Structural insights into neurokinin 3 receptor activation by endogenous and analogue peptide agonists

Neurokinin 3 receptor (NK3R) is a tachykinin receptor essential for the hypothalamic-pituitary-gonadal axis. The endogenous peptide agonist neurokinin B (NKB) preferentially activates NK3R, while substance P (SP) binds preferentially to NK1R. In addition, the SP analogue senktide more potently activates NK3R than NKB and SP. However, the mechanisms of preferential binding of peptide and NK3R activation remain elusive. Herein, we determined the cryogenic electron microscopy (cryo-EM) structures of the NK3R-G_q complex bound to NKB, SP and senktide. The three NK3R-G_q/peptide complexes utilize a class of noncanonical receptor activation mechanisms. Combining the structural analysis and functional assay illustrated that the consensus C-termini of the three peptide agonists share a conserved binding mode to NK3R, while the divergent N-termini of the peptides confer the preferential binding of the agonist to NK3R. In addition, the specific interactions between the N-terminus of senktide and the N-terminus and extracellular loops (ECL2 and ECL3) of NK3R lead to the improved activation displayed by senktide compared to SP and NKB. These findings pave the way to understand tachykinin receptor subtype selectivity and provide ideas to rationally develop drugs targeting NK3R.

A262 NEONATAL ACUTE LIVER FAILURE DUE TO PRESUMED GESTATIONAL ALLOIMMUNE LIVER DISEASE - A CASE REPORT

Background

Neonatal acute liver failure (NALF) is a rare disease that is distinct from acute liver failure seen in older children and adults. Gestational alloimmune liver disease (GALD) is the most frequent cause, is initiated in utero by sensitization of the maternal immune system to a fetal hepatocyte antigen and subsequent production of maternal immunoglobulin G antibodies that cross the placenta. Maternal IgG binds to a fetal hepatocyte antigen and initiates an innate immune response involving the terminal complement cascade and membrane attach complex. The understanding of the alloimmune origin has led to the use of intravenous immunoglobulin (IVIG) treatment and exchange transfusion, significantly increasing survival. However, approximately 25% of patients may not respond and require salvage liver transplantation. In spite of an increased rate of comorbidities, concern for technical difficulties and limited graft availability, young infants eligible for transplant have been shown to have similar overall patient and graft survival rates compared to older children with other indications for liver transplant.

Purpose

The primary aim of our study is to report a case of NALF with successful liver transplant.

Method

We present the case of a preterm girl with NALF due to GALD refractory to medical management, requiring liver transplantation.

Result(s)

This is a 35-week preterm girl, with scant pre-natal care, birth weight of 1.825 kg and Apgar 9/9. She is the seventh child of non-consanguineous parents, with healthy siblings. On day-of-life (DOL) 1 she presented with acute kidney injury, progressive worsening metabolic acidosis and hyperammonemia and was found to be profoundly coagulopathic (INR 6), with normal liver enzymes and liver failure was diagnosed. Initial investigation ruled out congenital infections, sepsis, neonatal hemophagocytic lymphohistiocytosis and metabolic diseases. Magnetic resonance imaging of the body demonstrated findings in keeping with iron deposition in the thyroid, liver and pancreas, suggestive of GALD. Completed double volume exchange transfusion and IVIG on DOL 9 and repeat IVIG on DOL 13 and 15, with partial improvement in INR. Due to persistent ascites, conjugated hyperbilirubinemia and hyperammonemia she was transferred for urgent liver transplant assessment. Persistent liver dysfunction in the form of hyperammonemia, hypoglycemia and progressive coagulopathy led to transplant listing on DOL 30. ABO incompatible deceased donor liver transplant was completed on DOL 62 (4.075 kg, estimated dry weight 3.5 kg). The procedure was uncomplicated, liver enzymes normalized, coagulopathy and hypoglycemia resolved. She was transferred to the ward on post-operative day (POD) 6. and weaned off sedatives and transitioned to oral feeds within 2 weeks of transplant, with complex abdominal wound closure on POD 29.

Conclusion(s)

Successful liver transplantation is possible in neonates with acute liver failure due to GALD refractory to medical management and weighing 4kg or less.

