Real-world advantage and challenge of post-autologous stem cell transplantation MRD negativity in high-risk patients with double-hit multiple myeloma

BACKGROUND

Autologous stem-cell transplantation (ASCT) remains a beneficial approach for patients with newly diagnosed multiple myeloma (NDMM) in the age of novel therapeutic agents. Nevertheless, limited real-world data is available to establish criteria for identifying high-risk ASCT patients.

METHODS

We analyzed outcomes for 168 NDMM patients who underwent ASCT at our center from December 2015 to December 2022. We investigated the impact of the number of high-risk cytogenetics (HRCA), defined as t(4;14), t(14;16), 1q21 gain/amplification, and del(17p), as well as the post-ASCT minimal residual disease (MRD) status as prognostic indicators. We assessed progression-free survival (PFS) and overall survival (OS), and focused on identifying risk factors.

RESULTS

The cohort included 42% of patients (n = 71) with 0 HRCA, 42% (n = 71) with 1 HRCA, and 16% (n = 26) with ≥ 2 HRCA. After a median follow-up of 31 months, the median PFS was 53 months (95% CI, 37-69), and OS was not reached for the entire cohort. Despite similar rates of MRD-negativity post-ASCT, patients with ≥ 2 HRCA, termed "double hit" (DH), had a significantly higher risk of progression/mortality than those with 0 or 1 HRCA. Multivariate analysis highlighted DH (HR 4.103, 95% CI, 2.046-8.231) and MRD positivity post-ASCT (HR 6.557, 95% CI, 3.217-13.366) as adverse prognostic factors for PFS, with DH also linked to inferior OS. As anticipated, DH patients with post-ASCT MRD positivity displayed the poorest prognosis, with a median PFS of 7 months post-ASCT. Meanwhile, DH patients with MRD negativity post-ASCT showed improved prognosis, akin to MRD-negative non-DH patients. It is noteworthy to exercise caution, as DH patients who initially achieved MRD negativity experienced a 41% cumulative loss of that status within one year.

CONCLUSIONS

This study strongly advocates integrating DH genetic assessments for eligible ASCT patients and emphasizes the importance of ongoing MRD monitoring, as well as considering MRD-based treatment adaptation for those patients in real-world settings.

Changes and significance of the fibrinolytic system following two pulmonary thromboembolisms in a rabbit model

In this study, we examined the changes in the fibrinolytic system in a rabbit model of two acute pulmonary thromboembolisms (PTE). Fourteen healthy adult New Zealand white rabbits were divided into three groups: the single PTE group (five rabbits), the double PTE group (five rabbits), and the control group (four rabbits). A rabbit model of acute pulmonary embolism was established, and immunohistochemistry and polymerase chain reaction (PCR) were performed on tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) in plasma, and pulmonary embolism tissue. Plasma results: 1) t-PA levels: one hour following the initial modeling, the levels of t-PA in the modeling groups were significantly lower than those in the control group (P<0.05). In addition, the t-PA levels in the double PTE group were found to be lower after the modeling, as compared to the pre-modeling period (P<0.05). One hour after the second modeling, the double PTE group had lower t-PA levels compared to the control group (P<0.05). However, t-PA rebounded two hours after modeling in the double PTE group. One week after the second modeling, the double PTE group had higher t-PA levels compared to the other two groups (P<0.05). 2) PAI-1 results: one hour after the initial modeling, PAI-1 levels in the two modeling groups were lower compared to the pre-modeling period and control groups (P<0.05). Two hours following modeling, PAI-1 levels in both modeling groups were lower compared to the control group (P<0.05). PAI-1 levels were lower in the double PTE group one and two hours after the second modeling compared to the other two groups and pre-modeling period (P<0.05). 3) The immunohistochemistry results: the expression of PAI-1 decreased in the two modeling groups, while t-PA expression increased compared to the control group. 4) PCR results: t-PA mRNA expression did not differ among the three groups. The PAI-1 mRNA expression was lower in the two PTE groups compared to the control group. We conclude that in the early stages of PTE, the local fibrinolytic activity of the thrombus is increased, which is favorable for thrombolysis. However, as the thrombus persists, the activity of the fibrinolytic system is inhibited, contributing to the development of chronic thromboembolic pulmonary hypertension.

[The association between portal vein thrombosis and rebleeding after non-urgent endoscopic treatment of esophagogastric varices]

Objective: To investigate the association between portal vein thrombosis and rebleeding after non-urgent endoscopic treatment of esophagogastric varices. Methods: The cirrhotic patients with esophagogastric varices diagnosed in the People's Hospital of Zhengzhou University from January 2017 to March 2023 were retrospectively collected. The patients were divided into thrombotic group and non-thrombotic group according to the presence or absence of portal vein thrombosis. The failure rate of endoscopic treatment and rebleeding rate in different periods were compared between the two groups. Receiver operating characteristic (ROC) curve was used to select the best cutoff value of gastric varicose diameter that affected total rebleeding during follow-up in both groups. The influencing factors of rebleeding within 12 and 36 months in both groups were analyzed, and the influencing factors of rebleeding within 36 months in thrombus group were further analyzed. Results: A total of 106 patients were enrolled, including 53 patients in the thrombotic group [male 37, female 16, aged 18-78 (54±13) years] and 53 patients in the non-thrombotic group [male 37, female 16, aged 27-83 (55±12) years]. The follow-up time of the two groups were (20±15) and (25±15) months, respectively. The total rebleeding rate in the thrombotic group was higher than that in the non-thrombotic group [30.2% (16/53) vs 13.2% (7/53), P˂0.05]. The rebleeding rates within 6, 12, 24 and 36 months in the thrombotic group were higher than those in the non-thrombotic group [18.9% (10/53) vs 5.7% (3/53), 18.9% (10/53) vs 5.7% (3/53), 28.3% (15/53) vs 9.4% (5/53), 30.2% (16/53) vs 11.3% (6/53), all P˂0.05]. The best cut-off value of the diameter of gastric varices that affects the total rebleeding in the two groups was 10.4 mm (10 mm was selected as the best cut-off value for the convenience of practical clinical application). Hemoglobin ˂ 85 g/L (HR=0.202, 95%CI: 0.043-0.953, P=0.043), 10 mm ˂ the diameter of GV ≤ 15 mm (HR=5.321, 95%CI: 1.161-24.390, P=0.031) and endoscopic variceal ligation combined with endoscopic tissue adhesive injection (EVL+ETAI) (HR=7.172, 95%CI: 1.910-26.930, P=0.004) were the risk factors for the first gastroesophageal variceal rebleeding within 12 months after non-urgent endoscopic treatment. EVL+ETAI (HR=3.811, 95%CI: 1.441-10.084, P=0.007) and portal vein thrombosis (HR=4.026, 95%CI: 1.483-10.932, P=0.006) were the risk factors for the first gastroesophageal variceal rebleeding within 36 months after non-urgent endoscopic treatment. The study found that, 10 mm ˂ the diameter of GV ≤ 15 mm (HR=7.503, 95%CI: 1.568-35.890, P=0.012) was the risk factor for rebleeding within 36 months in the thrombotic group. Conclusion: Portal vein thrombosis is a risk factor for rebleeding after non-urgent endoscopic treatment of esophagogastric varices.

Multidisciplinary recommendations for the management of CAR-T recipients in the post-COVID-19 pandemic era

The outbreak of coronavirus disease 2019 (COVID-19) posed an unprecedented challenge on public health systems. Despite the measures put in place to contain it, COVID-19 is likely to continue experiencing sporadic outbreaks for some time, and individuals will remain susceptible to recurrent infections. Chimeric antigen receptor (CAR)-T recipients are characterized by durable B-cell aplasia, hypogammaglobulinemia and loss of T-cell diversity, which lead to an increased proportion of severe/critical cases and a high mortality rate after COVID-19 infection. Thus, treatment decisions have become much more complex and require greater caution when considering CAR T-cell immunotherapy. Hence, we reviewed the current understanding of COVID-19 and reported clinical experience in the management of COVID-19 and CAR-T therapy. After a panel discussion, we proposed a rational procedure pertaining to CAR-T recipients with the aim of maximizing the benefit of CAR-T therapy in the post COVID-19 pandemic era.

