AB1192 SARS-COV-2 VACCINE IN SPONDYLOARTHRITIS PATIENTS: OVERALL MODERATE/HIGH IMMUNOGENICITY IMPAIRED BY IMMUNOSUPPRESSANTS AND BIOLOGICAL THERAPY

Background

We recently reported an attenuate immunogenicity in patients with autoimmune rheumatic diseases. However, the effect of spondyloarthritis (SpA) and its treatment on COVID-19 vaccine immunogenicity remains to be determined for this group of patients. We therefore aimed to evaluate humoral immune responses to inactivated SARS-CoV-2 vaccine (CoronaVac) in patients with SpA (axial spondyloarthritis and psoriatic arthritis) taking DMARDs and commonly used targeted biological therapies, compared with a control group(CG).

Objectives

Evaluate immunogenicity and safety of CORONAVAC (Sninovac, Beijing) in Spondyloarthritis (SpA) patients.

Methods

Prospective observational cohort patients diagnosed with 194 SpA and 183 CG were vaccinated with CoronaVac in two doses with a 28-days interval. 194 patients completed the study and could be paired with CG for immunogenicity analysis. Blood samples were collected in the days 0, 28 and 69 (D69) to evaluate anti-SARS-CoV-2 IgG seroconversion(SC) and presence of neutralizing antibodies (NAb) in participants with negative IgG and NAb at baseline.

Results

Patients and GC were comparable regarding age (p=0.93) and sex (p=1.00). Immunogenicity at D69 showed a moderate/high SC (80.2% vs. 95.7%, p<0.0001) and Nab positivity (61.6% vs. 82.7%, p<0.0001) in SpA but lower than CG. Factors associated with lower immunogenicity were older age (56.8 vs. 51.4;p=0.03318) and higher frequencies of prednisone (25.7% vs 4.2%; p=0.0004), methotrexate (51.4% vs 40.1%, p=0.0016) and TNF inhibitor (TNFi) (62.9% vs 34.5%, p=0.0035). Likewise, prednisone (17.6% vs. 2.8%, p=0.0013) and TNFi (50% vs 33.9%; p=0.0408) were associated with diminished NAb positivity. Sulfasalazine was associated with higher SC rates (8.6% vs. 26.8%, p=0.0246) and NAb positivity (13.2% vs. 29.4%, p=0.0168). The multivariate analysis revealed that older age (p=0.037), prednisone (p=0.001), TNFi (p=0.016), and methotrexate(p=0.017) were independently associated with lower SC while prednisone (p=0.006) and TNFi (p=0.027) were also associated with reduced NAb response.

Conclusion

Our finding of an excellent safety and moderate/high SC rate in SpA supports the recommendation of CoronaVac vaccination. The impaired immune response in the minority of patients under immunosuppressive and biological therapy requires novel strategies to enhance antibody response in this subgroup of patients.

References

[1]Weaver A, Troum O, Hooper M, Koenig AS, Chaudhari S, Feng J, et al. Rheumatoid arthritis disease activity and disability affect the risk of serious infection events in RADIUS 1. J Rheumatol 2013;40:1275–81.

[2]Germano V, Cattaruzza MS, Osborn J, Tarantino A, Di Rosa R, Salemi S, et al. Infection risk in rheumatoid arthritis and spondyloarthropathy patients under treatment with DMARDs, corticosteroids and TNF-alpha antagonists. J Transl Med 2014;12:77.

[3]van Assen S, Agmon-Levin N, Elkayam O, Cervera R, Doran MF, Dougados M, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2011;70:414–22.

[4]WHO. Coronavirus disease (COVID-19) situation report - 36. Geneva: World Health Organization,2021.https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---27-april-2021 (accessed Nov 28, 2021).

[5]Sanche S, Lin YT, Xu C, Romero-Severson E, Hengartner N, Ke R. High contagiousness and rapid spread of severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis 2020; 26: 1470–77.]

Disclosure of Interests

None declared

THU0183 ABATACEPT AND LOW GAMMA-GLOBULIN LEVELS: NO ASSOCIATION WITH INFECTIOUS RISK OR RA DISEASE ACTIVITY CONTROL

Background:

Abatacept (ABA) can induce decrease in gamma-globulins, but the long-term safety of such reduction is unknown. Moreover, it is suggested that such decrease is dissociated from disease activity response.

