Assessment Of Circulating Endothelial Cells And Their Progenitors As Potential Biomarkers Of Disease Activity And Damage Accrual In Behçet's Syndrome

PURPOSE: To explore the potential role of circulating endothelial cells (CECs) and their progenitors (EPCs) as biomarkers of disease activity and damage accrual in patients with Behçet's syndrome (BS), by using a standardised and reliable flow cytometry protocol. PATIENTS AND METHODS: CECs and EPCs were assessed in 32 BS patients and 11 gender/age/smoking habits matched healthy controls (HC). They were identified by flow cytometry as alive/nucleated/CD45-negative/CD34-bright/CD146-positive and alive/nucleated/CD45-negative/CD34-bright/CD309-positive events, respectively. In BS patients, demographic and clinical features, including disease activity (assessed by Behçet's disease current disease activity form, BDCAF) and irreversible damage accrual (by the vasculitis damage index, VDI) were recorded. Uni- and multivariate analysis were performed to compare the CECs and EPCs concentrations in BS vs HC and to identify potential associations with demographic or clinical features. RESULTS: The CECs concentration was significantly higher in the BS patients than HCs [median (IQR) 15.0 (7.5-23.0) vs 6.0 (2.0-13.0) CECs/mL, p=0.024]. In BS patients, no significant associations were found between CECs and demographic features, present and past clinical manifestations, BDCAF score and ongoing treatment. A significant association was observed between CECs and organ damage, as assessed by the VDI (rho 0.356, p=0.045). Higher levels of CECs were especially associated with vascular damage [median (IQR) 23.0 (14.0-47.0) vs 13.0 (6.0-19.0) CECs/mL, p=0.011], including arterial aneurysm and stenosis, complicated venous thrombosis, cerebrovascular accident. The concentration of EPCs did not significantly differ between the BS and HC [median 26.5 (13.0-46.0) vs 19.0 (4.0-42.0) EPCs/mL, p=0.316] and no significant associations were observed between their levels and any clinical characteristic. CONCLUSION: Our study suggests that the CECs concentration is significantly higher in BS than healthy subjects, and it mainly correlates with vascular damage. A longitudinal extension of the present study on a wider cohort would be useful to validate the potential role of CECs as a marker or, hopefully, predictor of vascular damage in BS

Serum Albumin Is Inversely Associated With Portal Vein Thrombosis in Cirrhosis

We analyzed whether serum albumin is independently associated with portal vein thrombosis (PVT) in liver cirrhosis (LC) and if a biologic plausibility exists. This study was divided into three parts. In part 1 (retrospective analysis), 753 consecutive patients with LC with ultrasound-detected PVT were retrospectively analyzed. In part 2, 112 patients with LC and 56 matched controls were entered in the cross-sectional study. In part 3, 5 patients with cirrhosis were entered in the in vivo study and 4 healthy subjects (HSs) were entered in the in vitro study to explore if albumin may affect platelet activation by modulating oxidative stress. In the 753 patients with LC, the prevalence of PVT was 16.7%; logistic analysis showed that only age (odds ratio [OR], 1.024; P = 0.012) and serum albumin (OR, -0.422; P = 0.0001) significantly predicted patients with PVT. Analyzing the 112 patients with LC and controls, soluble clusters of differentiation (CD)40-ligand (P = 0.0238), soluble Nox2-derived peptide (sNox2-dp; P < 0.0001), and urinary excretion of isoprostanes (P = 0.0078) were higher in patients with LC. In LC, albumin was correlated with sCD4OL (Spearman's rank correlation coefficient [r(s)], -0.33; P < 0.001), sNox2-dp (r(s), -0.57; P < 0.0001), and urinary excretion of isoprostanes (r(s), -0.48; P < 0.0001) levels. The in vivo study showed a progressive decrease in platelet aggregation, sNox2-dp, and urinary 8-iso prostaglandin F2 alpha-III formation 2 hours and 3 days after albumin infusion. Finally, platelet aggregation, sNox2-dp, and isoprostane formation significantly decreased in platelets from HSs incubated with scalar concentrations of albumin. Conclusion: Low serum albumin in LC is associated with PVT, suggesting that albumin could be a modulator of the hemostatic system through interference with mechanisms regulating platelet activation

