CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

Implicaciones clínicas y pronósticas de los patrones radiológicos de las hiperintensidades de la sustancia blanca en pacientes con antecedente reciente de ictus isquémico. Estudio observacional por resonancia magnética

Un dels marcadors coneguts de malaltia de petit vas intracranial és la presència d'hiperintensitats en la substància blanca en ressonància magnètica. Es relaciona amb l'envelliment i amb factors de risc vascular i és més prevalent en pacients amb antecedent d'ictus. A més, és un factor predictor de nous esdeveniments isquèmics, així com de deteriorament cognitiu i funcional. El seu espectre de presentació topogràfica és variable i, avui dia, encara no hi ha suficient evidència de si aquesta variabilitat tradueix etiopatogènies diferents i justifica diferents presentacions clíniques. En aquest treball de tesi s'ha aprofundit en l'anàlisi de l'espectre d'aquestes hiperintensitats, des d'un entorn clínic, en dues cohorts de pacients amb antecedent d'ictus isquèmica partir de diferents abordatges d'anàlisis de la imatge, amb especial interès en els visuals. A través del mètode visual utilitzat s'han pogut avaluar determinats patrons de distribució menys estudiats. Els resultats obtinguts han trobat associacions significatives entre determinats patrons de distribució i perfils de risc vascular i de pronòstic funcional. En concret, les conclusions més rellevants han estat l'associació independent entre la hipertensió arterial amb les hiperintensitats periventriculars i de ganglis basals, la relació entre la dislipèmia amb les lesions en el tronc i, finalment, el pitjor pronòstic funcional dels pacients amb lesions en el tronc als tres mesos de l'esdeveniment. En conclusió, les evidències demostrades en aquesta tesi realcen la idea de la possible existència de vulnerabilitats topogràfiques específiques en la substància blanca, per la qual cosa sembla rellevant definir fenotips de distribució d'aquestes lesions per a continuar avançant en aquesta línia de recerca.Uno de los marcadores conocidos de enfermedad de pequeño vaso intracraneal es la presencia de hiperintensidades en la sustancia blanca en resonancia magnética. Se relaciona con el envejecimiento y con factores de riesgo vascular y es más prevalente en pacientes con antecedente de ictus. Además, es un factor predictor de nuevos eventos isquémicos, así como de deterioro cognitivo y funcional. Su espectro de presentación topográfica es variable y, a día de hoy, aún no hay suficiente evidencia de si esta variabilidad traduce etiopatogenias distintas y justifica diferentes presentaciones clínicas. En este trabajo de tesis se ha profundizado en el análisis del espectro de estas hiperintensidades, desde un entorno clínico, en dos cohortes de pacientes con antecedente de ictus isquémico a partir de diferentes abordajes de análisis de la imagen, con especial interés en los visuales. A través del método visual utilizado se han podido evaluar determinados patrones de distribución menos estudiados. Los resultados obtenidos han hallado asociaciones significativas entre determinados patrones de distribución y perfiles de riesgo vascular y de pronóstico funcional. En concreto, las conclusiones más relevantes han sido la asociación independiente entre la hipertensión arterial con las hiperintensidades periventriculares y de ganglios basales, la relación entre la dislipemia con las lesiones en el tronco y, finalmente, el peor pronóstico funcional de los pacientes con lesiones en el tronco a los tres meses del evento. En conclusión, las evidencias demostradas en esta tesis realzan la idea de la posible existencia de vulnerabilidades topográficas específicas en la sustancia blanca, por lo que parece relevante definir fenotipos de distribución de estas lesiones para seguir avanzando en esta línea de investigación.One of the known markers of intracranial small vessel disease is the presence of hyperintensities in the white matter on magnetic resonance imaging. It is related to aging and vascular risk factors and is more prevalent in patients with a history of stroke. It is also a predictor of new ischemic events as well as cognitive and functional deterioration. Its spectrum of topographic presentation is variable, and, to date, there is still not enough evidence as to whether this variability translates different etiopathogenesis and justifies different clinical presentations. This thesis work has deepened into the analysis of the spectrum of these hyperintensities, from a clinical setting, in two cohorts of patients with a history of ischemic stroke based on different image analysis approaches, with special interest in visuals. Through the visual method used, it has been possible to evaluate certain less studied distribution patterns. The results obtained have found significant associations between certain distribution patterns and profiles of vascular risk and functional prognosis. Specifically, the most relevan conclusions have been the independent association between arterial hypertension with periventricular and basal ganglia hyperintensities, the relationship between dyslipidaemia with lesions in the brainstem and, finally, the worse functional prognosis of patients with lesions in the brainstem three months after the event. In conclusion, the evidence demonstrated in this thesis enhances the idea of the possible existence of specific topographic vulnerabilities in the white matter, so it seems relevant to define distribution phenotypes of these lesions to continue advancing in this line of research