Objectives:

To evaluate ABA-induced gamma-globulins reduction and its correlation with disease activity control and the risk of infection in rheumatoid arthritis(RA) patients.

Methods:

This is a retrospective inception cohort of RA patients undergoing ABA for the first time in a large single tertiary cohort (2007 to 2019). Patients were evaluated regarding clinical and inflammatory data, total and specific (IgG, IgM, IgA) gamma-globulins assessed before, at 3 and 6 months, and then every 6 months up to discontinuation/censoring. The occurrence of severe or recurrent infections as cause of discontinuation of treatment was recorded. All patients were submitted to a systematic infectious screening protocol before and during treatment.

Results:

One hundred seventy-nine RA patients were included. They were predominantly female (93%;n=167) and had a positive rheumatoid factor (RF, 84%; n=151). Median(range) age and disease duration were 55.1(17-81.3) and 14(1.6-39.8) years, respectively. ABA was used in median as the 3rd(1-8) bDMARD. Most patients (74.3%, n=134) had already used a TNFi previously and 34.1% (n=61) had failed to rituximab. Baseline DAS28 [median(range)] was 4.9 (2-8.62), CDAI 27(5-66), HAQ 1.5 (0-3), ESR 18(2-111), and CRP 8.1(0.1 -135.7). Levels of total gamma-globulins(TGG) were 1.2 (0.5-2.8g/dL), IgG 1,094(422-2,785mg/dL), IgM104(19-405 mg/dL), and IgA 324 (100-739mg/dL). Forty-five patients (25.1%) had low IgG before ABA, but only 8(4.5%) had IgG<600mg/dL and low TGG. At 3 months, remarkable decreases were observed in total gamma-globulin(1.2vs.1.1g/dL), IgG(1,094vs.992mg/dL), IgM(104vs.93mg/dL), and IgA(324vs.302mg/dL), in comparison to baseline(p<0.05). Longitudinal measurements demonstrated that levels of gamma-globulins remained stable for subsequent evaluations(p>0.05). At baseline, TGG, IgG, IgM and IgA correlated positively to all disease activity parameters: DAS28(r=+0.33; r=+0.31;r=+0.24 and r=+0.37, respectively; p<0.02 for all), SDAI (r=+0.35; r=+0.37; r=+0.43; r=+0.34, respectively; p<0.04 for all), CDAI (r=+0.32; r=+0.29; r=+0.39; r=+0.31, respectively; p<0.03 for all, except IgA), swollen joints (r=+0.24; r=+0.23; p<0.01 only for TGG and IgG, respectively); tender joints (r=+0.18; r=+0.21; p<0.04 only for IgG and IgM respectively), ESR (r=+0.35; r=+0.24; r=+0.41; p<0.02 for TGG, IgG and IgA, respectively) and CRP (r=+0.20; r=+0.16; r=+0.27; p<0.05 for TGG, IgG and IgA, respectively). Longitudinally, most of these correlations were lost(p>0.05). Moreover, at 6 months, 25 patients (14%) achieved DAS28 ≤ 2.6 and 49 (27.4%) had low disease activity (DAS28 ≤ 3.2). Baseline or longitudinal measures of TTG and subtypes were similar among patients who responded and those who did not, regardless of the cut-off used(p>0.05. Only 14 patients (9.4%) had the medication discontinued due to infections: 3 due to recurrent infections and 11 to severe infections. One patient died. The frequencies of low IgG (under the normal limit of normality) at baseline and all time points(p>0.05) were similar among patients with and without severe/recurrent infections. None of these patients had low TGG or very low IgG(<600mg/dL) at baseline or during treatment and the levels of TGG and all subtypes were comparable at all time points (p>0.05).

Conclusion:

This cohort of real-world RA patients shows that reduction in gamma-globulin levels induced by ABA is safe, non-progressive and not associated to a higher risk of infection, even in patients with low IgG or TGG. Additionally, it is not associated to clinical response.