[Transcriptomic analysis of tuberculosis peptide-based vaccine MP3RT in humanized mice]

Objective: To identify the differentially expressed genes (DEGs) induced by tuberculosis peptide-based vaccine MP3RT in a humanized mouse model using transcriptomics technology. Methods: This study was conducted from August 2019 to February 2022. We used edgeR software to screen DEGs with a fold change greater than or equal to 1.5 and a P value less than 0.05 as screening conditions. Gene ontology (GO), Kyoto encyclopedia of genes and genomes (KEGG), and protein interaction network analyses were performed on the screened DEGs. Then, these DEGs were verified by RT-qPCR and statistically analyzed by GraphPad Prism 8 software. Results: A total of 367 DEGs (214 up-regulated and 153 down-regulated) were identified by transcriptomics. Bioinformatics analysis showed that the GO enrichment of the DEGs mentioned above significantly focused on cell metabolism, growth, apoptosis, inflammation, and other terms. In contrast, the KEGG enrichment significantly focused on inflammatory pathways such as the MAPK signaling pathway. Protein interaction network analysis showed that protein Abl1 had the highest aggregation, the highest aggregation coefficient, and the best connectivity. RT-qPCR results showed that gene expressions of cpne4 (t=2.48, P=0.048 0), h2-q10 (t=2.95, P=0.025 6), mef2c (t=2.87, P=0.028 4), cr2 (t=3.23, P=0.178), ablim1 (t=2.91, P=0.033 5), dll1 (t=2.70, P=0.027 3) and ms4a2 (t=3.03, P=0.019 2) genes in the MP3RT group were significantly up-regulated than those in the PBS group, while gene expressions of cd163l1 (t=2.56, P=0.043 0), il1r1 (t=2.91, P=0.022 7) and cd34 (t=2.42, P=0.046 2) genes in the MP3RT group were significantly down-regulated than those in the PBS group. Conclusions: The MP3RT vaccine induced 367 DEGs in humanized mice, which were associated with metabolic and immune responses. Furthermore, we found that p38 MAPK and JNK/MAPK signaling pathways played an important role in the molecular mechanism of the MP3RT vaccine.

[Performance evaluation and validation of automated digital image analysis in peripheral blood cells morphology examination]

Objective: To verify and evaluate the performance of automated digital image(DIA) for peripheral blood cell morphology examination. Methods: Three hundred and seventy-nine routine peripheral blood smears and 18 plasmodium positive peripheral blood smears were collected. Blood smears were made and stained by Wright -Giemsa method.White blood cell (WBC) differentiation of blood smears were pre-classified by DIA (DIA direct classification), re-classified (manually reviewed after DIA classification), and artificially classified under microscope. the inter-assay and intra-assay coefficients of variation (CV) of DIA were respectively calculated for repeatability verification. Taking the artificial microscopy as the gold standard, the sensitivity、specificity and accuracy of DIA were calculated. The DIA ability of peripheral blood blast cell morphological count, platelet (PLT) morphological count and morphological examination of plasmodium were also verified. Results: Except for eosinophils and basophils, the inter-assay and intra-assay CV of WBC classification by DIA in normal samples were < 10%. The CV of WBC classification in abnormal samples increased with the decrease of cell percentage. The sensitivity, specificity and accuracy of DIA pre-classification were 90.5%, 99.2%, 98.2%. Through pre-classification and re-classification by DIA,the results of the blood smears which triggered blast cell alarm had a good correlation with manual classification(r=0.812, 0.983, both P<0.01). The PLT morphological count by DIA had high correlation with hematology analyzer (r=0.946, P<0.01). The deviation absolute value of two methods of PLT count was < 15%, while in PLT aggregation or giant thrombocytosis samples,the deviation absolute value of PLT count by two methods was > 15%. After image acquisition by DIA, 17 plasmodium trophozoites were detected in 18 plasmodium-positive peripheral blood smears, and the images were clear. Conclusions: The DIA system has good repeatability, high sensitivity, specificity and accuracy in peripheral blood WBC classification. Its pre-classification and re-classification results have high correlation with the manual classification results.

Molecular characterization and clinical outcomes in EGFR-mutant de novo MET-overexpressed advanced non-small-cell lung cancer

Background

Approximately 2%-8% of non-small-cell lung cancer (NSCLC) harbors concurrent epidermal growth factor receptor (EGFR) sensitizing mutation and mesenchymal–epithelial transition factor (MET) amplification prior to EGFR-tyrosine kinase inhibitor (EGFR-TKI) therapy. This study aimed to investigate the optimal first-line therapeutic options for patients with concurrent EGFR-mutant, MET-overexpressed/amplified advanced NSCLC.

Methods

A total of 104 treatment-naïve patients with EGFR-mutant de novo MET-overexpressed advanced NSCLC were identified using immunohistochemistry and stratified to four groups according to treatment regimen: EGFR-TKI monotherapy (n = 48), EGFR-TKI combined with either crizotinib (n = 9) or chemotherapy (n = 12), and chemotherapy (n = 35). A subpopulation of 28 patients was also tested with next-generation sequencing (NGS). Objective response rate (ORR) and progression-free survival (PFS) outcomes were analyzed according to treatment strategies and molecular features.

Results

All the patients (n = 104) achieved ORR of 36.5% and median PFS (mPFS) of 7.0 months. Baseline clinicopathologic characteristics were similar among the four treatment groups. Compared with chemotherapy, EGFR-TKI monotherapy or EGFR-TKI combination therapy achieved significantly higher ORR (P < 0.001) and longer mPFS (P = 0.003). No ORR or PFS difference was observed between EGFR-TKI monotherapy and combination therapy. In the NGS-identified population (n = 28), patients who received EGFR-TKI plus crizotinib (n = 9) achieved similar ORR (88.9% versus 57.9%, P = 0.195) and mPFS (9.0 versus 8.5 months, hazard ratio 1.10, 95% confidence interval 0.43-2.55, P = 0.45) than those who received EGFR-TKI monotherapy (n = 19), regardless of MET copy number status. Grade 3/4 rashes were significantly more among patients who received EGFR-TKI plus crizotinib (P = 0.026).

Conclusions

Our findings provided clinical evidence that patients with concurrent EGFR sensitizing mutation and de novo MET amplification/overexpression could benefit from first-line EGFR-TKI monotherapy.

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Concomitant EGFR sensitizing mutation and MET overexpression/amplification were detected in 2.6% of lung cancer patients.

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EGFR-TKI monotherapy elicited a higher response rate and longer PFS than chemotherapy.

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EGFR-TKI with or without crizotinib elicited comparable PFS regardless of MET copy number.

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EGFR-TKI monotherapy achieved lower number of grade 3/4 adverse events than EGFR-TKI plus crizotinib.

DNA crosslinking and recombination-activating genes 1/2 (RAG1/2) are required for oncogenic splicing in acute lymphoblastic leukemia

Background

Abnormal alternative splicing is frequently associated with carcinogenesis. In B‐cell acute lymphoblastic leukemia (B‐ALL), double homeobox 4 fused with immunoglobulin heavy chain (DUX4/IGH) can lead to the aberrant production of E‐26 transformation‐specific family related gene abnormal transcript (ERG_alt) and other splicing variants. However, the molecular mechanism underpinning this process remains elusive. Here, we aimed to know how DUX4/IGH triggers abnormal splicing in leukemia.

Methods

The differential intron retention analysis was conducted to identify novel DUX4/IGH‐driven splicing in B‐ALL patients. X‐ray crystallography, small angle X‐ray scattering (SAXS), and analytical ultracentrifugation were used to investigate how DUX4/IGH recognize double DUX4 responsive element (DRE)‐DRE sites. The ERG_alt biogenesis and B‐cell differentiation assays were performed to characterize the DUX4/IGH crosslinking activity. To check whether recombination‐activating gene 1/2 (RAG1/2) was required for DUX4/IGH‐driven splicing, the proximity ligation assay, co‐immunoprecipitation, mammalian two hybrid characterizations, in vitro RAG1/2 cleavage, and shRNA knock‐down assays were performed.

Results

We reported previously unrecognized intron retention events in C‐type lectin domain family 12, member A abnormal transcript (CLEC12A_alt) and chromosome 6 open reading frame 89 abnormal transcript (C6orf89_alt), where also harbored repetitive DRE‐DRE sites. Supportively, X‐ray crystallography and SAXS characterization revealed that DUX4 homeobox domain (HD)1‐HD2 might dimerize into a dumbbell‐shape trans configuration to crosslink two adjacent DRE sites. Impaired DUX4/IGH‐mediated crosslinking abolishes ERG_alt, CLEC12A_alt, and C6orf89_alt biogenesis, resulting in marked alleviation of its inhibitory effect on B‐cell differentiation. Furthermore, we also observed a rare RAG1/2‐mediated recombination signal sequence‐like DNA edition in DUX4/IGH target genes. Supportively, shRNA knock‐down of RAG1/2 in leukemic Reh cells consistently impaired the biogenesis of ERG_alt, CLEC12A_alt, and C6orf89_alt.

Conclusions

All these results suggest that DUX4/IGH‐driven DNA crosslinking is required for RAG1/2 recruitment onto the double tandem DRE‐DRE sites, catalyzing V(D)J‐like recombination and oncogenic splicing in acute lymphoblastic leukemia.

