Molecular mechanisms behind progressing chronic inflammatory dilated cardiomyopathy

Background: Inflammatory dilated cardiomyopathy (iDCM) is a common debilitating disease with poor prognosis that often leads to heart failure and may require heart transplantation. The aim of this study was to evaluate sera and biopsy samples from chronic iDCM patients, and to investigate molecular mechanism associated with left ventricular remodeling and disease progression in order to improve therapeutic intervention. Methods: Patients were divided into inflammatory and non-inflammatory DCM groups according to the immunohistochemical expression of inflammatory infiltrates markers: T-lymphocytes (CD3), active-memory T lymphocyte (CD45Ro) and macrophages (CD68). The inflammation, apoptosis, necrosis and fibrosis were investigated by ELISA, chemiluminescent, immunohistochemical and histological assays. Results: The pro-inflammatory cytokine IL-6 was significantly elevated in iDCM sera (3.3 vs. 10.98 μg/ml; P < 0.05). Sera levels of caspase-9, −8 and −3 had increased 6.24-, 3.1- and 3.62-fold, (P  < 0.05) and only slightly (1.3-, 1.22- and 1.03-fold) in biopsies. Significant release of Hsp60 in sera (0.0419 vs. 0.36 ng/mg protein; P < 0.05) suggested a mechanistic involvement of mitochondria in cardiomyocyte apoptosis. The significant MMP9/TIMP1 upregulation in biopsies (0.1931 - 0.476, P < 0.05) and correlation with apoptosis markers show its involvement in initiation of cell death and ECM degradation. A slight activation of the extrinsic apoptotic pathway and the release of hsTnT might support the progression of chronic iDCM. Conclusions: Data of this study show that significant increase of IL-6, MMP9/TIMP1 and caspases-9, −8, −3 in sera corresponds to molecular mechanisms dominating in chronic iDCM myocardium. The initial apoptotic pathway was more activated by the intramyocardial inflammation and might be associated with extrinsic apoptotic pathway through the pro-apoptotic Bax. The activated intrinsic form of myocardial apoptosis, absence of necrosis and decreased fibrosis are most typical characteristics of chronic iDCM. Clinical use of anti-inflammatory drugs together with specific anti-apoptotic treatment might improve the efficiency of therapies against chronic iDCM before heart failure occurs

Influence of Dextran Sulphate, Fibrin, and Ubiquitin on the Development of Casein-Induced Experimental AA Amyloidosis in C57BL/6 mice

The influence of subcutaneous injections of dextran sulphate (DS) and fibrin (F), as well as of an intraperitoneal  injection of ubiquitin (Ub), was investigated on 48 male C57BL/6 mice subjected to conventional  casein (C) induced amyloidosis. Histopathological examination of spleen and kidney tissue 3 and 5 weeks  after termination of the amyloidogenic stimulus showed that the amount of amyloid deposited (rated trace,  minimal, moderate or heavy) increased progressively with the duration of the amyloidogenic stimulus.  After 3 weeks of stimulation, 16.7% of mice injected with C had some perifollicular amyloid deposits in  the spleen while all had traces of amyloid in the kidney. Some amyloid was detected in the spleen of 33.3%  of the mice treated with C+DS and C+Ub and 83.3% treated with C+F. Half the latter group also showed  traces and half minimal amyloid deposits in their kidneys. In the other test groups, the incidence of kidney  amyloidosis was less. The most extensive tissue deposits were seen at 5 weeks postinjection (p.i.) with most in the C+F-treated  animals, all showing significantly more than the control C-treated group. Thus half the C+F-treated animals  had moderate and half heavy deposits throughout their spleens. Glomerulonephritis, kidney tubular  edema and some amyloid deposits were present in all of the animals. C+Ub resulted in a similar incidence  of amyloid accumulation in the spleen but in the kidneys 66.7% of animals had only traces of amyloid and  33.3%, minimal amyloid deposits. Amyloid was deposited in the mouse kidneys predominantly in the arterial  walls but also occurred in the basement membrane and interstitial tissues. A post-mortem examination  of the internal organs revealed splenomegaly in all the test groups and increased liver weight in the C-,  C+F-, and C+Ub-treated groups. The leukocyte count and ESR (erythrocyte sedimentation rate) were also  higher in all the experimental groups. Thus, the results indicated that F and Ub play a role in the amyloid deposition process in the experimentally  induced disorder in C57BL/6 mice and could enhance this pathological process.