Telemedicine for patients with rheumatic diseases: Systematic review and proposal for research agenda

Objective: To systematically review the scientific literature regarding tele-rheumatology and draw conclusions about feasibility, effectiveness, and patient satisfaction. Methods: PubMed, Scopus, and Cochrane database searches were performed (April 2016) using relevant MeSH and keyword terms for telemedicine and rheumatic diseases. Articles were selected if reporting outcomes for feasibility, effectiveness, and patient satisfaction and methodologically appraised using the Cochrane Collaboration's tool for assessing risk of bias and a modified version of CONSORT 2010 Statement. Results: A total of 177 articles were screened, 23 were selected for the present review but only 9 were RCTs. Five studies reported on feasibility, 14 effectiveness, and 9 satisfaction rates for different tele-rheumatology interventions grouped in synchronous (remotely delivered consultation) and asynchronous (remote disease activity assessment; tele-monitoring of treatment strategies or rehabilitation; and remotely delivered self-management programs). Seven studies (30.4%) were on rheumatoid arthritis, 2 (8.7%) were on systemic sclerosis (1 including also rheumatoid arthritis patients), 5 (21.7%) on fibromyalgia, 2 (8.7%) on osteoarthritis, 3 (13.0%) on juvenile idiopathic arthritis and 4 (17.4%) on mixed disease cohorts. Interventions and outcomes heterogeneity prevented meta-analysis of results. Overall, feasibility and patient satisfaction rates were high or very high across intervention types. Effectiveness was equal or higher than standard face-to-face approach in controlled trials which, however, were affected by small sample size and lack of blinding participants according to appraisal tools. Conclusion: Telemedicine may provide a well-accepted way to remotely deliver consultation, treatment and monitoring disease activity in rheumatology. Higher quality RCTs demonstrating effectiveness of different tele-rheumatology interventions are neede

Telemedicine in rheumatology: high specificity and sensitivity of follow-up virtual video consultations during COVID-19 pandemic

To evaluate the reliability of virtual video-assisted visits, added to the tight control strategy for inflammatory rheumatic diseases (IRDs), in identifying patients that need treatment adjustment

FRI0357 DRUG-INDUCED REMISSION AND SUBCLINICAL ACTIVITY IN PSORIATIC ARTHRITIS: TRANSCRIPTIONAL PROFILING TO CHARACTERIZE THE DISEASE STATE

Background Remission is an important goal of therapy in psoriatic arthritis (PsA), but data on molecular players of clinical remission and effective disease inactivation are scarce. Gene expression profiling analysis could be useful to elucidate the pathogenic mechanisms of diseases, and differential gene expression analysis between diverse disease conditions produces gene signatures characteristic of the state or disease being studied. Objectives Our aim was to compare the transcriptional profiles of patients with clinically active versus inactive (remission state) PsA (peripheral joint subset), and healthy controls (HCs). Methods From a cohort of around 300 patients affected by PsA according to CASPAR criteria, we first selected 20 patients (peripheral arthritis subset) with active disease state (without biologic treatment ongoing) (A) and 20 patients with >1-year remission induced by TNFα antagonism (R), as assessed by DAPSA > 14, and DAPSA ≤ 4 scores respectively, and from 20 HCs matching for age and gender ratio. Both PsA groups were not on corticosteroid treatment. RNA from peripheral blood was extracted and, following quality analysis by Agilent Bioanalyzer, each condition has been profiled using RNAs pools in biological duplicates by distinct Affymetrix Human GeneChip HTA 2.0, for a total of 6 arrays. Data analysis was performed using the commercial software Partek Genomics Suite, V 6.6. To identify a transcript as differentially expressed, a value of fold change 1.5 and p-value 0.05 has been set. Results The Venn diagram shows all comparative groups (A vs R, A vs HC, R vs HC) with their relative amount of transcripts differentially expressed, generated using abovementioned parameters, and the relationship between sets (fig1, panel A). Using the list of transcripts differentially expressed in at least one of the aforementioned comparison, a hierarchical clustering was carried out to highlight the intra-condition expression profile. We have identified (arbitrarily) 4 clusters of transcripts with analogous transcriptional profile and to each of them a color code has been assigned (Heatmap in Fig1, panel B). For these clusters and for all lists of transcripts differentially expressed founded by our comparative study, we carried out the Gene Set Enrichment Analysis by Gene Ontology (GO), in order to identify how molecular functions, cellular components or biological processes occurs more frequently than expected in a reference list of transcripts. Conclusion Observing the amount of differentially expressed transcripts, is evident that while active disease state (A) has a clear-cut different profile, the drug-induced remission (R) is more similar with HCs condition. However, in the hierarchical clustering this trend of similarity does not appear in all clusters of transcripts, as shown particularly in the red, orange and green clusters. Again, the Gene Set Enrichment Analysis Score showed us that mRNA transcripts dysregulated in the R condition vs HCs, are involved in several biological processes related to immune system, development, response to stimulus, localization and others. Our next step will be to validate, by Real Time PCR in a large cohort of patients, the most interesting dysregulated genes covering biological functions eventually sustaining subclinical activity in PsA