2-Mercaptoethanol (2-ME)-based IATs or Polybrene method mitigates the interference of daratumumab on blood compatibility tests

OBJECTIVES

Treating red blood cells (RBCs) with dithiothreitol (DTT) is a wildly-recommended to overcome the interference of the daratumumab (DARA) with blood compatibility testing. Nevertheless, DTT can be hard to obtain in the clinical laboratory, while its use in routine practice may be time-consuming. In the following study, we explored the feasibility of using a commercial 2-mercaptoethanol (2-ME) working solution or the time-saving Polybrene method to mitigate DARA interference.

METHODS

Antibody screening and cross-matching were performed using 2-ME or DTT-based indirect antiglobulin tests (IATs) and Polybrene method (with human IgG anti-E same IATs titer as DARA as positive control) on 37 samples. Most clinically important blood group antigens on RBCs were detected after treatment with 2-ME or DTT.

RESULTS

Treating RBCs with 2-ME eliminates the DARA interference with the antibody screening or cross-matching; yet, K antigen is denatured during treatment. DARA does not interfere with antibody screening and cross-matching via Polybrene method, while 2+ agglutinations of anti-E antibody with the same titer (IATs method) as DARA could be observed in the positive controls via this method.

CONCLUSION

2-ME-based IATs or Polybrene method could replace DTT-based IATs to mitigate DARA interference.

[Association between hyperuricemia and incidence risk for cardiometabolic abnormity in children]

Objective: To investigate the relationships between hyperuricemia and the incidence risk for cardiometabolic abnormity in children. Methods: Data were obtained from School-based Cardiovascular and Bone Health Promotion Program. In 2017, a total of 15 391 children aged 6-16 years in Beijing were selected through stratified cluster sampling at baseline survey. Follow-up investigation was conducted in 2019. Logistic regression model was used to analyze the relationships of uric acid quartiles and change in uric acid levels with incidence risks for cardiometabolic abnormity (hypertension, hyperglycemia and dyslipidemia). Results: A total of 8 807 children (4 376 boys, 4 431 girls) were included in the analysis, the average age of the children was (11.1±3.3) years at baseline survey. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of incidence risk for hypertension in the third and fourth quartiles of the UA were 1.39 (1.11-1.75) and 1.56 (1.19-1.81), respectively. The ORs and 95% CIs of risk for high LDL-C in the second, third and fourth quartiles were 1.88 (1.16-3.05),1.98 (1.23-3.17) and 2.25 (1.42-3.57). The uric acid level increased by one standard deviation, the risk increased by 17% for hypertension and 27% for high LDL-C. The uric acid level increased by 10 μmol/L, the risk increased by 2.1% for hypertension and 2.9% for high LDL-C. The gender-stratified analysis showed that the similar results. The ORs and 95% CIs were 1.32 (1.09-1.60) and 1.50 (1.05-2.16) for hypertension, 1.90 (1.38-2.60) and 2.96 (1.58-5.52) for high TC, 1.78 (1.26-2.51) and 2.84 (1.60-5.03) for high LDL-C in the groups of newly diagnosed hyperuricemia and persistent hyperuricemia. Conclusions: Higher uric acid level was associated with increased incidence risks for hypertension, abnormal TC and LDL-C. Maintaining optimal uric acid level by children might contribute to the early prevention of cardiovascular diseases.

[Change in obesity status and development of cardiometabolic disorders in school-age children]

Objective: To analyze the influence of obesity status on the development of cardiometabolic disorders in school-age children. Methods: Information about children's body weight, body height and cardiovascular risk factors were collected in baseline survey in 2017 and follow-up survey in 2019. The school-age children were divided into four groups based on their baseline and follow-up obesity status, i.e. sustained non-obesity group, restored obesity group, newly classified obesity group, and persistent obesity group. Analysis of covariance was used to compare the difference of change in levels of cardiometabolic factors among the four groups. The multivariate logistic regression model was used to analyze the relationship between obesity status and the incidence risk of cardiometabolic disorders. Results: The present study included 11 379 school-age children (boys accounting for 49.6%). During the 2 years, the incidence of obesity was 3.2% (95%CI: 2.9%-3.5%) with the restoration ratio of obesity of 4.4% (95%CI: 4.0%-4.8%). Compared with the sustained non-obesity group, increases in SBP, DBP, TG, LDL-C and non-HDL-C were much higher in newly classified obesity group and persistent obesity group, but lower in restored obesity groups except for DBP (all P<0.05). In addition, the incidence risk of hypertension, high glucose, dyslipidemia and cardiometabolic disorders (≥2 risks) were much higher in newly classified and persistent obese children than in sustained non-obese children. No difference was found in incidence risks of most cardiovascular disorders between restored obese children and sustained non-obese children, except for hypertension and cardiometabolic risks. Conclusion: Both newly classified obesity and persistent obesity increased the incidence risks for multi cardiovascular disorders, while these risks could be reduced when non-obese status restore.

[Incidence and risk factors of pediatric fractures in school-age children and adolescents in Beijing]

Objective: To investigate the incidence and risk factors of pediatric fracture in school-age children and adolescents in Beijing. Methods: A total of 12 056 students with complete fracture data of 2017 baseline survey and 2019 follow-up survey of School-based Cardiovascular and Bone Health (SCVBH) Promotion Program in Beijing were selected as study subjects. Logistic regression model was used to analyze associations of fracture incidence with age, BMI, fracture history and lifestyle. Results: The 2-year accumulative incidence rate of pediatric fracture was 3.1% (95%CI: 2.8%-3.4%) in school-age children and adolescents in Beijing, which was much higher in boys (4.1%) than in girls (2.1%) and increased with age in boys but decreased with age in girls. Fractures mainly occurred at upper-limb (69.0%), no gender and age specific significant in fracture sites were observed. Fracture history was the risk factor for fracture incidence in both boys and girls (boys: RR=1.81, 95%CI: 1.18-2.64; girls: RR=3.11, 95%CI: 1.74-5.13). In addition, higher duration and frequency of moderate to vigorous physical activities (≥120 min/day) and frequent consumption of sugar sweetened beverage (≥1 time/week) were also found to increase fracture risk in boys. Conclusion: The incidence of pediatric fracture was associated with gender, age, fracture history and lifestyle habits in school-age children and adolescents in Beijing. Targeted strategies are needed to prevent childhood fracture.

[Consistency between bioelectrical impedance analysis and dual-energy X-ray absorptiometry for body composition measurement in children aged 7-17 years]

Objective: To evaluate the consistency between bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) in the measurement of body composition in children and adolescents aged 7-17 years. Methods: Fat-free mass (FFM) and fat mass (FM) were measured by both BIA and DXA in 1 431 children. The consistency between the methods was evaluated by intra-class correlation coefficients (ICCs) and Bland-Altman analysis. Logarithmic transformation of both measurements was performed before Bland-Altman analysis. Results: The ICCs for FFM were 0.986 and 0.974 and ICCs for FM were 0.854 and 0.926 in boys and girls respectively. In boys, the mean ratio of FFMs by BIA and DXA was 1.04, with limits of Agreement (LoA) of 0.95-1.14, and in girls, the mean ratio of FFMs by BIA and DXA was 1.02, with the LoA of 0.90-1.15. The LoA of FFM became narrower with age in both boys and girls. Both boys and girls had the wide LoAs for FM (0.40-1.27 and 0.48-1.48, respectively). Additionally, the LoA ranges for FFM and FM narrowed with the increase of BMI level in both boys and girls. Conclusion: For all children, BIA showed good consistency with DXA for FFM, whereas significant errors occurred in FM measurement. The consistency between BIA and DXA was better for obese children than for underweight or normal-weight children.

