Hydrogen cyanamide exposure: a case series from Pavia Poison Control Centre

BACKGROUND

Hydrogen cyanamide is a plant growth regulator introduced in Italy as Dormex in 2000, but recalled from the market in 2008. It's currently not authorized in Europe. Inhalation/dermal contact may cause irritation/caustic burns, ingestion of severe organ damage and concomitant alcohol consumption disulfiram-like reaction due to aldehyde-dehydrogenase inhibition by hydrogen cyanamide.

AIMS

To study all exposure cases referred to our centre, evaluating temporal and geographic distribution and analysing clinical manifestations, including the ones after alcohol consumption.

METHODS

We retrospectively evaluated all hydrogen cyanamide exposures referred to our Poison Control Centre (January 2007-December 2021). For each case, age, sex, exposure route/year, geographical location, intent of exposure, alcohol co-ingestion, emergency department-admission Poison Severity Score, signs/symptoms and treatment were analysed.

RESULTS

Thirty subjects were included. Median case/year was 1 [1; 2]: 79% occurred after market withdrawal, 92% in Sicily. All exposures were unintentional and work related; 41% of patients also co-ingested alcohol. Mean poison severity score at emergency department admission was 1.54, more severe when ingestion occurred. The most common signs/symptoms were flushing, secondary to peripheral vasodilation (41%), hyperaemia/erythema (29%), dyspnoea (25%), nausea (20%), vomiting (12%), oedema (12%), II-III degrees burns (12%) and pharyngodynia (12%). All patients were treated symptomatically and fully recovered.

CONCLUSIONS

Hydrogen cyanamide exposure can lead to severe clinical manifestations. Despite its withdrawal from the Italian market, hydrogen cyanamide is still used: through PCC's crucial role in monitoring exposure to agricultural products efforts should be made to contrast illegal trade and increase awareness of its potential toxicity in those countries in which it's still legal.

POS0536 REFINING THE SEROLOGICAL SCORES OF THE ACR/EULAR 2010 RHEUMATOID ARTHRITIS CLASSIFICATION CRITERIA: AN INTERNATIONAL STUDY

Background

Rheumatoid factor (RF) and anti-cyclic citrullinated protein/peptide antibodies (ACPA) are included in the ACR/EULAR 2010 classification criteria for rheumatoid arthritis (RA)(1). Both markers are given the same weight in the criteria.

Objectives

As the performance characteristics differ significantly between RF and ACPA(2), we set out to refine the serological scores for RA classification.

Methods

Diagnostic samples from 398 RA patients and from 1073 diseased controls were evaluated with five RF assays (two RF IgM isotype-specific assays and three total RF assays) and five ACPA IgG assays from five different manufacturers.

Results

Firstly, we harmonized thresholds between manufacturers based on predefined specificity for low positive (at 92.5% specificity for RF and at 97.5% specificity ACPA) and high positive results (at 97.5% specificity RF and at 99.0% specificity for ACPA). Next, we determined likelihood ratios (LRs) for RF, ACPA, and combinations of both, for negative, low positive, and high positive results. The LR was higher for ACPA than for RF, for high positive results than for low positive results and for double positivity than for single positivity. Based on these data we refined the weights of serological scores for classification (Table 1).

Table 1.

Refined weights of serological scores for RA classification

RF negativeRF low positiveRF high positiveACPA negative011ACPA low positive233ACPA high positive344

Application of such refined serological weights significantly increased the area under the curve of receiver operating characteristics analysis to distinguish RA from controls, significantly reduced the serological scores in the controls as well as the number of RA misclassifications without affecting the diagnostic sensitivity.

Besides, we showed that combining predefined specificity thresholds with the refined serological scoring, reduced manufacturer-dependent variability in RA classification impacting RA classification for controls from 18.0-29.0% by ACR/EULAR to 11.0-13.0% (significantly increasing specificity) and for RA patients from 67.8-74.0% to 67.6-71.5% (without significantly affecting sensitivity).

Conclusion

Serological weight factors for RA classification can be improved by taking into account the antibody type (RF versus ACPA), the antibody level, and single or combined positivity.

References

[1]Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham COr, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010; 69: 1580-8.

