells lead to identification of unconventional myosin MYH15 as a novel mediator of elevated cell rigidity and invasiveness in TGFβ-stimulated NSCLC cells. Our experimental results provide insights into TGFβ-induced cytoskeletal remodeling of NSCLC cells and suggest that mediators of elevated cell stiffness and migratory activity such as unconventional cytoskeletal and motor proteins may represent promising pharmaceutical targets for restraining invasive spread of lung cancer.

Antigenic Proteins of Nucleolar Chromatin of Novikoff Hepatoma Ascites Cells

Nucleolar chromatin of Novikoff hepatoma ascites cells contains an antigen (no-Ag1) detected with antinucleolar antibodies by the immunodiffusion technique. This antigen was distinguished from the previously reported nuclear chromatin antigen NAg-1 (19) by the findings that tumor nucleolar antibodies which formed immunoprecipitin bands with no-Ag1 did not do so with NAg-1 and that tumor cytosol, which contains NAg-1, formed immunoprecipitin bands with tumor chromatin antibodies but not with antibodies to tumor nucleoli. Tumor nucleolar chromatin contains both NAg-1 and no-Ag1, but only no-Ag1 formed bands with tumor nucleolar antibodies. no-Ag1 is a component of tumor nucleolar chromatin that was not soluble in 0.075 M NaCl - 0.025 M EDTA, pH 8, and only slightly soluble in 0.01 M Tris-HCl, pH 8. no-Ag1 was not found in liver nucleoli. Antibodies to liver nucleoli formed immunoprecipitin bands with liver nucleolar antigens but none were confluent with those formed between tumor nucleolar antibodies and antigens of tumor nucleolar chromatin. Absorption of the tumor nucleolar antibodies with whole tumor cells or whole liver pressate did not alter band formation with no-Ag1. Three antigens in liver nucleoli were not found in tumor nucleoli.

Unterschiedliches Dokumentationsverhalten: Frei formulierter versus standardisiert dokumentierter psychopathologischer Befund (AMP-Beleg 3)

Der unter Routinebedingungen abgefaßte, frei formulierte psychopathologische Aufnahmebefund und der AMP-Beleg 3 wurden bei 111 Patienten miteinander verglichen. Auf der Symptomebene fand sich eine Übereinstimmung von 35,5%. Es wird diskutiert, daß ein Vergleich auf der Synclromebene eine höhere Übereinstimmung ergeben hätte. Auf dem AMP-Beleg wurden nicht nur zum Teil andere, sondern auch mehr Symptome markiert. Dies unterstreicht die Bedeutung des Dokumentationssystems für die Schätzung von Symptomhäufigkeiten; Zahl und Strukturzusammenhang der auf AMP angebotenen Symptome, das erhöhte Risiko falsch positiver Dokumentation bei Benutzung einer Symptomliste und das falsch negativer bei frei formulierter Befunddokumentation dürften für die gefundenen Unterschiede von wesentlicher Bedeutung sein. In gewissem Umfang ließ sich ein diagnosenabhängiger Einfluß auf die Symptomdokumentation nachweisen. Auch ein deutlicher untersucherabhängiger Einfluß wurde gefunden. Dieser korrelierte jedoch nicht mit der klinisch-psychiatrischen Erfahrung, was auf persönlichkeitsspezifische Einflüsse und die nur begrenzte Trainierbarkeit des psychiatrischen Dokumentationsverhaltens hinweist.