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None

Disclosure of Interest

None Declared

MICROBIOME & MICROBIAL THERAPY

Treatment of Patients with Waldenström Macroglobulinaemia: Clinical practice update from the Myeloma Foundation of Australia Medical and Scientific Advisory Group

Waldenström macroglobulinaemia (WM) is an indolent B-cell malignancy characterised by the presence of IgM paraprotein, bone marrow infiltration by clonal small B lymphocytes with plasmacytic differentiation and the MYD88 L265P mutation in >90% of cases. Traditionally, WM has been treated with chemoimmunotherapy. Recent trials have demonstrated the efficacy and safety of Bruton tyrosine kinase inhibitors in WM, both as monotherapy and in combination with other drugs. There is emerging evidence on use of other agents including BCL2 inhibitors and on treatment of rare presentations of WM. In this update, the Medical and Scientific Advisory Group of Myeloma Australia review the available evidence on the treatment of WM since the last publication in 2017 and provide specific recommendations to assist Australian clinicians in the management of this disease.

AB1392 COVID-19 HAD AN ADVERSE IMPACT ON DENOSUMAB TREATMENT PROVISION - COMPARISON WITH PRE-PANDEMIC WAITING TIMES AT A UK-BASED RHEUMATOLOGY DEPARTMENT

Background

Denosumab treatment is licensed for prevention of osteoporotic fractures. It can cause hypocalcaemia, so bone profile blood tests must be checked prior to treatment. In our department, we have a Standard that patients have blood tests within 1 month before their denosumab injection, and that they receive the injection within 1 month from its due date. A customized MS Access database to record this information and generate a date for the next dose was established in 2015 after a quality improvement project (QIP)1. At the onset of the COVID-19 pandemic, UK national guidance recommended continued provision of denosumab as an essential service.

Objectives

1. To re-audit delay from due date to actual injection date after establishment of our database.

2. To compare delay from due date to actual injection date before and after onset of COVID-19.

3. To compare the time between blood tests and actual injection date, before and after onset of COVID-19.

Methods

Data for 2 time-periods were extracted from the database: Time Period 1 (pre-COVID-19) 01-03-2019 – 29-02-2020; Time Period 2 (post-COVID-19 onset) 01-03-2020 – 28-02-2021. For each patient attendance, dates of blood test, due date and actual injection date were extracted. All patient details were anonymised, with a decryption key to identifiers held on a secure server at the host Trust. It was manually determined whether blood tests and injections were within 1 month of when they were due. Statistical analyses were carried out in Stata v.14.0. The Kolmogorov-Smirnov test was used to compare distributions between Time Periods 1 and 2.

Results

TIME PERIOD 1: 100 appointments were audited from 68 patients. 20% of blood tests were within 1 month of actual injection date. Median time between blood tests and actual injection was 45 days [IQR 35 – 59]. 52% of actual injections were given within 1 month from due date. (This compares favourably with our 2015 QIP, when 40% of actual injections were within 1 month from due date1). Median time between due date and actual injection was 29.5 days [IQR 13 – 50.5]. TIME PERIOD 2: 77 appointments were audited from 66 individual patients. 24.7% of blood tests were within 1 month of actual injection. Median time between blood tests and actual injection was 45 days [IQR 35 – 59]. 16.6% of actual injections were given within 1 month of due date. Median time between due date and actual injection was 82 days [IQR 40 – 141]. There were no significant differences in time between blood tests and actual injection between Time Periods 1 and 2. However, the time between due date and actual injection date was significantly longer in Time Period 2 (p<0.005).

Conclusion

The introduction of our customized database promoted an improvement in time between due date and actual injection date of denosumab. However, this improvement significantly declined after the onset of the COVID-19 pandemic. Resources may need to be increased and processes adapted to minimise the impact of future emergencies on denosumab provision.

References

[1]Ammori M et al. Rheumatology 2015;54(Suppl1):i105.

Disclosure of Interests

None declared

POS0509 DEVELOPMENT OF A MULITNOMIAL PREDICTION MODEL OF TREATMENT RESPONSE TO ETANERCEPT IN A MULTI-CENTRE COHORT OF PATIENTS WITH ESTABLISHED RA

Background

Treatment response in rheumatoid arthritis (RA) is assessed through EULAR response groups of good, moderate, and poor response. Clinical prediction models from the literature typically frame this as a binary model, to differentiate poor from good and moderate responders. Here, we develop a multinomial model, to predict each group separately, after 3 months on the anti-TNF drug Etanercept (ETN).

Objectives

Develop and validate a multinomial prediction model of treatment response to ETN in RA, based on baseline clinical covariates.