Phosphorylated tau181 in plasma as a potential biomarker for Alzheimer's disease in adults with Down syndrome

Plasma tau phosphorylated at threonine 181 (p-tau181) predicts Alzheimer's disease (AD) pathology with high accuracy in the general population. In this study, we investigated plasma p-tau181 as a biomarker of AD in individuals with Down syndrome (DS). We included 366 adults with DS (240 asymptomatic, 43 prodromal AD, 83 AD dementia) and 44 euploid cognitively normal controls. We measured plasma p-tau181 with a Single molecule array (Simoa) assay. We examined the diagnostic performance of p-tau181 for the detection of AD and the relationship with other fluid and imaging biomarkers. Plasma p-tau181 concentration showed an area under the curve of 0.80 [95% CI 0.73-0.87] and 0.92 [95% CI 0.89-0.95] for the discrimination between asymptomatic individuals versus those in the prodromal and dementia groups, respectively. Plasma p-tau181 correlated with atrophy and hypometabolism in temporoparietal regions. Our findings indicate that plasma p-tau181 concentration can be useful to detect AD in DS.This study was supported by the Fondo de Investigaciones Sanitario (FIS), Instituto de Salud Carlos III (PI14/01126 and PI17/01019 to J.F., PI13/01532 and PI16/01825 to R.B., PI18/00335 to M.C.I., PI18/00435 and INT19/00016 to D.A., PI15/01618 to R.R., PI14/1561 and AC19/00103 to A.L.) and the CIBERNED program (Program 1, Alzheimer Disease to A.L. and SIGNAL study, www.signalstudy.es), partly jointly funded by Fondo Europeo de Desarrollo Regional, Unión Europea, Una manera de hacer Europa. This work was also supported by the National Institutes of Health (NIA grants 1R01AG056850 - 01A1; R21AG056974 and R01AG061566 to J.F.), Departament de Salut de la Generalitat de Catalunya, Pla Estratègic de Recerca i Innovació en Salut (SLT002/16/00408 to A.L.), Fundació La Marató de TV3 (20141210 to J.F., 044412 to R.B. and 201437.10 to R.R.); I. Illán-Gala is supported by the Rio Hortega grant (CM17/00074) from “Acción Estratégica en Salud 2013-2016” and the Global Brain Health Institute (https://www.gbhi.org/). Fundació Catalana Síndrome de Down and Fundació Víctor Grífols i Lucas partially supported this work. This work was also supported by Generalitat de Catalunya (SLT006/17/00119 to J.F., SLT006/17/95 to E.V. and SLT006/17/00125 to D.A.) and a grant from the Fundació Bancaria La Caixa to R.B. M.F.I. acknowledges support from the Jérôme Lejeune and Sysley D’Ornano Foundations. A Bejanin was the recipient of a Juan de la Cierva-Incorporación grant from the Spanish Ministry of Economy and Competitiveness (IJCI-2017-32609) and a Miguel Servet I grant (CP20/00038) from the Carlos III Health Institute. T.K.K. holds a research fellowship from the BrightFocus Foundation (#A2020812F) and is further supported by the Swedish Alzheimer Foundation (Alzheimerfonden; #AF-930627), the Swedish Brain Foundation (Hjärnfonden; #FO2020-0240), the Swedish Dementia Foundation (Demensförbundet), Gamla Tjänarinnor Foundation, the Aina (Ann) Wallströms and Mary-Ann Sjöbloms Foundation, the Agneta Prytz-Folkes & Gösta Folkes Foundation (#2020-00124), the Gun and Bertil Stohnes Foundation, and the Anna Lisa and Brother Björnsson’s Foundation. H.Z. is a Wallenberg Scholar supported by grants from the Swedish Research Council (#2018-02532), the European Research Council (#681712), Swedish State Support for Clinical Research (#ALFGBG-720931), the Alzheimer Drug Discovery Foundation (ADDF), USA (#201809-2016862), the AD Strategic Fund and the Alzheimer’s Association (#ADSF-21-831376-C, #ADSF-21-831381-C and #ADSF-21-831377-C), the Olav Thon Foundation, the Erling-Persson Family Foundation, Stiftelsen för Gamla Tjänarinnor, Hjärnfonden, Sweden (#FO2019-0228), the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 860197 (MIRIADE), and the UK Dementia Research Institute at UCL. K.B. is supported by the Swedish Research Council (#2017-00915), the Alzheimer Drug Discovery Foundation (ADDF), USA (#RDAPB-201809-2016615), the Swedish Alzheimer Foundation (#AF-742881), Hjärnfonden, Sweden (#FO2017-0243), the Swedish state under the agreement between the Swedish government and the County Councils, the ALF-agreement (#ALFGBG-715986), and European Union Joint Program for Neurodegenerative Disorders (JPND2019-466-236). The authors would like to thank all the participants with Down’s syndrome, their families and their carers for their support of, and dedication to this research. We also acknowledge the Fundació Catalana Síndrome de Down for global support; Soraya Torres, Shaimaa El Bounasri, Laia Muñoz and Raúl Núñez for laboratory and sample handling; Reyes Alcoverro, Marta Salinas and Tania Martínez for administrative support; Concepción Escola for nursing handling. We also thank the clinicians for their help in acquiring the data reported in this article

