AB1198 PREVALENCE AND PSYCHOPATHOLOGICAL CHARACTERISTICS OF ANXIETY AND DEPRESSIVE SYMPTOMS IN FIBROMYALGIA PATIENTS

Background

Several studies reported higher depression and anxiety rates in fibromyalgia (FM) patients compared to the general population. Furthermore, dysfunctional coping strategies

have been pointed to as intrinsic parts of the pathogenesis of FM.

Objectives

Our study aimed to verify the prevalence of anxiety and depressive symptoms and explore their correlation with physical symptoms as fatigue, sleep, and widespread pain in a cohort of patients diagnosed with FM. We also aimed to determine whether dysfunctional coping strategies might increase the depression and anxiety burden, besides worsening the core symptoms of FM.

Methods

We analyzed a cohort of 105 patients (median age of 53 years 6 M, 99 F) with a diagnosis of FM according to the ACR 2016 criteria. The participants were consecutively recruited from the Fibromyalgia clinic of the University of Campania “Luigi Vanvitelli”. All patients underwent a psychiatric evaluation. We assessed widespread pain by the Widespread Pain Index (WPI) and the presence of fatigue by the Symptom Severity score (SS). Sleep disorders were investigated through Pittsburgh Sleep Quality Index (PSQI). We analyzed mental alterations by Hamilton Depression and Anxiety Rating Scales (HAM-D, HAM-A), and coping strategies by Coping Orientation to Problems Experienced (COPE) Inventory.

The Statistical Package for Social Sciences (SPSS) 22.0 was used; the level of significance was set at p < 0.05.

Results

All patients showed fatigue and widespread pain (100%); sleep disturbances were found in 90.5% of patients and overlapped with all sleep phases. The prevalence of anxiety associated with depression was 75.2%. We found isolated anxiety in 14.3% and isolated depression in 4.8% of patients. We further evidenced a different degree of depression: mild (50.7%), moderate (24.3%), and severe (6.5%). All patients showed depressed mood only if questioned (low tendency to spontaneous verbalization). COPE analysis showed no significant differences in the use of the three coping strategies (Problem-focused, emotion-focused, avoidance-focused). Pearson’s correlation analysis highlighted a negative relationship between problem-focused strategies and the severity of anxiety (r = -0.31, p = .001) and depression (r = -0.32, p = .001). Our analysis also highlighted a positive correlation between fatigue, sleep disturbances, widespread pain, and both anxiety and depression. The analysis of the characteristics of anxiety and depressive symptoms showed a scarce tendency to spontaneous verbalization of depressed mood and ideas of guilt, mostly limited to family relationships, and a sense of ineffectiveness conditioned by the physical symptoms of the disease. Most patients showed psychomotor agitation, psychic and somatic anxiety, poor insight. The analysis of coping strategies adopted showed a negative correlation between problem-focused strategies and anxiety-depressive symptoms, suggesting that such strategies are less frequent in FM patients with comorbid anxiety and depressive symptoms.

Conclusion

Our study confirms the high prevalence of anxiety and depressive symptoms in FM patients. A positive correlation between the pivotal symptoms and anxiety and depressive symptoms may suggest, without implying a cause-and-effect relationship, that psychiatric intervention should be considered along with rheumatologic treatment, to improve both physical symptoms and quality of life. Potentiating problem-focused coping strategies may represent a target to improve anxiety and depressive symptoms.

References

[1]Wolfe et al Revisions to the 2010/2011 FM diagnostic criteria. Semin Arth. Rheum. 2016

Table 1.

Correlation analysis between coping strategies and HAM-D and HAM-A total scores

HAM-DHAM- AProblem-focused Coping- 0,32**- 0,31**Avoidant Coping0,800,92Emotion Coping0,140,13

**p<0.01

Disclosure of Interests

None declared

AB0463 PREVALENCE AND PREDICTORS OF COGNITIVE DYSFUNCTION IN PATIENTS WITH LUPUS NEPHRITIS: A CROSS-SECTIONAL COMPARISON WITH PATIENTS WITH OTHER CHRONIC KIDNEY DISEASES

Background

Cognitive dysfunction (CD) is among the most frequent neuropsychiatric manifestation of systemic lupus erythematosus (SLE) that has a considerable impact on quality of life, but still lacks adequate screening in clinical routine.

Objectives

Our aim was to investigate the distribution and determinants of CD in patients with lupus nephritis, and to compare cognitive function with that in patients with other forms of glomerular chronic kidney disease (CKD) by the Montréal Cognitive Assessment (MoCA).

Methods

We carried out a cross-sectional case-control study with consecutive patients with SLE who fulfilled the 2012 SLICC (Systemic Lupus International Collaborating Clinics) classification criteria(1) and have history of lupus nephritis, using a similarly derived CKD control population matched by age and sex, to assess cognitive function using MoCA scale(2). CD was defined as score < 26/30, adjusted for duration of formal education. Demographic data and disease characteristics were collected. SLE disease activity was evaluated by using Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI2K) (3). The effect of disease-related parameters on the MoCA was examined by regression analysis.

Results

A total of 35 patients with SLE and 35 CKD controls were included in our study (Table 1). Among SLE patients, 7 (20%) patients had biopsy proven active nephritis, 7 (20%) had kidney failure and one a kidney transplant. CD according to MoCA score was found in 64.2% (n=45) patients (Figure 1). The proportion of patients with CD according to MoCA between patients with lupus nephritis and CKD controls was not statistically significant (62.8% vs 65.7%, p>0.05). SLE patients performed bad in all cognitive domains. Memory, abstraction and language skills were the most affected domains. Our study showed that active nephritis and disease duration were associated with poor cognitive performance (OR=1.4, p = 0.03; OR=1.2, p = 0.03). GFR values and other parameters evaluated (end stage renal disease, damage, age at diagnosis, use of glucocorticoids, hydroxychloroquine and immunosuppressive drugs) had no significant effect on development of CD in SLE patients.

Table 1.

Demographics and clinical characteristics of SLE patients

mean%Age44Women94.2Education>16 yrs51.416 -13 yrs37.1<13 yrs11.4Disease duration (yrs)16Kidney failure20Prednisone (% use)<20 mg11.4≥20mg88.5Hydroxychloroquine (% use)65.7Immunosuppressants (% use)57.1SLEDAI2.4SDI0.8Figure 1.

Montréal Cognitive Assessment (MoCA) results in patients with systemic lupus erythematosus (SLE) compared to hemodialysis and chronic kidney disease (CKD) patients.

Conclusion

In this study, two thirds of SLE patients had CD. Patients with lupus nephritis have comparable cognitive function than patients with other CKD. Decline in renal function was not associated with CD in SLE, suggesting that the CD in this population may represent a consequence of lupus itself rather than kidney-related central nervous system damage.

References

[1]Petri M, et al. Arthritis Rheum. 2012

[2]Nasreddine ZS, et al. J Am Geriatr Soc 2005

[3]Gladman DD, et al. J Rheumatol. 2002

Disclosure of Interests

None declared

POS0101 POTENTIAL INVOLVEMENT OF IL-40 AND IL-40 PRODUCING CELLS IN SYSTEMIC LUPUS ERYTHEMATOSUS AND LUPUS ASSOCIATED NEPHRITIS

Background

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder, characterized by a remarkable heterogeneity of clinical presentations. Glomerulonephritis (GN) remains a leading cause of morbidity and mortality in SLE, influencing long-term prognosis. The alteration of both innate and adaptive immune responses plays a pivotal role in SLE pathophysiology [1]. B lymphocytes are mainly involved in SLE through the production of autoantibodies but recent evidence suggests an effector role of these cells in cytokine production. IL-40 is a recently discovered cytokine, produced by B cells and involved in their homeostasis, that may participate in the pathogenesis of B-mediated autoimmune diseases, such as SLE [2].

Objectives

The purpose of this study was to evaluate the role of IL-40 in the pathogenesis of SLE, with a specific focus on renal involvement.

Methods

Peripheral blood and urine samples were collected from 10 consecutive SLE patients and 10 healthy controls; kidney biopsy specimens were obtained from 3 SLE patients and 3 controls. The concentration of IL-40 in serum and urine samples was evaluated by ELISA. IL-40 production by monocytes, B cells and T cells was assessed by flow cytometry at day 0 and after in vitro stimulation. Immunohistochemistry on kidney tissue was also performed to evaluate IL-40 expression.

Results

IL-40 levels were reduced in the serum of patients with active GN. This reduction was further observed in the serum of patients with previous GN. In the serum of active SLE patients, without renal involvement, the concentration of IL-40 did not change significantly compared to controls. Urinary levels of IL-40 showed no significant changes compared to controls. Consistently, immunohistochemistry on kidney showed the expression of IL-40 only in SLE patients (Figure 1). Flow cytometric analysis on T cells, B cells and monocytes isolated from peripheral blood of SLE patients with active GN did not show production of IL-40.

Figure 1.