Methods

We identified patients treated with ETN or biosimilars (N = 778) from the Biologics in RA Genetics and Genomics Study Syndicate (BRAGGSS). Response groups were derived from the CRP based 4C-DAS28 at baseline and 3 month follow up, yielding 310 good, 320 moderate, and 148 poor responders. A multinomial logistic regression model was fitted, using good responders as reference category. Multiple imputation by chained equations was used to impute missing data, and models were internally validated via bootstrapping. We report model accuracy, as well as calibration, and compare effect sizes across response groups. Table 1shows the baseline statistics, and odds ratios for the included covariates.

Table 1.

Baseline covariate statistics and odds ratios (in bold: significant at p < 0.05); HADS: Hospital Anxiety and Depression Scale

VariableMean (± SD)ORModerate [95% CI]pORPoor [95% CI]por % YesSwollen Joint8.84450.980.350.948e-3Count (SJC)(± 5.20)[0.95 1.02][0.89 0.98]Tender Joint14.68771.076e-61.050.01Count (TJC)(± 6.74)[1.04 1.10][1.01 1.08]General Health74.74291.000.60.981e-3Visual Analog Scale (GHVAS)(±17.79)[0.99 1.01][0.97 0.99]CRP19.07391.000.220.990.26(±25.07)[1.00 1.01][0.98 1.00]BMI30.30351.000.481.000.41(±23.28)[0.99 1.01][0.99 1.01]Age of47.33301.010.121.020.06onset(±13.86)[1.00 1.03][1.00 1.04]Disease9.94011.000.840.990.45duration(±10.35)[0.98 1.02][0.96 1.02]HAQ1.60851.480.022.951e-6(± 0.65)[1.06 2.08][1.91 4.54]HADS-Anxiety8.08681.040.191.060.12(± 4.54)[0.98 1.10][0.99 1.13]HADS-Depression7.38411.060.120.970.55(± 4.02)[0.99 1.13][0.89 1.06]Concurrent81.49%0.412e-40.520.03DMARD[0.26 0.66][0.28 0.94]Female78.66%1.390.121.110.71[0.92 2.10][0.65 1.87]Seropositive77.89%0.540.020.470.01[0.33 0.89][0.26 0.86]1st Biologic90.62%1.060.860.480.03[0.55 2.06][0.24 0.94]

Results

Adjusted for optimism, the multinomial model achieves an accuracy of 50.7% (IQR: 50 – 51.3%), with calibration slopes of 0.574 (IQR: 0.569 - 0.579) and 0.534 (IQR: 0.525 - 0.544) for moderate and poor response, respectively. Figure 1 shows a comparison of odds ratios (OR) for the different outcome groups. The Health Assessment Questionnaire (HAQ) score is the biggest driver of both moderate and poor response. Previous biologic treatment also predicts poor but not moderate response. Compared to the multinomial model, a binary model, that discriminates poor from moderate and good responders, underestimates the effect size of HAQ.

Figure 1.

Odds ratios of FIRSTBIO and HAQ for moderate and poor response. Size of crosses indicate 95% confidence intervals.

Conclusion

The model predicts EULAR response groups moderately well but is poorly calibrated, which can partly be explained by the generally higher sample size requirement of multinomial modelling. In the multinomial model, moderate and poor response is largely driven by the same covariates, which leads to blurred boundaries between good and poor responders, when response groups are merged to create a binary problem. Future research should consider the most appropriate model choice to describe data, including the use of multinomial instead of binomial models. More research and bigger sample sizes are required to improve on this multinomial model.

Disclosure of Interests

Michael Stadler: None declared, Stephanie Ling: None declared, Nisha Nair: None declared, John Isaacs Speakers bureau: Abbvie, Gilead, Roche, UCB, Grant/research support from: GSK, Janssen, Pfizer, Kimme Hyrich Speakers bureau: Abbvie, Grant/research support from: Pfizer and BMS, Ann Morgan Speakers bureau: Roche/ Chuga, Consultant of: GSK, Roche, Chugai, AstraZeneka, Regeneron, Sanofi, Vifor, Grant/research support from: Roche, Kiniksa Pharmaceuticals, Anthony G Wilson: None declared, Darren Plant: None declared, John Bowes: None declared, Anne Barton Grant/research support from: Pfizer, Galapagos, Scipher Medicine, and Bristol Myers Squibb.