[2]Bossuyt X. Anticitrullinated protein antibodies: taking into account antibody levels improves interpretation. Ann Rheum Dis 2017; 76: e33.

Acknowledgements

We thank all participating diagnostic companies for the in-kind support of assays, their technical training and the constructive discussions. Furthermore, we are very thankful to the laboratory technicians of all participating laboratories for their most appreciated assistance in the performance of the RF/ACPA analyses.

Disclosure of Interests

Lieve Van Hoovels Speakers bureau: Thermo Fisher, Consultant of: Thermo Fisher, Grant/research support from: Thermo Fisher, Bert Vander Cruyssen: None declared, Daniela Sieghart Speakers bureau: Thermo Fisher, Consultant of: Thermo Fisher, Carolien Bonroy: None declared, Eszter Nagy: None declared, Rille Pullerits: None declared, Saša Čučnik: None declared, Charlotte Dahle: None declared, Ingmar Heijnen Speakers bureau: Thermo Fisher, Luca Bernasconi Speakers bureau: Thermo Fisher, Farid Benkhadra: None declared, Laura Bogaert: None declared, Stefanie Van Den Bremt: None declared, Ann Vanliedekerke: None declared, Geert Vanheule: None declared, Johan Robbrecht: None declared, Lucy Studholme: None declared, Wirth Claudine: None declared, Rüdiger Müller: None declared, Diego Kyburz: None declared, Christopher Sjowall: None declared, Alf Kastbom: None declared, Rok Jese: None declared, Boja Jovancevic: None declared, Emese Virag Kiss: None declared, Peggy Jacques: None declared, Günter Steiner Speakers bureau: Thermo Fisher, Consultant of: Thermo Fisher, Patrick Verschueren: None declared, Xavier Bossuyt Speakers bureau: Thermo Fisher, Consultant of: Thermo Fisher.

Parallel implementation of the ab initio CRYSTAL program: electronic structure calculations for periodic systems

CRYSTAL is an ab initio electronic structure program, based on the linear combination of atomic orbitals, for periodic systems. This paper concerns the ability of CRYSTAL to exploit massively parallel computer hardware. A brief review of the theory, numerical implementations and parallel solutions will be given and some of the functionalities and capabilities highlighted. Some features that are unique to CRYSTAL will be described and development plans outlined.

Lifetime and actual prevalence of pain and headache in multiple sclerosis

The aim of the present study is to assess the actual and lifetime frequency of neuropathic (trigeminal neuralgia, Lhermitte’s sign, dysesthesic pain) and somatic (painful muscle spasms and low back pain) pain and headache (tensive headache and migraine) in a cross-sectional sample of 428 consecutive multiple sclerosis (MS) outpatients followed-up in an Italian University MS center over a 3-month period. The impact of demographic and disease-related variables on pain and headache risk is also studied. A semi-structured questionnaire was administered during a face-to-face interview with MS patients and a multivariate logistic regression model is applied to obtain crude and adjusted risk measures. The mean age of the sample was 38.4 years, and female/male ratio was 1.65. The mean disease duration was 9.6 years and the median Expanded Disability Status Scale was 2.0, with most of the patients (74.8%) being affected by the relapsing–remitting form. Lifetime prevalence at the date of examination of at least one type of neuropathic or somatic pain was 39.8% in MS patients, with 58.5% also including headache, while the actual prevalence was 23.8% and 39.9%, respectively. After multivariate analysis, a progressive course of disease was shown to increase the risk of dysesthesic pain and painful muscle spasms, while greater disability was responsible for a higher risk of back pain. L’Hermitte’s sign was more frequent in younger patients, while females had a higher risk of headache. Pain and headache in MS are not negligible symptoms and a neurological examination should not miss the assessment of risk factors for specific types of pain for a more specific and individualized treatment.

Beneficial effects of r-h-CLU on disease severity in different animal models of peripheral neuropathies

Clusterin is a protein involved in multiple biological events, including neuronal cytoprotection, membrane recycling and regulation of complement-mediated membrane attack after injury. We investigated the effect of recombinant human clusterin in preclinical models of peripheral neuropathies. Daily treatment with clusterin accelerated the recovery of nerve motor evoked potential parameters after sciatic nerve injury. Prophylactic or therapeutic treatment of experimental autoimmune neuritis rats with clusterin also accelerated the rate of recovery from the disease, associated with remyelination of demyelinated nerve fibers. These data demonstrate that clusterin is capable of ameliorating clinical, neurophysiological and pathological signs in models of peripheral neuropathies.