Disclosure of Interests: None declared

141 Positive effects of supplementation in bovine culture medium with 3 cytokines

Recently, our laboratory has identified that supplementation of 3 cytokines, 40ng mL−1 FGF2, 20ng mL−1 LIF, and 20ng mL−1 IGF1 (termed FLI), to porcine oocyte maturation medium leads to an increase in maturation percentage and embryo development to blastocyst. Similarly, addition of FLI to porcine embryo culture at Day 2 after fertilization increased the number of embryos that became blastocyst. The objective of this study was to determine whether the effect of FLI on embryonic development was maintained in the bovine. Two variations of the bovine culture medium, basic SOF and SOF-BE2 (containing 0.4mM trisodium citrate and 2.56mM myo-inositol), were supplemented with FLI at the beginning of culture, and development to the blastocyst stage on Day 8 was determined. Embryos were produced from abattoir-derived oocytes from Bos taurus breeds and fertilized with sperm from a single Holstein bull proven of high fertility under in vitro conditions. All statistical analyses were completed by logistic regression using the Genmod procedure of SAS v. 9.4 (SAS Institute Inc., Cary, NC, USA). In the first experiment, zygotes (oocytes exposed to sperm) were placed in culture in basic SOF with or without supplementation with FLI. After 4 replicates containing 90 control embryos and 93 FLI-treated embryos we found an increase (P&lt;0.05) in blastocyst percentages of 21.1±0.2% for the control compared with 40.9±0.2% for the FLI-treated embryos. In a second experiment, zygotes were cultured in SOF-BE2 with or without supplementation with FLI. A total of 679 zygotes (332 control and 347 FLI-treated zygotes) across 4 replicates were evaluated. Percentage of embryos developing to the blastocyst stage increased (P&lt;0.05) from 33.2±0.07% in the control group to 42.6±0.07% in the FLI-supplemented group. Next, blastocysts derived from the second experiment were vitrified for subsequent transfer to synchronized Angus recipient heifers. Re-expansion 16h after thawing was recorded before transfer. For the control group, 10 out of 24 embryos (41.7%), and 28 out of 41 embryos (68.3%) of the FLI-treated embryos, re-expanded. Three re-expanded blastocysts were then nonsurgically transferred to the uterine horn of each synchronized heifer (N=3 control embryo containing heifers, 9 FLI embryo containing heifers). The number of viable fetuses (presence of a heartbeat) per heifer will be determined via ultrasound around Day 35. Although more vitrification and transfer experiments are being completed, preliminary data suggest that supplementation of FLI during culture might improve of the embryos to freezing. Furthermore, supplementation of FLI improves development to the blastocyst stage in bovine embryos under different conditions. This work was supported in part by funds from the Agriculture and Food Research Initiative Competitive Grant no. 2013-68004-20365 from the United States Department of Agriculture National Institute of Food and Agriculture and National Institutes of Health Grant R01 HD072898, Food for the 21st Century, and the Clifton Murphy Scholarship Fund.

A soluble inorganic pyrophosphatase from the cattle tick Rhipicephalus microplus capable of hydrolysing polyphosphates

Polyphosphates have been found in all cell types examined to date and play diverse roles depending on the cell type. In eukaryotic organisms, polyphosphates have been investigated mainly in mammalian cells, and only a few studies have addressed arthropods. Pyrophosphatases have been shown to regulate polyphosphate metabolism. However, these studies were restricted to trypanosomatids. Here we focus on the tick Rhipicephalus microplus, a haematophagous ectoparasite that is highly harmful to cattle. We produced a recombinant R. microplus pyrophosphatase (rRmPPase) with the aim of investigating its kinetic parameters using polyphosphates as substrate. Molecular docking assays of RmPPase with polyphosphates were also carried out. The kinetic and Hill coefficient parameters indicated that rRmPPase has a greater affinity, higher catalytic efficiency and increased cooperativity for sodium phosphate glass type 15 (polyP₁₅ ) than for sodium tripolyphosphate (polyP₃ ). Through molecular docking, we found that polyP₃ binds close to the Mg²⁺ atoms in the catalytic region of the protein, participating in their coordination network, whereas polyP₁₅ interactions involve negatively charged phosphate groups and basic amino acid residues, such as Lys56, Arg58 and Lys193; polyP₁₅ has a more favourable theoretical binding affinity than polyP₃ , thus supporting the kinetic data. This study shows, for the first time in arthropods, a pyrophosphatase with polyphosphatase activity, suggesting its participation in polyphosphate metabolism.