[Association of vitamin D nutritional status with calcaneal bone mineral density in school-age children: a prospective cohort study]

Objective: To investigate the relationships between vitamin D nutritional status and the calcaneal bone mineral density (BMD) in children. Methods: Data were obtained from School-based Cardiovascular and Bone Health Promotion Program. In 2017, a total of 15 391 children aged 6-16 years in Beijing selected through stratified cluster sampling were included in the baseline survey. A follow-up investigation was conducted in 2019. The questionnaire survey, detection of serum 25-hydroxyvitamin D [25(OH)D] level and ultrasound measurement of calcaneal BMD were conducted. Multivariable linear and logistic regression models were used to analyze the relationships between baseline vitamin D nutritional status and the follow-up calcaneal BMD. Results: A total of 10 914 children aged (11.5±3.3) years (boys accounting for 49.6%) were included in the analysis. The average 25(OH)D level was (35.4±12.0) nmol/L, and the deficiency rate was 36.1%. After the adjustment for age, gender, body mass index, smoking status, alcohol use status, dairy products intake, vitamin D supplement, calcium supplement, physical activity, pubertal development, and baseline calcaneal BMD Z-score, for per 10 nmol/L increase in 25(OH)D, the follow-up calcaneal BMD Z-score increased by 0.01(P=0.041), and the OR(95%CI) of decreased calcaneal BMD Z-score after 2 years was 0.96 (0.93-1.00)(P=0.030). Compared with vitamin D adequacy, the follow-up calcaneal BMD Z-score of children with vitamin D insufficiency and deficiency decreased by 0.03(P=0.307) and 0.06 (P=0.046), and the risk of decreased calcaneal BMD Z-score after 2 years increased by 15%(P=0.037) and 21%(P=0.006), respectively (P for trend<0.05). Conclusions: Vitamin D nutritional status was closely related to calcaneal BMD, and children with adequate vitamin D nutritional status tended to obtain higher BMD. Children and adolescents are encouraged to maintain sufficient vitamin D levels, strengthen nutrition and exercise to promote bone health.

[Association of vitamin D nutritional status with body muscle mass in school-age children adolescents]

Objective: To investigate the association between vitamin D nutritional status and the body muscle mass in children. Methods: Data were obtained from School-based Cardiovascular and Bone Health Promotion Program. In 2017, a total of 15 391 children aged 6-16 years in Beijing were selected through stratified cluster sampling in baseline survey. A follow-up investigation was conducted in 2019. The questionnaire survey and the detection of serum 25-hydroxyvitamin D [25(OH)D] level were conducted. The bioelectrical impedance analysis (BIA) apparatus was used to measure body muscle mass, and muscle mass index (MMI) was calculated. Multivariable linear models were used to analyze the association of vitamin D nutritional status with the baseline and follow-up MMI measures. Results: A total of 10 890 children aged (11.5±3.3) years(boys accounting for 49.6%) were included in the analysis. The average 25(OH)D level was (35.4±12.0) nmol/L, with an adequacy ratio of 11.1%. After multivariate linear regression adjustment for age, sex, body fat mass, smoking status, alcohol use status, dairy supplement, calcium supplement, physical activity, and pubertal development, no statistically significant association between vitamin D nutritional status and baseline MMI level was observed (P>0.05). For the follow-up MMI, the Z-score increased by 0.008 (P=0.058) for per 10 nmol/L increase in 25(OH)D, which were 0.002 (P=0.815) and 0.037 (P=0.031) higher in children with insufficient and adequate vitamin D than those with vitamin D deficiency, respectively (P for trend =0.089). Subgroup analysis showed that in the normal BMI group, for per 10 nmol/L increase in 25 (OH) D, the MMI at baseline survey and MMI Z-score at follow-up of children with adequate vitamin D and increased by 0.019 and 0.014, respectively (both P<0.05). Conclusions: Vitamin D nutritional status was related to muscle mass in children, and children with adequate vitamin D tended to obtain higher MMI. Children and adolescents are encouraged to maintain sufficient vitamin D levels, strengthen nutrition and exercise to promote body health.

[Study on the association between vitamin D and body fat distribution in children and adolescents]

Objective: To investigate the association of vitamin D with distribution of body fat in children and adolescents. Methods: Data were obtained from the baseline survey of School-based Cardiovascular and Bone Health Promotion Program in 2017. Multiple linear regression and multinomial logistic regression models were applied to analyze the relationships of body mass index (BMI), fat mass index (FMI), trunk fat mass index (TFMI), appendicular fat mass index (AFMI), and visceral fat area(VFA) with vitamin D level and status in children and adolescents. Results: A total of 11 960 children and adolescents were included in the analysis (boys accounting for 49.7%). The average age and serum vitamin D level of study population were (11.0±3.3) years and (35.0±11.9) nmol/L, respectively. The deficiency rate of vitamin D was 37.2%. Gender-specific associations of BMI, FMI, TFMI, and AFMI with vitamin D level were found (P for interaction <0.05): they were inversely associated with vitamin D level in boys (BMI: β=-0.56; FMI: β =-0.59; TFMI: β=-0.60; AFMI: β=-0.59; all P<0.05), but not in girls (P>0.05). VFA was positively associated with vitamin D deficiency and insufficiency in both boys and girls, and the risks of vitamin D deficiency and insufficiency all increased by 17%(95%CI: 9%-25%) for per increment of standard deviation in VFA. Conclusions: The higher level of visceral fat was associated with the lower vitamin D levels in children. Abdominal obese children and boys with excessive body fat are the key population in the prevention and control of vitamin D deficiency.

[A prospective cohort study on the associations between vitamin D nutritional status and cardiometabolic abnormities in children]

Objective: To investigate the relationships between vitamin D nutritional status and the risks of cardiometabolic abnormities in children. Methods: Data were obtained from the School-based Cardiovascular and Bone Health Promotion Program. In 2017, a total of 15 391 children aged 6-16 years in Beijing were selected by using a stratified cluster sampling method in the baseline survey. A Follow-up investigation was conducted in 2019. Log-binomial regression was used to analyze the relationships between baseline vitamin D nutritional status and the risks of cardiometabolic abnormities (obesity, hypertension, hyperglycemia, and dyslipidemia). Results: A total of 10 482 participants were involved in the study. The average vitamin D level was (35.6 ± 12.0) nmol/L, and the deficiency rate was 35.1%. The 2-year cumulative incidence rates of obesity, hypertension, hyperglycemia, high TC, high LDL-C, low HDL-C, high TG, and high non-HDL-C were 4.3%, 10.8%, 8.5%, 3.1%, 2.5%, 3.4%, 2.5%, and 3.9% respectively. After the adjustment of potential confounding factors, children with vitamin D inadequacy or deficiency had higher risks of high TC [RR (95%CI): inadequacy, 2.06 (1.19-3.58); deficiency, 2.80 (1.61-4.89)], high LDL-C [RR (95%CI): inadequacy, 1.67 (1.02-2.73); deficiency, 1.99 (1.19-3.33)], and high non-HDL-C [RR (95%CI): inadequacy, 2.00 (1.26-3.17); deficiency, 2.45 (1.53-3.92)] compared with children with adequate vitamin D, and the risks of them increased with the decrease of vitamin D level (trend P<0.05). The gender-stratified analysis showed that vitamin D deficiency was remained associated with high TC [RR (95%CI): boy, 2.64 (1.19-5.87); girl, 3.13 (1.43-6.83)] and high non-HDL-C [RR (95%CI): boy, 2.58(1.40-4.77); girl, 2.31 (1.10-4.84)]. Conclusions: The risks of abnormal TC, LDL-C, and non-HDL-C were inversely associated with vitamin D level. Maintenance of adequate vitamin D status in children may contribute to the early prevention of cardiovascular diseases.

[Developmental characteristics on body composition in Chinese urban children and adolescents aged 3-17 years old]

Objective: To describe the body composition related developmental characteristics in Chinese children and adolescents aged 3-17 years. Methods: Data were obtained from the 'China Child and Adolescent Cardiovascular Health (CCACH) cross-sectional survey' in 2015, which including seven cities. Questionnaire survey, anthropometric measurements were carried out with body composition also measured, using the Hologic Discovery Dual Energy X-ray Absorptiometry (DXA) scanner. BMI, fat mass percentage (FMP), fat mass index (FMI) and fat free mass index (FFMI) were calculated. SAS 9.4 and SPSS 20.0 softwares were used for data analysis. Results: A total of 10 867 participants aged 3-17 years were involved in this study, including 5 512 boys (50.7%). FMP in boys decreased obviously between 10-15 years old[β=-1.811 (95%CI: -1.987 - -1.635)]. FMP in girls decreased between 3-7 years old[β=-0.896 (95%CI: -1.100 - -0.691)] and increased obviously between 12-15 years old [β=0.989 (95%CI: 0.753-1.224)]. In general, FMP in girls were higher than that in boys in every age group, except for the 9 and 10 years old groups ( all P<0.05). FFMI of boys was higher than that in girls at all ages. Differences on FFMI were getting bigger between boys and girls in the 11 years old group and above. FMI increased with age [boys: β=0.033 (95%CI: 0.018-0.048); girls: β=0.192 (95%CI: 0.181-0.204)] and intersected between genders. Adiposity rebound age was earlier in the obese group than that in both overweight and normal weight groups. FMI in normal weight boys decreased with age and remained lower than 5 kg/m(2), while FMI in overweight [β=0.114 (95%CI: 0.091-0.136)] and obese [β=0.211 (95%CI: 0.176-0.245)] boys increased with age. FMP in boys decreased with age from 10 years old in all weight status groups [normal weight: β=-0.836 (95%CI: -0.924 - -0.748); overweight: β=-1.090 (95%CI: -1.269 - -0.910); obese: β=-1.144 (95%CI: -1.321- -0.967)]. BMI, FFMI, FMI in girls changed with age similarly in all weight status groups and increased from 8 years old[normal weight: β=0.174 (95%CI: 0.165- 0.182); overweight: β=0.325 (95%CI: 0.304-0.346); obesity: β=0.447 (95%CI: 0.406-0.488)]. Changes in FMP in girls increased significantly with age after 12 years old [normal weight: β=0.963 (95%CI: 0.851-1.074); overweight: β=0.910 (95%CI: 0.695-1.125); obesity: β=0.895 (95%CI: 0.569-1.221)]. In total, correlation indexes of BMI and FMI were strong (boys: r=0.767; girls: r=0.873) and were different in various weight status groups. Conclusions: The growth chart of BMI presented inconsistently with the different developmental characteristics of body fat, and gender. Measurement on body composition needs to be developed for children and adolescents to give more precisely assessment on growth and development of children.