IL-40 overexpression in lupus nephritis at tissue level. Kidney biopsies stained for IL-40 in controls (A), Class III lupus nephritis (B) and Class V lupus nephritis (C) showed intense IL-40 positivity in lupus nephritis (B, C) compared to controls (A).

Conclusion

To the best of our knowledge this is the first demonstration of IL-40 expression at kidney level in SLE associated nephritis. These preliminary data suggest an active role of IL-40 in SLE, with specific focus on active kidney disease. Our results highlight a potential use of IL-40 as a marker of active GN, although its specific mechanism of action needs to be further elucidated.

References

[1]Tsokos GC, Lo MS, Costa Reis P, Sullivan KE. New insights into the immunopathogenesis of systemic lupus erythematosus. Nat Rev Rheumatol. 2016;12(12):716-730.

[2]Catalan-Dibene J, Vazquez MI, Luu VP, Nuccio SP, Karimzadeh A, Kastenschmidt JM, et al. Identification of IL-40, a Novel B Cell-Associated Cytokine. J Immunol. 2017;199(9):3326-35.

Disclosure of Interests

Chiara Rizzo: None declared, Lidia La Barbera: None declared, Marianna Lo Pizzo: None declared, Leila Mohammadnezhad: None declared, Vincenzo Luca Lentini: None declared, DENISE DONZELLA: None declared, Francesco Ciccia Speakers bureau: lilly, pfizer, novartis, celgene, abbvie, roche, janssen, UCB, SERENA FASANO: None declared, Giuliana Guggino Speakers bureau: pfizer, novartis, celgene, abbvie, roche, lilly, janssen, UCB

AB0279 THE IMPACT OF HYDROXYCHLOROQUINE DAILY DOSE IN THE PREVENTION OF FLARES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN REMISSION

Background:

The EULAR recommendations for the management of systemic lupus erythematosus (SLE) suggest a hydroxychloroquine (HCQ) dose of ≤5.0 mg/kg/day instead of 6.5 mg/kg/day to reduce the risk of HCQ-induced retinopathy (1). This change in HCQ dose may potentially lead to undertreatment with blood levels below the presumed therapeutic range.

Objectives:

The aim of this study was to compare flare rates and HCQ blood levels between the two different oral dosages in patients with SLE in remission.

Methods:

Eligible patients were SLE patients in clinical remission according to the preliminary Definitions of Remission in SLE (DORIS) criteria for at least one year and treatment with stable dose of HCQ for at least six months and stable dose of glucocorticoids and/or immunosuppressants (2). Flares were defined by SELENA-SLEDAI Flare Index (3). A venous blood sample was collected on two different occasions from all patients, reflecting actual therapeutic adherence. The biosamples were analyzed in a UPLC-MS/MS system composed of a Nexera chromatograph (Shimadzu) coupled with a Q-trap 6500 spectrometer (AB Sciex). A mean [HCQ] value ([HCQm]) for each patient was then calculated. Predictors of flares were analyzed by Cox regression.

Results:

We selected 66 patients who were stratified according to HCQ oral dose in two groups (Table 1). We observed 23 (35%) flares that developed in mean 26,0 (±15,1) months: 8/32 (25%) patients taking HCQ 5 mg/kg/day; 15/34 (44%) in the other group. No statistically significant difference was observed between the two group in number of flares (p=0,106), mean time of occurrence (p=0,904) and median [HCQm] (p=0,983). At regression analysis, older age at baseline was protective against flare occurrence (HR 0,93), while concomitant immunosuppressive therapy showed significant positive association (HR 3,66).

Conclusion:

Our study suggests that low dosage of HCQ (5 mg/kg/day) may safely be prescribed in SLE patients in remission, without significant differences in terms of blood concentration and impact on the clinical course of SLE.

References:

[1]Fanouriakis A, et al. Ann Rheum Dis 2019;78:736-745.

[2]van Vollenhoven R, et al. Ann Rheum Dis 2017;76:554-561.

[3]Petri M, et al. Arthritis Rheum. 2012;64(8):2677-2686.

Table 1.

Demographic, clinical and therapeutic features of the cohort and follow up data.

All patients (n= 66)HCQ≤5mg/Kg/die(n=32)HCQ6,5mg/Kg/die (n=34)PSex, female65 (99)31 (97)34 (100)0,3026Age, y, mean (SD)42,00±11,2741,80±10,2542,10±12,300,9140Disease duration, y, mean (SD)15,70 (9,02)17,80 (8,01)13,67 (9,50)0,0624SLEDAI, median (range)2 (0-4)1 (0-4)2 (0-4)0,6480SLICC, median (range)0 (0-2)0 (0-2)0 (0-1)0,8556[HCQm] ng/mL, median (range)512,60(104,41-3105,66)457,16(104,41-3105,66)538,49(149,24-1239,15)0,5989[DCQ] ng/mL,median (range)73,41(4,16-649,84)66,84(4,16-649,84)66,31(10,75-258,41)0,9380Time remission, y, median (range)2,00 (1-11)2,96 (1-10)2,00 (1-11)0,6588Previous renal involvement31 (47)15 (47)16 (47)0,9882Time HCQ, y, median (range)5 (0-32)8 (0-26)5 (1-32)0,2391Glucocorticoids33 (50)18 (56)15 (44)0,4700Mycophenolate mofetil6 (9)2 (6)4 (12)0,4396Azathioprine7 (11)4 (14)3 (9)0,6305Methotrexate1 (2)01 (3)0,3320Cyclosporine2 (3)1 (3)1 (3)0,9655Belimumab1 (2)01 (3)0,3320Follow up time, m, median (range)49 (4-67)52 (7-67)43 (4-67)0,1115Number of flares23 (35)8 (25)15 (44)0,1060Time to flare, m, mean (SD)26,0 (±15,1)26,6 (±16,4)25,8 (±14,9)0,9042Ocular alterations6 (9)4 (12)2 (6)0,0947Figure 1.

Predictors of flares analyzed by Cox regression. *Serena Fasano and Valentina Messiniti contributed equally to this abstract

Disclosure of Interests:

None declared

POS0693 EFFICACY AND SAFETY OF BELIMUMAB IN PATIENTS WITH LUPUS NEPHRITIS IN REAL-LIFE SETTING: RESULTS FROM A LARGE, NATIONWIDE, MULTICENTRIC, PROSPECTIVE COHORT

Background:

LN is still a severe manifestation of Systemic lupus erythematosus (SLE) and multitarget therapy is needed to control the disease especially in refractory cases.

Objectives:

To evaluate renal response in SLE patients with glomerulonephritis (GN) treated with Belimumab in real-life setting.

Methods:

Patients with proteinuria >0.5 g/24 h and/or active sediment at baseline enrolled in a multicentre Italian cohort of SLE patients (BeRLiSS study), treated with monthly iv Belimumab 10 mg/kg plus standard of care were considered in this study. Complete renal response (CRR) was defined as proteinuria <0.5 g/24 h, estimated glomerular filtration rate (eGFR)≥90ml/min/1.73m2 and no rescue therapy. Primary efficacy renal response (PERR) was defined as proteinuria ≤0.7 g/24 h, eGFR ≥60ml/min/1.73m2 and no rescue therapy. Prevalence and predictive factors of CRR and PERR at 12 and 24 months after Belimumab initiation were analyzed by multivariate logistic regression analysis.

Results:

A total of 91 patients were considered in this study, 79 female, mean age 40.51±9.03 years, mean disease duration 12.18±8.15 years, median follow-up time after Belimumab initiation 22 months. Twenty patients had baseline proteinuria ≥0.5 <1 g/day, 17 ≥1 <2 g/day, 13 ≥2 g/day. Belimumab was started at GN onset in 20 (22%) patients and at the time of a renal flare in all other cases. Seventy-five patients underwent a renal biopsy: 1 class I, 4 class II, 14 class III, 47 class IV and 9 class V. Baseline serum creatinine was 82.44±29.26 umol/L; 15 patients showed eGFR<60ml/min/1.73m2 at baseline. Immunosuppresants were taken by 70 (76.9%) patients: 47 micofenolate, 15 azathioprine and 5 ciclosporine. Sixty patients (65.9%) were on antimalarials. During follow-up 34 (37.4%) patients achieved CRR. Among them 5 (14.7%) patients relapsed and 29 (85.3%) patients maintained remission. Mean time to achieved CRR was 9.71±5.91 months.

High levels of baseline proteinuria were a negative independent predictor of CRR and PERR at 6 months (OR 0.044 CI95% 0.006-0.320 p=0.002 and OR 0.232 CI95% 0.091-0.596 p=0.002) and 12 months (OR 0.029 CI95% 0.002-0.556 p=0.019 and OR 0.056 CI95% 0.009-0.327 p=0.001). High levels of baseline creatinine were a negative independent predictor of renal response. Renal response at 6 months was a strong predictive factor of renal response at 12 and 24 months.

Conclusion:

Belimumab is an effective add-on therapy in the treatment of GN in real-life practice setting.

