Transient global amnesia and hippocampal diffusion restriction: an overlooked radiological finding

Transient global amnesia (TGA) is characterized by isolated sudden anterograde amnesia. Diffusion restriction can be observed in the hippocampus on DWI-MRI at varying rates in TGA patients. This study analyzes the prevalence and characteristics of the hippocampal diffusion restriction (HDR), its relationship with vascular risk factors, and the prevalence of lesions overlooked in routine reports. 91 patients diagnosed with TGA at a tertiary hospital between 2011 and 2022 were evaluated retrospectively. The mean age was 64.8 ± 7.3 years, and 63.7% of patients were female. 75.8% of the patients had at least one vascular risk factor. Focal diffusion restriction was detected in 17 patients (18.5%) on DWI-MRI, with only one being extra-hippocampal. 81.2% of HDR was detected when DWI-MRI scan was performed between 12 and 96 h after the onset of symptoms. HDR was detected most when the imaging was performed in 24 to 48 h (p = 0.03). There was no correlation between the duration of symptoms and the detection rates of HDR (p = 0.55). In 9 patients (53% of 17) diffusion restriction was not specified in routine radiology reports. Although focal ischemia, venous flow abnormalities, migraine and epileptic phenomena have been suggested in its etiology, TGA is a clinical condition of which pathophysiology has not been determined clearly. Signal changes observed in DWI-MRI has led to discussions that cerebrovascular etiology may play a role, yet more comprehensive studies are required to prevent and manage TGA. HDRs can be overlooked in routine reports. Therefore, the DWI-MRI images of patients with TGA should be examined vigilantly.

Development of ISB 1442, a CD38 and CD47 bispecific biparatopic antibody innate cell modulator for the treatment of multiple myeloma

Antibody engineering can tailor the design and activities of therapeutic antibodies for better efficiency or other advantageous clinical properties. Here we report the development of ISB 1442, a fully human bispecific antibody designed to re-establish synthetic immunity in CD38+ hematological malignancies. ISB 1442 consists of two anti-CD38 arms targeting two distinct epitopes that preferentially drive binding to tumor cells and enable avidity-induced blocking of proximal CD47 receptors on the same cell while preventing on-target off-tumor binding on healthy cells. The Fc portion of ISB 1442 is engineered to enhance complement dependent cytotoxicity, antibody dependent cell cytotoxicity and antibody dependent cell phagocytosis. ISB 1442 thus represents a CD47-BsAb combining biparatopic targeting of a tumor associated antigen with engineered enhancement of antibody effector function to overcome potential resistance mechanisms that hamper treatment of myeloma with monospecific anti-CD38 antibodies. ISB 1442 is currently in a Phase I clinical trial in relapsed refractory multiple myeloma.

Intra-prostatic tumour evolution, steps in metastatic spread and histogenomic associations revealed by integration of multi-region whole-genome sequencing with histopathological features

BACKGROUND

Extension of prostate cancer beyond the primary site by local invasion or nodal metastasis is associated with poor prognosis. Despite significant research on tumour evolution in prostate cancer metastasis, the emergence and evolution of cancer clones at this early stage of expansion and spread are poorly understood. We aimed to delineate the routes of evolution and cancer spread within the prostate and to seminal vesicles and lymph nodes, linking these to histological features that are used in diagnostic risk stratification.

METHODS

We performed whole-genome sequencing on 42 prostate cancer samples from the prostate, seminal vesicles and lymph nodes of five treatment-naive patients with locally advanced disease. We spatially mapped the clonal composition of cancer across the prostate and the routes of spread of cancer cells within the prostate and to seminal vesicles and lymph nodes in each individual by analysing a total of > 19,000 copy number corrected single nucleotide variants.

RESULTS

In each patient, we identified sample locations corresponding to the earliest part of the malignancy. In patient 10, we mapped the spread of cancer from the apex of the prostate to the seminal vesicles and identified specific genomic changes associated with the transformation of adenocarcinoma to amphicrine morphology during this spread. Furthermore, we show that the lymph node metastases in this patient arose from specific cancer clones found at the base of the prostate and the seminal vesicles. In patient 15, we observed increased mutational burden, altered mutational signatures and histological changes associated with whole genome duplication. In all patients in whom histological heterogeneity was observed (4/5), we found that the distinct morphologies were located on separate branches of their respective evolutionary trees.

CONCLUSIONS

Our results link histological transformation with specific genomic alterations and phylogenetic branching. These findings have implications for diagnosis and risk stratification, in addition to providing a rationale for further studies to characterise the genetic changes causally linked to morphological transformation. Our study demonstrates the value of integrating multi-region sequencing with histopathological data to understand tumour evolution and identify mechanisms of prostate cancer spread.

Vesicular HMGB1 release from neurons stressed with spreading depolarization enables confined inflammatory signaling to astrocytes

The role of high mobility group box 1 (HMGB1) in inflammation is well characterized in the immune system and in response to tissue injury. More recently, HMGB1 was also shown to initiate an "inflammatory signaling cascade" in the brain parenchyma after a mild and brief disturbance, such as cortical spreading depolarization (CSD), leading to headache. Despite substantial evidence implying a role for inflammatory signaling in prevalent neuropsychiatric disorders such as migraine and depression, how HMGB1 is released from healthy neurons and how inflammatory signaling is initiated in the absence of apparent cell injury are not well characterized. We triggered a single cortical spreading depolarization by optogenetic stimulation or pinprick in naïve Swiss albino or transgenic Thy1-ChR2-YFP and hGFAP-GFP adult mice. We evaluated HMGB1 release in brain tissue sections prepared from these mice by immunofluorescent labeling and immunoelectron microscopy. EzColocalization and Costes thresholding algorithms were used to assess the colocalization of small extracellular vesicles (sEVs) carrying HMGB1 with astrocyte or microglia processes. sEVs were also isolated from the brain after CSD, and neuron-derived sEVs were captured by CD171 (L1CAM). sEVs were characterized with flow cytometry, scanning electron microscopy, nanoparticle tracking analysis, and Western blotting. We found that HMGB1 is released mainly within sEVs from the soma of stressed neurons, which are taken up by surrounding astrocyte processes. This creates conditions for selective communication between neurons and astrocytes bypassing microglia, as evidenced by activation of the proinflammatory transcription factor NF-ĸB p65 in astrocytes but not in microglia. Transmission immunoelectron microscopy data illustrated that HMGB1 was incorporated into sEVs through endosomal mechanisms. In conclusion, proinflammatory mediators released within sEVs can induce cell-specific inflammatory signaling in the brain without activating transmembrane receptors on other cells and causing overt inflammation.

