Key Genes of the Immune System and Predisposition to Acquired Hemophilia A: Evidence from a Spanish Cohort of 49 Patients Using Next-Generation Sequencing.

Acquired hemophilia A (AHA) is a rare bleeding disorder caused by the presence of autoantibodies against factor VIII (FVIII). As with other autoimmune diseases, its etiology is complex and its genetic basis is unknown. The aim of this study was to identify the immunogenetic background that predisposes individuals to AHA. HLA and KIR gene clusters, as well as KLRK1, were sequenced using next-generation sequencing in 49 AHA patients. Associations between candidate genes involved in innate and adaptive immune responses and AHA were addressed by comparing the alleles, genotypes, haplotypes, and gene frequencies in the AHA cohort with those in the donors' samples or Spanish population cohort. Two genes of the HLA cluster, as well as rs1049174 in KLRK1, which tags the natural killer (NK) cytotoxic activity haplotype, were found to be linked to AHA. Specifically, A*03:01 (p = 0.024; odds ratio (OR) = 0.26[0.06-0.85]) and DRB1*13:03 (p = 6.8 × 103, OR = 7.56[1.64-51.40]), as well as rs1049174 (p = 0.012), were significantly associated with AHA. In addition, two AHA patients were found to carry one copy each of the low-frequency allele DQB1*03:09 (nallele = 2, 2.04%), which was completely absent in the donors. To the best of our knowledge, this is the first time that the involvement of these specific alleles in the predisposition to AHA has been proposed. Further molecular and functional studies will be needed to unravel their specific contributions. We believe our findings expand the current knowledge on the genetic factors involved in susceptibility to AHA, which will contribute to improving the diagnosis and prognosis of AHA patients.

Effect of Several Pretreatments on the Lactic Acid Production from Exhausted Sugar Beet Pulp.

Exhausted sugar beet pulp (ESBP), a by-product of the sugar industry, has been used as a substrate to produce lactic acid (LA). Due to the fact that ESBP contains a high percentage of pectin and hemicellulose, different pretreatments were studied to solubilize them and to facilitate the access to cellulose in the subsequent enzymatic hydrolysis. Several pretreatments were studied, specifically biological, oxidant with alkaline hydrogen peroxide (AHP), and thermochemical with acid (0.25, 0.5, or 1% w/v of H2SO4). Pretreated ESBP was enzymatically hydrolysed and fermented with the strain Lactiplantibacillus plantarum for LA production. The hydrolysis was carried out with the commercial enzymes Celluclast®, pectinase, and xylanase, for 48 h. After that, the hydrolysate was supplemented with yeast extract and calcium carbonate before the bacteria inoculation. Results showed that all the pretreatments caused a modification of the fibre composition of ESBP. In most cases, the cellulose content increased, rising from 25% to 68% when ESBP was pretreated thermochemically at 1% w/v H2SO4. The production of LA was enhanced when ESBP was pretreated thermochemically. However, it was reduced when biological and AHP pretreatments were applied. In conclusion, thermochemical pretreatment with 1% w/v H2SO4 had a positive impact on the production of LA, increasing its concentration from 27 g/L to 50 g/L.

Treatment preferences as basis for decision making in patients using direct oral anticoagulants in Spain.