S.6.1 β-catenin is a central mediator in SSc

Background. β-catenin is the central integrator of canonical Wnt signalling. Since recent evidence suggests a central role of Wnts in fibrosis, we examined the β-catenin/Wnt pathway in SSc and focused on the role of β-catenin in fibroblast activation. Methods. We performed qPCR for several Wnt ligands and axin-2 to examine Wnt expression in SSc skin. We further studied protein levels of Wnt-1, -4, -10b and β-catenin by IHC. To establish the effects of β-catenin/Wnt signalling on collagen release, we created mice with fibroblast-specific stabilization of β-catenin (dEx3 β-catenin (wt/fl) × Col1a2; Cre-ER) as well as mice carrying fibroblast-specific deletion of β-catenin [Ctnnb1(fl/fl) × Col1a2; Cre-ER]. Summary of the results. We could demonstrate mRNA overexpression of Wnt-1, -2, -9a, -9b, -10a, -10b and -16 in SSc skin. Wnt-1, -4 and -10b consistently showed strong expression in SSc skin when compared with healthy skin. On protein level, however, Wnt-4 was indistinguishable between SSc patients and healthy controls, whereas Wnt-1 and Wnt-10b protein levels were increased in SSc skin. The overexpression of Wnt-1 and Wnt-10b resulted in a prominent nuclear accumulation of β-catenin in fibroblasts. Finally, increased mRNA levels of the target gene axin-2 confirmed the activation of canonical Wnt signalling. In dEx3 β-catenin (wt/ex) mice, we addressed the consequences of enhanced Wnt signalling and increased accumulation of β-catenin in SSc. We selectively targeted β-catenin in fibroblasts. Cre-activated dEx3 β-catenin (wt/fl) × Col1a2; Cre-ER mice showed massive and spontaneous dermal thickening even 2 weeks after Cre activation. Eight weeks after Cre-activation, skin thickening cumulated at 102.6% (P < 0.001). In line with the dermal thickening, hydroxyproline content and myofibroblast counts showed strong increases. To test the therapeutic potential of targeting β-catenin/Wnt signaling, we created Ctnnb1(fl/fl) x Col1a2;Cre-ER mice to specifically delete β-catenin in fibroblasts. After Cre activation and β-catenin deletion in fibroblasts, mice were challenged with bleomycin subcutaneously for 4 weeks. We found that Cre-activated Ctnnb1(fl/fl) × Col1a2; Cre-ER mice were protected from bleomycin-induced dermal with a reduction of skin thickening by 71% (P < 0.05). Conclusions. We demonstrated a prominent activation of canonical Wnt signalling in SSc with nuclear accumulation of β-catenin in fibroblasts and activation of the target gene axin-2. Our results showed that fibroblast-specific stabilization of β-catenin resulted in enhanced collagen release, whereas deletion of β-catenin potently reduced collagen production. Together, our findings highlight a key role of β-catenin in fibroblast activation and fibrosis. Thus, β-catenin may be promising molecular target for anti-fibrotic therapie