Cooperation of Dnmt3a R878H with Nras G12D promotes leukemogenesis in knock-in mice: a pilot study

BACKGROUND

DNMT3A R882H, a frequent mutation in acute myeloid leukemia (AML), plays a critical role in malignant hematopoiesis. Recent findings suggest that DNMT3A mutant acts as a founder mutation and requires additional genetic events to induce full-blown AML. Here, we investigated the cooperation of mutant DNMT3A and NRAS in leukemogenesis by generating a double knock-in (DKI) mouse model harboring both Dnmt3a R878H and Nras G12D mutations.

METHODS

DKI mice with both Dnmt3a R878H and Nras G12D mutations were generated by crossing Dnmt3a R878H knock-in (KI) mice and Nras G12D KI mice. Routine blood test, flow cytometry analysis and morphological analysis were performed to determine disease phenotype. RNA-sequencing (RNA-seq), RT-PCR and Western blot were carried out to reveal the molecular mechanism.

RESULTS

The DKI mice developed a more aggressive AML with a significantly shortened lifespan and higher percentage of blast cells compared with KI mice expressing Dnmt3a or Nras mutation alone. RNA-seq analysis showed that Dnmt3a and Nras mutations collaboratively caused abnormal expression of a series of genes related to differentiation arrest and growth advantage. Myc transcription factor and its target genes related to proliferation and apoptosis were up-regulated, thus contributing to promote the process of leukemogenesis.

CONCLUSION

This study showed that cooperation of DNMT3A mutation and NRAS mutation could promote the onset of AML by synergistically disturbing the transcriptional profiling with Myc pathway involvement in DKI mice.

Histone variants: critical determinants in tumour heterogeneity

Malignant cell transformation could be considered as a series of cell reprogramming events driven by oncogenic transcription factors and upstream signalling pathways. Chromatin plasticity and dynamics are critical determinants in the control of cell reprograming. An increase in chromatin dynamics could therefore constitute an essential step in driving oncogenesis and in generating tumour cell heterogeneity, which is indispensable for the selection of aggressive properties, including the ability of cells to disseminate and acquire resistance to treatments. Histone supply and dosage, as well as histone variants, are the best-known regulators of chromatin dynamics. By facilitating cell reprogramming, histone under-dosage and histone variants should also be crucial in cell transformation and tumour metastasis. Here we summarize and discuss our knowledge of the role of histone supply and histone variants in chromatin dynamics and their ability to enhance oncogenic cell reprogramming and tumour heterogeneity.

Fundamental studies of ultrasonic melt processing

Ultrasonic (cavitation) melt processing attracts considerable interest from both academic and industrial communities as a promising route to provide clean, environment friendly and energy efficient solutions for some of the core issues of the metal casting industry, such as improving melt quality and providing structure refinement. In the last 5 years, the authors undertook an extensive research programme into fundamental mechanisms of cavitation melt processing using state-of-the-art and unique facilities and methodologies. This overview summarises the recent results on the evaluation of acoustic pressure and melt flows in the treated melt, direct observations and quantitative analysis of cavitation in liquid aluminium alloys, in-situ and ex-situ studies of the nucleation, growth and fragmentation of intermetallics, and de-agglomeration of particles. These results provide valuable new insights and knowledge that are essential for upscaling ultrasonic melt processing to industrial level.

[Characteristics of cardiovascular health of children and adolescents aged 6-16 years in Beijing during 2017-2018]

Objective: To describe the status of cardiovascular health (CVH) of children and adolescents aged 6-16 years in Beijing during 2017-2018. Methods: The school-based Cardiovascular and Bone Health Promotion Program(SCVBH) was conducted from November 2017 to January 2018. 15 391 children and adolescents aged 6-16 years were selected from grade 1 to 4 in 8 primary schools, grade 1 in 21 middle schools and senior grade 1 in one twelve-year education school in Dongcheng, Fangshan, Miyun and Haidian Districts of Beijing by using a cluster sampling method. Seven cardiovascular health indicators, including smoking, body mass index, dietary intake, physical activity, blood pressure, blood glucose, and total cholesterol, were categorized as poor, intermediate, and ideal according to American Heart Association (AHA) criteria. The status of CVH was evaluated according to the criteria of the ideal CVH related behaviors and factors defined by AHA. Results: The proportion of children and adolescents with an ideal smoking, dietary intake and physical activity indicators reached 99.2%(4 982/15 108), 19.7%(2 921/14 805), 17.8% (2 499/14 056), respectively. The proportion of children and adolescents with 7 and 4-5 ideal cardiovascular health indicators was 1.7%(209/12 560) and 65.1%(8 176/12 560). The proportion of children and adolescents with 4-7 ideal cardiovascular health indicators, 2-4 ideal health behavior indicators and 2-3 ideal health factors was significantly higher in urban than that in rural all P values<0.001. The proportion of females with 4-7 ideal cardiovascular health indicators, 2-4 ideal health behavior indicators and 2-3 ideal health factors was significantly higher than that in males (all P values<0.001). Conclusion: The prevalence of ideal cardiovascular health of children and adolescents aged 6-16 years in Beijing during 2017-2018 was very low, particularly for healthy dietary intake and physical activity. Effective public health interventions should be implemented to improve the status of cardiovascular health of them.

[Characteristics of cardiometabolic risk factors of children and adolescents aged 6-17 years in seven cities in China from 2013 to 2015]

Objective: To describe characteristics of cardiometabolic risk factors of children and adolescents aged 6-17 years in 7 cities in China from 2013 to 2015. Methods: Data was from the China Child and Adolescent Cardiovascular Health (CCACH) study. 12 590 children and adolescents were selected from 24 schools (3 kindergartens, 7 primary schools, 7 junior high schools and 7 senior high schools) in seven cities (Changchun, Yinchuan, Beijing, Jinan, Shanghai, Chongqing and Tianjin) during 2013-2015 by using a stratified cluster random sampling method. The demographic characteristics, e.g. birth date, feed status and history of disease, were collected by questionnaires. Anthropometric measurements, i.e. weight, height, waistline, blood pressure, total cholesterol, fasting plasma glucose, triglyceride and high-density lipoprotein, were also collected. The detection rate of metabolic syndrome was calculated respectively according to "international diabetes federation standard " and "definition and prevention of metabolic syndrome in Chinese children and adolescents " . Results: The prevalence of cardiometabolic risk factors such as obesity, hypertension, hyperglycemia and dyslipidemia was 12.0%(1 497/12 491), 18.2%(2 193/12 035), 24.4%(3 028/12 422) and 15.8%(1 977/12 490), respectively. The prevalence of these four cardiometabolic risk factors in males was significantly higher than that in females (all P values<0.05). The prevalence of metabolic syndrome was 3.3%(272/8 328) with international diabetes federation 2007 definition and 5.4% (453/8 325) with Chinese definition among children above 10 years old. The prevalence of hypertension, hyperglycemia, hypertriglyceridemia, high total cholesterol, low high-density lipoproteincholesterol and dyslipidemia increased with the change of obesity type from non-obesity to complex obesity (all P values<0.001). Conclusion: The prevalence of cardiometabolic risk factors was still high in children and adolescents, which has become an important factor threatening the healthy growth of children and adolescents.