Skull bone marrow channels as immune gateways to the central nervous system

Decades of research have characterized diverse immune cells surveilling the CNS. More recently, the discovery of osseous channels (so-called 'skull channels') connecting the meninges with the skull and vertebral bone marrow has revealed a new layer of complexity in our understanding of neuroimmune interactions. Here we discuss our current understanding of skull and vertebral bone marrow anatomy, its contribution of leukocytes to the meninges, and its surveillance of the CNS. We explore the role of this hematopoietic output on CNS health, focusing on the supply of immune cells during health and disease.

Preclinical characterization of ISB 1342, a CD38 × CD3 T-cell engager for relapsed/refractory multiple myeloma

Although treatment of multiple myeloma (MM) with daratumumab significantly extends the patient's lifespan, resistance to therapy is inevitable. ISB 1342 was designed to target MM cells from patients with relapsed/refractory MM (r/r MM) displaying lower sensitivity to daratumumab. ISB 1342 is a bispecific antibody with a high-affinity Fab binding to CD38 on tumor cells on a different epitope than daratumumab and a detuned scFv domain affinity binding to CD3ε on T cells, to mitigate the risk of life-threatening cytokine release syndrome, using the Bispecific Engagement by Antibodies based on the TCR (BEAT) platform. In vitro, ISB 1342 efficiently killed cell lines with different levels of CD38, including those with a lower sensitivity to daratumumab. In a killing assay where multiple modes of action were enabled, ISB 1342 showed higher cytotoxicity toward MM cells compared with daratumumab. This activity was retained when used in sequential or concomitant combinations with daratumumab. The efficacy of ISB 1342 was maintained in daratumumab-treated bone marrow patient samples showing lower sensitivity to daratumumab. ISB 1342 induced complete tumor control in 2 therapeutic mouse models, unlike daratumumab. Finally, in cynomolgus monkeys, ISB 1342 displayed an acceptable toxicology profile. These data suggest that ISB 1342 may be an option in patients with r/r MM refractory to prior anti-CD38 bivalent monoclonal antibody therapies. It is currently being developed in a phase 1 clinical study.

Abstract 2970: Overcoming mechanisms of escape from treatments for multiple myeloma with ISB 2001, a potential first-in-class trispecific BCMA and CD38 targeted T cell engager

Immune therapies targeting a single tumor associated antigen (TAA) have demonstrated their efficacy against multiple myeloma (MM) in recent years. However, durable responses are still limited, which may be due to downregulation of the targeted TAA or expansion of clones with low target expression . To improve binding to tumor cells and enhance tumor cell killing, we propose to simultaneously target BCMA and CD38 using ISB 2001, a potential first-in-class TREAT™ trispecific CD3 T-cell engager based on Ichnos’ proprietary BEAT platform. To understand whether dual targeting could improve binding to tumors and enhance killing, we compared ISB 2001 to control molecules lacking one of the two TAA binders. Potency of ISB 2001 was greater than control molecules lacking either BCMA or CD38 used alone or in combination in a re-directed lysis assay on multiple myeloma cells These results were consistent with the binding to tumor cell lines, in which ISB 2001 showed higher maximal binding than control molecules lacking either CD38 or BCMA binding domains. We also compared the tumor killing potency of ISB 2001 to teclistamab, a BCMAxCD3 bispecific antibody recently approved to treat relapsed/refractory (RR) MM patients who have received prior lines of treatment. To mimic the heterogeneity of tumor cells, the killing of MM cell lines expressing varying levels of BCMA and CD38 was evaluated. ISB 2001 exhibited potent killing of the cell lines with EC50 ranging from 0.2 to 1.5 pM, which was statistically superior to that of teclistamab. These results were consistent with elevated binding of ISB 2001 to MM cells compared to teclistamab. In the presence of soluble BCMA or APRIL, ISB 2001 was 100-fold more potent than teclistamab. When evaluated in a therapeutic PBMC-humanized mouse model subcutaneously engrafted with BCMAlow/CD38low KMS-12-BM cells, ISB 2001 resulted in complete tumor regression and showed statistically higher potency than teclistamab at 0.1 mg/kg dose. In addition, ISB 2001 showed more potent anti-tumor activity than teclistamab in bone marrow aspirates of MM patients, indicating that ISB 2001 to leverage its cytotoxic properties with available immune cells. Taken together, we show that there is a clear advantage of avid binding achieved by the dual targeting using a TREAT-based ISB 2001, which results in potent and efficacious killing of tumor cells in vitro and in vivo. These data support clinical development of ISB 2001 as a promising treatment of RRMM through co-targeting of BCMA and CD38. Significant benefit is anticipated for RRMM patients who may experience tumor escape through target downregulation mechanisms. The evaluation of ISB2001 in a phase 1 clinical trial is planned for the first half of 2023.