SAT0035 IS PHARMACOLOGICAL CLINICAL REMISSION SYNONYMOUS WITH BIOLOGICAL INACTIVE DISEASE? DIFFERENTIAL GENE EXPRESSION ANALYSIS IN RHEUMATOID ARTHRITISAND HEALTY CONTROLS

Background: Remission is an important goal of therapy in rheumatoid arthritis (RA), but data on molecular players of clinical remission and effective disease inactivation are scarce. Gene expression profiling analysis is useful to elucidate the pathogenic mechanisms of diseases, and differential gene expression analysis between diverse disease conditions produces gene signatures characteristic of the state or disease being studied. Objectives: Our aim was to compare the transcriptional profiles of patients with clinically active versus inactive (remission state) RA, and healthy controls (HCs). Methods: From a cohort of around 1000 patients affected by RA according to ACR-EULAR 2010 criteria, we first selected 20 patients with active disease state (without biologic treatment ongoing) (A) and 20 patients with >1-year remission induced by TNFα antagonism (Etanercept) (R), as assessed by DAS28(PCR) scores, and from 20 HCs matching for age and gender ratio. Both RA groups were not on corticosteroid treatment. RNA from peripheral blood was extracted and, following quality analysis by Agilent Bioanalyzer, each condition has been profiled using RNAs pools in biological duplicates by distinct Affymetrix Human GeneChip HTA 2.0, for a total of 6 arrays. Data analysis was performed using the commercial software Partek Genomics Suite, V 6.6. To identify a transcript as differentially expressed, a value of fold change 1.5 and p-value 0.05 has been set. Results: The Venn diagram shows all comparative groups (A vs R, A vs HC, R vs HC) with their relative amount of transcripts differentially expressed, generated using abovementioned parameters, and the relationship between sets (fig1, panel A). Using the list of transcripts differentially expressed in at least one of the aforementioned comparison, a hierarchical clustering was carried out to view the intra-condition expression profile. Here, we have identified (arbitrarily) 4 clusters of transcripts with analogous transcriptional profile and to each of them a color code has been assigned (Heatmap in Fig1, panel B). For these clusters and for all lists of transcripts differentially expressed founded by our comparative study, we carried out the Gene Set Enrichment Analysis by Gene Ontology (GO), in order to identify how molecular functions, cellular components or biological processes occurs more frequently than expected in a reference list of transcripts. Conclusion: Considering the amount of differentially expressed transcripts and the hierarchical clustering analysis, is evident that the drug-induced remission (R) is more similar with HCs condition, while active disease state (A) has a different profile; however “similar” profile does not mean “identical”. In fact, the Gene Set Enrichment Analysis Score showed us that mRNA transcripts dysregulated in the R condition vs HCs, are involved in several biological processes regarding the immune system, response to stimulus, biological regulation, locomotion and others. Our next step will be to validate, by Real Time PCR in a large cohort of patients, the most interesting dysregulated genes covering biological functions eventually sustaining disease activity