[The association between body fat distribution and calcaneal bone mineral density in children and adolescents aged 6-16 years in Beijing]

Objective: To understand the association between body fat distribution and calcaneal bone mineral density (BMD) in children and adolescents aged 6-16 years in Beijing. Methods: Children and adolescents were selected in 30 schools (8 primary schools, 21 middle schools and one 12-year education school) from Dongcheng, Tongzhou, Fangshan and Miyun districts of Beijing by using a stratified cluster sampling method from November 2017 to January 2018. A total of 15 030 students in grade 1 to 4 of primary school, grade 1 of junior and senior middle school were enrolled after excluding subjects who were not able to participate into this study due to trauma or other uncomfortable physical conditions or with missing key values or with diabetes and kidney diseases. Questionnaire survey, body composition and calcaneus bone mineral density were conducted. The relation of fat mass percentage (FMP), trunk to total fat ratio (TrTFR), trunk to limb fat ratio (TrLFR), limb to total fat ratio (LTFR) and viscera to total fat ratio (VTFR) with calcaneus BMD were assessed using the multivariate linear regression models after adjusting for possible confounding effects. The central fat distribution types were divided into 4 groups including type 1: both trunk fat and visceral fat greater than the sex-and age-specific internal P(75); type 2: barely trunk fat greater than P(75); type 3: barely visceral fat greater than P(75); type 4: both trunk fat and visceral fat greater than P(75). The central fat distribution types were included into the model in the form of dummy variables to analyze its relationship with calcaneal BMD. The sex-and age-specific z-scores of fat distribution indicators and BMD were calculated. Results: A total of 15 030 participants aged (11.4±3.3) years (50.2% boys) were involved in the analysis. In both genders, after adjusting for age, height, lean mass index, smoking, drinking, physical activity, milk intake, vitamin D and calcium supplementation, FMP, TrTFR, TrLFR and VTFR were negatively correlated with calcaneal BMD (all P value<0.05), while LTFR was positively associated with calcaneal BMD (all P values<0.05). Compared to the central fat distribution type 1, the regression coefficients (95% CI) of type 2, 3 and 4 were -0.253 (-0.418, -0.087), -0.385 (-0.567, -0.204) and -0.428 (-0.487, -0.369) in boys, respectively; the regression coefficients (95% CI) of type 3 and 4 were -0.158 (-0.301, -0.015) and -0.226 (-0.290, -0.163), respectively. Conclusion: Body fat distribution and central fat distribution in children and adolescents were correlated with calcaneus bone mineral density.

[The association between blood lipids and calcaneus bone mineral density in children and adolescents aged 6-16 years in Beijing]

Objective: To investigate the association between blood lipid and calcaneus bone mineral density (BMD) in children and adolescents aged 6-16 years in Beijing. Methods: Children and adolescents were selected in 30 schools (8 primary schools, 21 middle schools and one 12-year education school) from Dongcheng, Tongzhou, Fangshan and Miyun districts of Beijing by using a stratified cluster sampling method from November 2017 to January 2018. A total of 14 303 students in grade 1 to 4 of primary school, grade 1 of junior and senior middle school were enrolled after excluding subjects who were not able to participate into this study due to trauma or other uncomfortable physical conditions or with missing key values or with diabetes and kidney diseases. Questionnaire survey, blood lipid and calcaneus BMD were conducted. Multivariate linear regression was applied to quantify the association between calcaneal BMD as a dependent variable and blood lipid level as an independent variable after adjusting for the potential confounding factors. Furthermore, quantile regression was used to analyze the association between blood lipid level and different percentiles (P(25), P(50) and P(75)) of ultrasonic velocity values of bone mineral density, and parallel test was conducted for regression coefficients of different percentiles. Results: A total of 14 303 participants aged (11.4±3.3) years (49.9% boys) were involved in the analysis. The mean age of 14 303 participants was (11.0±3.3) years. 7 142 boys accounted for 49.9%. The mean±SD of calcaneal BMD, total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein-cholesterol (HDL-C) were (1 540.9±33.8) m/s, (3.90±0.76), (2.18±0.62), and (1.40±0.32) mmol/L, respectively. The P(5)0 (P(25), P(75)) of triglyceride (TG) was 0.69 (0.49-0.94) mmol/L. After the adjustment of age, height, smoking, drinking, vitamin D and calcium supplementation, dairy intake, physical activity, FMI, and MMI, a significantly inverse association (P<0.05) between TG level and calcaneus BMD was observed in both genders, which the regression coefficients (95%CI) in boys and girls were -0.064 (-0.085, -0.044) and -0.073 (-0.094, -0.053), respectively. Conclusion: The level of BMD was associated with TG in boys and girls. Therefore, it is important to prevent children from hypertriglyceridemia for the bone health promotion.

Lymphocyte-Specific Chromatin Accessibility Pre-determines Glucocorticoid Resistance in Acute Lymphoblastic Leukemia

Glucocorticoids play a critical role in the treatment of lymphoid malignancies. While glucocorticoid efficacy can be largely attributed to lymphocyte-specific apoptosis, its molecular basis remains elusive. Here, we studied genome-wide lymphocyte-specific open chromatin domains (LSOs), and integrated LSOs with glucocorticoid-induced RNA transcription and chromatin modulation using an in vivo patient-derived xenograft model of acute lymphoblastic leukemia (ALL). This led to the identification of LSOs critical for glucocorticoid-induced apoptosis. Glucocorticoid receptor cooperated with CTCF at these LSOs to mediate DNA looping, which was inhibited by increased DNA methylation in glucocorticoid-resistant ALL and non-lymphoid cell types. Our study demonstrates that lymphocyte-specific epigenetic modifications pre-determine glucocorticoid resistance in ALL and may account for the lack of glucocorticoid sensitivity in other cell types.

[Influence of change in blood pressure status from childhood to adulthood on renal dysfunction: a cohort study]

Objective: To investigate the influence of change in blood pressure status from childhood to adulthood on renal damage. Methods: Data were obtained from Beijing Blood Pressure Cohort initiated from 1987. 3 198 children and adolescents aged 6-18 years from 6 primary and 6 middle schools in Chaoyang, Xicheng and Haidian Districts of Beijing were enrolled at baseline by using a cluster random sampling method, and 1 222 participants were followed up during 2010-2012. The measurements included weight, height, and blood pressure at baseline and microalbumin, serum creatinine, cystatin C and blood pressure at follow-up. Based on blood pressure status in childhood and adulthood, the participants were divided into four groups: participants with normal blood pressure in both childhood and adulthood, participants with elevated blood pressure in childhood but normal blood pressure in adulthood, participants with normal blood pressure in childhood but elevated blood pressure in adulthood, and participants with elevated blood pressure in both childhood and adulthood. Multivariate linear regression model was used to investigate the association of change in blood pressure from childhood to adulthood on renal dysfunction. Results: The prevalence of elevated blood pressure in childhood and adulthood was 17.9% and 39.9%, respectively. The P(50) (P(25)-P(75)) of microalbumin was 5.7(3.0-12.0) mg/L, and the concentration of eGFR and cystatin C were (118.0±19.8)% and (0.734±0.184)mg/L, respectively. With adjustment for sex, baseline age and follow-up years, compared with participants with persistently normal blood pressure from childhood to adulthood, participants with normal blood pressure in childhood but elevated blood pressure in adulthood had significantly higher levels of microalbumin (β=0.502, 95%CI: 0.320-0.684) and cystatin C (β=0.049, 95%CI: 0.025-0.073). After adjustment for sex, baseline age, follow-up duration, and adult BMI, smoking and drinking, participants with normal blood pressure in childhood and elevated blood pressure in adulthood had higher levels of adult urine microalbumin (β=0.322, 95%CI: 0.128-0.516) and cystatin C (β=0.032, 95%CI:0.007-0.057). Conclusion: An increase in blood pressure during childhood and adulthood has an adverse impact on renal functional damage in adulthood. These findings underscore the importance of maintaining normal blood pressure during life course to prevent the development of chronic kidney disease.

[The baseline characteristics of School-based Cardiovascular and Bone Health Promotion Program in Beijing]

Objective: To describe the baseline characteristics of School-based Cardiovascular and Bone Health Promotion Program(SCVBH) in Beijing. Methods: Children and adolescents were selected in 30 schools (8 primary schools, 21 middle schools and one 12-year education school) from Dongcheng, Tongzhou, Fangshan and Miyun districts of Beijing by using a stratified cluster sampling method. 15 391 students in grade 1 to 4 from primary schools, grade 1 from junior and senior high schools were enrolled in the investigation with an exclusion of students who were not able to participate due to trauma or other uncomfortable physical conditions. The baseline survey including a questionnaire survey, physical examination and blood biochemical test was conducted from September 2017 to January 2018. Obesity, blood pressure, fasting blood glucose, lipid, bone density and grip were evaluated. Results: The prevalence of obesity, hypertension, hyperglycemia (impaired fasting glucose and diabetes), dyslipidemia, lower bone density were 22.3%(3 394), 14.8%(2 248), 10.4%(1 490), 20.3%(2 919) and 2.1%(316) in total respectively, and 27.2%(2 081), 16.3%(1 244), 12.8%(922), 22.2%(1 595) and 1.2%(94) for boys, 17.3%(1 313), 13.3% (1 004), 7.9%(568), 18.4%(1 324) and 2.9%(229) for girls. Boys had higher prevalence of obesity, hypertension, hyperglycemia, and dyslipidemia and lower prevalence of low bone density than girls (all P values <0.05) The mean of body mass index, systolic blood pressure, fasting plasma glucose and grip of boys were significantly higher than that of girls (all P values <0.05).The mean of body mass index, systolic blood pressure, fasting plasma glucose and grip of boys were significantly higher than that of girls (all P values <0.05), the mean of fat mass percentage, total cholesterol, triglyceride, high density lipoprotein-cholesterol and low density lipoprotein-cholesterol of boys were significantly lower than those of girls (all P values <0.05). Conclusion: The prevalence of risk factors of chronic cardiovascular disease was high and the low bone density was appearing in children and adolescents in this study. The promotion of cardiovascular and bone health should be implemented in children and adolescents.

