Navigating trans visibilities, trauma and trust in a new cervical screening clinic

Trans and gender diverse people are globally recognised as being under-served in clinical services, with significant implications for their health. During a national reorientation of the Australian cervical screening programme - from Papanicolaou smears to human papillomavirus screening - we conducted interviews with 12 key informants in cancer policy, sexual and reproductive health and trans health advocacy to understand how trans people's needs and experiences were being accounted for and addressed in health policy and practice. Themes captured the complexities of increasing visibility for trans people, including men and non-binary people with a cervix. These complexities reflect the extensive system and cultural change required in asking policymakers and practitioners to think differently about who is at risk of a disease typically associated with cisgender women. Informants drew on the language of trauma to explain the resistance many trans people feel when engaging with clinical services, particularly relating to sexual and reproductive health. In doing so, they argued for increasing resources and processes to elicit trans people's willingness to put their trust in such services. Thinking critically about the relationship between the politics of trans visibilities, trauma and trust can support effective and inclusive approaches to transgender health.

Technical considerations when designing a gene expression panel for renal transplant diagnosis

Gene expression analysis is emerging as a new diagnostic tool in transplant pathology, in particular for the diagnosis of antibody-mediated rejection. Diagnostic gene expression panels are defined on the basis of their pathophysiological relevance, but also need to be tested for their robustness across different preservatives and analysis platforms. The aim of this study is the investigate the effect of tissue sampling and preservation on candidate genes included in a renal transplant diagnostic panel. Using the NanoString platform, we compared the expression of 219 genes in 51 samples, split for formalin-fixation and paraffin-embedding (FFPE) and RNAlater preservation (RNAlater). We found that overall, gene expression significantly correlated between FFPE and RNAlater samples. However, at the individual gene level, 46 of the 219 genes did not correlate across the 51 matched FFPE and RNAlater samples. Comparing gene expression results using NanoString and qRT-PCR for 18 genes in the same pool of RNA (RNAlater), we found a significant correlation in 17/18 genes. Our study indicates that, in samples from the same routine diagnostic renal transplant biopsy procedure split for FFPE and RNAlater, 21% of 219 genes of potential biological significance do not correlate in expression. Whether this is due to fixatives or tissue sampling, selection of gene panels for routine diagnosis should take this information into consideration.

OP0044 WHOLE KIDNEY TRANSCRIPTOMIC ANALYSIS OF FORMALIN-FIXED PARAFFIN-EMBEDDED LUPUS NEPHRITIS KIDNEY BIOPSY TISSUE USING THE NANOSTRING NCOUNTER PLATFORM

Background:

There is an ongoing effort to elucidate the molecular pathways that are key to kidney injury in lupus nephritis (LN). One approach is to study the transcriptome utilising kidney tissue obtained during diagnostic renal biopsy [1]. In clinical practice the most common tissue that is surplus to diagnostic requirements is formalin-fixed paraffin-embedded (FFPE) tissue. However, due to RNA degradation, transcriptomic analysis has been sub-optimal and challenging using standard procedures. The NanoString technology platform has the advantage that reliable detection of transcripts can be achieved even with degraded RNA. In this study we explored the utility of NanoString technology in identifying transcripts in RNA isolated from archival FFPE kidney biopsy sections in a cohort of patients with LN.

Objectives:

To explore the utility of the NanoString platform in elucidating a renal transcriptomic signature in formalin-fixed paraffin-embedded Lupus Nephritis kidney biopsy tissue.

Methods:

We utilised well defined Class III (n=11); Class IV (n=22) and Class V (n=24) LN FFPE kidney biopsies from female patients attending the Imperial College Healthcare NHS Trust. We excluded biopsies with mixed lesions or chronic lesions (i.e. significant glomerular scarring). Kidney biopsies from patients with Thin Basement Membrane (TBM; n=14) disease were used as controls. Six 10 micron thick sections were obtained from each biopsy and RNA isolated using the Qiagen RNeasy FFPE Kit. 100 micrograms of RNA was used for the detection of transcripts. We used the NanoString PanCancer immune profiling panel (770 transcript probes) and an additional 30 custom designed probes, enabling us to detect 800 transcripts, including 40 reference genes. Transcript analysis was performed according to manufacturer’s instructions using the NanoString nSolver software. When analysing differential gene expression (DGE) we used Benjamini-Hochberg adjustment to account for multiple testing. The threshold for statistical significance was an adjusted P value of 0.05 (5% false discovery rate).