Citation Format: Maria Pihlgren, Laura Carretero, Jeremy Berret, Olivia Hall, Carole Estoppey, Adam Drake, Daniela Pais, Julie Macoin, Myriam Chimen, Perrine Suere, Emily Nallet, Blandine Pouleau, Elodie Stainnack, Jeremy Loyau, Thierry Monney, Aurore Delachat, Cyrille Dreyfus, Stan Blein, Zeynep Kaya, Thomas Matthes, Rebecca Croasdale-wood, James Edwards, Claire Edwards, Lamine Mbow, Michael Dyson, Cyril Konto, Ankita Srivastava, Eugene Zhukovshy, Mario Perro. Overcoming mechanisms of escape from treatments for multiple myeloma with ISB 2001, a potential first-in-class trispecific BCMA and CD38 targeted T cell engager [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2970.

Evaluation of EfficientNet models for COVID-19 detection using lung parenchyma

When the COVID-19 pandemic broke out in the beginning of 2020, it became crucial to enhance early diagnosis with efficient means to reduce dangers and future spread of the viruses as soon as possible. Finding effective treatments and lowering mortality rates is now more important than ever. Scanning with a computer tomography (CT) scanner is a helpful method for detecting COVID-19 in this regard. The present paper, as such, is an attempt to contribute to this process by generating an open-source, CT-based image dataset. This dataset contains the CT scans of lung parenchyma regions of 180 COVID-19-positive and 86 COVID-19-negative patients taken at the Bursa Yuksek Ihtisas Training and Research Hospital. The experimental studies show that the modified EfficientNet-ap-nish method uses this dataset effectively for diagnostic purposes. Firstly, a smart segmentation mechanism based on the k-means algorithm is applied to this dataset as a preprocessing stage. Then, performance pretrained models are analyzed using different CNN architectures and with our Nish activation function. The statistical rates are obtained by the various EfficientNet models and the highest detection score is obtained with the EfficientNet-B4-ap-nish version, which provides a 97.93% accuracy rate and a 97.33% F1-score. The implications of the proposed method are immense both for present-day applications and future developments.

Effects of feeding systems on yield and performance of Linda geese (Anserinae sp.) in hot climatic conditions

This study evaluated the effects of various types of feeding on fattening period and performance of Linda geese. Feeding patterns consisted of concentrate feed-based intensive and pasture feed-based semi-intensive. A total of 150 goslings aged three days were divided into two groups, each consisting of three replications. All groups were given rations containing 23% crude protein and 3100 kcal/kg ME in weeks 0–6, and rations containing 20% crude protein 3100 kcal/kg ME between weeks 7 and 17. After the seventh week, the feed for the semi-intensive group was diluted with 20% barley and from the tenth week, this group started to graze on pasture. Live weight gain of the two groups was similar, although geese kept indoors consumed more concentrate. Feed protein digestion of geese was similar in the two feeding types. Digestion-related visceral weight in the pasture-supplemented group increased, whereas carcass weight decreased. Growth curves were used to estimate the age of Linda geese to the end of the fattening period. The average slaughter age was the fourth and fifth months, as indicated by Von Bertalanffy, Logistic, and Gompertz growth models, which used the data from the third week. Concentrate feeding enabled Linda geese to reach earlier higher slaughter weight, although it was not considered economical. Although averages of bodyweight gain over the trial appeared slightly better in the concentrate-based intensive group, the results revealed that concentrate feed supplement and pasture may be the best and most economical form of feeding for Linda geese.

Metabolic profiling of prostate cancer in skeletal microenvironments identifies G6PD as a key mediator of growth and survival

The spread of cancer to bone is invariably fatal, with complex cross-talk between tumor cells and the bone microenvironment responsible for driving disease progression. By combining in silico analysis of patient datasets with metabolomic profiling of prostate cancer cells cultured with bone cells, we demonstrate the changing energy requirements of prostate cancer cells in the bone microenvironment, identifying the pentose phosphate pathway (PPP) as elevated in prostate cancer bone metastasis, with increased expression of the PPP rate-limiting enzyme glucose-6-phosphate dehydrogenase (G6PD) associated with a reduction in progression-free survival. Genetic and pharmacologic manipulation demonstrates that G6PD inhibition reduces prostate cancer growth and migration, associated with changes in cellular redox state and increased chemosensitivity. Genetic blockade of G6PD in vivo results in reduction of tumor growth within bone. In summary, we demonstrate the metabolic plasticity of prostate cancer cells in the bone microenvironment, identifying the PPP and G6PD as metabolic targets for the treatment of prostate cancer bone metastasis.

Confocal reflectance microscopy for metal and lipid nanoparticle visualization in the brain

Background: A requirement for nanoparticle (NP) research is visualization of particles within cells and tissues. Limitations of electron microscopy and low yields of NP fluorescent tagging warrant the identification of alternative imaging techniques. Method: Confocal reflectance microscopy (CRM) in combination with fluorescence imaging was assessed for visualizing rhodamine B-conjugated silver and fluorescein isothiocyanate-conjugated lipid core-stearylamine NP uptake in vitro and in vivo. Results: CRM successfully identified cellular uptake and blood-brain barrier penetration of NPs owing to their distinguishing refractive indices. NP-dependent reflectance signals in vitro were dose and incubation time dependent. Finally, CRM facilitated the distinction between nonspecific fluorescence signals and NPs. Conclusion: These findings demonstrate the value of CRM for NP visualization in tissues, which can be performed with a standard confocal microscope.

Parenchymal neuroinflammatory signaling and dural neurogenic inflammation in migraine

Background

Pain is generally concomitant with an inflammatory reaction at the site where the nociceptive fibers are activated. Rodent studies suggest that a sterile meningeal inflammatory signaling cascade may play a role in migraine headache as well. Experimental studies also suggest that a parenchymal inflammatory signaling cascade may report the non-homeostatic conditions in brain to the meninges to induce headache. However, how these signaling mechanisms function in patients is unclear and debated. Our aim is to discuss the role of inflammatory signaling in migraine pathophysiology in light of recent developments.