Disclosure of Interests:

None declared

POS1210 PREVALENCE OF COVID-19 AMONG PATIENTS WITH RHEUMATIC DISEASES: AN OBSERVATIONAL SURVEY DURING THE TWO WAVES IN ITALY

Background:

The new coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) is a source of concern for the management of patients suffering from rheumatic and musculoskeletal diseases (RMDs) treated with immunomodulatory therapies (1).

Objectives:

We aimed to analyze the prevalence of SARS-CoV-2 infection in patients with RMDs living in Italy.

Methods:

During the first wave (March-May 2020) and during the second wave (October-December 2020) of COVID-19, we conducted a survey to investigate the incidence of SARS-CoV-2 infection in patients with RMDs followed at the Rheumatology Unit of the University of Campania, Italy. The demographic data, medication use, the frequency of respiratory symptoms and the incidence of COVID-19 confirmed by nasopharyngeal swab were collected with questionnaires administered by phone. The prevalence of COVID-19 of our cohort was compared to that of the general population (2).

Results:

During the first wave, we collected data from 900 patients with RMDs (Table 1): 320 patients with rheumatoid arthritis (RA), 295 patients with spondyloarthropathies (SpA), 283 patients with systemic lupus erythematosus (SLE), 2 patients with vasculitis. 546 (60%) were treated with bDMARD/tsDMARDs. Overall, a total of 11/900 (1%) cases were tested for COVID-19 due to compatible symptoms. 2 (0.2%) adult patients treated with bDMARDs were registered as swab test positive by PCR for COVID-19. 2 patients without confirmed COVID-19 developed pneumonia that required admission to hospital. No deaths occurred among the patients with confirmed COVID-19.

During the second wave, data were collected from 470 patients who accepted to take part of the study (Table 1). 49 presented with symptoms that were compatible with COVID-19. 139 patients were tested whereas 30 patients (6%) had a swab confirmation of SARS-CoV-2 infection. Among them, 16 (53%) were treated with bDMARDs and a patient was treated with tofacitinib. we found no increase in COVID-19 prevalence in patients treated with bDMARD/tsDMARDs (p>0.05). A patient with SLE developed pneumonia that required admission to hospital and died.

Lacking distinct prevalence data between first and second waves, we found no differences in total COVID-19 prevalence between general population living in Campania (215.752/5.802.000; 3.7%) and patients with RMDs (32/900; 3.5%). However, we had a significant increase in COVID-19 prevalence in our cohort during the second wave compared to the first. Nevertheless, no increase in mortality or hospitalization was recorded, confirming the safety of immunomodulatory therapies in patients with RMDs.

Conclusion:

In this cohort of patients with RMDs in a geographical region with a high prevalence of COVID-19, the risk of SARS-CoV-2 infection does not appear different from that observed in the general population.

References:

[1]Wang L., Wang Y., Ye D. Int J Antimicrob Agents. 2020:105948.

[2]http://www.protezionecivile.gov.it/ (accessed 28.01.21)

Table 1.

Demographics and clinical characteristics of 900 patients with rheumatic diseases during the COVID-19 Pandemic.

First waveSecond waveWomen, n 660 (73 %) 366(77%)Age, years, median (range)56 (54-57)53 (51-55)Rheumatoid Arthritis320 (35.5%)143 (30%)Spondyloarthritis295 (32%)110 (23%)Systemic Lupus Erythematosus283 (31%)217 (46 %)Vasculitis2 (0.2%)1 (0.2%)Prior ILD56 (6%)22 (4.6%)Smokers220 (24%)118 (25%)Hydroxychloroquine215 (23%)155 (32%)Steroids337 (37%)194 (41%)Prednisone equivalent dose, median (range)5 (0-75)5 (0-50)bDMARD/tsDMARDs546 (60%)247 (52%)csDMARDS387 (43%)185 (39%)Angiotensin-converting enzyme (ACE) inhibitors178 (19.8%)101 (21%)Angiotensin II receptor blockers(ARBs)153 (17%)61 (13%)Fever64 (7%)30 (6.3%)Cough83 (9%)36 (7%)Shortness of breath34 (3%)15 (3%)Sore throat32 (3%)11 (2.3%)Rhinorrhoea36 (3%)11 (2.3%)Headache5 (0.5%)2 (0.4%)Anosmia10 (1%)24 (5%)Myalgia2 (0.2%)1 (0.2%)Gastrointestinal symptoms24 (2.6%)3 (0.6%)Pneumonia2 (0.2%)2 (0.4%)Admission to hospital2 (0.2%)9 (1.9%)Swab confirmation of SARS-CoV-2 infection230

Disclosure of Interests:

None declared.

SAT0340 A REDUCED NUMBER OF CAPILLARIES AND AN INCREASED NUMBER OF MEGACAPILLARIES PREDICT THE DEVELOPMENT OF SYSTEMIC SCLEROSIS IN RAYNAUD’S PHENOMENON PATIENTS AT RISK

Background:

Undifferentiated connective tissue disease at risk for systemic sclerosis (UCTD-risk-SSc) is a condition characterised by Raynaud’s phenomenon and either SSc marker autoantibodies or typical capillaroscopic findings or both, unsatisfying classification criteria for SSc and evolving into definite SSc in about 30-50% of cases (1,2). Recently, we developed a weighted score based on a baseline IF-ANA titer ≥1:320, marker autoantibody positivity and presence of avascular areas at videocapillaroscopy identifying patients who will evolve with a 91.3% sensitivity and a 73.2% specificity (3).

Objectives:

To improve the predictivity of the score assessing the role of marker autoantibody ELISA titer and further capillaroscopic items.

Methods:

The 102 UCTD-risk-SSc patients investigated for the development of the previous score were reassessed for anti-Scl-70 and anti-centromere antibody titers detected by ELISA and for the mean number of capillaries observed in the same capillaroscopic field (Cs) and the total number of giant capillaries (GC) by videocapillaroscopy (4). Each patient was evaluated every 6 months to assess disease progression. Risk prediction was assessed by Cox regression analyses. The predictive value of the score was determined by receiver operating curve (ROC) analysis.

Results:

Table 1 shows the resulting predictive variables in multivariate Cox analysis and their relative weight in a 10-point scale. No increase in the predictivity was detected by adding the anti-Scl-70 and anti-centromere antibody ELISA titers. However, a mean number of Cs≤5/mm and GC>5 improved the score. At ROC analysis (Figure 1) a score >3.25 predicted evolution to SSc with a sensitivity of 93.5% and a 75% specificity (AUC=0.91).

Table 1.

Indipendent predictive variables in multivariate regression analysis and the resulting weighted prediction model *

VariableβHR95% CIPWeightAnti-Scl70Cs≤5/mm2.95531.909319.216.754.87-75.762.07-22.00<0.0010.0013.252ANA ≥ 1:3201.74025.701.42-22.850.012ACA1.67405.331.51-1.900.011.75GC>51.00492.731.44-5.170.0021

*β: regression coefficients; HR: hazard ratio; 95% CI: 95% confidence interval; Cs: Capillaries; ANA: anti-nuclear antibodies; ACA: anti-centromere antibodies; GC: giant capillaries

Conclusion:

Assessing the mean number of capillaries/mm and the total number of giant capillaries instead of avascular areas at videocapillaroscopy, resulted in improving the sensitivity and specificity of the score recently developed to predict the evolution of UCTD-risk-SSc into definite SSc.

References:

[1]Valentini G. Autoimmun Rev 2015;

[2]Valentini G. et al. Arthritis Care Res (Hoboken). 2014;

[3]Riccardi A. et al. Autoimmun Rev. 2019;

[4]Sambataro et al. Arthritis Research & Therapy 2014, 16:462.

Disclosure of Interests:

Antonella Riccardi: None declared, Antonella Marcoccia: None declared, SERENA FASANO: None declared, Tiziana Guastafierro: None declared, Rosaria Irace: None declared, Valentina Messiniti: None declared, Francesco Bondanini: None declared, Alessandro Sanduzzi: None declared, Marialuisa Bocchino: None declared, Aldo Ciani: None declared, Michele D’Alto: None declared, Paola Argiento: None declared, Giovanni Maria De Matteis: None declared, Alberto Spanò: None declared, Gabriele Valentini Grant/research support from: BMS, MSD, NOVARTIS, LILLY, PFIZER, ABBVIE, CELGENE

SAT0162 WITHDRAWAL OF LOW-DOSE STEROIDS IN SYSTEMIC LUPUS ERYTHEMATOSUS IN REMISSION: PREDICTORS OF FLARES AND DIFFERENCE IN OUTCOMES IN SEROLOGICALLY ACTIVE CLINICALLY QUIESCENT PATIENTS

Background:

According to the recent recommendations for Systemic Lupus Erythematosus (SLE), a progressive tapering until withdrawal of glucocorticoids (GC) is considered one of the main goals of SLE management (1). However, which patient may be a candidate for safe GC withdrawal has not been determined yet and a proportion of patients are kept on long-term low-dose prednisone despite clinical remission.

Objectives:

to evaluate the rate of low-dose GC withdrawal in SLE patients in remission and to identify predictors of flares.