Results:

Transcriptomic data passing NanoString nSolver quality control metrics was obtained from all sections. Notably sections included biopsies up to 16 years old (range: 1-16 years). Our transcript panel contained several Type I interferon (IFN) responsive genes, including sialic acid-binding Ig-like lectin 1 (Siglec-1). We detected a type I IFN signature using 8 IFN-responsive transcripts in 39 (68.4%) of the LN biopsies but in none of the TBM biopsies. This signature was present in Class III (n=9, 81.8%), Class IV (n=16, 72.7%) and Class V (n=14, 58.3%) LN samples. When we performed DGE analysis using TBM as the baseline we detected significantly increased expression across the classes (Class III = 202; Class IV = 357 and Class V = 237 differentially expressed transcripts, Figure 1).

Conclusion:

We have successfully identified transcriptomic signatures in RNA samples derived from a relatively large cohort of FFPE LN samples. Consistent with published reports we could detect a type I IFN signature in the LN kidney tissue [1]. Consistent with a recent study [1], we detected increased expression of OPN (osteopontin) and FN1 (fibronectin-1) in proliferative (Class III and IV) but not Class V LN. We are now performing clinical correlations to determine if the differentially expressed transcripts are clinically informative.

References:

[1]Almaani S, Prokopec SD, Zhang J, Yu L, Avila-Casado C, Wither J, Scholey JW, Alberton V, Malvar A, Parikh SV, Boutros PC, Rovin BH, Reich HN. Rethinking Lupus Nephritis Classification on a Molecular Level. J Clin Med. 2019 Sep 23;8(10).

Disclosure of Interests:

Alyssa C. Gilmore: None declared, Hannah Wilson: None declared, Tom Cairns: None declared, Marina Botto: None declared, Liz Lightstone Grant/research support from: Roche - ended 2018, Consultant of: GSK, Aurinia, Pfizer, Achillion, Speakers bureau: Alexion, Ian N. Bruce Grant/research support from: Genzyme Sanofi, GSK, and UCB, Consultant of: Eli Lilly, AstraZeneca, UCB, Iltoo, and Merck Serono, Speakers bureau: UCB, Terry Cook Grant/research support from: Achillion funding for natural history study on C3 glomerulopathy, Consultant of: Scientific consultant to Apellis, Alexion, Achillion, GSK, Speakers bureau: Alexion, Matthew Pickering Grant/research support from: Funding for investigation of therapeutic compounds in pre-clinical models of complement-mediated kidney disease; Achillion funding for natural history study on C3 glomerulopathy, Consultant of: Scientific Advisor for Alexion, Achillion, Apellis

Reconstruction of the naso-orbital-ethmoid (NOE) complex using the osteocutaneous radial forearm flap (OCRFF)

OBJECTIVES

Describe the utility of osteocutaneous forearm flaps in reconstruction of naso-orbito-ethmoid (NOE) defects.

STUDY DESIGN

Case series with chart review.

SETTING

Tertiary medical centers.

SUBJECTS AND METHODS

The study was conducted on patients treated between the years 2000 and 2014 undergoing NOE resection with reconstruction using the radial forearm flap. Decision making, technical feasibility, need for revisions, and patient disease outcomes were included to assess the durability of reconstruction over remaining survival period.

RESULTS

Fifteen patients underwent NOE reconstruction in the timeframe studied. Five recent patients reported poor nasal airway but no diplopia or immediately clinically evident enopthalmus after NOE reconstruction in mean follow-up of 17.3 months. One-third of patients succumbed to disease in the study period, 3 without revision, and all but 2 surviving patients required revisions.

CONCLUSION

Osteocutaneous radial forearm flap (OCRFF) is a cosmetically acceptable method of reconstructing NOE defects. Though a 1-step reconstruction can be serviceable without multiple additional procedures, longer surviving patients frequently receive revision surgery as with more traditional planned staged procedures.