Assessing the effects of different prebiotic dietary oligosaccharides in sheep milk ice cream

The objective of this study was to assess the effects of different prebiotic dietary oligosaccharides (inulin, fructo-oligosaccharide, galacto-oligossacaride, short-chain fructo-oligosaccharide, resistant starch, corn dietary oligosaccharide and polydextrose) in non-fat sheep milk ice cream processing through physical parameters, water mobility and thermal analysis. Overall, the fat replacement by dietary prebiotic oligosaccharides significantly decreased the melting time, melting temperature and the fraction and relaxation time for fat and bound water (T₂₂) while increased the white intensity and glass transition temperature. The replacement of sheep milk fat by prebiotics in sheep milk ice cream constitutes an interesting option to enhance nutritional aspects and develop a functional food.

Histological assessment of non-ablative laser stimulation of tissue repair in acellular dermal grafts

AIM

The objective of this study was to compare integration of AlloDerm® acellular dermal grafts in animals subjected to non-ablative laser irradiation and animals not exposed to this therapy.

METHODS

Standardized AlloDerm® fragments measuring 5 mm² were grafted into the subcutaneous tissue overlying the calvaria in 32 Wistar rats. Laser therapy (685 ηm), at a dose of 4 J/cm2 per session, was applied immediately after surgical intervention and every 48 hours thereafter for a total of four applications.

RESULTS

Analysis of histology slides revealed significantly greater edema in the control group. There was no neutrophil infiltration in the laser-irradiated group at any point during the study period, whereas such infiltration was present in control animals at three of the four points of observation. In the laser therapy group, lymphocyte infiltration was observed from day 1, whereas in the control group, it was only apparent from day 3. Vascularization was substantially greater in the control group. In the experimental group, the AlloDerm® graft was completely replaced by fibrous tissue.

CONCLUSION

These findings suggest that add-on non-ablative laser therapy is an effective stimulator of healing and graft integration after placement of AlloDerm® acellular dermal grafts.

Immunogenicity and safety of two doses of a non-adjuvanted influenza A H1N1/2009 vaccine in young autoimmune rheumatic diseases patients

Objectives

The aim of this study was to evaluate the immunogenicity and safety of the influenza A H1N1/2009 vaccine in children under 9 years old with autoimmune rheumatic diseases (ARD).

Methods

Thirty-eight ARD patients and 11 healthy children received two doses of non-adjuvanted influenza A/California/7/2009 (H1N1) virus-like vaccine. Subjects were evaluated before and 21 days after vaccination. Seroprotection (SP) and seroconversion (SC) rates, geometric mean titers (GMT) and factor increases (FI) in GMT were calculated.

Results

Mean ages were comparable between patients and controls. Pre-vaccination SP and GMT were similar in patients and controls ( p > 0.05). Three weeks after immunization, SP (81.6% vs. 81.8%, p = 1.0), SC (81.6% vs. 90.9%, p = 0.66), GMT (151.5 vs. 282.1, p = 0.26) and the FI in GMT (16.7 vs. 36.3, p = 0.23) were similar in patients and controls, with both groups achieving an adequate response, according to the European Medicines Agency and Food and Drug Administration standards. Analysis of the possible factors influencing SC showed no difference in demographic data, leukocyte/lymphocyte counts or immunosuppressant use between seroconverted and non-seroconverted patients ( p > 0.05). The vaccine demonstrated a satisfactory safety profile in this population.

Conclusions

Two doses of influenza A H1N1/2009 vaccination induced an effective antibody response and caused adverse events in rare instances, suggesting this vaccine is appropriate and can be recommended for this age group.