Methods:

Eligible patients were SLE patients according to the ACR criteria (2) who were in prolonged clinical remission defined by a cSLEDAI=0 for at least 2 years and on a stable SLE treatment (immunosuppressive drugs and/or hydroxychloroquine (HCQ) and daily 5 mg prednisone). A SACQ period was defined as at least 1-year period with persistent serologic activity without clinical manifestations. Flares were defined by SELENA-SLEDAI Flare Index (3). Damage was assessed by SLICC damage index (SDI). Data were compared by the unpaired student’s t test or chi-squared test as appropriate. Predictors of flares after GC withdrawal were analyzed by Cox regression.

Results:

Out of 246 SLE patients registered in the Naples Lupus Clinic database, 132 eligible patients were identified. Among them, we selected 57 (43%) patients in whom a GC withdrawal was attempted. 75 (57%) patients were in the prednisone maintenance group.

There were no significant differences between the two treatment groups (table 1). The proportion of patients experiencing a flare was not significantly lower in the maintenance group than in the withdrawal group (15/75 vs 16/57; p=0.28). Moreover, the proportion of patients who had an increase in the SDI at the end of follow up was similar between the two groups (14/75 vs 8/57; p=0.48). However, among the withdrawal group, the rate of flares was significantly higher in SACQ patients (10/22 vs 6/35; p=0.02), while the majority of serologically inactive patients (82%) successfully stopped GCs without subsequent flares. At Cox regression analysis (Table 2), duration of HCQ therapy and >4 year remission at withdrawal were protective factors, while a SACQ disease and history of lupus nephritis (LN) increased the risk of disease flare.

Table 1.

Baseline characteristics of 132 patients at study entry

CharacteristicsWithdrawal group (n=57)Maintenance group (n=75)p-valueFemale, no. (%)54 (94)70 (93)0.73Age, years26.7±10.128.5±11.70.37Disease duration, years8.5±2.99.1±12.90.73History of lupus nephritis, no. (%)13(22)22(29)SDI score0.40±0.70.57±0.80.26Immunosuppressive drugs, no. (%)31 (54)33(44)0.16HCQ, no. (%)52 (91)66 (88)0.06Low C3, no. (%)28 (49)41(54)0.52Increased dsDNA Ab, no. (%)11 (19)19 (25)0.41Table 2.

Factors predicting lupus flares during follow-up at Cox regression analysis

VariablesHR95% CIp valueSACQ2.991.08 – 8.250.03Age0.970.93 – 1.020.29Disease duration0.990.94 – 1.040.84History of LN3.381.22-9.330.01SDI score1.130.63 – 2.010.66Immunosuppressive drugs2.390.86 – 6.620.09HCQ, ever2.920.43 – 35.20.95Duration of HCQ0.840.72 – 0.980.035years remission0.120.04 – 0.390.0003

Conclusion:

GC withdrawal is an achievable target in SLE and may be attempted in patients in complete remission. In SACQ patients, maintenance of 5mg prednisone is superior to its withdrawal in order to prevent flares. Long-term HCQ therapy and prolonged remission can significantly reduce the risk of disease relapse after GC withdrawal.

References:

[1]Fanouriakis A, et al. Ann Rheum Dis. 2019;78(6):736–45.

[2]Tan EM, et al. Arthritis Rheum. 1982;25(11):1271–7.

[3]Petri M, et al. Lupus. 1999;8(8):685–91.

Disclosure of Interests:

Serena Fasano: None declared, Luciana Pierro: None declared, Melania Alessia Coscia: None declared, laura Bucci: None declared, silvia scriffignano: None declared, Antonella Riccardi: None declared, francesco ciccia Grant/research support from: pfizer, novartis, roche, Consultant of: pfizer, novartis, lilly, abbvie, Speakers bureau: pfizer, novartis, lilly, abbvie

The association between duration of remission, fatigue, depression and health-related quality of life in Italian patients with systemic lupus erythematosus

OBJECTIVE

To evaluate the impact of duration of remission on the health-related quality of life (HRQoL) of patients with systemic lupus erythematosus (SLE).

METHODS

We conducted a 5-year retrospective study on two Italian cohorts. Remission was defined as a continuative period of no clinical disease activity, according to the Systemic Lupus Erythematosus Disease Activity Index 2 K, and a permitted maximum prednisone dose of 5 mg/day. HRQoL was measured using the 36-Item Short-Form Health Survey (SF36) during the last visit.

RESULTS

We enrolled 136 female SLE patients. During observation, 15 (11%) patients had been in remission for ≥1 and <2 years, 15 (11%) for ≥2 and <3 years, 19 (14%) for ≥3 and <4 years, 9 (7%) for ≥4 and <5 years, and 53 (39%) had been in prolonged remission for ≥5 years. In the multivariate model, considering depression and fatigue as covariates, patients in prolonged remission showed significantly better scores in the physical functioning (p = 0.039), role physical (p = 0.029), bodily pain (p = 0.0057), general health (p = 0.0033) and social functioning (p = 0.0085) components of the SF36, compared with those in remission <5 years or unremitted. Subsequent mediation analyses found that these effects were partly influenced by depression.

CONCLUSION

Lupus remission could improve the HRQoL of SLE patients, particularly when associated with appropriate management of depression and fatigue.

Characterization of Follicular Atresia Responsive to BPA in Zebrafish by Morphometric Analysis of Follicular Stage Progression

Bisphenol A is an industrial chemical compound, pervasively polluting the environment and diet, classified as an endocrine disruptor because of its interference effects on the endocrine system. In zebrafish, BPA exposure induces follicular atresia. To acquire knowledge on this atretic effect, using a qualitative and quantitative histomorphological approach, we studied zebrafish ovarian follicular stage development in response to low BPA concentrations. Results show that BPA interferes with follicular progression by affecting the previtellogenic and vitellogenic phases. In particular, BPA exposure (i) increases follicular recruitment by acting on primary stage follicles, (ii) forces the follicular transition from stage III to stage IV producing enlarged stage IV follicles, and (iii) induces atresia by producing atretic follicles that are peculiarly enlarged (i.e., big atretic follicles). We suggest that BPA induces atresia by the primary effect on recruitment of stage I follicles. This forces follicular progression and produces stage IV follicles that are peculiarly enlarged that undertake the atretic development.

Hypothalamic-Pituitary-Ovarian Axis in Women with Operable Breast Cancer Treated with Adjuvant CMF and Tamoxifen

The effect of adjuvant CMF (cyclophopshamide, methotrexate, and 5-fluorouracil) and tamoxifen (TM) on hypothalamic-pituitary-ovarian function was studied in 120 women with stage I-II operable breast cancer. Sixty patients were premenopausal, of whom 25 were treated with CMF for 9 cycles, 25 with CMF for 9 cycles + TM for 2 years, started concurrently, and 10 with TM alone for 2 years. Sixty patients were postmenopausal and they were all treated with TM alone for 2 years. In all groups treatment was started within 4 weeks of mastectomy. Plasma levels of estrone (E1), estradiol-17β (E2), follicle-stimulating hormone, luteinizing hormone (LH), prolactin (Prl), testosterone (T) and thyroid-stimulating hormone (TSH) were determined in all patients before surgery and again at 3-month intervals from initiation of the adjuvant therapy. In ten patients of each treatment group FSH-LH and Prl-TSH release was determined following stimulation with releasing hormones. CMF and CMF + TM therapy resulted in amenorrhea in 42/50 premenopausal patients with decrease of E1 + E2 (p < 0.001) and elevation of FSH (p < 0.001) and LH (p < 0.01) plasma concentration to postmenopausal levels. In premenopausal women treated with TM a marked increase of E1 + E2 (p < 0.001) was observed with unaltered FSH-LH plasma concentration. A significant fall of Prl also occurred in these patients. In postmenopausal women and premenopausal patients with CMF-induced amenorrhea TM produced a marked fall of FSH-LH and a decrease of Prl plasma level. Plasma TSH and T were not affected in any patient by any of the treatment regimens. The results of the stimulatory tests are in agreement with the hormonal changes observed under basal conditions and indicate that, whereas CMF suppresses the ovary and does not alter hypothalamic-pituitary function, TM induces profound changes of the hypothalamic-pituitary-ovarian axis.

Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review

Background

Systemic lupus erythematosus is associated with an increased risk of cardiovascular disease. Low-dose aspirin, hydroxychloroquine and statins have been suggested to play a prophylactic role of cardiovascular events. This study is devoted to reviewing the literature on the topic and assessing the effects of these drugs in preventing a first cardiovascular event in a two-centre Italian series.

Methods

A PubMed search on cardiovascular prevention in systemic lupus erythematosus was performed. Moreover, systemic lupus erythematosus patients admitted to two centres from 2000–2015, who at admission had not experienced any cardiovascular event, were investigated. Aspirin, hydroxychloroquine and statin use, and the occurrence of any cardiovascular event, were recorded at each visit. Kaplan-Meier and Cox regression analyses were performed to evaluate the role of traditional, disease-related cardiovascular risk factors and of each of the three drugs in the occurrence of new cardiovascular events.