Epidemiology of Lyme Disease in a Highly Endemic European Zone

Background and objective: Lyme disease, also known as Lyme borreliosis (LB), is a tick-borne infectious disease caused by the spirochete bacteria Borrelia. The risk of infection depends on the geographical area, ecological factors, and human behavior. Clinical manifestations of Lyme borreliosis have a wide range, but the most frequent clinical symptom, which is also a diagnostic symptom, is a skin rash called erythema migrans (EM). The disease is very common worldwide. In Lithuania, the disease frequency is 99.9 cases per 100,000 population (Centre for Communicable Diseases and AIDS, Lithuania, 2017). The main aim of this study was to obtain the baseline characteristics of the disease regarding the infected Lithuanian population. Materials and Methods: We analyzed data from the Centre for Communicable Diseases and AIDS about all Lyme disease (A69.2) diagnosed patients over a three-year period (from 2014 to 2016) in Lithuania. Results: In 2014–2016, 7424 (crude incidence rate 85.4) cases with LB were diagnosed in Lithuania. Most of them (4633 (62.4%)) were identified in women. Older people were more likely to suffer from LB. Urban residents were 2.6 times more often affected that those living in villages. Tick bites were primarily observed in high season months, from May to September (90%), with the highest peak in July. There was a higher number of observed tick bites (p = 0.003) in the urban residents. Erythema migrans occurred in 75.6% LB cases, while other symptoms did not exceed a quarter of all LB cases. There were 7353 (99.6%) cases where LB was confirmed via clinical symptoms and/or laboratory tests. Also, 1720 (23.2%) patients were tested for LB immunoglobulins. Conclusions: This study found a high incidence of Lyme disease in Lithuania. We elucidated the baseline characteristics regarding the infected Lithuanian population which may ease medical clinicians’ work on new Lyme diagnoses

KOMPRESINIŲ STUBURO SLANKSTELIŲ LŪŽIŲ KLINIKINIAI IR RADIOLOGINIAI YPATUMAI BEI JŲ SĄSAJOS SU RIZIKOS VEIKSNIAIS MOTERIMS POMENOPAUZINIU PERIODU

Darbo tikslas. Įvertinti kompresinių stuburo slankstelių lūžių dažnį tarp moterų, kurioms nustatyta sumažėjusi kaulų masė pomenopauziniu periodu, bei apibūdinti klinikinius ir radiologinius šių lūžių pasireiškimo ypatumus, įvertinti sąsajas su lūžių rizikos veiksniais. Tiriamieji ir metodai. Atliktas pjūvinis tyrimas, kurio metu menopauzės laikotarpį išgyvenančioms moterims, besikreipiančioms dėl profilaktinio sveikatos patikrinimo ar sveikatos sutrikimų į savo šeimos gydytojus, išmatuotas kaulų mineralų tankis dvisrautės radioabsorbciometrijos (dual-photon energy X-ray absorbtiometry – DXA) metodu. Tiriamosioms, kurioms buvo nustatytas sumažėjęs kaulų mineralų tankis (T lygmuo mažesnis už -1), buvo atliekama stuburo šoninės juosmeninės ir krūtininės dalių rentgenogramos, kurios įvertintos dėl kompresinių stuburo slankstelių deformacijų. Stuburo slankstelių lūžiai vertinti remiantis pusiau kiekybiniu Genanto metodu. Moterims, kurioms nustatytos kompresinės stuburo slankstelių deformacijos, vertinti klinikinės lūžių išraiškos bei rizikos veiksniai. Statistinė analizė atlikta PASW 18.0 programa. Rezultatai. Iš 330 tiriamųjų sumažėjusi kaulų masė nustatyta 206 (62,4 proc.) moterims, iš jų stuburo šoninės juosmeninės ir krūtininės dalių rentgenogramos atliktos 181, vertinimui tinkamos buvo 177 (85,9 proc.). Kompresiniai stuburo slankstelių lūžiai iš vertinimui tinkamų rentgenogramų nustatyti 18,4 proc. (33) tiriamųjų. Visi lūžiai įvertinti kaip seniai įvykę. Vyravo vieno slankstelio (69,7 proc. (23)) ir I° lūžiai (63,6 proc. (21)). Lėtinį nugaros skausmą jautė 24 (72,7 proc.), ūminį patyrė 4 (12,1 proc.) tiriamosios. 12 (36,4 proc.) moterų buvo skausminga palpacija stuburo slankstelių projekcijoje, priestuburinių raumenų skausmingumas ir vietinis tonuso padidėjimas – 9 (27,3 proc.). Didesnė kūno masė ir didesnis kūno masės indeksas bei fizinis aktyvumas statistiškai reikšmingai susiję su didesne kaulų mase. Lėtinis nugaros skausmas, lėtinės širdies ir kraujagyslių ligos, ūgio sumažėjimas, palyginus su buvusiu 30 m., bei didesnis gimdymų skaičius buvo statistiškai reikšmingai susiję su didesniu lūžusių slankstelių skaičiumi. Išvados. Kompresiniai stuburo slankstelių lūžiai nustatyti 33 (18,4 proc.) tiriamosioms iš 177 asmenų vertinimui tinkamų rentgenogramų. Visos nustatytos kompresinės stuburo slankstelių deformacijos įvertintos kaip seniai įvykę lūžiai. Vyravo vieno slankstelio ir I° lūžiai. Didesnis stuburo slankstelių lūžių skaičius reikšmingai statistiškai susijęs su dažniau jaučiamu lėtiniu nugaros skausmu, ūgio sumažėjimu, lėtinėmis širdies ir kraujagyslių ligos, didesniu gimdymų skaičiumi.</jats:p