Body

Rodent studies suggest that a sterile meningeal inflammatory reaction can be initiated by release of peptides from active trigeminocervical C-fibers and stimulation of resident macrophages and dendritic/mast cells. This inflammatory reaction might be needed for sustained stimulation and sensitization of meningeal nociceptors after initial activation along with ganglionic and central mechanisms. Most migraines likely have cerebral origin as suggested by prodromal neurologic symptoms. Based on rodent studies, a parenchymal inflammatory signaling cascade has been proposed as a potential mechanism linking cortical spreading depolarization (CSD) to meningeal nociception. A recent PET/MRI study using a sensitive inflammation marker showed the presence of meningeal inflammatory activity in migraine with aura patients over the occipital cortex generating the visual aura. These studies also suggest the presence of a parenchymal inflammatory activity, supporting the experimental findings. In rodents, parenchymal inflammatory signaling has also been shown to be activated by migraine triggers such as sleep deprivation without requiring a CSD because of the resultant transcriptional changes, predisposing to inadequate synaptic energy supply during intense excitatory transmission. Thus, it may be hypothesized that neuronal stress created by either CSD or synaptic activity-energy mismatch could both initiate a parenchymal inflammatory signaling cascade, propagating to the meninges, where it is converted to a lasting headache with or without aura.

Conclusion

Experimental studies in animals and emerging imaging findings from patients warrant further research to gain deeper insight to the complex role of inflammatory signaling in headache generation in migraine.

DNA binding alters ARv7 dimer interactions

Androgen receptor (AR) splice variants are proposed to be a potential driver of lethal castration-resistant prostate cancer. AR splice variant 7 (ARv7) is the most commonly observed isoform and strongly correlates with resistance to second-generation anti-androgens. Despite this clinical evidence, the interplay between ARv7 and the highly expressed full-length AR (ARfl) remains unclear. In this work, we show that ARfl/ARv7 heterodimers readily form in the nucleus via an intermolecular N/C interaction that brings the four termini of the proteins in close proximity. Combining fluorescence resonance energy transfer and fluorescence recovery after photobleaching, we demonstrate that these heterodimers undergo conformational changes following DNA binding, indicating dynamic nuclear receptor interaction. Although transcriptionally active, ARv7 can only form short-term interactions with DNA at highly accessible high-occupancy ARfl binding sites. Dimerization with ARfl does not affect ARv7 binding dynamics, suggesting that DNA binding occupancy is determined by the individual protein monomers and not the homodimer or heterodimer complex. Overall, these biophysical studies reveal detailed properties of ARv7 dynamics as both a homodimer or heterodimer with ARfl.

Evaluation of parents' knowledge, attitudes, and practices regarding self-medication for their children's dental problems during the COVID-19 pandemic: a cross-sectional survey

BACKGROUND

Self-medication refers to taking medicine without consultation with a doctor or dentist, and it is an important health issue, especially during the COVID-19 pandemic. There are no data about parents' SM practices for their children's dental problems during the COVID-19 pandemic. The present study aims to evaluate parents' knowledge, attitudes, and practices regarding self-medication for their children's dental problems during the COVID-19 pandemic in Northern Turkey.

METHODS

A cross-sectional survey was carried out in the pediatric dental clinic at Ondokuz Mayis University, Faculty of Dentistry, Department of Pediatric Dentistry, immediately after the COVID-19 lockdown ended. A total of 389 parents who agreed to participate in the study completed the questionnaire from July 1 to October 1. A questionnaire with 18 items was designed to collect information on the parents' knowledge and attitudes regarding when, why, and how to use drugs and on their practices on medicating their children. The collected data were analyzed using descriptive and analytical statistics (chi-square test).

RESULTS

The majority of parents (n = 273; 70.2%) practiced self-medication for their children's dental problems. Self-medication with a previously prescribed medications was usually preferred by parents (n = 179; 62.2%). Analgesics (98%) were the most commonly used medicines by parents in their self-medication for their children's dental problems.

CONCLUSION

Prevalence of self-medication practices for children's dental problems is high in Turkey during the COVID-19 pandemic. Therefore, new healthcare services, such as teledentistry, may be useful to overcome problems related to the self-medication of children during times when the ability to reach healthcare providers is limited, such as during pandemics.

In silico Analysis of Sulpiride, Synthesis, Characterization and In vitro Studies of its Nanoparticle for the Treatment of Schizophrenia

BACKGROUND

Sulpiride, which has selective dopaminergic blocking activity, is a substituted benzamide antipsychotic drug playing a prominent role in the treatment of schizophrenia, which more selective and primarily blocks dopamine D2 and D3 receptor.

OBJECTIVE

This study has two main objectives, firstly; the molecular modeling studies (MD and Docking, ADME) were conducted to define the molecular profile of sulpiride and sulpiridereceptor interactions, another to synthesize polymeric nanoparticles with chitosan, having the advantage of slow/controlled drug release, to improve drug solubility and stability, to enhance utility and reduce toxicity.

METHODS

Molecular dynamic simulation was carried out to determine the conformational change and stability (in water) of the drug and the binding profile of D3 dopamine receptor was determined by molecular docking calculations. The pharmacological properties of the drug were revealed by ADME analysis. The ionic gelation method was used to prepare sulpiride loaded chitosan nanoparticles (CS NPs). The Dynamic Light Scattering (DLS), UV-vis absorption (UV), Scanning Electron Microscopy (SEM), Fourier transform infrared (FT-IR) spectroscopy techniques were carried out to characterize the nanoparticles. In vitro cell cytotoxicity experiments examined with MTT assay on mouse fibroblast (L929), human neuroblastoma (SH-SY5Y) and glioblastoma cells (U-87). The statistical evaluations were produced by ANOVA.