Results

The literature search produced conflicting results. Two hundred and ninety-one systemic lupus erythematosus patients were included in the study and followed for a median of eight years. During follow-up, 16 cardiovascular events occurred. At multivariate analysis, taking aspirin (hazard ratio: 0.24) and hydroxychloroquine for more than five years (hazard ratio: 0.27) reduced, while antiphospholipid antibody positivity (hazard ratio: 4.32) increased, the risk of a first cardiovascular event. No effect of statins emerged.

Conclusion

Our study confirms an additive role of aspirin and hydroxychloroquine in the primary prophylaxis of cardiovascular events in Italian patients with systemic lupus erythematosus. The lack of any detected effect in previous reports may depend on the design of studies and their short follow-up period.

Autoimmune gastrointestinal complications in patients with systemic lupus erythematosus: case series and literature review

The association of systemic lupus erythematosus (SLE) with gastrointestinal autoimmune diseases is rare, but has been described in the literature, mostly as case reports. However, some of these diseases may be very severe, thus a correct and early diagnosis with appropriate management are fundamental. We have analysed our data from the SLE patient cohort at University College Hospital London, established in 1978, identifying those patients with an associated autoimmune gastrointestinal disease. We have also undertaken a review of the literature describing the major autoimmune gastrointestinal pathologies which may be coincident with SLE, focusing on the incidence, clinical and laboratory (particularly antibody) findings, common aetiopathogenesis and complications.

Expression and localization of the deubiquitinating enzyme mUBPy in wobbler mouse testis during spermiogenesis

Mouse ubiquitin-specific processing protease (mUBPy) is a deubiquitinating enzyme highly expressed in both brain and testis. In testis, it interacts with the DnaJ protein, MSJ-1; both mUBPy and MSJ-1 are located on the cytoplasmic surface of the developing acrosome and in the centrosomal region during spemiogenesis. Present data show the first appearance in testis of mUbpy mRNA and protein at 10 days post-partum (d.p.p.). In addition, to investigate on a possible role of mUBPy in sperm formation, we took advantage of mutant wr/wr (wobbler) mice characterized by male infertility, which is likely due to the lack of a real, functional acrosome. RT-PCR and Northern blot analyses show that mUbpy is up-regulated in adult wobbler testis. Furthermore, in wild-type testis mUBPy protein is primarily detected by Western blot in the soluble (cytosolic/nuclear) fraction during the first round of spermatogenesis and in the adult. By contrast, mUBPy is primarily detected in membranous/insoluble protein fraction when wobbler phenotype is clearly shown (30 d.p.p.) and in adult wobbler testis. By immunohistochemistry, whereas in wild-type animals mUBPy marks the profile of the acrosomic vesicle in differentiating spermatids, in wobbler mice only a detergent pre-treatment procedure allows to detect mUBPy immunoreactivity, which results in diffuse spotted granules inside the cytoplasm and around the nuclear shape. In conclusion, in wobbler testis expression of mUbpy is up-regulated, while a differential sorting of the protein characterizes wobbler spermatids where acrosome formation is impaired.

Multipotential neural precursors transplanted into the metachromatic leukodystrophy brain fail to generate oligodendrocytes but contribute to limit brain dysfunction

Neural stem cells appear to be best suited for regenerative therapy in neurological diseases. However, the effects of high levels of potentially toxic substances such as sulfatides--which accumulate in metachromatic leukodystrophy (MLD)--on this regenerative ability are still largely unclear. To start addressing this question, in vitro and in vivo experiments were used to examine the behavior of multipotential neural precursors exposed to abnormally high levels of sulfatides. Following transplantation of dissociated neurospheres into the brain of presymptomatic MLD pups, the majority of donor-derived cells were distributed in a caudal to rostral direction, with higher numbers in the cortex. Most if not all of the donor cells acquired an astroglial phenotype. We found no evidence of oligodendrocyte or neuronal commitment of transplanted cells in long-term-treated MLD mice (e.g. up to 1.5 years of age). This was in line with our in vitro findings of sulfatides blocking oligodendrocyte formation after induction of differentiation in sulfatide-treated epidermal growth factor/fibroblast growth factor responsive neurospheres. Transplanted MLD mice showed an improved arylsulfatase A (ARSA) activity and a significant amelioration of sulfatide metabolism, neurodegeneration and motor-learning/memory deficits. Furthermore, transplanted cells were shown to act as a source of ARSA enzyme that accumulated in endogenous brain cells, indicating the occurrence of enzyme cross-correction between transplanted and host cells. These results provide a first insight into the effect of sulfatides on the stemness properties of neural stem cells and on the effects of the MLD environment on the in vivo expectations of using neural stem cells in cell therapy.

Structure of msj-1 gene in mice and humans: a possible role in the regulation of male reproduction

Msj-1 gene encodes a DnaJ protein highly expressed in spermatids and spermatozoa of both rodents and amphibians, possibly involved in vesicle fusion and protein quality control by means of interaction with heat shock proteins. We isolated and characterized the entire murine msj-1 gene and searched for putative msj-1-like genes into the human genome. Furthermore, ultrastructural localization of MSJ-1 was analyzed in mouse germ cells by immunogold electron microscopy. The analysis of murine msj-1 genomic sequence reveals that it is an intron less gene. Putative promoter region was predicted within the 600 bp upstream the transcription start site. In mouse, msj-1 maps on chromosome 1, into an intronic region of UDP glucuronosyl-transferase 1 family cluster. At ultrastructural level, MSJ-1 marks the developing acrosomic vesicle and the sperm centriolar region. A blast search against the human genome database revealed two closed regions (Ha and Hb) on human chromosome 2 having high nucleotide identity with murine msj-1 coding region. Similarly to mouse, in human both regions map into an intronic region of UDP glycosyl-transferase 1 family polypeptide A cluster (ugt1a@). A significant ORF encoding a putative DnaJ protein of 145 aa was predicted from Ha. Finally, expression analysis, conducted by RT-PCR in human sperm cells, demonstrated that Ha mRNA is effectively present in humans; by Western blot, a specific MSJ-1 band of approximately 30kDa was detected in human sperm. Taken together, these data suggest that msj-1 gene might be conserved among vertebrates and might exert fundamental functions in reproduction.

Safety of Arylsulfatase A Overexpression for Gene Therapy of Metachromatic Leukodystrophy

Successful gene therapy approaches for metachromatic leukodystrophy (MLD), based either on hematopoietic stem/progenitor cells (HSPCs) or direct central nervous system (CNS) gene transfer, highlighted a requirement for high levels of arylsulfatase A (ARSA) expression to achieve correction of disease manifestations in the mouse model. Full assessment of the safety of ARSA expression above physiological levels thus represents a prerequisite for clinical translation of these approaches. Here, using lentiviral vectors (LVs), we generated two relevant models for the stringent evaluation of the consequences of ARSA overexpression in transduced cells. We first demonstrated that ARSA overexpression in human HSPCs does not affect their clonogenic and multilineage differentiation capacities in clonogenic assays and in a neonatal hematochimeric mouse model. Further, we studied ARSA overexpression in all body tissues by generating transgenic mice overexpressing the ARSA enzyme by LV up to 15-fold above the normal range and carrying multiple copies of LV in their genome. Characterization of these mice demonstrated the safety of ARSA overexpression in two main gene therapy targets, HSPCs and neurons, with maintenance of the complex functions of the hematopoietic and nervous system in the presence of supraphysiological enzyme levels. The activity of other sulfatases dependent on the same common activator, sulfatase-modifying factor-1 (SUMF1), was tested in ARSA-overexpressing HSPCs and in transgenic mice, excluding the occurrence of saturation phenomena. Overall, these data indicate that from the perspective of clinical translation, therapeutic levels of ARSA overexpression can be safely achieved. Further, they demonstrate an experimental platform for the preclinical assessment of the safety of new gene therapy approaches.

Structure of msj-1 gene: a comparative analysis

Msj-1 gene encodes a DnaJ protein highly expressed in spermatids and spermatozoa of both rodents and amphibians. We isolated and characterized the msj-1 gene in mice. A bioinformatic approach was then used to predict the putative promoter region, chromosomal localization, and its presence in the human genome. The analysis of msj-1 genomic sequence revealed that msj-1 is an intronless gene. Interestingly, two regions (A and B, separated by 10,682 bp) on human chromosome 2 having respectively 78% and 77% nucleotide identity with the murine msj-1 coding region were identified. This suggests the existence of an msj-1-like gene also in humans.

Cerebellar neurons and glial cells are transducible by lentiviral vectors without decrease of cerebellar functions

Due to the profuse connections of the cerebellum to the rest of the central nervous system, cerebellar dysfunction impacts tremendously on movement coordination, maintenance of equilibrium, muscle tone and motor memory. Efficient gene transfer of therapeutic genes to this central nervous system structure would constitute a relevant step ahead the design of treatments to ameliorate cerebellar dysfunction. Lentiviral vectors (LVs) have been used as efficient vehicles to integrate transgenes into dividing and non-dividing cells, such as postmitotic adult neurons, with minimal toxicity and immune response. This study aimed to use LVs carrying green fluorescent protein (GFP) cDNA for transduction of cerebellar cells in vivo without compromising neurological cerebellar functions. Our results indicate that LVs, injected in the lobulus simplex, transduced different cerebellar neurons including stellate, Purkinje cells, granular neurons and glial cells such as astrocytes, oligodendrocytes, and that this gene transfer approach was not accompanied by cerebellar deficits.