Structural insights into the activation of somatostatin receptor 2 by cyclic SST analogues

The endogenous cyclic tetradecapeptide SST14 was reported to stimulate all five somatostatin receptors (SSTR1-5) for hormone release, neurotransmission, cell growth arrest and cancer suppression. Two SST14-derived short cyclic SST analogues (lanreotide or octreotide) with improved stability and longer lifetime were developed as drugs to preferentially activate SSTR2 and treat acromegalia and neuroendocrine tumors. Here, cryo-EM structures of the human SSTR2-Gi complex bound with SST14, octreotide or lanreotide were determined at resolutions of 2.85 Å, 2.97 Å, and 2.87 Å, respectively. Structural and functional analysis revealed that interactions between β-turn residues in SST analogues and transmembrane SSTR2 residues in the ligand-binding pocket are crucial for receptor binding and functional stimulation of the two SST14-derived cyclic octapeptides. Additionally, Q102^2.63, N276^6.55, and F294^7.35 could be responsible for the selectivity of lanreotide or octreotide for SSTR2 over SSTR1 or SSTR4. These results provide valuable insights into further rational development of SST analogue drugs targeting SSTR2.

Different conformational responses of the β2-adrenergic receptor-Gs complex upon binding of the partial agonist salbutamol or the full agonist isoprenaline

G protein-coupled receptors (GPCRs) are responsible for most cytoplasmic signaling in response to extracellular ligands with different efficacy profiles. Various spectroscopic techniques have identified that agonists exhibiting varying efficacies can selectively stabilize a specific conformation of the receptor. However, the structural basis for activation of the GPCR-G protein complex by ligands with different efficacies is incompletely understood. To better understand the structural basis underlying the mechanisms by which ligands with varying efficacies differentially regulate the conformations of receptors and G proteins, we determined the structures of β2AR-Gαs$\beta $γ bound with partial agonist salbutamol or bound with full agonist isoprenaline using single-particle cryo-electron microscopy at resolutions of 3.26 Å and 3.80 Å, respectively. Structural comparisons between the β2AR-Gs-salbutamol and β2AR-Gs-isoprenaline complexes demonstrated that the decreased binding affinity and efficacy of salbutamol compared with those of isoprenaline might be attributed to weakened hydrogen bonding interactions, attenuated hydrophobic interactions in the orthosteric binding pocket and different conformational changes in the rotamer toggle switch in TM6. Moreover, the observed stronger interactions between the intracellular loop 2 or 3 (ICL2 or ICL3) of β2AR and Gαs with binding of salbutamol versus isoprenaline might decrease phosphorylation in the salbutamol-activated β2AR-Gs complex. From the observed structural differences between these complexes of β2AR, a mechanism of β2AR activation by partial and full agonists is proposed to provide structural insights into β2AR desensitization.

A genetically encoded small-size fluorescent pair reveals allosteric conformational changes of G proteins upon its interaction with GPCRs by fluorescence lifetime based FRET

The dynamics of GPCRs (G protein-coupled receptors) coupling for cognate G proteins play a critical role in signal transduction. Herein, we reported a site-specifically labelled small-sized fluorescent pair 7-HC/FlAsH ((7-hydroxycoumarin-4-yl)-ethylglycine/fluorescein arsenical hairpin) for fluorescence lifetime based FRET (fluorescence resonance energy transfer) to reveal conformational differences of Gαi1 (inhibitory G proteins) and Gαs (stimulatory G proteins) upon β2AR (β2-adrenergic receptor) coupling. It offers a new generally applicable method to probe protein dynamic interactions or conformational changes.

Diabetes in adults with intellectual disability: prevalence and associated demographic, lifestyle, independence and health factors

BACKGROUND

As people with intellectual disabilities (ID) are now living longer, they are more at risk of developing non-communicable diseases, including type 2 diabetes mellitus. However, understanding of factors associated with diabetes for targeted management and prevention strategies is limited. This study aimed to investigate prevalence of diabetes in adults (aged ≥18 years) with ID and its relationship with demographic, lifestyle, independence and health factors.

METHOD

This was a cross-sectional analysis of interview data from 1091 adults with ID from the Leicestershire Learning Disability Register from 1 January 2010 to 31 December 2016. Logistic regression models were used to identify factors associated with diabetes in the study population.