RESULTS

The residues (ASP-119, PHE-417) of D3 receptor provided a stable docking with the drug, and the important pharmacological values (blood brain barrier, Caco-2 permeability and human oral absorption) were also determined. The average particle size, PdI and zeta potential value of sulpiride- loaded chitosan NPs having a spherical morphology were calculated as 96.93 nm, 0.202 and +7.91 mV. The NPs with 92.8% encapsulation and 28% loading efficiency were found as a slow release profile with 38.49% at the end of the 10th day. Due to the formation of encapsulation, the prominent shifted wave numbers for C-O, S-O, S-N stretching, S-N-H bending of Sulpiride were also identified. Mitochondrial activity of U87, SHSY-5Y and L929 cell line were assayed and evaluated using the SPSS program.

CONCLUSION

To provide more efficient use of Sulpiride having a low bioavailability of the gastrointestinal tract, the nanoparticle formulation with high solubility and bioavailability was designed and synthesized for the first time in this study for the treatment of schizophrenia. In addition to all pharmacological properties of drug, the dopamine blocking activity was also revealed. The toxic effect on different cell lines have also been interpreted.

Non-hexagonal neural dynamics in vowel space

Are the grid cells discovered in rodents relevant to human cognition? Following up on two seminal studies by others, we aimed to check whether an approximate 6-fold, grid-like symmetry shows up in the cortical activity of humans who "navigate" between vowels, given that vowel space can be approximated with a continuous trapezoidal 2D manifold, spanned by the first and second formant frequencies. We created 30 vowel trajectories in the assumedly flat central portion of the trapezoid. Each of these trajectories had a duration of 240 milliseconds, with a steady start and end point on the perimeter of a "wheel". We hypothesized that if the neural representation of this "box" is similar to that of rodent grid units, there should be an at least partial hexagonal (6-fold) symmetry in the EEG response of participants who navigate it. We have not found any dominant n-fold symmetry, however, but instead, using PCAs, we find indications that the vowel representation may reflect phonetic features, as positioned on the vowel manifold. The suggestion, therefore, is that vowels are encoded in relation to their salient sensory-perceptual variables, and are not assigned to arbitrary grid-like abstract maps. Finally, we explored the relationship between the first PCA eigenvector and putative vowel attractors for native Italian speakers, who served as the subjects in our study.

Silibinin and ellagic acid increase the expression of insulin receptor substrate 1 protein in ultraviolet irradiated rat skin

Daily exposure to ultraviolet (UV) light induces inflammation and tumorigenesis in the skin. Silibinin and ellagic acid are natural products that exhibit anti-inflammatory and anti-tumorigenic properties. Insulin receptor substrate protein 1 (IRS1) is important for skin homeostasis and physiology, but its activity following UV radiation remains unclear. We investigated the effects of ellagic acid and silibinin on IRS1 expression in ultraviolet A (UVA) and ultraviolet B (UVB) irradiated rat skin. Forty-two female Wistar rats were divided randomly into six groups of seven animals. The dorsal skin of rats was exposed to UVA + UVB, then treated with ellagic acid and silibinin by gavage. IRS1 expression in skin tissues was determined by western blot analysis. IRS1 expression increased significantly following treatment with ellagic acid and silibinin in UVA + UVB irradiated skin compared to the UVA + UVB only group. After UVA + UVB treatment, ellagic acid effected greater induction of IRS1 expression than silibinin. Our findings suggest that the photoprotective roles of ellagic acid and silibinin may be due to induction of IRS1 expression in UVA + UVB treated rat skin.

P3688Familial recurrent autoimmune myocarditis associated with a truncating nonsense mutation of the desmoplakin gene

Background

Arrhythmogenic cardiomyopathy (AC) is an important cause of ventricular arrhythmias in children and young adults. AC is associated with mutation of desmosomal proteins, however, cardiac disease penetrance is incomplete and the clinical course varies widely without recognizable exogenous or epi/genetic co-factors. Importantly, DSP mutation carriers may also display entirely non-cardiac e.g. dermatological phenotypes.

Methods and results

In two brothers with recurrent fulminant myocarditis, mutation screening of 218 cardiomyopathy-related genes identified a truncating mutation Arg1458* of desmoplakin (DSP). DSP immunhistology unexpectedly revealed complete loss (“knockout”) of DSP protein in endomyocardial biopsies (EMBs), but none of the histological anomalies of AC. Criteria for histological diagnosis of myocarditis were not either fulfilled, and cardiac MRI revealed no features associated with AC. Screening for infections was negative, there was no substance abuse, medication or vaccination. Possible disease triggers were competitive sport events. Myosin and troponin I autoantibodies were detected at titers up to 1:320.

We used allele-specific RT-PCR to distinguish if the patients' allele classified as “normal” was actually defective due to promotor mutation or epigenetic silencing. RT-PCRs were done on EMBs and peripheral blood mononuclear cells (PBMCs). In a cohort of dilated cardiomyopathy (DCM) patients we were able to detect DSP transcripts in both, PBMC and left-ventricular heart tissue. RNA sequencing of human PBMC subpopulations suggested that DSP transcription may be restricted to certain immune cell subtypes. RT-PCRs revealed that both Arg1458* carriers have a functional second DSP allele, indicating that their “DSP knockout” occurs at the protein level and may be due to protein instability and degradation within desmosomes.

We screened additional existing cohorts for such variants and identified stopgain variant Gln307Ter in a 37-yrs-old woman with ARVC. This patient's sister died from heart failure at the age of 39. In a 59-yrs-old female LVNC patient, stopgain variant Y1391X was identified. Here, family history was unclear, her brother probably died from coronary artery disease. In a 71-yrs-old female DCM patient with no family history, stopgain variant Tyr1512Ter was identified.

Conclusions

The described patients with DSP truncations strongly suggest the existence of additional genetic or exogenous modifiers driving pathogenesis either way. DSP defects may cause recurrent myocarditis, and mutation screening is advisable to enable early detection of high-risk patients with similar phenotypes. Our finding of complete myocardial DSP protein loss emphasizes that DNA sequencing may miss critical molecular disturbances. It is indispensable to also analyze transcriptome and protein level in the tissue actually affected in a patient in order to recognize his/her individual pathogenesis.