Jun localization in cytosolic and nuclear compartments in brain-pituitary system of the frog, Rana esculenta: an analysis carried out in parallel with GnRH molecular forms during the annual reproductive cycle

The presence of c-jun like mRNA was assessed in the brain of the frog, Rana esculenta, during the annual sexual cycle. In parallel, Jun protein and GnRH molecular form (mammalian and chicken II also indicated as GnRH1 and GnRH2, respectively) activity was studied in order to establish possible relationships. Northern blot analysis of total RNA reveals the presence of a 2.7 kb c-jun-like mRNA. Western blots, carried out on cytoplasmic and nuclear protein extracts, show the presence of Jun immunoreactive band of 39 kDa in brain and pituitary. Fluctuations of c-jun-like mRNA and Jun immunoreactive protein (cytoplasmic and nuclear) levels in brains during the year indicate relationships among transcription, translation, and nuclear activity. In particular, mRNA levels increase gradually from September until November when Jun protein concentration peaks in cytosolic extracts. Conversely, the nuclear protein reaches highest concentration in July when the cytosolic level shows low values. Immunocytochemical studies confirm the presence of Jun immunoreactivity in both cytoplasmic and nuclear compartments of several brain areas, including those primarily involved in gonadotropin discharge (e.g., anterior preoptic area and preoptic nucleus). GnRH molecular forms and Jun are colocalized in anterior preoptic area and preoptic nucleus. Moreover, during the period characterized by GnRH release, Jun levels strongly decrease in nuclei. Finally, we show that treatments with a GnRH analog (buserelin, Hoechst, Frankfurt) increase Jun levels in brain nuclear extracts.

Early defect in the expression of mouse sperm DNAJ 1, a member of the DNAJ/heat shock protein 40 chaperone protein family, in the spinal cord of the wobbler mouse, a murine model of motoneuronal degeneration

Prevention of protein misfolding is ensured by chaperone proteins, including the heat shock proteins (HSP) of the DNAJ/HSP40 family. Detection of abnormal protein aggregates in various neurodegenerative diseases has led to the proposal that altered chaperone activity contributes to neurodegeneration. Msj-1, a DNAJ/HSP40 protein located around the spermatozoa acrosome, was recently found to be down-regulated in the testis of wobbler mutant mice. Wobbler is an unidentified recessive mutation which triggers progressive motoneuron degeneration with abnormal intracellular protein accumulations, and defective spermatozoa maturation. Here, we examined Msj-1 expression in the spinal cord of the mutants and their controls. Msj-1 transcripts were amplified by reverse transcription-polymerase chain reaction from mutant and wild-type spinal cord RNA. Sequencing of Msj-1 coding region revealed no change in the mutant. In contrast, decreased Msj-1 mRNA levels were observed in five to six-week-old wobbler mice spinal cord, when motoneuron degeneration is at its apex, as compared to controls. A similar decrease was observed in two-week-old wobbler spinal cord, when the number of motoneurons is still unaltered, indicating that the decreased mRNA content is intrinsic to the mutant and not simply related to the loss of cells expressing Msj-1. Assays of Msj-1 protein levels yielded similar results. Immunofluorescent labeling revealed numerous Msj-1-ir motoneurons in five-week-old control spinal cord while no signal was observed in age-matched wobbler. Our results show, therefore, that Msj-1 expression is down-regulated in both organs affected by the wobbler mutation, the CNS and the testis, and that this defect precedes the first histological signs of motoneuron degeneration. These results provide the first example of an association between transcriptional repression of a chaperone protein and a neurodegenerative process.

Cellular mechanisms of striatum-dependent behavioral plasticity and drug addiction

The striatum has long been known to be involved in the control of motor behavior, since disruption of dopamine-mediated function in this brain structure is directly linked to Parkinson's disease and other disorders of movement. However, it is now accepted that both dorsal and ventral striatal nuclei are also essential for a variety of cognitive processes, which depend on reward-based stimulus-response learning. Since the neuroanatomical and neurochemical organization of dorsal and ventral striatum is only partially overlapping, it is likely that both common and nucleus-specific cellular and molecular events contribute to synaptic plasticity, learning and memory processes mediated by these cerebral structures. Alterations in cell signaling in the striatum may be particularly important in the response to both acute and chronic administration of drugs of abuse, resulting in maladaptive changes in the reward-based associative learning involved in addiction, withdrawal and relapse.

The amphibian testis as model to study germ cell progression during spermatogenesis

Testicular morphology of vertebrate testis indicates requirement of local control. In urodeles, the testis is organized in lobes of increasing maturity throughout the cephalocaudal axis. The anuran testis is organized in tubules. Spermatogenesis occurs in cysts composed by Sertoli cells enveloping germ cells at synchronous stages. Moreover, in numerous species germ cell progression lasts a year which defines the sexual cycle. Due to the above quoted features, research on factors regulating germ cell progression in amphibians may reach greater insight as compared with mammalian animal models. In particular, studies on endocrine and paracrine/autocrine factors involved in the regulation of germ cell functions reveal that fos activation and a J protein, previously specifically found in mouse testis, exert an important role in spermatogonial proliferation and maturation of post-meiotic stages, respectively.

Effects of multiple injections of ethane 1,2-dimethane sulphonate (EDS) on the frog, Rana esculenta, testicular activity

Ethane 1,2-dimethane sulphonate (EDS) is an alkylating agent, which has a selective cytotoxic effect on Leydig cells in some mammalian species. Similarly, in the frog, Rana esculenta, Leydig cells are destroyed after a single EDS injection and regenerate after 28 days. Regeneration of Leydig cells in frogs appears to be independent of the pituitary. The present experiments in R. esculenta were carried out: a) to investigate Leydig cell responsiveness to gonadotropin stimulation during 58 days after a single EDS injection; and b) to assess whether four consecutive EDS injections induce additional effects on the testicular cell population. Our results show that androgen stimulation after gonadotropin injections is restored after 44 days from a single EDS injection. Since the interstitial compartment appears to be normal at least 28 days after EDS treatment, it is likely that new Leydig cells lack gonadotropin receptors. With respect to multiple-EDS injections, Leydig cells completely disappear in several areas and the adjacent germinal compartment is disorganised. In some cases damaged germinal compartment is still surrounded by intact Leydig cells. Surprisingly, testicular and plasma androgens strongly increase in EDS-treated animals. Therefore, Sertoli cells may produce substances inhibiting androgen production in Leydig cells. J. Exp. Zool. 287:384-393, 2000.

Fos localization in cytosolic and nuclear compartments in neurones of the frog, Rana esculenta, brain: an analysis carried out in parallel with GnRH molecular forms

C-fos activity was determined in the brain of the frog, Rana esculenta, during the annual sexual cycle. The localization of GnRH molecular forms (mammalian- and chicken-GnRHII) was also carried out to determine whether or not the proto-oncogene and the peptides showed a functional relationship. Northern blot analysis of total RNA revealed the presence of a single strong signal of c-fos like mRNA of 1.9 Kb during February and April. This was followed by expression of c-Fos protein (Fos) in several brain areas during March and July shown by immunocytochemistry. In particular, the olfactory region, the lateral and medial pallium, the nucleus lateralis septi, the ventral striatum, the caudal region of the anterior preoptic area, the suprachiasmatic nucleus, the ventral thalamus, tori semicircularis and ependymal layers of the tectum were immunostained. There was no overlap between Fos immunoreactive perikarya and GnRH immunoreactive perikarya (e.g. gonadotrophin-releasing hormone (GnRH) in the rostral part and Fos in the caudal region of the anterior preoptic area). Interestingly, a cytoplasmic localization of Fos was also observed by immunocytochemistry and gel retardation experiments supported this observation. Cytoplasmic extracts from September-October animals bound the AP1 oligonucleotide. The complex was not available in the nuclear extracts from the same preparation, suggesting that, besides Fos, Jun products were also present. Conversely, nuclear but not cytosolic binding was detected in the brain of animals collected in July. In conclusion, we show that Fos and GnRH activity does not correlate in the frog brain and, for the first time in a vertebrate species, we give evidence of a cytoplasmic AP1 complex in neuronal cells.

c-fos activity in Rana esculenta testis: seasonal and estradiol-induced changes

Estradiol-17beta (E2) is suspected to exert a role in the regulation of testicular activity. Using a nonmammalian vertebrate model (the frog, Rana esculenta), we have investigated whether c-fos activity is detectable in the testis during the annual sexual cycle and whether E2 exerts a regulatory role on spermatogenesis through fos activity. FOS protein is available in testicular nuclear extracts (about 60 kDa) and, surprisingly, also in cytosolic extracts (about 60, 80, and 100 kDa). Estradiol induces primary spermatogonia (ISPG) proliferation [this effect is counteracted by antiestrogens (Tamoxifen and ICI 182-780)] and FOS appearance in testicular cytosolic extracts as well as c-fos transcription. Also, this effect is counteracted by ICI 182-780. Interestingly, the number of FOS immunopositive nuclei of ISPG strongly increases after E2 treatment, whereas a great increase of immunopositivity in the cytoplasm of ISPG is observed with the contemporaneous treatment with antiestrogens. In conclusion, our results demonstrate that E2 induces ISPG multiplication in the frog, R. esculenta, and, for the first time in a vertebrate species, that it triggers c-fos activity in the testis. Moreover, E2 may be involved in mechanisms related to FOS transport in the nucleus of ISPG to induce the mitotic activity.