Pseudoaneurysm of the lingual artery as an unusual radiological finding of oropharyngeal carcinoma

Pseudoaneurysms of the lingual artery are an extremely rare entity and often are consequence of neck surgery, trauma or inflammation (e.g., due to chemoradiotherapy or odontogenic infection), and may cause life-threatening bleeding. To our knowledge, this is the first report of buccal bleeding secondary to the presence of a previously undiagnosed oropharyngeal carcinoma with an associated lingual artery pseudoaneurysm

A randomized trial of deep brain stimulation to the subcallosal cingulate and nucleus accumbens in patients with treatment-refractory, chronic, and severe anorexia nervosa: initial results at 6 months of follow up

Background: The main objective of this study was to assess the safety and efficacy of deep brain stimulation (DBS) in patients with severe anorexia nervosa (AN). Methods: Eight participants received active DBS to the subcallosal cingulate (SCC) or nucleus accumbens (NAcc) depending on comorbidities (affective or anxiety disorders, respectively) and type of AN. The primary outcome measure was body mass index (BMI). Results: Overall, we found no significant difference (p = 0.84) between mean preoperative and postoperative (month 6) BMI. A BMI reference value (BMI-RV) was calculated. In patients that received preoperative inpatient care to raise the BMI, the BMI-RV was defined as the mean BMI value in the 12 months prior to surgery. In patients that did not require inpatient care, the BMI-RV was defined as the mean BMI in the 3-month period before surgery. This value was compared to the postoperative BMI (month 6), revealing a significant increase (p = 0.02). After 6 months of DBS, five participants showed an increase of ≥10% in the BMI-RV. Quality of life was improved (p = 0.03). Three cases presented cutaneous complications. Conclusion: DBS may be effective for some patients with severe AN. Cutaneous complications were observed. Longer term data are needed

Epigenetic Clock Explains White Matter Hyperintensity Burden Irrespective of Chronological Age

