Efficacy and Safety of Ravulizumab in Adults With Anti-Aquaporin-4 Antibody-Positive (AQP4-Ab+) Neuromyelitis Optica Spectrum Disorder (NMOSD): Interim Analysis From the Ongoing Phase 3 CHAMPION-NMOSD Trial (S38.007)
While the strong connection between oxidative stress and atherosclerosis has many to hypothesize that antioxidant therapy may be viable therapeutic target in combating progression of atherosclerosis, numerous clinical trials of antioxidant interventions that scavenge multiple reactive oxygen species have been negative. Here, we test the hypothesis that overexpression of catalase—an enzyme which selectively degrades H 2 O 2 —plays a protective role against the initiation and expansion of calcific lesions in advanced atherosclerotic plaques. In vitro, we used aortic smooth muscle cells (SMC) from Ldlr -/- ApoB 100/100 (LA) mice that were either wild-type for human catalase (LA-Cat 0/0 ) or overexpressing human catalase (LA-Cat Tg/0 ). After treatment with BMP2 or TNFα for 24 hours, we found that catalase-overexpressing VSMCs had modest reductions in TNFα-induced inflammatory markers but paradoxical increases in mRNA levels of BMP2-induced osterix and the SMAD-specific target ID1. To determine if these effects were conserved in vivo, we analyzed aortic tissue from LA mice fed a Western diet for 3 or 12 months. Surprisingly—and unlike our cell-based experiments—aorta from LA-Cat Tg/0 tended to have higher expression of inflammatory markers compared to their LA-Cat 0/0 littermates. Similarly, expression of osterix was increased in LA-Cat Tg/0 mice compare to their LA-Cat 0/0 littermates, which was also associated with an increase in intimal plaque calcification. Collectively, these data strongly suggest that systemically overexpression of catalase (a close parallel to systemic administration of a selective H 2 O 2 -scavenging antioxidant) does not result in molecular, histopathological, or functional benefits in large arteries from hypercholesterolemic mice. Future studies aimed at characterizing the complex interplay between reactive oxygen species and specific intracellular signaling pathways are an essential next step to understanding the role of endogenous reactive oxygen species in the pathogenesis of atherosclerotic vascular disease.
Abstract 729: Tissue Specific Reductions in Sirtuin-6 Expression Affect Calcium Burden and Pro-osteogenic Signaling in the Aortic Valve
Sirtuin-6 (SIRT6) is a protein deacetylase that functions in several pathways related to aging, as complete loss of SIRT6 in mice elicits multiple age-associated phenotypes and premature death. While increasing age is a major risk factor for development of calcific aortic valve disease (CAVD), it is unclear whether loss of SIRT6 accelerates aortic valve calcification. Here, we report the role of SIRT6 in a subset of aortic valve interstitial cell progenitors (neural crest-derived VICs) by crossing mice carrying Cre recombinase under the control of a PAX3 promoter with mice harboring a SIRT6 gene that can be conditionally inactivated (SIRT6 FL/+ ). We hypothesized that tissue-specific reductions of SIRT6 would increase calcification, increase pro-osteogenic signaling, and impair aortic valve function. We examined mice of the genotypes Cre-/SIRT6 FL/+ or Cre+/ SIRT6 FL/+ at two different time points: young (3 months) and old (14-24 months). First, we used qRT-PCR to demonstrate that SIRT6 was effectively reduced in the aortic valve from PAX3-cre/SIRT6 FL/FL mice. Although reductions in SIRT6 did not change aortic valve calcium (Alizarin Red) in young mice, reducing SIRT6 increased valvular calcium levels in old mice compared to their WT littermates. Interestingly, protein levels of osterix were substantially increased in young, SIRT6-deficient mice compared to WT littermates but were paradoxically decreased in old SIRT6-deficient mice. Regardless of age, histopathological, or molecular changes, we did not observe detectable changes in cusp separation distance at any time point. Collectively, these data suggest that, contrary to our hypothesis, depletion of SIRT6 in neural crest cells—which are key progenitors of valve interstitial cells—is not sufficient to impair aortic valve function. Importantly, this finding suggests that age-associated reductions in SIRT6 may be a permissive context for development of CAVD but relies heavily on the presence of additional risk factors.
Primary Leptomeningeal Melanocytosis, A Case Report (P9-6.012)
Abstract Background: Pharmacogenomic studies on antidepressant treatment outcomes could be conducted using previously collected data from electronic health record (EHR)-linked biobanks. However, absence of EHR based outcome measures is an unmet need in designing such studies We aimed to define EHR-derived antidepressant outcome measures and explore their utility in showing associations between treatment outcomes and Cytochrome P450 (CYP) metabolizer phenotypes in a proof-of-concept study. Methods: Using data from the EHR-linked cohort, Right Drug, Right Dose, Right Time: Using Genomic Data to Individualize Treatment (RIGHT 10K) Study, we collected prescription data and patient health questionnaire 9 (PHQ-9) scores to compute 3 proxy measures for antidepressant response, efficacy, and acceptability: change in PHQ-9 scores, longest treatment interval with a single antidepressant, and antidepressant non-refill. Subsequently, we tested the association of both prescription-based outcomes with DNA-predicted CYP metabolizer phenotypes in European-ancestry participants. Results: We identified 3920 RIGHT 10K participants with at least 1 antidepressant prescription and European-ancestry. Participants had a mean age of 61 years and 72% were women. Implementation of the PHQ-9 outcome was not feasible because of missingness. Of both prescription-based outcomes, antidepressant non-refill reproduced several known antidepressant-CYP interactions. However, the pilot was limited by small subgroups of participants with non-normal metabolizer phenotypes. Conclusions: Derived from structured data, antidepressant non-refill is a promising outcome measure for EHR-linked biobanks that partially reproduced antidepressant-CYP interactions. However, testing on larger datasets is necessary to understand whether it would be a useful for pharmacogenomic research.
Etiology of Acceleromyographic Train-of-four Overshoot: A Hypothesis