17 beta-estradiol effects on mast cell number and spermatogonial mitotic index in the testis of the frog, Rana esculenta

Estrogen affects mast cell activity and cellular proliferation in several vertebrate tissues. Due to the presence of mast cells in the interstitial tissue of the testis and due to the annual changes of spermatogonial proliferation and estradiol level in the frog, Rana esculenta, we have studied the possible regulation of mast cell number (MCN) and primary spermatogonial mitosis exerted by 17 beta-estradiol (E2). MCN changed in the testis during the annual reproductive cycle, showing peaks in December and in May. Administration of E2 elicited an increase of MCN both in intact and hypophysectomized frogs, and this effect was counteracted by tamoxifen. In vitro experiments indicated that E2 induced an increase of both MCN and the primary spermatogonial mitotic index. Moreover, a significant decrease of intratesticular androgen content was measured in E2-treated testes. All the in vitro effects induced by E2 were counteracted by tamoxifen. In conclusion, our data indicate that in Rana esculenta testis E2 increase MCN and primary spermatogonial mitotic index via intratesticular mechanisms. A possible involvement of the decrease of androgen levels exerted by E2 in the mechanism underlying the increase of MCN is also considered.

c-fos- and c-jun-like mRNA expression in frog (Rana esculenta) testis during the annual reproductive cycle

The expression of c-fos and c-jun mRNA has been examined in the testis of a seasonal breeder (the frog, Rana esculenta) during the annual reproductive cycle, using Northern blot analysis along with measurements of plasma levels of estradiol-17 beta and androgens (testosterone + 5 alpha-dihydrotestosterone). A c-fos-like transcript of 1.9 kb was revealed using a 1.1-kb v-fos probe, while three different transcripts of 3.7, 3.4, and 2.7 kb were seen using 1.0-kb human (h)-c-jun fragment. The proto-oncogene-like mRNAs appear during the period of the year associated with the new wave of spermatogenic activity. The levels of fos-like mRNA were highest after the estradiol-17 beta peak, while low levels were concomitant with high androgen concentrations. It is concluded that there is a close correlation between c-fos- and c-jun-like expression and testicular activity in R. esculenta.

Detection of GnRH molecular forms in brains and gonads of the crested newt, Triturus carnifex

Gonadotrophin-releasing hormone (GnRH) immunoreactivity is detectable in the brain, ovary, and testis of the newt, Triturus carnifex, collected during February (reproductive phase), May, and July (nonreproductive phase). In the brain of May animals, chicken GnRH-II positive cell bodies are located within the terminal nerve, the anterior preoptic area, and the preoptic nucleus, which appears to be devoid of immunoreactive mammalian GnRH cell bodies. During February and July, both chicken GnRH-II and mammalian GnRH are detected only within the terminal nerve and anterior preoptic area. Generally, in the reproductive as well as the nonreproductive periods, chicken GnRH-II fibers are widely distributed in the brain; however, the distribution of fibers of both molecular forms suggests that they exert hypophysiotropic activity. High-pressure liquid chromatography (HPLC) coupled with radioimmunoassay indicates the presence of an early-eluting GnRH peak in brains and gonads but not in plasma. Using chicken GnRH-II antiserum, immunoreactivity is observed in spermatocytes, spermatozoa, and the external theca layer. Seasonal changes of the GnRH-like material are observed in both sexes, and its high concentration detectable during February is in good correlation with the timing of reproduction.

Induction of S-phase entry by a gonadotropin releasing hormone agonist (buserelin) in the frog, Rana esculenta, primary spermatogonia

In the testis of the frog, Rana esculenta, mitotic activity of primary spermatogonia is regulated by gonadotropins and synergistically by testosterone. In addition GnRH-like material directly stimulates gonadal activity. Intact animals were treated with a GnRH agonist (GnRHa, buserelin, Hoechst) and/or a GnRH antagonist giving injections intraperitoneally on alternate days for 15 days. Moreover, testes were treated in vitro for 24 hr with GnRHa. 3H-thymidine and colchicine were used to assess the labelling and the mitotic index (LI and MI) of primary spermatogonia. Both LI and MI were increased by the treatment with GnRHa but the rate of cells measured by LI was significantly higher than that of cells measured by MI. Therefore, our results confirm the role of GnRH-like material as local regulator of the testicular activity in vertebrates and show its involvement in promoting the G1-S transition of spermatogonial cell cycle in the frog, Rana esculenta.

Chicken GnRH-II and salmon GnRH effects on plasma and testicular androgen concentrations in the male frog, Rana esculenta, during the annual reproductive cycle

In the frog, Rana esculenta, two molecular forms of GnRH, coeluting with chicken (c) GnRH-II and salmon (s) GnRH, have been detected using HPLC and radioimmunoassay. Mammalian (m) GnRH seems to be also present. In amphibians the role of cGnRH-II seems to be primarily the involvement in the regulation of neuroendocrine processes and, while the mGnRH has been postulated to act as a neurotransmitter and/or neuromodulator, the activity of sGnRH-like material has not been investigated. Therefore, we have treated the frogs with single or multiple injections of cGnRH-II or sGnRH (6 micrograms) or both peptides (6 micrograms of each) to detect differences in the response measured as testicular or plasma androgen (testosterone plus 5 alpha-dihydrotestosterone) concentration during the annual reproductive cycle. The basal profile of testicular and plasma androgen shows that the spring peak disappeared in control animals given multiple injections and kept in short-term captivity. We show in the treatment with cGnRH-II and/or sGnRH that the effects of the peptides depend on the season, the experimental design, and the tissue in which androgen levels were measured. In particular, both peptides strongly stimulate androgen production during the autumn-winter period, the time of the greater response to the GnRHs when basal levels of steroids are highest.

Changes in proto-oncogene activity in the testis of the frog, Rana esculenta, during the annual reproductive cycle

Proto-oncogenes are said to influence the regulation of cellular growth and differentiation. Myc, Fos, Jun, and Mos protein localization has been studied by immunocytochemistry in the testis of the frog, Rana esculenta, during the annual reproductive cycle. Oncoproteins have been localized in the primary and secondary (I and II) spermatogonia (SPG). Myc and Mos also appear in I and II spermatocytes (SPC) while Jun appears in II SPC. Myc, Fos, and Jun in SPG translocate in the nucleus during the periods of active spermatogenesis. Myc, Fos, and Jun are also localized in Sertoli cells. Fos is present in interstitial cells during the period characterized by the androgen peak which precedes the sharp increase of estradiol. It is suggested that proto-oncogene activity exerts a regulatory role in steroidogenesis and spermatogenesis.

Detection of c-mos related products in the dogfish (Scyliorhinus canicula) testis

The objective of the present paper was to do a comparative study to assess somatic versus germ cell localization of c-mos products in the testis. In mouse and amphibian oocytes, c-mos activity is necessary for meiotic maturation. Lack of c-mos expression has been reported in somatic cells of male and female gonads while transcripts have been found in germ cells of testis and ovary. Using a v-mos probe, we report here the detection of a c-mos related transcript (1.7 kb) in the dogfish Scyliorhinus canicula testis. Western blot analysis detects two proteins of 106 and 32 kDa. A specific immunostaining was exclusively localized in the interstitial tissue while the germinal compartment was completely negative. In conclusion, our results indicate for the first time the presence of c-mos products in an elasmobranch species and, moreover, their presence in somatic testicular cells rather than germ cells. Therefore, this finding in an ancient vertebrate indicates that c-mos activity does not have a direct universal role in the regulation of spermatogenesis.