In this manuscript we studied the relationship between WMH and biological age (B-age) in patients with acute stroke. We included in this study 247 patients with acute stroke recruited at Hospital del Mar having both epigenetic (DNA methylation) and magnetic resonance imaging data. WMH were measured using a semi-automated method. B-age was calculated using two widely used methods: the Hannum and Horvath formulas. We used multiple linear regression models to interrogate the role of B-age on WMH volume after adjusting for chronological age (C-age) and other covariables. Average C-age of the sample was 68.4 (±11.8) and we observed a relatively high median WMH volume (median = 8.8 cm3, Q1–Q3 = 4.05–18.8). After adjusting for potential confounders, we observed a significant effect of B-ageHannum on WMH volume (βHannum = 0.023, p-value = 0.029) independently of C-age, which remained significant (βC-age = 0.021, p-value = 0.036). Finally, we performed a mediation analysis, which allowed us to discover that 42.7% of the effect of C-age on WMH is mediated by B-ageHannum. On the other hand, B-ageHoarvath showed no significant associations with WMH after being adjusted for C-age. In conclusion, we show for the first time that biological age, measured through DNA methylation, contributes substantially to explain WMH volumetric burden irrespective of chronological age

Epigenetic clock explains white matter hyperintensity burden irrespective of chronological age

In this manuscript we studied the relationship between WMH and biological age (B-age) in patients with acute stroke. We included in this study 247 patients with acute stroke recruited at Hospital del Mar having both epigenetic (DNA methylation) and magnetic resonance imaging data. WMH were measured using a semi-automated method. B-age was calculated using two widely used methods: the Hannum and Horvath formulas. We used multiple linear regression models to interrogate the role of B-age on WMH volume after adjusting for chronological age (C-age) and other covariables. Average C-age of the sample was 68.4 (±11.8) and we observed a relatively high median WMH volume (median = 8.8 cm3, Q1–Q3 = 4.05–18.8). After adjusting for potential confounders, we observed a significant effect of B-ageHannum on WMH volume (βHannum = 0.023, p-value = 0.029) independently of C-age, which remained significant (βC-age = 0.021, p-value = 0.036). Finally, we performed a mediation analysis, which allowed us to discover that 42.7% of the effect of C-age on WMH is mediated by B-ageHannum. On the other hand, B-ageHoarvath showed no significant associations with WMH after being adjusted for C-age. In conclusion, we show for the first time that biological age, measured through DNA methylation, contributes substantially to explain WMH volumetric burden irrespective of chronological age

Brain structure and function in school-aged children with sluggish cognitive tempo symptoms

Objective: Sluggish cognitive tempo (SCT) is a cluster of symptoms associated with poor function in various domains of major life activities that may comprise a novel attention disorder distinct from attention-deficit/hyperactivity disorder (ADHD). Nevertheless, very little is known about the neural substrate of SCT in children. The present study aimed to examine associations between SCT symptoms and brain structure and function in school-aged children. Method: We performed a cross-sectional MRI study in 178 children 8 to 12 years old from primary schools in Barcelona, Spain. Data were collected between January 2012 and March 2013. Parents completed the Sluggish Cognitive Tempo-Child Behavior Checklist (SCT-CBCL). Participants underwent magnetic resonance imaging to assess regional brain volume, white matter integrity using diffusion tensor imaging, and functional connectivity in major neural networks. Results: SCT symptoms were associated with altered anatomy of the frontal lobe in the form of increased regional volume. The anomalously large cortical regions were less mature in terms of functional connectivity. Importantly, all the anatomical and functional anomalies identified remained significant after adjusting the analyses for ADHD symptom scores. Conclusion: Our results suggest that SCT symptoms are associated with distinct features of brain structure and function that differ from the classical neural substrates described in ADHD.This work was supported by the European Research Council under the ERC (grant number 268479)—the BREATHE project. The Agency of University and Research Funding Management of the Catalonia Government part icipated in the context of Research Group SGR2014-16