Infliximab plus methotrexate is superior to methotrexate alone in the treatment of psoriatic arthritis in methotrexate-naive patients: the RESPOND study

Objective: To compare the efficacy and safety of treatment with infliximab plus methotrexate with methotrexate alone in methotrexate-naive patients with active psoriatic arthritis (PsA). Methods: In this open-label study, patients 18 years and older with active PsA who were naive to methotrexate and not receiving disease-modifying therapy (N=115) were randomly assigned (1:1) to receive either infliximab (5 mg/kg) at weeks 0, 2, 6 and 14 plus methotrexate (15 mg/week); or methotrexate (15 mg/week) alone. The primary assessment was American College of Rheumatology (ACR) 20 response at week 16. Secondary outcome measures included psoriasis area and severity index (PASI), disease activity score in 28 joints (DAS28) and dactylitis and enthesitis assessments. Results: At week 16, 86.3% of patients receiving infliximab plus methotrexate and 66.7% of those receiving methotrexate alone achieved an ACR20 response (p<0.02). Of patients whose baseline PASI was 2.5 or greater, 97.1% receiving infliximab plus methotrexate compared with 54.3% receiving methotrexate alone experienced a 75% or greater improvement in PASI (p<0.0001). Improvements in C-reactive protein levels, DAS28 response and remission rates, dactylitis, fatigue and morning stiffness duration were also significantly greater in the group receiving infliximab. In the infliximab plus methotrexate group, 46% (26/57) had treatment-related adverse events (AE) and two patients had serious AE, compared with 24% with AE (13/54) and no serious AE in the methotrexate-alone group. Conclusions: Treatment with infliximab plus methotrexate in methotrexate-naive patients with active PsA demonstrated significantly greater ACR20 response rates and PASI75 improvement compared with methotrexate alone and was generally well tolerated. This trial is registered in the US National Institutes of Health clinicaltrials.gov database, identifier NCT00367237

Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort.

Objectives To determine whether progressive skin fibrosis is associated with visceral organ progression and mortality during follow-up in patients with diffuse cutaneous systemic sclerosis (dcSSc). Methods We evaluated patients from the European Scleroderma Trials and Research database with dcSSc, baseline modified Rodnan skin score (mRSS) ≥7, valid mRSS at 12±3 months after baseline and ≥1 annual follow-up visit. Progressive skin fibrosis was defined as an increase in mRSS &gt;5 and ≥25% from baseline to 12±3 months. Outcomes were pulmonary, cardiovascular and renal progression, and all-cause death. Associations between skin progression and outcomes were evaluated by Kaplan-Meier survival analysis and multivariable Cox regression. Results Of 1021 included patients, 78 (7.6%) had progressive skin fibrosis (skin progressors). Median follow-up was 3.4 years. Survival analyses indicated that skin progressors had a significantly higher probability of FVC decline ≥10% (53.6% vs 34.4%; p&lt;0.001) and all-cause death (15.4% vs 7.3%; p=0.003) than non-progressors. These significant associations were also found in subgroup analyses of patients with either low baseline mRSS (≤22/51) or short disease duration (≤15 months). In multivariable analyses, skin progression within 1 year was independently associated with FVC decline ≥10% (HR 1.79, 95% CI 1.20 to 2.65) and all-cause death (HR 2.58, 95% CI 1.31 to 5.09). Conclusions Progressive skin fibrosis within 1 year is associated with decline in lung function and worse survival in dcSSc during follow-up. These results confirm mRSS as a surrogate marker in dcSSc, which will be helpful for cohort enrichment in future trials and risk stratification in clinical practice

Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the european scleroderma trials and research (eustar) cohort

Objectives To determine whether progressive skin fibrosis is associated with visceral organ progression and mortality during follow-up in patients with diffuse cutaneous systemic sclerosis (dcSSc). Methods We evaluated patients from the European Scleroderma Trials and Research database with dcSSc, baseline modified Rodnan skin score (mRSS) ≥7, valid mRSS at 12±3 months after baseline and ≥1 annual follow-up visit. Progressive skin fibrosis was defined as an increase in mRSS &gt;5 and ≥25% from baseline to 12±3 months. Outcomes were pulmonary, cardiovascular and renal progression, and all-cause death. Associations between skin progression and outcomes were evaluated by Kaplan-Meier survival analysis and multivariable Cox regression. Results Of 1021 included patients, 78 (7.6%) had progressive skin fibrosis (skin progressors). Median follow-up was 3.4 years. Survival analyses indicated that skin progressors had a significantly higher probability of FVC decline ≥10% (53.6% vs 34.4%; p&lt;0.001) and all-cause death (15.4% vs 7.3%; p=0.003) than non-progressors. These significant associations were also found in subgroup analyses of patients with either low baseline mRSS (≤22/51) or short disease duration (≤15 months). In multivariable analyses, skin progression within 1 year was independently associated with FVC decline ≥10% (HR 1.79, 95% CI 1.20 to 2.65) and all-cause death (HR 2.58, 95% CI 1.31 to 5.09). Conclusions Progressive skin fibrosis within 1 year is associated with decline in lung function and worse survival in dcSSc during follow-up. These results confirm mRSS as a surrogate marker in dcSSc, which will be helpful for cohort enrichment in future trials and risk stratification in clinical practice

Predictors of disease worsening defined by progression of organ damage in diffuse systemic sclerosis: a European Scleroderma Trials and Research (EUSTAR) analysis.

Objectives Mortality and worsening of organ function are desirable endpoints for clinical trials in systemic sclerosis (SSc). The aim of this study was to identify factors that allow enrichment of patients with these endpoints, in a population of patients from the European Scleroderma Trials and Research group database. Methods Inclusion criteria were diagnosis of diffuse SSc and follow-up over 12\ub13 months. Disease worsening/organ progression was fulfilled if any of the following events occurred: new renal crisis; decrease of lung or heart function; new echocardiography-suspected pulmonary hypertension or death. In total, 42 clinical parameters were chosen as predictors for the analysis by using (1) imputation of missing data on the basis of multivariate imputation and (2) least absolute shrinkage and selection operator regression. Results Of 1451 patients meeting the inclusion criteria, 706 had complete data on outcome parameters and were included in the analysis. Of the 42 outcome predictors, eight remained in the final regression model. There was substantial evidence for a strong association between disease progression and age, active digital ulcer (DU), lung fibrosis, muscle weakness and elevated C-reactive protein (CRP) level. Active DU, CRP elevation, lung fibrosis and muscle weakness were also associated with a significantly shorter time to disease progression. A bootstrap validation step with 10 000 repetitions successfully validated the model. Conclusions The use of the predictive factors presented here could enable cohort enrichment with patients at risk for overall disease worsening in SSc clinical trial