Production and characterization of a conserved M2e peptide-based specific IgY antibody: evaluation of the diagnostic potential via conjugation with latex nanoparticles

Antibodies play an important role in combating and controlling viral diseases such as influenza. Immunoglobulin Y (IgY) antibodies have several advantages such as a less invasive manufacturing process, ease of isolation, higher affinity compared with IgG antibodies, and cost-effectiveness. To date, although specific IgY production has been performed for different strains of influenza A, to the best of our knowledge, an IgY against the M2e peptide has not been produced. In the current study, IgY antibodies are produced, purified, and characterized using the M2e peptide sequence for the first time with the intent to apply them for the diagnosis of influenza A virus. Anti-M2e IgY antibodies are obtained from eggs using a two-step purification method. The activity and characterization of the antibodies are determined using an enzyme-linked immunosorbent assay, a nano-spectrophotometer, an SDS-Page assay, and a Western Blot analysis. Finally, anti-M2e IgY antibodies are conjugated to the latex nanoparticles, and the reaction between the influenza A virus and the nanoparticles is demonstrated using light microscopy, transmission electron microscopy, and energy dispersive X-ray spectroscopy. In conclusion, this study shows that anti-M2e IgY antibodies can contribute to the diagnosis, treatment, and prevention of the influenza A virus.

Successful treatment of renal infiltration complicated by atypical hemolytic uremic syndrome in a leukemic child

Renal infiltration in children with acute leukemia has been reported previously; however, it has rarely been described in association with atypical hemolytic uremic syndrome (aHUS). We present a case of 9-year-old boy who developed life-threatening aHUS in the 1^st week of Burkitt leukemia/lymphoma diagnosis with renal infiltration. Complete resolution of aHUS was achieved after therapeutic plasma exchange. This is an uncommon complication of Burkitt leukemia/lymphoma in a pediatric case.

Abstract 3522: Structural characterization of androgen receptor variant 7 in prostate cancer

Prostate cancer is an extremely common disease that affects one in every seven men in their lifetime. The standard care for late-stage cancer is designed to inhibit the activation of androgen receptor (AR). While this therapeutic approach is initially efficient, the cancer almost always develops resistance and gives rise to castration-resistant prostate cancer (CRPC). When therapy fails, the median survival of patients who suffer from CRPC is 12-16 months. It is critical to understand the mechanism of CRPC better to ameliorate the outcome of late-stage prostate cancer patients.

AR is a transcription factor that consists of an N-terminal domain (NTD), a DNA binding domain (DBD) and a ligand binding domain (LBD). Upon activation by androgen, an intramolecular interaction between NTD and LBD occurs. The AR translocates into the nucleus where it forms a homodimer. It binds to the promoter and enhancer elements of the AR target genes and triggers gene transcription. It has been demonstrated in many clinical studies that AR is important for the progression of prostate cancer including CRPC. In CRPC, although androgen production and binding is inhibited, how the AR can still be activated is a fundamental question to be answered. One of the several different mechanisms proposed is the alternative splicing of the AR generating truncated AR variants that lack LBD. These variants do not require androgens to be activated and they are intrinsically resistant to clinically approved therapeutics.

Despite the fact that the AR variants have been shown to be critical in late-stage prostate cancer, the mechanism of gene transcription initiation by the AR variants is not well-known. We propose to characterize the mechanism of the AR variant activation. Since ARV7 is the most commonly observed variant, we utilize ARV7. We develop a FRET based methodology to identify how ARV7 dimers form and to test if full-length AR is necessary for transcriptional activation mediated by ARV7. We are able to demonstrate possible intermolecular interaction between the full length AR and ARV7 measuring the FRET intensity between the fluorophores attached to the N and C terminus of two proteins. FRET measurements are analyzed by tracking single cells and recording the FRET intensities during the process. Our preliminary data suggest that the full-length AR and ARV7 may interact in the presence of androgen. ARV7 is always localized in the nucleus whereas the AR requires androgen to be activated and translocates into the nucleus. Being in close proximity, putative interaction between the AR and ARV7 occurs in the nucleus. Additionally, we use NTD and DBD point mutants to determine critical positions of intermolecular interaction between them.

Supporting the significance of ARV7 in prostate cancer, our results clarify the dimerization process. It gives an opportunity to test clinical drugs currently in development to effectively inhibit ARV7 activation.

Citation Format: Fatma Özgün, Zeynep Kaya, Halil Bayraktar, Selen Manioğlu, Doğancan Özturan, Nathan Lack. Structural characterization of androgen receptor variant 7 in prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3522. doi:10.1158/1538-7445.AM2017-3522

Aza-capped cyclodextrins for intra-cavity metal complexation

N,N-Chelators based on aza-capped cyclodextrins were designed to produce complexes with an encapsulated metal unit.

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.

CONCLUSIONS

Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.

Impact of glucocorticoid receptor gene (NR3C1) polymorphisms in Turkish patients with metabolic syndrome

BACKGROUND

The metabolic syndrome (MetS) is characterized by a cluster of metabolic factors, including insulin resistance and type-2 diabetes, abdominal obesity, dyslipidemia, hypertension and microalbuminuria. Impaired glucocorticoid receptor (GR) activity also plays an important role in the etiology of MetS. The objective of our study is to evaluate the effects of GR gene polymorphisms (BclI, N363S, TthIII1 and ER22/23EK) in Turkish patients with MetS.

MATERIALS AND METHODS

Seventy subjects with MetS and 185 healthy controls were enrolled in the study. PCR-RFLP analysis was used for genotyping. Results for each polymorphism have been verified by allele-specific oligonucleotide analysis.