Treatment preferences are considered a relevant decision-making driver by the main atrial fibrillation (AF) guidelines. Direct Oral Anticoagulants (DOACs), considered as similar clinically, have administration differences useful for treatment individualization. Preferences, priorities and satisfaction of DOAC users were assessed through an observational, multicentric (25 hospitals), cross-sectional study including adult AF-patients (and/or caregivers) in Spain. Three study groups were considered according to DOAC posology preferences: (A) once-daily, with water; (B) once-daily, with food; (C) twice-daily. Overall, 332 patients and 55 caregivers were included. Mean (SD) age was 73.7 (10.7) years [58.7 (13.9) for caregivers]; 51.5% women [69.1% for caregivers]; 80.7% showed comorbidities and poly-pharmacy [6.6 (3.3) drugs/day]. No statistically significant differences were shown among study groups. Once-daily administration was preferred by 274 patients (82.5%) [60.8% (Group A); 21.7% (Group B); 17.5% (Group C)], and 47 caregivers (85.5%) [58.2% (Group A); 27.3% (Group B); 14.5% (Group C)]. Once-daily DOACs were prescribed in 42.8% of the patients. Bleeding risk was the main concern for both, patients and caregivers, followed by DOAC posology and interactions. Although treatment satisfaction (patients and caregivers) was high (9.0 and 9.1 points, respectively), match between individual treatment preferences and real prescriptions was only shown in 41.0% of AF-patients, evidencing a need for patient involvement on treatment decision-making. There is not a patient profile linked to treatment preferences, and clinical criteria must be the main driver for decision-making. However, for most AF-patients (elderly patients), aged, with comorbidity, poly-pharmacy and high cardiovascular risk, once-daily DOACs would be the preferred option.

Valorisation of fungal hydrolysates of exhausted sugar beet pulp for lactic acid production.

BACKGROUND: Exhausted sugar beet pulp pellets (ESBPP) were used as raw material for lactic acid (LA) fermentation. The enzymatic hydrolysis of ESBPP was performed with the solid obtained after the fungal solid-state fermentation of ESBPP as a source of hydrolytic enzymes. Subsequently, a medium rich in glucose and arabinose was obtained, which was used to produce LA by fermentation. For LA production, two Lactobacillus strains were assayed and the effects of the supplementation of the hydrolysate with a nitrogen source and the mode of pH regulation of the fermentation were investigated. Moreover, a kinetic model for LA fermentation by Lactobacillus plantarum of ESBPP hydrolysates was developed. RESULTS: L. plantarum produced a LA concentration 34% higher than that produced by L. casei. The highest LA concentration (30 g L-1 ) was obtained with L. plantarum when the hydrolysate was supplemented with 5 g L-1 yeast extract and the pH was controlled with CaCO3 . The concentration of acetic acid differed depending on the concentration of CaCO3 added, producing its maximum value with 27 g L-1 CaCO3 . The proposed kinetic model was able to predict the evolution of substrates and products depending on the variation of the pH in the hydrolysate, according to the amount of CaCO3 added. CONCLUSIONS: ESBPP can be revalorised to produce LA. A pure LA stream or a mixture of LA and acetic acid, depending on the pH control method of the fermentation, can be produced. Thus, this control is of great interest depending on the destination of the effluent. © 2020 Society of Chemical Industry.

Conversion of Exhausted Sugar Beet Pulp into Fermentable Sugars from a Biorefinery Approach.

In this study, the production of a hydrolysate rich in fermentable sugars, which could be used as a generic microbial culture medium, was carried out by using exhausted sugar beet pulp pellets (ESBPPs) as raw material. For this purpose, the hydrolysis was performed through the direct addition of the fermented ESBPPs obtained by fungal solid-state fermentation (SSF) as an enzyme source. By directly using this fermented solid, the stages for enzyme extraction and purification were avoided. The effects of temperature, fermented to fresh solid ratio, supplementation of fermented ESBPP with commercial cellulase, and the use of high-solid fed-batch enzymatic hydrolysis were studied to obtain the maximum reducing sugar (RS) concentration and productivity. The highest RS concentration and productivity, 127.3 g·L-1 and 24.3 g·L-1·h-1 respectively, were obtained at 50 °C and with an initial supplementation of 2.17 U of Celluclast® per gram of dried solid in fed-batch mode. This process was carried out with a liquid to solid ratio of 4.3 mL·g-1 solid, by adding 15 g of fermented solid and 13.75 g of fresh solid at the beginning of the hydrolysis, and then the same amount of fresh solid 3 times every 2.5 h. By this procedure, ESBPP can be used to produce a generic microbial feedstock, which contains a high concentration of monosaccharides.