RESULTS

The study population did not have healthy lifestyles: just under half reported having lower physical activity levels than people without ID of a similar age; one-quarter consumed fizzy drinks daily; and 20% consumed five or more fruit and/or vegetables per day. Prevalence of carer/self-reported diabetes was 7.3% (95% confidence interval 5.9-9.0). After adjustment, diabetes was positively associated with South Asian ethnicity (P = 0.03) and older age groups (P < 0.001). Diabetes was less common in people living with family members (P = 0.02). We did not find a relationship between any of the lifestyle, independence and health factors investigated.

CONCLUSIONS

A significant proportion of people with ID are living with diabetes. Diabetes management and prevention strategies should be tailored to individuals' complex needs and include consideration of lifestyle choices. Such strategies may want to focus on adults of South Asian ethnicity and people living in residential homes where prevalence appears to be higher.

Temperature-dependent ESR and computational studies on antiferromagnetic electron transfer in the yeast NADH dehydrogenase Ndi1

The electron transfer mechanism of Ndi1.

Combined approaches of EPR and NMR illustrate only one transmembrane helix in the human IFITM3

Interferon-inducible transmembrane protein IFITM3 was known to restrict the entry of a wide spectrum of viruses to the cytosol of the host. The mechanism used by the protein to restrict viral entry is unclear given the unavailability of the membrane topology and structures of the IFITM family proteins. Systematic site-directed spin labeling (SDSL) and electron paramagnetic resonance (EPR) studies of IFITM3 in detergent micelles identified a single, long transmembrane helix in the C-terminus and an intramembrane segment in the N-terminal hydrophobic region. Solution NMR studies of the same sample verified the secondary structure distribution and demonstrated two rigid regions interacting with the micellar surface. The resulting membrane topology of IFITM3 supports the mechanism of an enhanced restricted membrane hemi-fusion.

Effect of daily short-duration weight-bearing on disuse-induced deterioration of musculoskeletal system

OBJECTIVES

To investigate deterioration of musculoskeletal system due to prolonged disuse and the potential of daily short-duration weight-bearing as countermeasures.

METHODS

Twenty-four adult male Sprague-Dawley rats were divided into Control Group (CG, no intervention), Tail-suspension Group (TG, tail-suspension without treatment), and Weight-Bearing Group (WBG, tail-suspension with 20 min/day, 5 days/week body weight loading). After four weeks of treatment, femur and tibia, soleus and extensor digitorum longus were evaluated for bone and muscle quality respectively. Tensile properties of bone-tendon insertion (BTI) were evaluated using patella-patellar tendon complex.

RESULTS

Disuse induced deterioration on bone, muscle, and BTI after four weeks. Compared with CG, TG and WBG showed significant decrease in bone mineral density (BMD) of trabecular bone in distal femur (4.3-15.2%), muscle mass (31.3-52.3%), muscle cross-sectional area (29.1-35%), and failure strength of BTI (23.9-29.4%). Tensile test showed that the failure mode was avulsion of bone at the BTI. No significant difference was detected between TG and WBG for all assessments on bone, muscle, and BTI.

CONCLUSIONS

Disuse caused deterioration of bone, muscle, and BTI while daily short-duration of weight-bearing did not prevent this deterioration. Mechanical stimulation with higher intensity and longer duration may be necessary to prevent musculoskeletal deterioration resulted from prolonged disuse.

Decreased microRNA-206 and its function in cervical cancer

OBJECTIVE

MicroRNA-206 plays important roles in tumorigenesis and tumor progression of various human malignancies. However, its involvement in cervical cancer has remained unclear.

OBJECTIVE

The aim of this study was to examine the expression patterns and clinical implications of miR-206 in cervical cancer.

MATERIALS AND METHODS

Quantitative RT-PCR was performed to evaluate the expression levels of miR-206 in cervical cancer cell lines and primary tumor tissues. The clinicopathologic significance and the prognostic value of miR-206 expression were further determined. Finally, the effects of miR-206 on HeLa cell proliferation, apoptosis, invasion, and migration were investigated.

RESULTS

MiR-206 expression was significantly downregulated in cervical cancer samples when compared with normal adjacent tissues. Low level of miR-206 was associated with advanced FIGO stage (p < 0.001), positive lymph node metastasis (p < 0.001), poor differentiation (p = 0.016), and human papillomavirus infection (p = 0.007). Multivariate Cox regression analysis revealed that decreased miR-206 expression was an independent unfavorable prognostic factor for overall survival. In addition, transfection of miR-206 mimics in HeLa cells was able to reduce cell proliferation, promote cell apoptosis, and inhibit cell invasion and migration.

