HLA-B27 did not protect against COVID-19 in patients with axial spondyloarthritis - data from the ReumaCov-Brasil Registry

Abstract Background Some studies have suggested the HLA-B27 gene may protect against some infections, as well as it could play a benefit role on the viral clearance, including hepatitis C and HIV. However, there is lack of SARS-CoV-2 pandemic data in spondyloarthritis (SpA) patients. Aim To evaluate the impact of HLA-B27 gene positivity on the susceptibility and severity of COVID-19 and disease activity in axial SpA patients. Methods The ReumaCoV-Brasil is a multicenter, observational, prospective cohort designed to monitor immunemediated rheumatic diseases patients during SARS-CoV-2 pandemic in Brazil. Axial SpA patients, according to the ASAS classification criteria (2009), and only those with known HLA-B27 status, were included in this ReumaCov-Brasil's subanalysis. After pairing them to sex and age, they were divided in two groups: with (cases) and without (control group) COVID-19 diagnosis. Other immunodeficiency diseases, past organ or bone marrow transplantation, neoplasms and current chemotherapy were excluded. Demographic data, managing of COVID-19 (diagnosis, treatment, and outcomes, including hospitalization, mechanical ventilation, and death), comorbidities, clinical details (disease activity and concomitant medication) were collected using the Research Electronic Data Capture (REDCap) database. Data are presented as descriptive analysis and multiple regression models, using SPSS program, version 20. P level was set as 5%. Results From May 24th, 2020 to Jan 24th, 2021, a total of 153 axial SpA patients were included, of whom 85 (55.5%) with COVID-19 and 68 (44.4%) without COVID-19. Most of them were men (N = 92; 60.1%) with mean age of 44.0 ± 11.1 years and long-term disease (11.7 ± 9.9 years). Regarding the HLA-B27 status, 112 (73.2%) patients tested positive. There were no significant statistical differences concerning social distancing, smoking, BMI (body mass index), waist circumference and comorbidities. Regarding biological DMARDs, 110 (71.8%) were on TNF inhibitors and 14 (9.15%) on IL-17 antagonists. Comparing those patients with and without COVID-19, the HLA-B27 positivity was not different between groups (n = 64, 75.3% vs. n = 48, 48%, respectively; p = 0.514). In addition, disease activity was similar before and after the infection. Interestingly, no new episodes of arthritis, enthesitis or extra-musculoskeletal manifestations were reported after the COVID-19. The mean time from the first symptoms to hospitalization was 7.1 ± 3.4 days, and although the number of hospitalization days was numerically higher in the B27 positive group, no statistically significant difference was observed (5.7 ± 4.11 for B27 negative patients and 13.5 ± 14.8 for B27 positive patients; p = 0.594). Only one HLA-B27 negative patient died. No significant difference was found regarding concomitant medications, including conventional or biologic DMARDs between the groups. Conclusions No significant difference of COVID-19 frequency rate was observed in patients with axial SpA regarding the HLA-B27 positivity, suggesting a lack of protective effect with SARS-CoV-2 infection. In addition, the disease activity was similar before and after the infection. Trial registration This study was approved by the Brazilian Committee of Ethics in Human Research (CONEP), CAAE 30186820.2.1001.8807, and was registered at the Brazilian Registry of Clinical Trials - REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.

IL-22 increases the production of sFRP3 by FLS in inflammatory joint diseases

Rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) are inflammatory diseases with different bone remodeling patterns. Fibroblast-like synoviocytes (FLS) are cells involved in the transition from an acute and reparable phase to a chronic and persistent stage in these diseases. The distinction of joint phenotypes involves inflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin (IL)-17, and IL-22 directly or through key signaling pathways such as Wnt. To evaluate the role of FLS as the source of Wnt antagonists (sFRP3/FRZB and Dkk1) in the synovia, levels of TNF- α, IL-17, IL-22, Dkk1, and sFRP3 were measured by ELISA directly in the synovial fluid of patients with RA, PsA, or AS. Dkk1 and sFRP3 were also measured in the FLS culture supernatants after different inflammatory stimulus. sFRP3 and Dkk1 are constitutively expressed by FLS. IL-22 and sFRP3 were positively correlated (r=0.76; P<0.01) in synovial fluid. The stimulation of FLS with IL-22, but not TNF-alpha and IL-17, increased the production of sFRP3. No stimulus altered the basal expression of Dkk1. These results showed, for the first time, the ability of IL-22 to increase the expression of sFRP3/FRZB by human FLS in both in vitro and ex vivo models. This finding linked IL-22 to local inhibition of Wnt signaling and possibly to blockade of osteogenesis. Furthermore, FLS presented as a source of this inhibitor in synovial fluid, assigning to this cell a bone injury mechanism.

Influência de diferentes tipos de micro-organismos na contagem bacteriana total por citometria de fluxo do leite cru refrigerado / Influence of different types of microorganisms in total bacterial count by flow cytometry of refrigerated raw milk

Contagens bacterianas de 179 amostras de leite cru refrigerado, provenientes de diferentes bacias leiteiras de Minas Gerais, foram realizadas pelos métodos de citometria de fluxo e contagem padrão em placas. O estudo das associações entre a contagem bacteriana total e as contagens bacterianas dos diferentes grupos de micro-organismos foi realizado pela correlação de Pearson. Houve uma forte correlação positiva e significativa entre os valores de contagem de psicrotróficos (r = 0,67) e mesófilos (r = 0,70), determinados pelo método de referência, e os valores da contagem bacteriana total, determinados pela citometria de fluxo. Foi possível estabelecer uma curva de calibração para o citômetro de fluxo utilizando equações de regressão linear. As equações para a contagem bacteriana obtida por citometria de fluxo em função da contagem de mesófilos e psicrotróficos foram: log (CBI) = 0,701 log mesófilos + 1,9091 e log (CBI) = 0,4703 log psicrotróficos + 3,2784, respectivamente. Não foi possível estabelecer curvas de calibrações para termófilos e termodúricos, pois as correlações obtidas entre as contagens desses micro-organismos e a contagem bacteriana total, determinada por citometria de fluxo, foram fracas (r = 0,30 e 0,27, respectivamente).(AU)