Feasibility of exhausted sugar beet pulp as raw material for lactic acid production.

BACKGROUND: Exhausted sugar beet pulp pellets (ESBPP), a sugar industry by-product generated after sugar extraction in the sugar production process, have been used as a raw material for lactic acid (LA) production via hydrolysis and fermentation by Lactobacillus casei. To design a more cost-effective process, simultaneous saccharification and fermentation (SSF) of ESBPP is proposed in the present study. The effects of pH control, nutrient supplementation and solid addition in fed-batch SSF on lactic acid production were investigated. RESULTS: The highest LA concentration (26.88 g L-1 ) was reached in fed-batch SSF at a solid/liquid loading of 0.2 g mL-1 , with pH control (by adding 30 g L-1 CaCO3 to the medium) and nutrient supplementation (by adding 20 mL of MRS medium per 100 mL of buffer). Under these conditions, a maximum productivity of 0.63 g L-1 h-1 was achieved, which is 2.7 times higher than that attained in the control experiment (SSF inoculated at time 0 h). However, a slightly lower LA yield was obtained, revealing the need of an increasing dose of enzymes at high solid loading SSF. CONCLUSION: An efficient fed-batch SSF strategy with pH control and MRS supplementation is described in the present study, attaining higher LA productivity compared to separate hydrolysis and fermentation and SSF. © 2020 Society of Chemical Industry.

Qualitative study of patients with metastatic prostate cancer to adherence of hormone therapy.

PURPOSE: To explore adherence to oral hormone treatment in patients with metastatic prostate cancer (mCRPC) and to identify the factors that influence it. METHODS: A qualitative exploratory study was conducted at the National Cancer Institute of Rome. Patients aged >18 years with castration-resistant prostate cancer (mCRPC) and who were using oral hormone drugs were recruited. Semi-structured interviews were used for data collection, subsequently transcribed verbatim and analysed using Ritchie and Spencer's framework analysis. RESULTS: The sample included 13 patients with a median age of 72 who were treated, on average, for seven months with abiraterone acetate (AA) (76.9%) and enzalutamide (ENZ) (23.1%). Five themes were identified: expression of the concept of adherence, favouring factors, obstacle factors, functional strategies and levels of adherence. CONCLUSIONS: The patients express a good level of adherence, which they define in different ways-the helping relationship with the attending physician, the support of the family members and the few side effects of the drugs. For the future, it is recommended to perform a multicentre mixed method study to explain the levels of adherence and distress in women with breast cancer.

Recomendaciones del Grupo Catalán de Trombosis (Tromboc@t Working Group) para el tratamiento de los pacientes que reciben anticoagulantes orales directos / Tromboc@t Working Group recommendations for management in patients receiving direct oral anticoagulants

Antecedentes y objetivos: En los últimos años los anticoagulantes orales directos (ACOD) se han convertido en una alternativa a los antagonistas de la vitamina K (AVK) para la prevención del ictus y embolia sistémica en pacientes con fibrilación auricular no valvular (FANV), así como para la prevención y tratamiento de la trombosis venosa profunda. Los ensayos clínicos han demostrado la no inferioridad y la potencial superioridad en comparación con la warfarina, lo cual permite ampliar las opciones de anticoagulación. En nuestro medio, las Unidades de Tratamiento Anticoagulante (UTA) y los Centros de Atención Primaria (CAP) son los encargados de la educación, seguimiento, control de adherencia y del manejo en situaciones especiales de los pacientes anticoagulados. Estas consideraciones han motivado la preparación del presente documento de consenso, que tiene como objetivo establecer recomendaciones que incorporen los hallazgos de la investigación científica a la práctica clínica para mejorar la calidad asistencial en el ámbito de la anticoagulación. Material y métodos: Un grupo de expertos del Grupo Catalán de Trombosis (TROMBOC@T) ha revisado la bibliografía publicada entre 2007 y 2016 para poder establecer recomendaciones basadas en la evidencia clínica. Resultados: Como resultado del proyecto se han establecido un conjunto de recomendaciones de carácter práctico que facilitarán el tratamiento, educación, seguimiento y manejo en situaciones especiales de los pacientes anticoagulados con ACOD. Conclusiones: El aumento progresivo del uso de los ACOD requiere establecer y homogeneizar las directrices de actuación clínica en el paciente anticoagulado con estos antitrombóticos tanto en las UTA como en los CAP