Abstract 3173: Lymphocyte-specific chromatin accessibility predetermines glucocorticoid resistance in acute lymphoblastic leukemia

Glucocorticoids are well known for their immunosuppressive activity, and play a critical role in the treatment of lymphoid malignancies. However, the development of resistance remains a significant barrier to cure and the mechanisms are poorly defined. Moreover, glucocorticoids are rarely efficacious in treating myeloid and other non-lymphoid malignancies, and the mechanisms of lymphocyte-specific efficacy are unclear. To address these issues, we first carried out a global analysis of DNase I hypersensitive sites in 18 lymphoid and 64 non-lymphoid cell types to map lymphocyte-specific open chromatin domains (LSOs). We then integrated these domains with genome-wide glucocorticoid-induced gene transcription and epigenetic modulation in an in vivo patient-derived xenograft (PDX) model of acute lymphoblastic leukemia (ALL). Performing chromatin immunoprecipitation and assays for transposase-accessible chromatin (ATAC), we determined a strong correlation between glucocorticoid receptor (GR) binding and chromatin accessibility, acetylated histone marks and binding of a DNA structural protein (CTCF), and identified 1,536 GR bound LSOs. We next analyzed RNA-seq data in glucocorticoid sensitive and resistant ALL PDXs for expression changes in genes located within 100 kb of the LSOs after glucocorticoid treatment in vivo, and identified four groups comprising 389 genes that were significantly differentially expressed. Of the 198 up-regulated genes, 143 showed increased H3K27Ac enrichments at 177 LSOs. Forty-two LSOs showed the increase only in glucocorticoid sensitive but not resistant ALLs. Applying this to an extended panel of ALL PDXs, basal DNA methylation at the 42 LSOs was significantly higher in resistant ALLs despite no difference within the gene bodies, whereas the basal chromatin accessibility indicated by ATAC abundance was diminished. Pathway analysis indicated that the LSO regulated genes were involved in repressing B- and T- cell receptor signaling pathways and activating the apoptotic pathway. One such LSO was at the pro-apoptotic BIM gene locus, where CTCF binding was found only in lymphocytes but not in other cell types. The GR cooperated with CTCF to mediate interactions between the promoter and the BIM LSO to direct DNA looping, thus triggering BIM transcription. Importantly, this LSO was heavily methylated in resistant ALLs as well as non-lymphoid cells. Azacitidine, a DNA demethylating drug that is routinely used in the clinic, could partially reverse these changes and restore glucocorticoid sensitivity. Taken together, this study demonstrated for the first time that lymphocyte-specific epigenetic modifications pre-determine glucocorticoid resistance in ALL and may account for the lack of glucocorticoid sensitivity in other cell type. Reversal of these epigenetic changes may lead to improvements in the use of glucocorticoids in the clinic.

Citation Format: Duohui Jing, Yizhou Huang, Xiaoyun Liu, Keith Sia, Rebecca C. Poulos, Miriam Span, Chao Zhang, Jianqing Mi, Jason WH Wong, Dominik Beck, John E. Pimanda, Richard B. Lock. Lymphocyte-specific chromatin accessibility predetermines glucocorticoid resistance in acute lymphoblastic leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3173.

Metformin induces autophagy and G0/G1 phase cell cycle arrest in myeloma by targeting the AMPK/mTORC1 and mTORC2 pathways

Background

Metformin is a commonly used drug for the treatment of diabetes. Accumulating evidence suggests that it exerts anti-tumor effects in many cancers, including multiple myeloma (MM); however, the underlying molecular mechanisms have not been clearly elucidated.

Methods

The anti-myeloma effects of metformin were evaluated using human MM cell lines (RPMI8226 and U266) in vitro and in vivo NOD-SCID murine xenograft MM model. Cell viability was assessed with CCK8 and cell proliferation was measured by EdU incorporation assay. Cell cycle distribution and apoptosis were examined by flow cytometry. Transmission electron microscopy was used to visualized autophagosomes. Activation of AMPK and inhibition of mTORC1/C2 pathways was assessed by Western blot analysis. RPMI8226 cells and U266 cell lines with AMPK knockdown were generated by transfection with small interfering RNA targeting the AMPK-α1 and α2 subunits using Lipofectamine 2000 reagent.

Results

Metformin effectively inhibited the proliferation of MM cell lines, an effect that was associated with the induction of autophagy and G0/G1 cell cycle arrest, but not apoptosis. Metformin activated AMPK and repressed both mTORC1 and mTORC2 signaling pathways in myeloma cells as well as downstream molecular signaling pathways, such as p-4EBP1 and p-AKT. AMPK activation resulted in direct phosphorylation and activation of tuberous sclerosis complex 2 (TSC2), leading to inhibition of the mammalian target of rapamycin (mTOR). In addition, metformin inhibited myeloma cell growth in an AMPK-dependent manner. The xenograft mouse model further confirmed that metformin inhibited tumor growth by upregulation of AMPK and downregulation of mTOR.

Conclusions

Metformin inhibits the proliferation of myeloma cells by inducing autophagy and cell-cycle arrest. Our results suggest that the molecular mechanism involves dual repression of mTORC1 and mTORC2 pathways via AMPK activation. Our study provides a theoretical basis for the development of novel strategies for the treatment of MM using metformin as an already approved and safe drug.

[Association between rs10938397 polymorphism in GNPDA2 and obesity in children at different stages of development]

Objective: To examine the association between rs10938397 polymorphism in glucosamine-6-phosphate deaminase 2 (GNPDA2) and risk of obesity in children at different stages of development and analyze the differences in the association. Methods: A total of 3 503 school-aged children were selected from the Beijing Child and Adolescent Metabolic Syndrome (BCAMS) study in Beijing and their complete anthropometry weight, height, fat mass percentage (FMP), fat mass index (FMI) and free fat mass index (FFMI) and sexual maturation (SM) data were used. The developmental stages were evaluated using male testicular volume and female breast Tanner staging. FMP, FM and FFM were measured by bioelectrical impedance analysis. General obesity and adiposity were respectively defined according to Chinese sex-age-specific body mass index (BMI) cutoffs and sex-age-specific FMP cutoffs. The SNP rs10938397 were genotyped by the TaqMan Allelic Discrimination Assay with the GeneAmp 7900 sequence detection system (Applied Biosystems, Foster city, CA, USA). Relationships between rs10938397 polymorphism and BMI, FMP, FMI and FFMI and different types of obesity were tested using multivariate linear regression and logistic regression models. Results: After age adjustment and correction for multiple testing, the rs10938397-G was associated with BMI and risk of general obesity in boys in early puberty (β=0.328, P=0.001; OR=1.420, 95%CI: 1.126-1.790), and the rs10938397-G was associated with BMI in girls in late puberty (β=0.266, P=0.001). The associations of GNPDA2 rs10938397-G with FFMI and FMI were observed in boys in early puberty (β=0.137, P=0.016; β=0.202, P=0.007) and the associations of rs10938397-G with FMP and FMI were observed in girls in late puberty (β=0.153, P=0.002; β=0.168, P=0.001). The rs10938397-G was also associated with adiposity in girls in late puberty (OR=1.339, 95%CI: 1.093-1.637). Conclusion: The rs10938397 polymorphism in GNPDA2 is associated with adiposity in girls, and it is important to use an accurate indicator of obesity in exposing the genuine association between genes and obesity.