Cortical function abnormalities in migraine: neurophysiological and neuropsychological evidence from reaction times and event-related potentials to the Stroop Test

Cortical hyperexcitability was studied in migraine patients using reaction times (RT's) and Event-Related Potentials (ERP) to the Stroop test. We found a slower RTs in patients if compared to controls, supporting the hypothesis of a mild cortical functions impairment even in interictal periods in this group of patients.

Maturation of the humoral autoimmune response to epitopes of GAD in preclinical childhood type 1 diabetes

GAD is a major target of autoimmunity in preclinical type 1 diabetes. Here we examine the maturation of the humoral response to GAD epitopes sequentially from birth to diabetes onset or current follow-up in 29 GAD antibody (GADA)+ offspring of parents with diabetes from the BABYDIAB Study. Antibodies were measured against GAD65, GAD67, and GAD65/67 chimeras by radiobinding assay. In 28 of 29 offspring, the first GADAs contained reactivity against epitopes within GAD65 residues 96-444, suggesting that the middle GAD65 region is a primary target of GAD humoral autoimmunity. In 7 of these 28 offspring, initial antibody reactivity was against all epitope regions tested (middle GAD65, COOH-terminal GAD65 residues 445-585, NH2-terminal GAD65 residues 1-95, and GAD67); in 16 offspring, reactivity was to middle and COOH-terminal GAD65 epitopes, and in 5 offspring, reactivity was only to the middle GAD65 epitopes. The single offspring without middle GAD65 reactivity had antibodies to the NH2-terminal epitopes in the absence of all other islet autoimmunity. Subsequent GADA epitope spreading was frequent and seen in 10 of 15 offspring with informative follow-up samples. Spreading was mostly (eight cases) to NH2-terminal GAD65 epitopes. In two offspring, spreading to new epitopes was found when antibody titers to GAD65 and early epitopes were declining, suggesting determinant-specific regulation of the humoral response. None of the GADA reactivities nor any changes in reactivity over time were specifically associated with diabetes onset. The findings suggest that the humoral autoimmune response to GAD found in childhood is dynamic, is initially against epitopes within the middle portion of GAD65, and spreads to epitopes in other regions of GAD65 and GAD67.

Confocal microscopic localization of anti-myelin-associated glycoprotein autoantibodies in a patient with peripheral neuropathy initially lacking a detectable IgM gammopathy

We report here on a patient with anti-myelin-associated glycoprotein (MAG) neuropathy in whom examination of a sural nerve biopsy by multichannel confocal microscopy showed a partly overlapping distribution of MAG and IgM deposits in myelinated fibers. Our data demonstrate that MAG in Schmidt-Lanterman incisures and paranodal loops, as well as some additional HNK-1-positive components of the basal lamina, are the major targets of the anti-MAG monoclonal IgM autoantibodies in this neuropathy in vivo. Perforation of the basal lamina can allow the penetration and binding of anti-MAG IgM inside myelinated fibers. Our results support and extend the notion that the production of monoclonal anti-MAG IgM may be antigenically driven by MAG molecules and that this process may occur in the immunologically privileged environment of the nerve prior to the appearance of a genuine gammopathy in serum.

Inhibition of Bax channel-forming activity by Bcl-2

Proteins of the Bcl-2 family are intracellular membrane-associated proteins that regulate programmed cell death (apoptosis) either positively or negatively by as yet unknown mechanisms. Bax, a pro-apoptotic member of the Bcl-2 family, was shown to form channels in lipid membranes. Bax triggered the release of liposome-encapsulated carboxyfluorescein at both neutral and acidic pH. At physiological pH, release could be blocked by Bcl-2. Bcl-2, in contrast, triggered carboxyfluorescein release at acidic pH only. In planar lipid bilayers, Bax formed pH- and voltage-dependent ion-conducting channels. Thus, the pro-apoptotic effects of Bax may be elicited through an intrinsic pore-forming activity that can be antagonized by Bcl-2.