Cost effectiveness of two rehabilitation programmes for neck and back pain patients: A seven year follow-up

The cost effectiveness of work-oriented rehabilitation for persons on long-term sick leave needs to be assessed. This prospective observational study presents a follow-up seven years after rehabilitation using two different evidence-based work-oriented regimens. Individuals on sick leave for neck and back pain were referred to two rehabilitation programmes in Sweden. The first programme was a relatively low-intensity programme based on orthopaedic manual therapy and exercise programme (OMTP). The second programme was a full-time multidisciplinary programme (MDP). The primary outcome was sickness absence seven years after intervention. Cost effectiveness was calculated on the basis of loss of production due to sickness absence. The results show that participants referred to MDP and with less than 60 sick days before rehabilitation have reduced sickness absence after intervention as compared to matched controls. This corresponds to a cost reduction of about 94,494 EUR per referred individual. Further, the results indicate that participants of the OMTP who have more than 60 sick days before rehabilitation have a statistically significant increased risk of disability pension. This means increased cost in terms of loss of production of 44,593 EUR per referred individual. The results of this study show that MPD but not OMTP achieves the goal of working life-oriented rehabilitation. A direct comparison between the rehabilitation programmes strengthened the assumption that long-term sickness absence prior to rehabilitation is associated with more days on sick leave after rehabilitation. This analysis also indicated the importance of participants' pain self-efficacy beliefs and recovery beliefs on rehabilitation outcome.

[Coating with plasma-deposited functionalized diamond-like carbon to decrease encrustations on urological implants]

The double-J stents used today for palliative artificial urinary diversion very often show extreme formation of encrustations, even a short time after implantation. Despite increased scientific material development, the complication rate has not really been strongly influenced. Grant-aided by the German Federal Ministry of Education and Research, we chose a new interdisciplinary and translational approach by coating standard stent materials with plasma-deposited amorphous diamond-like carbon. These stents show clearly reduced rates of encrustation in vitro. Ongoing clinical trials demonstrate a further enhancement of this effect in vivo. The underlying mechanisms are being investigated by extending the established in vitro model, thereby pushing research in this field to a new level.

Self-Efficacy Beliefs Predict Sustained Long-Term Sick Absenteeism in Individuals With Chronic Musculoskeletal Pain

Recovery beliefs are assumed to predict rehabilitation outcomes and return-to-work in various clinical conditions but are less frequently assessed in musculoskeletal disorders. We tested the hypothesis that recovery beliefs constitute a risk factor for sustained long-term sick absenteeism in men and women suffering from nonspecific chronic musculoskeletal disorders. A total of 233 subjects with a recent or ongoing experience of long-term sick leave were included in a prospective design. Subjects answered a postal baseline questionnaire and were followed up via register data for 1 year. Multivariate logistic regression analyses indicated that subjects with negative recovery beliefs (OR: 2.41; CI: 1.22-4.77), low sense of mastery (OR: 2.08; CI: 1.27-3.40), perceived high mental demands at work (OR: 1.77; CI: 1.05-2.99), and prior experiences of long-term sick absenteeism (OR: 1.86; CI: 1.02-3.37) had an increased probability of receiving sickness benefits at follow-up. We conclude that prolonged sickness absence contributes strongly to increase patients' sense of helplessness, lower self-efficacy, and hinder future work return. To improve work return, patients' maladaptive beliefs should be clarified and challenged early in the rehabilitation process.

Self-efficacy beliefs predict sustained long-term sick absenteeism in individuals with chronic musculoskeletal pain

Recovery beliefs are assumed to predict rehabilitation outcomes and return-to-work in various clinical conditions but are less frequently assessed in musculoskeletal disorders. We tested the hypothesis that recovery beliefs constitute a risk factor for sustained long-term sick absenteeism in men and women suffering from nonspecific chronic musculoskeletal disorders. A total of 233 subjects with a recent or ongoing experience of long-term sick leave were included in a prospective design. Subjects answered a postal baseline questionnaire and were followed up via register data for 1 year. Multivariate logistic regression analyses indicated that subjects with negative recovery beliefs (OR: 2.41; CI: 1.22-4.77), low sense of mastery (OR: 2.08; CI: 1.27-3.40), perceived high mental demands at work (OR: 1.77; CI: 1.05-2.99), and prior experiences of long-term sick absenteeism (OR: 1.86; CI: 1.02-3.37) had an increased probability of receiving sickness benefits at follow-up. We conclude that prolonged sickness absence contributes strongly to increase patients' sense of helplessness, lower self-efficacy, and hinder future work return. To improve work return, patients' maladaptive beliefs should be clarified and challenged early in the rehabilitation process.