RESULTS

BclI GG genotype was significantly associated with an increased risk of MetS (p = 0.02). Also, only in women, the G allele carriers were significantly associated with higher C-peptide. T allele carriers of TthIII1 polymorphism were significantly associated with higher C-peptide, triglyceride, insulin and C-reactive protein (CRP, p value 0.048, 0.022, 0.005 and 0.022, respectively), and lower fasting blood glucose (FBG, p = 0.02). The combined carriers of BclI polymorphism G allele and TthIII1 polymorphism T allele were significantly associated with higher diastolic blood pressure in all patients, and lower FBG and postprandial blood glucose in only men. All the ER22/23EK polymorphisms coexisted with polymorphic variant of TthIII1 (p = 0.0058).

CONCLUSION

The presence of homozygote polymorphic variant of BclI might be good predictive markers for the disease susceptibility. The BclI and the TthIII1 polymorphism are associated with sex-specific clinical parameters. Our findings also suggest that the combination of BclI and TthIII1 polymorphisms may play a protective role in blood glucose.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN.

Serum ceruloplasmin levels in acute decompensated heart failure

BACKGROUND

Ceruloplasmin (Cp) is a serum protein that belongs to the family of α2-globulins and it is increased in patients with after acute myocardial infarction complicated with heart failure. Aim of the study was to investigate levels of serum Cp in patients with acute decompensated heart failure.

MATERIALS AND METHODS

The present cross-sectional observational study consists of three groups: Fifty patients with decompensated heart failure (Group 1) and same 50 patients after compensation (Group 2); 50 control patients group with comparable age and sex without heart failure (Group 3). Demographic, echocardiographic and biochemical data of patients were collected. Serum Cp level was determined spectrophotometrically.

RESULTS

Serum ceruloplasmin was significantly increased in Groups 1 (820.8 ± 78.5 IU/dL) and 2 (873.5 ± 121.0 IU/dL) compared, to Group 3 (640.6 ± 132.4 IU/dL) (p<0.001). In the sub-group analysis, this difference was due to the difference between Groups 3, Group 1 and 2 (both p=0.0001) whereas no significant difference was present between Group I and Group 2 (p>0.063). A positive correlation was found between Cp and female sex, heart rate, systolic and diastolic blood pressure, acetylsalisilic acid and diuretic use, left ventricular systolic and diastolic diameter, mitral regurgitation, and negative correlation was found between Cp and ejection fraction (p<0.05 for all) whereas none of the parameters were independently associated with serum Cp level (p>0.05).

CONCLUSIONS

Findings of the present study suggest that serum Cp level is increased in both decompensated and compensated HF compared to controls. Further large scale studies are needed to elucidate the pathophysiological mechanisms of increased Cp in HF.

Prevalence of sleep disturbance in chronic pain

OBJECTIVE

Sleep is a vital function for human beings, which can be affected by several factors. Chronic pain is one of these factors where it is the most frequent cause for seeking medical care in combination with insomnia. The aim of this study is to examine the prevalence and relationship between sleep disturbance and chronic pain.

PATIENTS AND METHODS

After approval, a total of 85 Family Medicine Units from over 170 in Tokat were randomly selected using a 50% sampling. A sample of 2635 subjects, over the age of 19 years, who were registered with the selected Family Medicine Units, were assessed due to gender, age group, and the urban/rural population size of Tokat using the stratified sampling method. The sample size distribution was calculated as 1515 urban subjects, 1120 rural subjects; 1345 female subjects, 1290 male subjects; 1123 subjects between 20-39 years of age, 1103 subjects between the ages of 40-64, and 409 subjects over 64 years of age. After sampling, subjects were invited to participate in the study via an invitation letter, and agreeing individuals were taken to the Family Medicine Unit for face-to-face meetings. Written, informed consent was obtained, along with demographic data. The presence of chronic pain was recorded. According to the presence of chronic pain, all subjects were separated into two groups as Group Chronic Pain and Group Non-Chronic Pain. The visual analog scale for pain intensity, and Pittsburgh Sleep Quality Index for sleep quality, were performed with all subjects. A multiple linear regression model was used to assess the predictors of sleep quality. Analyses were conducted using the Statistical Package for Social Sciences program (SPSS Inc., Chicago, IL, USA), version 20.0. The statistical significance for all analyses was set at p < 0.05.

RESULTS

The mean global Pittsburgh Sleep Quality Index score of Group Chronic Pain (5.30 ± 4.29) was significantly higher than in Group Non-Chronic Pain (3.22 ± 3.30; p < 0.01). The mean Pittsburgh Sleep Quality Index scores of females (5.69 ± 4.40) were significantly higher than males (4.54 ± 3.96) in Group Chronic Pain (p = 0.000045). A total of 40.7% of patients in Group Chronic Pain, and 21.9% in Group Non-Chronic Pain demonstrated poorer sleep quality according to the Pittsburgh Sleep Quality Index scores, with a cut-off level > 5. A moderate positive correlation was found between the global Pittsburgh Sleep Quality Index and Visual Analog Scale scores (r = 0.310, p < 0.01). A multiple linear regression analysis showed that age, gender, income, Visual Analog Scale, and presence of depression were the significant predictors for Pittsburgh Sleep Quality Index score.

CONCLUSIONS

The current study revealed that chronic pain and pain intensity are important predictors of sleep quality.

Delayed right atrial lateral electromechanical coupling relative to the septal one can be associated with paroxysmal atrial fibrillation

BACKGROUND

Non-invasive prediction of paroxysmal atrial fibrillation (PAF) is one of the most recent interests of cardiology.

AIM

The current study investigates the relationship between the atrial electromechanical coupling time (EMCT) and PAF.