Cross-cultural adaptation of the Behçet's Disease Current Activity Form (BDCAF) to Brazilian Portuguese language

The Behçet's Disease Current Activity Form (BDCAF) is a clinical instrument used to assess the activity of Behçet's disease (BD), which was originally developed in English. The aim of the present study was to perform a cross-cultural adaptation of the BDCAF to Brazilian Portuguese language and to evaluate its reliability in a population of Brazilian patients with BD. Brazilian Portuguese version of the BDCAF, named BR-BDCAF, was obtained according to established guidelines. Forty Brazilian patients with BD diagnosed according to the International Study Group for Behçet's Disease criteria were assessed by two rheumatologists in independent sessions and submitted to the BR-BDCAF. Inter- and intraobserver agreement were then evaluated by kappa scores (values higher than 0.6 indicated good agreement). Good inter- and intraobserver agreements were achieved for the most common manifestations of BD: kappa scores higher than 0.6 were obtained for oral and genital ulcerations, skin lesions, and articular and general complaints. Moderate interobserver agreement was obtained for ocular activity (kappa 0.483) and fair interobserver agreement was obtained for gastrointestinal (kappa 0.322), major vessel (kappa 0.281), and central nervous system activity (kappa 0.304). BR-BDCAF was found to be a reliable instrument for the classic mucocutaneous and articular manifestations of BD and for general complaints, but complementary assessment is needed to evaluate specific visceral involvement for disease activity.

Relationship between glutathione S-transferase, catalase, oxygen consumption, lipid peroxidation and oxidative stress in eggs and larvae of Boophilus microplus (Acarina: Ixodidae)

Glutathione S-transferases (GSTs) are enzymes that act in excretion of physiologic and xenobiotic substances, protecting cells against chemical toxicity and stress. In this work, we characterized the enzymatic activity of GST in eggs and larvae of cattle tick Boophilus microplus, on different days after oviposition and eclosion. The results showed that the GST activity varied depending on the time elapsed after oviposition and eclosion. Molecules involved in mechanism of protection from oxidative stress are correlated with the increase in GST activity. The oxygen consumption kinetics showed a positive correlation with the increase in GST activity during embryogenesis. A high content of thiobarbituric acid reactive substances were observed in egg and larva extracts, indicating that ticks face high oxidative stress during embryogenesis and aging. In eggs and larvae, GST activity can be correlated to kinetic parameters of oxidative stress such as catalase and glutathione. In addition, GST activity showed strong positive correlation with lipid peroxidation, an indication that it plays a role in oxidant defences in eggs.

Binding and storage of heme by vitellin from the cattle tick, Boophilus microplus

We have previously shown (, Curr. Biol. 9, 703-706) that the cattle tick Boophilus microplus does not synthesize heme, relying solely on the recovery of the heme from the diet to make all its hemeproteins. Here we present evidence that Vitellin (VN(1)), the main tick yolk protein, is a reservoir of heme for embryo development. VN was isolated from eggs at different days throughout embryogenesis. Immediately after oviposition, Boophilus VN contains approximately one mol of heme/mol of protein. During embryo development about one third of egg VN is degraded. The remaining VN molecules bind part of the heme released. These results suggest that VN functions as a heme reservoir, binding any free heme that exceeds the amount needed for development. In vitro measurement of the binding of heme to VN showed that each VN molecule binds up to 31 heme molecules. The association of heme with VN strongly inhibits heme-induced lipid peroxidation, suggesting that binding of heme is an important antioxidant mechanism to protect embryo cells from oxidative damage. This mechanism allows this hematophagous arthropod to safely store heme obtained from a blood meal inside their eggs for future use. Taken together our data suggest that, besides its known roles, VN also plays additional functions as a heme deposit and an antioxidant protective molecule.

Anagallis arvensis poisoning in cattle and sheep in Uruguay

Outbreaks of Anagallis arvensis poisoning were observed from 1994 to 1998 in cattle and sheep in Uruguay during December and January. Cattle morbidity varied between 3.2 and 53.2% and lethality 42.6 and 100%. Sheep morbidity was 2.8 to 42.9% and lethality 81.3 to 100%. Nine outbreaks occurred on barley and wheat stubble, and 1 in a field previousy ploughed but not cultivated. Clinical signs were weakness, staggers, diarrhea (sometimes bloody), coma, and death. Serum levels of creatinine and urea were elevated. Gross lesions were characterized by sc petechiae, fluid in body cavities, mesenteric and perirenal edema, yellowish or pale kidneys with petechiae on the cortex, esophageal erosive lesions or ulcers, and hemorrhagic abomasitis and enteritis. Severe nephrosis was observed histologically. The green plant collected in a field where an outbreak occurred was administered to 2 sheep at doses of 160 and 224 g/kg bw and produced clinical signs and pathology similar to those observed in field cases.