Influence of spatiotemporally correlated noise on structure formation in excitable media

We discuss the influence of additive, spatiotemporally correlated (i.e., colored) noise on pattern formation in a two-dimensional network of excitable systems. The signature of spatiotemporal stochastic resonance (STSR) is analyzed using cross-correlation and information theoretic measures. It is found that the STSR behavior is affected by both the spatial and temporal correlations of the noise due to an interplay with the length scales of the deterministic network. Increasing the spatiotemporal noise correlation shifts the occurrence of STSR to smaller values of the noise variance. Additionally, if the spatial correlation of the noise exceeds that of the network, the excitation patterns disappear in favor of cloudy structures, directly rendering the underlying spatial noise field.

Menopausal transition and psychological development

OBJECTIVE

To study women's psychological development during menopause and to examine the relationship between women's appraisal of menopause and symptom reporting.

DESIGN

A population-based sample of 130 healthy women was assessed annually for 5 consecutive years using semistructured interviews, a menopausal symptom rating scale, and the Symptom Checklist-90 rating scale.

RESULTS

Qualitative analyses of the interviews showed that the majority of the women (57%) had neutral beliefs about menopause, whereas 31% were pessimistic and 12% were optimistic. Optimistic and neutral expectations were associated with low levels of symptom reporting, whereas the pessimistic appraisal was significantly related to elevated symptom scores. The majority of the neutral and pessimistic women reappraised menopause during the study period, and at the last follow-up, 67% appraised menopause positively. A positive reappraisal among the initially pessimistic women was associated with more frequent statements about personal growth compared with the other subgroups.

CONCLUSIONS

Menopause has a developmental potential and is a positive period for most women.

Method for detecting the signature of noise-induced structures in spatiotemporal data sets

Spatiotemporal stochastic resonance (STSR) is a phenomenon, where the stability of spatial patterns in an extended dynamical system displays a resonance-type dependence on the noise amplitude with the patterns being optimal at intermediate noise level. This dynamical behavior has been found in theoretical systems as well as in biochemical processes, where the noise level has been controlled externally. However, it is an open question how to identify the signature of a spatiotemporal stochastic resonance in a natural system, e.g., in ecology, when the noise amplitude is not known. This question is addressed in the present paper. We provide analysis tools, which allow to reconstruct the noise intensity in a spatiotemporal data set from the data alone. These tools are based on nearest-neighbor considerations inspired by cellular automata and are an appropriate method for detecting STSR, when combined with some measure of spatial order. As a test of our analysis tools, we apply them to sample data generated by four theoretical model systems. We show explicitly that without knowledge of the theoretical value of the noise amplitude for those systems displaying STSR the corresponding resonance curve can be reconstructed from the data alone. In addition, the other (nonresonant) cases are properly identified by our method with no resonance curve being found.

Effect of colored noise on networks of nonlinear oscillators

We discuss noise-induced pattern formation in different two-dimensional networks of nonlinear oscillators, namely a sequence of biochemical reactions and the Lorenz system. The main focus of the work is on the dependence of these patterns on the correlation time (i.e., the color) of exponentially correlated Gaussian noise. It is seen that in the nonchaotic case, the homogeneity (or average cluster size) goes through a minimum with higher correlation time, while in its chaotic regime the Lorenz system shows a higher degree of synchronization when the correlation time of the noise is increased. In order to elucidate the origin of this phenomenon, the effect of colored noise on the individual oscillator is investigated. It is shown that the specific dependence of the network's homogeneity on the noise correlation time arises from an interplay of the collective behavior and the properties of the single oscillators.