CONCLUSIONS

miR-206 may act not only as a novel diagnostic and prognostic marker, but also as a potential target for molecular therapy of cervical cancer.

Expression and prognostic significance of microRNA-451 in human epithelial ovarian cancer

OBJECTIVE

MicroRNA-451 has been proved to be downregulated in many human malignancies and correlated with tumor progression. However, its expression and clinical significance in epithelial ovarian cancer (EOC) is still unclear. The aim of this study was to explore the effects of miR-451 in EOC tumorigenesis and development.

MATERIALS AND METHODS

The expression levels of miR-451 were quantified by qRT-PCR in 115 EOC and 34 normal ovarian tissues, and correlated with clinicopathological factors and prognosis. MTT, flow cytometric assay, and transwell invasion assay were used to test the proliferation, apoptosis, and invasion of SKOV-3 EOC cells transfected with miR-451 mimics or negative control (NC) RNA-oligonucleotides.

RESULTS

MiR-451 expression was significantly downregulated in EOC compared with normal ovarian tissues. Low level of miR-451 was associated with advanced FIGO stage (p = 0.005), higher serum CA125 expression level (p = 0.005), and lymph node metastasis (p = 0.002). Multivariate Cox regression analysis identified decreased miR-451 expression as an independent factor predicting poor prognosis for EOC patients. In addition, transfection of miR-451 mimics in SKOV-3 was able to reduce cell proliferation, promote cell apoptosis, and inhibit cell invasion.

CONCLUSIONS

miR-451 may act not only as a novel diagnostic and prognostic marker, but also as a potential target for molecular therapy of EOC.

Basiliximab with delayed introduction of calcineurin inhibitors as a renal-sparing protocol following liver transplantation in children with renal impairment

Renal impairment is frequently compromised in patients with end-stage liver disease and is associated with increased long-term mortality post-LT. In contrast to CNI, basiliximab is an immunosuppressive agent with minimal nephrotoxic potential. This study reviews the experience of a single pediatric liver transplant center's renal-sparing approach with the use of basiliximab and MMF to compensate for delayed entry of CNI in children with renal impairment at the time of organ availability. There were no differences in renal function between pediatric patients with and without pre-LT renal impairment within the first year (cGFR: 135 mL/min/1.73 m2 vs. 144 mL/min/1.73 m2 ; p = 0.56) or at 5-8 yr following LT, (129 mL/min/1.73 m2 vs. 130 mL/min/1.73 m2 ; p = 0.97). In addition, there was no difference in ACR rates (50% vs. 43%, p = 0.62) between patients in the basiliximab group and those patients receiving standard CNI and steroid strategies. The utilization of a renal-sparing approach with basiliximab alongside delayed entry and lower early target trough levels of CNI in children with renal impairment at the time of LT is safe and maintains excellent long-term kidney function.

A causal role for circulating miR-34b in osteosarcoma

PURPOSE

To investigate the associations between plasma miR-34b/c expression levels and osteosarcoma (OS).

SUBJECTS AND METHODS

A case-control study was conducted in 133 patients with OS and 133 controls. MiR-34b/c levels were detected by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) assays. Genotyping of SNP rs4938723 was done using the TaqMan assay. The causal association was examined by mendelian randomization analysis.

RESULTS

Plasma miR-34b level was significantly lower in OS patients than in controls (P = 0.001). Expression levels of miR-34b in OS tissues decreased (P = 3.22 × 10(-4)) and was significantly related with its expression in plasma (r = 0.21, P = 0.004). Compared with wild-type TT genotype, the variant genotypes of rs4938723 TC/CC were significantly associated with increased OS risk (TC vs. TT: OR, 1.97 [95% CI: 1.40-2.55], P = 0.021; CC vs. TT: OR, 2.76 [95% CI: 2.00-3.53], P = 0.009; TC + CC vs. TT: OR, 2.16 [95% CI: 1.61-2.70], P = 0.006), consistent with its decreased effect on plasma miR-34b (TC vs. TT: -0.32 (-0.43, -0.21), P < 0.001; CC vs. TT: -0.70 (-0.84, -0.56), P < 0.001; TC + CC vs. TT: -0.42 (-0.53, -0.32), P < 0.001). Adjustment for miR-34b completely abolished the association between SNP rs4938723 and OS risk (P > 0.05). In addition, plasma expression levels of miR-34b were significantly decreased in the metastatic patients compared with that in the non-metastatic ones (P = 0.004).