Total Bacterial count was performed in 179 raw milk samples from different dairy farms in Minas Gerais State, Brazil, through flow cytometry and standard plate count, that was regarded as the reference method. There was significant strong correlation between the values of psychrotrophic and mesophilic counts determined by the reference method with the values of bacterial count determined by flow cytometry (r = 0.67 and 0.70, respectively), which allowed to establish linear regression equations for bacterial count to calibrate the flow cytometry and estimate the count of mesophilic (log bacterial individual count (BIC) by flow cytometry = 0.701 log mesophilic + 1.9091) and psychrotrophic (log BIC by flow cytometry = 0.4703 log psychrotrophic + 3.2784) bacteria. It was not possible to establish calibration curves for thermophiles and thermodurics due to the weak to moderate correlation coefficients found among these microorganism counts and total bacterial count determined by flow cytometry (r = 0.30 and 0.27, respectively).(AU)

Avaliação da qualidade microbiológica de bebida láctea e creme de leite UAT por ATP-Bioluminescência / Evaluation of microbiological quality of UHT milk drink and UHT milk cream by ATP-Bioluminescence

Embora métodos tradicionais sejam utilizados na avaliação microbiológica de produtos UAT, metodologias rápidas, baseadas em ATP-Bioluminescência, têm sido desenvolvidas. Os resultados da aplicação dessa técnica em 54 amostras de bebida láctea UAT achocolatada e 12 de creme de leite UAT foram comparados com os resultados de métodos microbiológicos, utilizando-se diferentes meios de cultura e tempos de incubação das referidas amostras. A técnica de ATP-Bioluminescência foi aplicada por meio do sistema MLS, e os resultados foram expressos em unidades relativas de luz (RLU). Em todos os tempos de incubação - 48, 72 e 168 horas - , as amostras apresentaram contagens baixas de microrganismos mesófilos e psicrotróficos aeróbios quando analisadas em meio PCA, BHI, PetrifilmTM AC e por ATP-Bioluminescência (<150 RLU), demonstrando alta especificidade da técnica. Apenas uma amostra de creme de leite UAT apresentou contagem de mesófilos aeróbios acima do padrão estabelecido pela legislação brasileira (<100 UFC/mL) quando analisada em meio PCA (260 UFC/mL) e PetrifilmTM AC (108 UFC/mL), no tempo de 168 horas. Essa alta contagem de microrganismos mesófilos aeróbios também foi detectada pela técnica de ATP-Bioluminescência (416 RLU). Os resultados da técnica de ATP-Bioluminescência foram iguais aos resultados em meio PCA, BHI e PetrifilmTM AC.

Although traditional methods are used for the microbiological evaluation of UHT products, rapid methodologies based on ATP-Bioluminescence have been developed. The results of applying this technique in 54 samples of chocolate UHT milk drink and 12 of UHT milk cream were compared with the results of microbiological methods, using different culture media and incubation times for the referred samples. The ATP-Bioluminescence technique was applied through the MLS system and the results were expressed as relative light units (RLU). In all incubation times - 48, 72, and 168 hours - , the samples showed lower counts of mesophilic and psychrotrophic aerobic microorganisms when analyzed using PCA, BHI, PetrifilmTM AC and ATP-Bioluminescence (<150RLU), demonstrating the technique's high specificity. Only one sample of UHT milk cream showed a mesophilic aerobic count above the standard established by Brazilian legislation (<100CFU/mL) when analyzed in PCA (260 CFU/mL) and PetrifilmTM AC (108CFU/mL) at 168 hours. This high count of aerobic mesophilic microorganisms was also detected by the ATP-Bioluminescence (416 RLU) technique. The results of the ATP-Bioluminescence technique were equal to the results in PCA, BHI and PetrifilmTM AC.

Tratamento das dermatomicoses com ketoconazole por via oral - estudo multicentrico. / Treatment of dermatomycosis with ketoconazole by oral route - multicenter study

Neste estudo foram incluidos 148 doentes, sendo 65 com pitiriase versicolor e 83 com dermatofitoses, submetidos a tratamento com ketoconazole por via oral. A dose diaria foi de 200mg (um comprimido) durante duas a quatro semanas para os casos de pitiriase versicolor e de quatro a oito semanas para os de dermatofitoses. O tratamento determinou, nos doentes de pitiriase versicolor, cura clinica e micologica em 50 (78,1%), apenas cura clinica em dois (3,1%) e cura micologica em um (1,6%). Nos doentes com dermatofitoses, em 69 (84,1%) houve cura clinica e micologica, quatro (4,9%) apresentaram cura micologica e cinco (6,1%) tiveram apenas cura clinica. Efeitos colaterais foram observados em 11 doentes (7,4%), sendo que dois necessitaram abandonar o tratamento por intolerancia (um teve nauseas de grau moderado e outro, nauseas, vomitos e tonturas de grau moderado, ambos no 1o. dia de tratamento).O ketoconazole por via oral demonstrou ser bastante eficaz no tratamento de pitiriase versicolor e de dermatofitoses