Immunocytochemical localization of nucleophosmin and RH-II/Gu protein in nucleoli of HeLa cells after treatment with actinomycin D

HeLa cells were studied with the use of light microscopical immunocytochemistry to obtain more information on the nucleolar localization of nucleophosmin (B23 protein) and RH-II/Gu protein. In control cells these proteins are colocalized. After structural rearrangement of nucleoli induced by actinomycin D, nucleophosmin was present in the nucleolar periphery and nucleolar peripheral caps. In contrast, RH-II/Gu protein was observed mainly in central regions of nucleoli as a compact body. However, in some nucleoli the proteins colocalized in a small portion of the peripheral nucleolar cap. The proteins were also colocalized in micronucleoli but occasionally RH-II/Gu protein was absent or both proteins were not present.

Human RNA helicase II/Gu gene: genomic organization and promoter analysis

Human RNA helicase II/Gu (hRH II/Gu) protein unwinds double-stranded RNA, folds single-stranded RNA, and may play important roles in ribosomal RNA biogenesis, RNA editing, RNA transport, and general transcription. The genomic organization and the regulation of expression of the hRH II/Gu gene were analyzed. The hRH II/Gu gene is over 29 kb in length, and includes 15 exons. All intron-exon junctions contain consensus GT-AG sequences. An 85 bp basic promoter was identified which lacks a functional TATA box. In LNCaP cells, the hRH II/Gu promoter was up to 50 times as active as pGL2-control vector which has an SV 40 early promoter. Mutation of a putative c-Myc/USF binding site in the region between -110 and -85 caused a decrease in the promoter activity by 2- to 3-fold. A negative regulatory region was also found between -324 and -264. Studies of transcriptional regulation of hRH II/Gu under different physiological and pathophysiological conditions may provide clues to its biological function.

Adriamycin inhibits human RH II/Gu RNA helicase activity by binding to its substrate

RNA helicases are enzymes important in RNA synthesis, processing, transport, and turnover. Human nucleolar RNA helicase II/Gu protein (RH II/Gu) was expressed in a baculovirus system. The purified recombinant RH II/Gu protein has RNA helicase activity on a 5' tailed ds RNA substrate in vitro. We found that Adriamycin, a widely used anticancer drug, inhibited RH II/Gu helicase activity in a dose-dependent manner with an IC(50) of 40 microM. Adriamycin bound to the RNA substrate, and the binding was disrupted by boiling or treatment with 1% SDS, suggesting that the binding of Adriamycin to RNA is reversible. Adriamycin was also found by gel electrophoresis to bind to yeast tRNA to form slow-migrating complexes. These results suggest that Adriamycin can inhibit RNA synthesis or processing by binding to RNA substrates.

The silver reaction of nucleolar proteins in the main structural compartments of ring-shaped nucleoli in smear preparations

The present study was undertaken to provide more information on the conditions which result in preferential silver staining of the main nucleolar structural compartments using silver stainable proteins as their markers at the light microscopic level. For this study the mostly used method in cytology and pathology in which the nucleolar silver-positive structures are "developed" with the colloidal developer (Howell and Black, 1980; Ploton et al., 1986) was selected as silver reaction. Ring-shaped nucleoli of mature human lymphocytes represent a convenient model for such a study because they consist of one large fibrillar center, adjacent nucleolar regions with dense fibrillar components and the nucleolar peripheral shell with dense granular components. All these nucleolar compartments are known to possess characteristic silver stainable proteins. The results demonstrated that proteins of the fibrillar center and possibly adjacent nucleolar regions reacted preferentially with silver after a relatively long fixation with formaldehyde or methanol in unwashed specimens before the silver reaction. In contrast, the preferential staining of proteins in the nucleolar peripheral shell with silver was achieved after the fixation with acidified methanol or ethanol as well as after short fixation with formaldehyde vapors. In addition, the commonly used fixation before the silver reaction are not necessary and may be omitted for the visualization of all silver stainable proteins present in the fibrillar center as well as in the adjacent nucleolar regions and the nucleolar peripheral shell. In addition, similar results were achieved for the simultaneous visualization of proteins in the fibrillar center and nucleolar peripheral shell after fixation with ethanol.