CONCLUSION

Plasma miR-34b was causally associated with OS risk and related with its metastatic status, suggesting that plasma miR-34b might be a novel biomarker and a potential treatment target for OS.

Cell adhesion molecules as pharmaceutical target in atherosclerosis

Cell adhesion molecules (CAMs) are transmembrane proteins that mediate adhesion and interactions between cells or cell and extra-cellular matrix. Increased expression and activation of CAMs in vascular endothelial cells and circulating leukocytes, as occurring in the settings of inflammation, hypercholesterolemia, hypertension and diabetes, stimulates leukocyte recruitment into the vascular endothelium, an important step in the pathogenesis of atherosclerosis. CAMs are a potential therapeutic target in clinical practice and in recent years pharmaceutical agents with specific effects on the production and function of these molecules have been studied and developed. This article reviews recent progress regarding pathophysiology of CAMs in atherogenesis and pharmaceutical products or chemicals that are active against CAMs, and assesses the possibilities for clinical developments in this area that might enhance the prevention, monitoring and treatment of atherosclerotic cardiovascular diseases.

Resistive vibration exercise retards bone loss in weight-bearing skeletons during 60 days bed rest

Countermeasures are desirable to retard bone loss during long-term space flight. We evaluated the effect of an intervention protocol on bed rest-induced bone loss.

INTRODUCTION

We developed a resistive vibration exercise (RVE) platform to test if an intervention RVE protocol would be effective to protect bed rest-induced bone loss.

METHODS

Fourteen male subjects were assigned randomly to either the RVE group (n = 7) that performed daily supervised resistive vibration exercise or to the no any exercise control (CON) group (n = 7). Both dual-energy X-ray absorptiometry and peripheral quantitative computed tomography were used to monitor changes in bone mineral density.

RESULTS

RVE significantly prevented bone loss at multiple skeletal sites, including calcaneus, distal tibia, hip, and lumbar spine (L2-L4). The ratio of urinary calcium and creatinine was found higher after starting bed rest in CON group while no significant changes were observed in RVE group. No significant temporal change was found for osteocalcin-N during and after bed rest in CON group. However, a significant increase was shown after bed rest in RVE group. In both groups, the urinary concentration of bone resorption markers, such as C-telopeptide of type I collagen (CTX-I) and deoxypyridinoline (DPD), were significantly elevated after bed rest. In the CON group, no significant temporal effect was found for hydroxyproline (HOP), CTX-I, and DPD during bed rest and the serum concentration of HOP and TGF-β significantly increased about 52.04% and 24.03%, respectively only after bed rest. However, all these markers tended to decrease in the RVE group.

CONCLUSIONS

Our results might imply that the intervention of RVE retarded bone loss induced by simulated microgravity in humans that was mainly attributed to its anabolic effects.

The PROMISE study: a phase 2b multicenter study of voclosporin (ISA247) versus tacrolimus in de novo kidney transplantation

Voclosporin (VCS, ISA247) is a novel calcineurin inhibitor being developed for organ transplantation. PROMISE was a 6-month, multicenter, randomized, open-label study of three ascending concentration-controlled groups of VCS (low, medium and high) compared to tacrolimus (TAC) in 334 low-risk renal transplant recipients. The primary endpoint was demonstration of noninferiority of biopsy proven acute rejection (BPAR) rates. Secondary objectives included renal function, new onset diabetes after transplantation (NODAT), hypertension, hyperlipidemia and pharmacokinetic-pharmacodynamic evaluation. The incidence of BPAR in the VCS groups (10.7%, 9.1% and 2.3%, respectively) was noninferior to TAC (5.8%). The incidence of NODAT for VCS was 1.6%, 5.7% and 17.7% versus 16.4% in TAC (low-dose VCS, p = 0.03). Nankivell estimated glomerular filtration rate was respectively: 71, 72, 68 and 69 mL/min, statistically lower in the high-dose group, p = 0.049. The incidence of hypertension and adverse events was not different between the VCS groups and TAC. VCS demonstrated an excellent correlation between trough and area under the curve (r(2) = 0.97) and no difference in mycophenolic acid exposure compared to TAC. This 6-month study shows VCS to be as efficacious as TAC in preventing acute rejection with similar renal function in the low- and medium-exposure groups, and potentially associated with a reduced incidence of NODAT.