Survival and growth of chestnut backcross seeds and seedlings on surface mines

Some scientists consider the loss of the American chestnut from forests in the eastern United States as one of the greatest forest ecological disasters in the 20th century. The American Chestnut Foundation has been attempting to restore chestnut by backcrossing blight-resistant Chinese chestnut to American chestnut and selecting those strains with blight resistance. Third-generation backcross seeds and seedlings have been produced and planted by researchers. Surface-mined lands provide a land base where these backcross chestnut seedlings may be introduced back into forests. In 2008, seeds of two parent species of chestnut (100% American and 100% Chinese) and three breeding generations (BF, BF, and BF backcrosses) were planted into loosely graded mine soils with and without tree shelters. First-year establishment from seeds averaged 81%. After the fourth year, survival without shelters declined for all chestnut stock types except for Chinese (80%): American 40%, BF 70%, BF 40%, and BF 55%. Survival with shelters was only slightly better after the fourth year (average, 60% with shelters and 57% without). Height growth was not different among stock types, and average height after the fourth year was 43 cm without shelters and 56 cm with shelters. In 2009, seeds and seedlings of the same chestnut stock types were planted into brown (pH 4.5) or gray (pH 6.6) mine soils. Only six out of 250 seeds germinated, which was very poor considering 81% average seed germination in 2008. Transplanted chestnut seedling survival was much better. After the third year, seedling survival was 85% in brown and 80% in gray soil, but significant differences were found with stock types. Survival was significantly higher with American, Chinese, and BF stock types (75%) than with BF and BF (60%). Height after the third season averaged 90 cm on brown and 62 cm on gray soil. Chestnut backcrosses displayed no hybrid vigor and were not better in survival and growth than the parent stock. All five stock types grew on mine soils in West Virginia, and we found surface mines to be promising sites for introducing blight-resistant chestnut backcross trees into the Appalachian forest.

Functional genomic analysis unravels a metabolic-inflammatory interplay in adrenoleukodystrophy

X-linked adrenoleukodystrophy (X-ALD) is an inherited disorder characterized by axonopathy and demyelination in the central nervous system and adrenal insufficiency. Main X-ALD phenotypes are: (i) an adult adrenomyeloneuropathy (AMN) with axonopathy in spinal cords, (ii) cerebral AMN with brain demyelination (cAMN) and (iii) a childhood variant, cALD, characterized by severe cerebral demyelination. Loss of function of the ABCD1 peroxisomal fatty acid transporter and subsequent accumulation of very-long-chain fatty acids (VLCFAs) are the common culprits to all forms of X-ALD, an aberrant microglial activation accounts for the cerebral forms, whereas inflammation allegedly plays no role in AMN. How VLCFA accumulation leads to neurodegeneration and what factors account for the dissimilar clinical outcomes and prognosis of X-ALD variants remain elusive. To gain insights into these questions, we undertook a transcriptomic approach followed by a functional-enrichment analysis in spinal cords of the animal model of AMN, the Abcd1⁻ null mice, and in normal-appearing white matter of cAMN and cALD patients. We report that the mouse model shares with cAMN and cALD a common signature comprising dysregulation of oxidative phosphorylation, adipocytokine and insulin signaling pathways, and protein synthesis. Functional validation by quantitative polymerase chain reaction, western blots and assays in spinal cord organotypic cultures confirmed the interplay of these pathways through IkB kinase, being VLCFA in excess a causal, upstream trigger promoting the altered signature. We conclude that X-ALD is, in all its variants, a metabolic/inflammatory syndrome, which may offer new targets in X-ALD therapeutics.

800 facets of retinal degeneration

In today's world of genomics and large computational analyses, rapid progress has been made in identifying genes associated with human retinal diseases. Nevertheless, before significant advances toward effective therapeutic intervention is made, a clearer understanding of the molecular and cellular role of these gene products in normal and diseased photoreceptor cell biology is required. Given the complexity of the vertebrate retina, these advancements are unlikely to be revealed in isolated human cell lines, but instead, will require the use of numerous model systems. Here, we describe several parallels between vertebrate and invertebrate photoreceptor cell biology that are beginning to emerge and advocate the use of Drosophila melanogaster as a powerful genetic model system for uncovering molecular mechanisms of human retinal pathologies, in particular photoreceptor neurodegeneration.