Ethane 1,2-dimethane sulfonate effects on the testis of the lizard, Podarcis s. sicula Raf: morphological and hormonal changes

Ethane 1,2-dimethane sulfonate (EDS) destroys Leydig cells in the testis of some rodents (mice excluded), disrupts interstitial and germinal compartments in the frog, Rana esculenta, while it stimulates testicular activity in the teleost, Gobius paganellus. In the Japanese quail the toxin removes mature spermatozoa. There is no information on EDS effects in reptiles. The present study examines the effect of EDS treatment in the lizard Podarcis s. sicula Raf during two different periods of the testicular cycle (winter stasis and breeding season). Animals received a single EDS injection (100 mg/kg body wt) and were sacrificed at 0 and 24 hr and 3, 5, 7, 11, and 28 days after injection. Androgens were measured in plasma and right testes, while left testes were examined histologically. Plasma androgen levels decreased 5-7 days after EDS injection, alongside interstitial tissue destruction and mast cell appearance, with slight but significant increases on Days 11 and 28. Testicular androgen levels did not change. On Day 11 metaphases were present in the interstitial tissue which regenerated on Day 28. Between Days 5 and 7 some pycnotic nuclei of spermatocytes appeared, mitotic activity of spermatogonia was normal, but germ cell stages were disorganized and empty spaces appeared at the boundary of the tubule. These data show that a single EDS injection results in destruction and repopulation of the interstitial cells in a reptile. Moreover, the effects of EDS in the lizard suggest that P. s. sicula Raf testis responds to the toxin in a similar fashion to the rat testis.

Detection and localization of gonadotrophin-releasing hormone (GnRH)-like material in the frog, Rana esculenta, ovary

GnRH-like material has been identified using HPLC followed by RIA in the ovary of Rana esculenta. During the reproductive cycle three immunoreactive GnRH peaks were eluted. One of them coeluted with s-GnRH, the other two forms between GnRH and cII-GnRH. During the recovery phase s-GnRH immunoreactivity disappears. By immunocytochemistry, cII-GnRH immunostaining was localized to granulosa cells while s-GnRH was present in the perinuclear zone of the oocytes.

Opioid peptides and testicular activity in the lizard Podarcis s. sicula Raf

In mammals endorphinergic systems have been shown to modulate reproductive processes and beta-endorphin (beta-EP) has been found to influence sexual functions, acting at the hypothalamus-pituitary-gonadal axis level. Using immunocytochemical and in vitro studies, evidence for a diffuse pro-opiomelanocortin-related opioid system in the lizard Podarcis s. sicula was produced. In the testis, beta-EP immunoreactivity showed seasonal variation, being most pronounced in the interstitial cells of sexually quiescent lizards (December). Reverse-phase high-performance liquid chromatography, coupled with radioimmunoassay and immunocytochemistry, showed that beta-EP and acetyl beta-EP increased during December, while their concentrations were low during April, when the highest testicular activity occurred. Using in vivo studies, it was found that naltrexone treatment, blocking pituitary opioid receptor, increased androgen levels in the plasma and in the testis. It was also found with in vitro studies that the endogenous opioid system inhibits gonadotrophin release and therefore androgen production by the testis. The data reported here provide evidence for the physiological role played by opioid peptides at the pituitary level to regulate the seasonal reproductive activity of the lizard Podarcis s. sicula.

Regeneration of the testicular interstitial compartment after ethane dimethane sulfonate treatment in the hypophysectomized frog Rana esculenta: independence of pituitary control

The effects of ethane dimethane sulfonate (EDS) on the testes of hypophysectomized frogs (Rana esculenta) were investigated by light and electron microscopy. Initial signs of interstitial cell damage were observed in EDS- and EDS plus pituitary homogenate (PH)-treated animals 5 days after a single injection of EDS (100 mg/Kg body weight). The germinal compartment in these two groups appeared disorganized adjacent to the damaged interstitial tissue only in the EDS-treated animals, and by Day 8, spermatogenesis seemed to be affected in the EDS + PH-treated frogs in which Leydig cells had disappeared in some areas. On Day 28, regeneration of the interstitial tissue was complete and spermatogenesis was restored to normal. These data suggest that, in hypophysectomized frogs, the regeneration of the interstitial compartment is independent of pituitary activity and that the lack of interstitial cells activates the production of local factors responsible for the differentiation and proliferation of new Leydig cells. It is concluded that in addition to gonadotropins, the intratesticular environment is fundamental in the maintenance and regulation of testicular structure and function.

Two GnRHs fluctuate in correlation with androgen levels in the male frog Rana esculenta

ChickenII-(cII-) and salmon (s-) GnRH levels have been measured in the male frog Rana esculenta during the annual cycle. The presence of pituitary binding activity for both peptides and plasma androgen levels has been investigated in order to give insight into the significance of the dual control exerted by the GnRH forms present in the R. esculenta brain. ChickenII- and s-GnRHs showed high values during the spring-summer period. Conversely, while cII-GnRH peaked in February, s-GnRH declined slowly from February until May. Plasma androgen levels increased as the peptides decreased during the autumn-winter period. Still high androgen levels (but significantly lower as compared with winter concentrations) were found during spring. Using iodinated cII-GnRH, GnRH binding sites were detected in pituitary preparations when the corresponding peptide concentration decreased in the brain. On the contrary, no binding sites were found using labeled s-GnRH. Our results indicate that cII-GnRH has a hypophysiotropic activity, while the role of s-GnRH needs to be further investigated.

Opioids and testicular activity in the frog, Rana esculenta

The presence and activity of brain, pituitary and testicular beta-endorphin (beta-EP)-like material have been studied in the frog, Rana esculenta, using reverse-phase high-pressure liquid chromatography, coupled with radioimmunoassay and immunocytochemistry. In-vivo and in-vitro treatments with naltrexone were carried out to assess the putative physiological activity of opioid peptides. beta-EP(1-31) and (1-27), together with their acetylated forms, have been identified in brain, pituitary and testis. In particular, beta-EP(1-31) concentrations peaked during July in the brain and pituitary, whilst in testes maximum concentrations were found in April and November. beta-EP immunoreactivity was present in the brain within the nucleus preopticus and nucleus infundibularis ventralis while positive fibres in the retrochiasmatic regions projected to the median eminence. In the testis, interstitial cells, canaliculi of the efferent system, spermatogonia and spermatocytes showed positive immunostaining for beta-EP. In intact animals, naltrexone treatment increased plasma and testicular androgen levels and this effect was confirmed in in-vitro incubations of minced testes. Naltrexone also induced a significant increase in germ cell degeneration. Our results indicated that an opioid system modulates the hypothalamus-pituitary-gonadal axis in the frog, Rana esculenta and, for the first time, we have shown that the testicular activity of a non-mammalian species may be regulated by opiates locally.

Dopamine regulation of testicular activity in intact and hypophysectomized frogs, Rana esculenta

In intact frogs, both GnRHA and L-dopa were able to increase testicular and plasma androgen levels and to induce spermiation. The dopamine antagonist pimozide inhibited both the effects of L-dopa but not those of GnRHa. Hypophysectomy reduced androgen levels, but spermiation was still induced by both GnRHa and L-dopa, suggesting that these agents can directly influence the testis through a route not involving the pars distalis. Again, pimozide antagonised spermiation induced by L-dopa but not that induced by GnRHa.

Intratesticular control of spermatogenesis in the frog, Rana esculenta

Adult intact and hypophysectomized (PDX) frogs, Rana esculenta, were treated with a gonadotropin releasing hormone agonist (GnRHA, HOE 766) and/or cyproterone acetate (CPA), the antiandrogen, in order to investigate the regulation of primary spermatogonial (I SPG) multiplication in vertebrates. Treatment with GnRHA (injections containing 900 ng administered for 12 days on alternate days) caused a significant increase of the mitotic index (MI) of I SPG in PDX animals and a further MI increase of SPG was observed when 0.66 mg CPA was given concomitantly with GnRHA. The treatment with 0.66 mg CPA in combination with GnRHA also increased secondary spermatocyte (II SPC) appearance. Moreover, number of nests containing spermatids (SPT) decreased as CPA, in combination with GnRHA, was administered in increasing doses (0.33 and 0.66 mg/injection). Intact animals treated with CPA (0.66 mg/injection) showed a time-dependent I SPG multiplication increase which reached highest values after 28 days. Secondary SPC also proliferated until day 28; meanwhile the number of nests containing SPT decreased. Neither testosterone nor R5020 (a progestin which is not converted to androgens) modified the basal and GnRHA-induced spermatogonial proliferation. These results confirm that in the frog, Rana esculenta, spermatid formation is impaired by CPA treatment and that I SPG multiplication is enhanced by a direct effect of GnRHA; moreover, we suggest that the absence of spermatids constitutes a signal promoting spermatogonial proliferation.

Immunoreactive Met-enkephalin-like material in the testis of Rana esculenta: identification and localization

Methionine-enkephalin (Met-Enk) has been detected in the testis of the frog, Rana esculenta, using a reverse-phase high-performance liquid chromatography system coupled with a specific radioimmunoassay. By means of immunocytochemical techniques Met-Enk positive cells have been localized in interstitial and germinal compartments. Particularly, spermatogonia, spermatocytes, and spermatozoa were stained in seminiferous tubules, and numerous interstitial cells showed strong cytoplasmic immunoreactivity in summer animals. Variations in the concentration of Met-Enk immunoreactive material occurred during the annual cycle. Our data show that Met-Enk is present in testes of nonmammalian vertebrate species. These results suggest that autocrine and/or paracrine mechanisms may regulate testicular activity in amphibians.