Combination of arsenic trioxide and Dasatinib: a new strategy to treat Philadelphia chromosome-positive acute lymphoblastic leukaemia

Tyrosine kinase inhibitors (TKIs) have significantly improved the prognosis of Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph⁺ ALL), one of the most common and aggressive forms of haematological malignancies. However, TKI resistance has remained an unsolved issue. In this study, we investigate the impact of adding arsenic trioxide (ATO) on the action of Dasatinib, a second-generation TKI, in Ph⁺ ALL. We show that ATO cooperates with Dasatinib in both TKI-sensitive and resistant Ph⁺ ALL cell lines to increase apoptosis and we unravel the underlying mechanisms. Indeed, combining ATO and Dasatinib leads to severe cell apoptosis by activating the UPR apoptotic IRE1/JNK/PUMA axis, while neutralizing the UPR ATF4-dependent anti-apoptotic axis, activated by ATO alone. Additionally, ATO and Dasatinib in combination repress the expression of several genes, which we previously showed to be associated with shorter survival probability in ALL patients. Overall these data support the use of ATO in combination with Dasatinib as a novel therapeutic regimen for Ph⁺ ALL patients.

[The study of growth differentiation factor-15 in chronic thromboembolic pulmonary hypertension following acute pulmonary thromboembolism]

Objective: To evaluate the incidence of chronic thromboembolic pulmonary hypertension (CTEPH) secondary to acute pulmonary thromboembolism (PTE) and the serum level of growth differentiation factor-15(GDF-15). Methods: Ninety-six acute PTE patients were recruited in the study. Clinical data, Wells score, blood gas analysis, D-dimmer level, GDF-15 level, atrial and ventricular sizes, pulmonary arterial systolic pressure (PASP) and pulmonary artery CT (CTPA) data were collected. Patients were followed up to evaluate the cardiac function (WHO class), ultrasonic cardiogram and CTPA to confirm the incidence of CTEPH. Results: Eighty-fivepatients were followed for 5 months to 58 months (average 26.5±14.7 months). The incidence of CTEPH was 12.9% (11/85). Between CTEPH patients and non-CTEPH patients, PASP, right atrial and ventricular sizes, and GDF-15in the acute stage were significantly different(P<0.05). According to binary logistic regression analysis, the incidence of CTEPH was correlated positively with acute PASP and the serum level of GDF-15. Conclusions: The incidence of CTEPH in acute PTE patients was 12.9% in this study. Acute PASP and higher level of GDF-15 are predictive factors for CTEPH secondary to acute PTE.

FGF21 deficiency is associated with childhood obesity, insulin resistance and hypoadiponectinaemia: The BCAMS Study

OBJECTIVE

Fibroblast growth factor 21 (FGF21) exerts beneficial effects on metabolic homoeostasis and has been reported to be regulated by adiponectin, leptin and resistin. However, while an association between increased circulating FGF21 and metabolic disorders has been reported in adults, paediatric-specific data are lacking.

DESIGN AND METHODS

This study investigated the relationship between FGF21 levels and obesity, insulin resistance (IR), the metabolic syndrome (MetS) and adipokines (adiponectin, leptin and resistin) in a cohort of 3231 Chinese youngsters aged 6-18.

RESULTS

There were gender- and puberty-related differences in FGF21 levels. Unexpectedly, FGF21 levels were decreased in children with obesity, and negatively correlated with insulin, HOMA-IR and leptin levels after adjusting for age, gender, puberty and lifestyle factors. Moreover, multiple regression analyses showed that serum FGF21 positively predicted adiponectin levels while resistin positively predicted FGF21 levels independent of BMI (P<0.05). Children in the lowest FGF21 quintile were more likely to have IR (OR: 1.85, 95% CI: 1.41-2.42; P=0.002) and MetS (OR: 1.62, 95% CI: 1.14-2.28; P=0.007) than those in the highest quintile. Further adjusting for BMI and/or the three adipokines modified the association of FGF21 with MetS (P>0.10) but not with IR (P<0.01).

CONCLUSION

Although the associations between adiponectin, leptin, resistin and metabolic abnormalities in our paediatric population were similar to those in adults, correlations of FGF21 levels with obesity, IR and MetS were the inverse of those found in adults. Our present findings suggest that FGF21 deficiency, rather than resistance, contribute to IR and hypoadiponectinaemia independently of obesity in young people.

Design and Characterisation of Metallic Glassy Alloys of High Neutron Shielding Capability

This paper reports the design, making and characterisation of a series of Fe-based bulk metallic glass alloys with the aim of achieving the combined properties of high neutron absorption capability and sufficient glass forming ability. Synchrotron X-ray diffraction and pair distribution function methods were used to characterise the crystalline or amorphous states of the samples. Neutron transmission and macroscopic attenuation coefficients of the designed alloys were measured using energy resolved neutron imaging method and the very recently developed microchannel plate detector. The study found that the newly designed alloy (Fe₄₈Cr₁₅Mo₁₄C₁₅B₆Gd₂ with a glass forming ability of Ø5.8 mm) has the highest neutron absorption capability among all Fe-based bulk metallic glasses so far reported. It is a promising material for neutron shielding applications.

[Association between SEC16B polymorphisms and body mass index variation or risk of obesity: a Meta-analysis]

Objective: To systematically evaluate the associations between SEC16B polymorphisms and body mass index (BMI) or risk of obesity in different ethnic populations. Methods: A literature retrieval was carried out by using Wanfangdata, Chinese National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP databases), PubMed, Embase, Web of Science, NIH GWAS catalog databases to collect the research papers published between 2009 and 2015 on the associations between SEC16B polymorphisms and BMI or risk of obesity. Summary beta estimates (βs), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the strength for the BMI analyses and obesity status. Meta-analysis was performed with Stata 12.0 software. Results: Totally 15 papers for rs10913469 and 13 papers for rs543874 were included in this Meta-analysis. Under additive genetic model, rs10913469 and rs543874 in SEC16B gene were positively associated with BMI, and the combined β was 0.04 (95%CI: 0.03-0.05) and 0.03 (95%CI: 0.02-0.04), respectively, and rs10913469 and rs543874 were also associated with the risk of obesity, and the combined OR was 1.11 (95%CI: 1.08-1.15) and 1.28 (95%CI: 1.20-1.36), respectively. There were no significant differences among subgroups of ethnicity, different age groups and literatures with different quality. Conclusion: rs10913469 and rs543874 in SEC16B gene are significantly associated with BMI and the risk of obesity, and C allele of rs10913469 and G allele of rs543874 increase the risk for obesity in different ethnic populations.

The Time to Clearance of Peripheral Blood Blasts Predicts Complete Remission and Survival in Chinese Adults with Acute Myeloid Leukemia

The value of clearance of peripheral blood blasts (PBB) as a predictor of outcomes in acute myeloid leukemia (AML) is controversial. To investigate the prognostic significance of the time to clearance of PBB after induction in Chinese patients with AML, a retrospective analysis of 146 patients with newly diagnosed AML at Shanghai Ruijin Hospital was performed. Patients were categorized into early blast clearance (EBC; ≤5 days) and delayed blast clearance (DBC; >5 days) groups based on a receiver operating characteristic analysis. Complete remission (CR) after induction chemotherapy was related to the time to clearance of PBB (p < 0.001). Relapse-free survival (RFS; p = 0.003) and overall survival (p < 0.001) were longer in the EBC group. Multivariate analysis demonstrated that the time to clearance of PBB and cytogenetic risk independently predicted CR and RFS. Early clearance of PBB after induction chemotherapy can be a significant predictor of survival outcomes in AML patients.

Nasal endoscopic findings and nasal symptoms in patients with asthma: a clinical study from a rhinological perspective

OBJECTIVE

Allergic rhinitis (AR), non-allergic rhinitis (NAR), chronic rhinosinusitis with nasal polyps (CRSwNP), and chronic rhinosinusitis without nasal polyps (CRSsNP) occur frequently in asthmatic patients. We evaluated nasal symptoms and nasal endoscopic findings in patients with asthma and correlated them to asthma severity.

METHODS

Subjects (n=150) with asthma completed questionnaires designed to provide information related to asthma and nasal disease. Patients were divided into four groups based on asthma severity. Pulmonary function tests, skin-prick tests (SPTs) and nasal endoscopy were performed on every patient. Clinical findings were compared in asthma patients by rhinologists.

RESULTS

The total incidence of AR, NAR, CRSwNP and CRSsNP in these patients with asthma was 76%. By using Fisher's Exact Test, there was no statistical significance between asthma severity and the incidence of AR, NAR, CRSwNP and CRSsNP (P=0.311). There was a significant difference in the total nasal symptoms score among subjects with different grades of asthma (P=0.002). However, there were no significant differences in the total Lund-Kennedy endoscopic score (LKS) (P=0.736). The nasal endoscopic scores were significantly correlated at a high degree with the nasal symptoms score (P=0.000). A significant correlation was found between the nasal endoscopic score and the duration of asthma in the patients with different grades of asthma (P<0.05).

CONCLUSIONS

The relationship between rhinitis and asthma is complex. Nasal airways should become part of standard clinical assessment and follow-up in patients with asthma.