PATIENTS AND METHODS

A group of 35 patients with PAF was compared with a group of 37 subjects without PAF. Pulsed wave tissue Doppler evaluations of atrial walls were performed from apical four chambers view under ECG monitoring. The time intervals from the onset of P wave to the onset of late diastolic wave (A') at right atrial wall (P-RA), interatrial septum (P-IAS), and left atrial wall (P-LA, maximum EMCT) were measured. The right atrial EMCT (P-RA minus P-IAS), left atrial EMCT (P-LA minus P-IAS) and interatrial EMCT (P-LA minus P-RA) were computed. A' wave velocities were measured from each atrial wall.

RESULTS

RA (16.0±13.1 vs. -8.7±18.6 ms, p < 0.001) and maximum (91.5±32.6 vs. 72.0±23.1 ms, p = 0.001) EMCT were longer, RA A' velocity was higher in the patient group. There were no differences between the groups in LA and interatrial EMCT, and septal and LA A' velocities. Regression analysis revealed that only RA [OR: 1.148 (1.041-1.267), p = 0.006] and maximum [OR: 1.099 (1.009-1.197), p = 0.031] EMCT were independent variables for PAF. In order to predict patients with PAF, we have chosen +7.5 msn for the RA EMCT which yielded 69% sensitivity and 71.4% specificity to predict patients.

CONCLUSIONS

Delayed RA lateral EMCT relative to septal one and delayed maximum EMCT detected by tissue Doppler could be a valuable method for identifying patients with PAF.

Effects of isoflurane in an intoxication model: experimental study

BACKGROUND

Isoflurane is a volatile anaesthetic that has been commonly used since 1980. The major metabolites of isoflurane are fluoride ion and trifluoroacetate, both excreted in the urine.

AIM

This study manage to show the histopathological findings of ingested isoflurane on liver, kidney and lugs in an animal model. Twenty-one rabbits were selected and divided into three groups: Group Isoflurane-5 (I-5); Group Isoflurane-10 (I-10); and Group Control (C). Each group consisted of seven rabbits. I-5 and I-10 received 5 ml/kg and 10 ml/kg of liquid isoflurane, respectively, via nasogastric tube, while C received 5 ml/kg saline (0.9% NaCI). All animals in I-5 and I-10 were sacrificed without anesthetic drug administration. Tissue samples from livers, kidneys and lungs were collected, preserving tissue unity and avoiding infliction of any trauma. Samples were fixed in 10% formalin solution, embedded in paraffin blocks and sliced into 5 μm sections. To investigate the effects of isoflurane, sections were examined under light microscope and histopathological changes were scored.

RESULTS

Mean injury scores and the appearance of portal lymphocyte infiltration in liver samples showed significant increases in I-5 and I-10 compared to C (p = 0.005, p = 0.001 and p = 0.001, respectively). Mean lung injury scores revealed significant increases after isoflurane treatment in I-5 and I-10 compared to C (p = 0.026 and p = 0.017, respectively).

CONCLUSIONS

Ingested isoflurane led to mild liver and lung injuries in rabbits.

Association of serum paraoxonase activity and coronary artery calcification

AIM

It has been known that there was a relation between the activities of serum paraoxonase (PON) and the severity of the coronary artery disease. However, little is known about association of coronary artery calcification (CAC) and serum PON activities. The aim of this study is to evaluate the relationship between CAC and serum PON activities.

PATIENTS AND METHODS

We measure serum PON activities from 122 patients (42 female, mean age = 62±10 years) with angiographically documented CAC (Group I), and 138 patients (54 female, mean age = 60±10 years) without CAC (Group II). Coronary calcification was detected with fluoroscopy before coronary angiography. Serum PON activities were measured by spectrophotometrically method. Patient characteristics and baseline data were recorded from patient's files.

RESULTS

The triglyceride levels is lower in group I than group II (p = 0.040). Diastolic blood pressure and frequency of diabetes mellitus was higher in the group I than group II (respectively p = 0.012 and p = 0.022). The other clinic and laboratory parameters were similar in two groups (all p > 0.05). The only statistically significant differences between with CAC and without CAC groups in respect to serum PON activities were present (170.6 ± 59.6 vs. 209.6 ± 69.8 U/ml; respectively, p < 0.001). There was a negative correlation between serum PON activities and presence of CAC (p < 0.001).

CONCLUSIONS

These data indicate that the serum PON activities are decreased in patients with CAC. The serum PON activities may play a role in development of the CAC and reduced serum PON activity might represent a biochemical marker of CAC.

Prospective, randomized, double-blinded comparison of the effects of caudally administered levobupivacaine 0.25% and bupivacaine 0.25% on pain and motor block in children undergoing circumcision surgery

BACKGROUND

Caudal anesthesia is widely used as intraoperative and postoperative analgesia in children's subumbilical surgeries such as on the urogenital system, lower extremities and lower abdomen to reduce the stress response to surgery and to facilitate the general anesthesia.

AIM

The purpose of this study was to compare the effects of caudally administered bupivacaine and levobupivacaine of equal volume and concentration on motor block and postoperative pain in children undergoing circumcision surgery.

PATIENTS AND METHODS

The prospective, randomized, double-blind study included 60 patients with ages ranging from 1-10 years and ASA (American Society of Anesthesiologists) physical status of I-II who underwent elective circumcision surgery. The patients were divided into two groups: group B received 0.5 ml/kg of bupivacaine 0.25% caudally and group L received 0.5 ml/kg of levobupivacaine 0.25% caudally. Postoperative pain was assessed by children's and infant's postoperative pain scale and motor block was assessed by the Bromage scale.

RESULTS

The mean children's and infant's postoperative pain scale of group B was significantly lower than that of group L (p < 0.001). Three patients in group B and seven patients in group L needed additional analgesia after the incision. There was no significant difference between groups in terms of Bromage scores and in both groups the residual motor block was found to be zero at the 150th minutes.

CONCLUSION

According to these findings, bupivacaine has an adequate quality of analgesia than levobupivacaine. We suggest that bupivacaine for caudal block at the concentration of 0.25% (0.5 ml/kg) provides an adequate level of analgesia for outpatient circumcision surgery.