Cloning and characterization of GEF-H1, a microtubule-associated guanine nucleotide exchange factor for Rac and Rho GTPases

The Rho-related small GTPases are critical elements involved in regulation of signal transduction cascades from extracellular stimuli to cell nucleus and cytoskeleton. The Dbl-like guanine nucleotide exchange factors (GEF) have been implicated in direct activation of these GTPases. Here we have identified a new member of the Dbl family, GEF-H1, by screening a human HeLa cell cDNA library. GEF-H1 encodes a 100-kDa protein containing the conserved structural array of a Dbl homology domain in tandem with a pleckstrin homology domain and is most closely related to the lfc oncogene, but additionally it contains a unique coiled-coil domain at the carboxyl terminus. Biochemical analysis reveals that GEF-H1 is capable of stimulating guanine nucleotide exchange of Rac and Rho but is inactive toward Cdc42, TC10, or Ras. Moreover, GEF-H1 binds to Rac and Rho proteins in both the GDP- and guanosine 5'-3-O-(thio)triphosphate-bound states without detectable affinity for Cdc42 or Ras. Immunofluorescence reveals that GEF-H1 colocalizes with microtubules through the carboxyl-terminal coiled-coil domain. Overexpression of GEF-H1 in COS-7 cells results in induction of membrane ruffles. These results suggest that GEF-H1 may have a direct role in activation of Rac and/or Rho and in bringing the activated GTPase to specific target sites such as microtubules.

Green fluorescent protein tag for studies of drug-induced translocation of nucleolar protein RH-II/Gu

We have constructed a human osteogenic sarcoma cell line, U-2 OS/GFP-Gu, that expresses nucleolar RNA helicase RH-II/Gu tagged with green fluorescent protein (GFP). The presence of a GFP tag does not inhibit RNA helicase, RNA folding and ATPase activities of RH-II/Gu protein. The derived cell line responds to cytotoxic agents like the parental cell line U-2 OS. In the presence of either actinomycin D or toyocamycin, the GFP-RH-II/Gu fusion protein translocates from the nucleolus to the nucleoplasm in the same way as the translocation of endogenous RH-II/Gu. The drug-induced translocation of GFP-RH-II/Gu is easily monitored by direct observation of live cells in vivo. This cell line can be used to screen cytotoxic drugs and to study the mechanisms of drug-induced translocation of RH-II/Gu. The cellular localization of RH-II/Gu during the cell cycle-dependent formation of the nucleolus is readily monitored. Real-time results are obtained more quickly without the disadvantages associated with cell fixation and immunofluorescence-based staining.

CENP-G: a new centromeric protein that is associated with the alpha-1 satellite DNA subfamily

A new constitutive centromere-specific protein (CENP) has been identified as a result of its recognition as an autoantigen by serum from a patient with gastric antral vascular ectasia disease. Conventional immunoblotting and two-dimensional double blotting with both this antiserum and a known anti-centromere antiserum showed that this antiserum predominantly recognized a Mr 95,000 protein that is different from all known CENPs. We have named this new protein CENP-G. This protein was detected at the centromeric region throughout the cell cycle. In mitosis, it was restricted to the kinetochore inner plate as shown by immunogold labeling and electron microscopy. The centromeres of some human chromosomes are known to contain two subfamilies of alpha-satellite DNA. Using immunofluorescence combined with fluorescent in situ hybridization with subfamily-specific DNA probes, we revealed that CENP-G was specifically associated with one of the subfamilies, which we have named alpha-1, but not the other. The localization and the alpha-1-specific association suggested that CENP-G may play a role in kinetochore organization and function. Like CENP-B and C, but unlike CENP-A, this protein remained with the nuclear matrix after intensive extraction. While CENP-B is absent from the human Y chromosome, the existence of CENP-G on the Y chromosome has been proven by immunofluorescence and whole chromosome painting. CENP-G was also detected in CHO, Indian muntjac and Chinese muntjac cells, suggesting that it is conserved in evolution.