Imbalanced MMP-3 and MMP-12 serum levels in systemic lupus erythematosus patients with Jaccoud's arthropathy and a distinctive MRI pattern

Metalloproteinase (MMP)-3 and MMP-12 are proteolytic enzymes especially implicated in joint inflammation. This study aims to evaluate their association with arthritis features and hand MRI abnormalities in patients with SLE

Rapporto tecnico sulle attività di campagna oceanografica “BANSIC 2013”

La campagna oceanografica BANSIC 2013 è stata condotta a bordo della N/O “Urania” dal 26 Giugno al 16 Luglio 2013 nell’ambito delle attività previste dal WP3 del progetto SSD-Pesca, finanziato dal MIUR su fondi MISE, a supporto della pesca italiana nelle Regioni Obiettivo 1, e dal progetto bandiera RITMARE (SP2_WP1_AZ1_UO01 e UO04) Obiettivi generali della campagna oceanografica sono stati lo studio delle relazioni tra le strutture oceanografiche a mesoscala (vortici verticali ed orizzontali, upwelling, ecc.) e le strutture spaziali dei fenomeni biologici relativi ai primi anelli della catena trofica (zooplancton, distribuzione e abbondanza di larve di piccoli pelagici e grandi pelagici), e lo sviluppo del dispositivo di Fishing Vessel Monitoring System denominato FOOS (Fishery Oceanography Observing System) da installare a bordo di imbarcazioni da pesca. In particolare, il campionamento di uova di acciuga è finalizzato all’applicazione del metodo DEPM (Daily Egg Production Method) per la stima dell’abbondanza dello stock riproduttore (SP2_WP1_AZ3_UO04). Il campionamento ittioplanctonico, che ha riguardato anche le acque Maltesi, è inserito anche nel piano di lavoro del progetto regionale MIPAF-FAO “MedSudMed” (“Assessment and Monitoring of the Fishery Resources and the Ecosystems in the Straits of Sicily”). La campagna ha visto anche l’avvio di una linea di ricerca in collaborazione con la Martin-Luther-Universität Halle-Wittenberg, avente come obiettivo i radiolari

Prevalence and determinants of peripheral microvascular endothelial dysfunction in rheumatoid arthritis patients: a multicenter cross-sectional study

Objectives. To define the prevalence and determinants of peripheral microvascular endothelial dysfunction (ED) in a large series of rheumatoid arthritis (RA) patients free of previous cardiovascular events. Materials and Methods. Data from 874 RA patients enrolled in the EDRA study (Endothelial Dysfunction Evaluation for Coronary Heart Disease Risk Estimation in Rheumatoid Arthritis - ClinicalTrials.gov: NCT02341066) were analyzed. Log-transformed reactive hyperemia index (Ln-RHI) was evaluated by peripheral arterial tonometry (PAT) using the EndoPAT2000 device: values of Ln-RHI < 0.51 were considered indicative of peripheral ED. Results. Peripheral microvascular ED was documented in one-third of RA patients (33.5%); in multiple logistic regression analysis, ACPA negativity and higher triglycerides concentrations were independently associated with the presence of peripheral ED [OR (95% CI) = 1.708 (1.218-2.396), p<0.01 and OR (95% CI) = 1.005 (1.002-1.009), p<0.01, respectively]. Multiple regression analysis showed a positive correlation between Ln-RHI values and systolic blood pressure and HDL cholesterol levels; furthermore, higher values of Ln-RHI were associated with ACPA positivity, while smoking habit was associated with lower Ln-RHI values. Conclusions. This study demonstrates for the first time a high prevalence of peripheral microvascular ED in patients with RA free of previous cardiovascular events that appear to be only partially driven by traditional cardiovascular risk factors. The association between ACPA negativity and ED warrants further exploration