A bacterial signal peptide directs efficient secretion of eukaryotic proteins in the baculovirus expression system

Escherichia coli remains an organism of choice for the production of recombinant proteins required in large quantities. Whenever possible, secretion is the preferred strategy since it permits easy and efficient purification from the extracellular medium. Our efforts to use E. coli to secrete a human CD23 soluble variant fused to a pair of IgG binding domains via the Staphylococcal protein A signal peptide were unsuccessful. Surprisingly, when the same construct was expressed in the baculovirus system, efficient secretion was observed and cleavage of the signal peptide occurred at the expected site. Varying the genes in the fusions or the tags, or the topology of the gene and the tag, did not affect the high-level secretion and cleavage at the correct site. We envision that fusion of the bacterial signal sequence to eukaryotic recombinant genes will prove to be a tool of value for efficient protein secretion in insect cells using the baculovirus expression system.

Expression and intracellular localization of catechol O-methyltransferase in transfected mammalian cells

The intracellular localization of soluble and membrane-bound isoforms of rat and human catechol O-methyltransferase (COMT) was studied by expressing the recombinant COMT proteins either separately or together in mammalian cell lines (HeLa and COS-7 cells) and in rat primary neurons. The distribution of soluble and membrane-bound COMT enzyme was visualized by immunocytochemistry. For comparison, the localization of native COMT was studied in rat C6 glioma cells by immunoelectron microscopy. Staining of cells expressing membrane-bound COMT with a COMT-specific antiserum revealed an immunofluorescence signal in intracellular reticular structures and in the nuclear membrane. Double-staining of the cells with antisera against proteins specific for the rough endoplasmic reticulum indicated that they colocalized with membrane-bound COMT, suggesting that it resided in the endoplasmic reticulum. Notably, no COMT-specific fluorescence of plasma membranes was detected. The signal in the endoplasmic reticulum was also evident in the cells expressing both recombinant COMT forms. Intracellular native COMT reaction was detected by immunoelectron microscopy in rat C6 glioma cells and an intense cytoplasmic signal was seen in the primary neurons infected with the recombinant Semliki Forest virus. The cells expressing recombinant soluble COMT revealed intense nuclear staining together with diffuse cytoplasmic immunoreactivity, suggesting that a part of soluble COMT is transported to nuclei. Western blotting from rat liver and brain revealed soluble COMT in the nuclei. Enzyme activity measurements from liver cytoplasmic and nuclear fractions suggested that about 5% of the soluble COMT resided in nuclei. The intracellular localization of both COMT forms implies that COMT acts in the cytoplasm and possibly also in the nuclear compartment, and that the physiological substrates of COMT enzymes may have to be internalized before their methylation by COMT.

Dissecting processing and apoptotic activity of a cysteine protease by mutant analysis

We have compared the behavior of wild-type mouse NEDD-2, a neural precursor cell-expressed, developmentally down-regulated cysteine protease gene, to various mutant forms of the gene in both apoptotic activity in neuronal cells and proteolytic cleavage in the Semliki Forest virus and rabbit reticulocyte protein expression systems. Our results confirm that NEDD-2 processing and apoptotic activity are linked phenomena. They identify aspartate residues as likely targets for autocatalytic cleavage. They establish that cleavage events only occur at specific sites. Finally, they pinpoint differential effects of individual mutations on the overall proteolytic cleavage patterns, raising interesting questions related to the mechanisms of subunit assembly.

Expression of the 69K movement protein of turnip yellow mosaic virus in insect cells

The nonstructural 69-kilodalton (K) protein of turnip yellow mosaic virus is necessary for systemic spread of the virus within the plant. To examine the behavior of the 69K protein in vivo, antibodies were raised against the carboxy-terminal region of this protein. The full-length 69K protein was also expressed in insect cells using a recombinant baculovirus. Studies on the posttranslational modifications of the 69K protein in insect cells revealed that the protein is phosphorylated but not glycosylated. Further experiments of subcellular fractionation and indirect immunolocalization in insect cells showed that the 69K protein is localized in the cytoplasm and/or in the plasma membrane.