Background and objectives: In recent years, direct oral anticoagulants (DOACs) have become an alternative to vitamin K antagonists (VKA) for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF) as well as for prevention and treatment of deep venous thrombosis. Pivotal trials have demonstrated non-inferiority and potential superiority compared to warfarin, which increases the options of anticoagulant treatment. In our setting, the Anticoagulant Treatment Units (ATUs) and Primary Care Centres (PCCs) play an important role in the education, follow-up, adherence control and management in special situations of anticoagulated patients. These considerations have motivated us to elaborate the present consensus document that aims to establish clear recommendations that incorporate the findings of scientific research into clinical practice to improve the quality of care in the field of anticoagulation. Material and methods: A group of experts from the Catalan Thrombosis Group (TROMBOC@T) reviewed all published literature from 2009 to 2016, in order to provide recommendations based on clinical evidence. Results: As a result of the project, a set of practical recommendations have been established that will facilitate treatment, education, follow-up and management in special situations of anticoagulated patients with ACODs. Conclusions: Progressive increase in the use of DOACs calls for measures to establish and homogenise clinical management guidelines for patients anticoagulated with DOACs in ATUs and PCCs

Tromboc@t Working Group recommendations for management in patients receiving direct oral anticoagulants. / Recomendaciones del Grupo Catalán de Trombosis (Tromboc@t Working Group) para el tratamiento de los pacientes que reciben anticoagulantes orales directos.

BACKGROUND AND OBJECTIVES: In recent years, direct oral anticoagulants (DOACs) have become an alternative to vitamin K antagonists (VKA) for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF) as well as for prevention and treatment of deep venous thrombosis. Pivotal trials have demonstrated non-inferiority and potential superiority compared to warfarin, which increases the options of anticoagulant treatment. In our setting, the Anticoagulant Treatment Units (ATUs) and Primary Care Centres (PCCs) play an important role in the education, follow-up, adherence control and management in special situations of anticoagulated patients. These considerations have motivated us to elaborate the present consensus document that aims to establish clear recommendations that incorporate the findings of scientific research into clinical practice to improve the quality of care in the field of anticoagulation. MATERIAL AND METHODS: A group of experts from the Catalan Thrombosis Group (TROMBOC@T) reviewed all published literature from 2009 to 2016, in order to provide recommendations based on clinical evidence. RESULTS: As a result of the project, a set of practical recommendations have been established that will facilitate treatment, education, follow-up and management in special situations of anticoagulated patients with ACODs. CONCLUSIONS: Progressive increase in the use of DOACs calls for measures to establish and homogenise clinical management guidelines for patients anticoagulated with DOACs in ATUs and PCCs.

cis-9,trans-11,cis-15 and cis-9,trans-13,cis-15 CLNA mixture activates PPARα in HEK293 and reduces triacylglycerols in 3T3-L1 cells.

Scientific research is constantly working to find new molecules that are effective in preventing excessive accumulation of body fat. The aim of the present work was to assess the potential agonism on PPARα and PPARγ of a conjugated linolenic acid (CLNA) isomer mixture, consisting of two CLNA isomers (cis-9,trans-11,cis-15 and cis-9,trans-13,cis-15). Secondly, we aimed to analyze the effects of this mixture on triacylglycerol accumulation in 3T3-L1 mature adipocytes. Luciferase transactivation assay was used to analyze whether the CLNA mixture activated PPARs. The expression of several enzymes and transcriptional factors involved in the main metabolic pathways that control triacylglycerol accumulation in adipocytes was assessed by real time RT-PCR in 3T3-L1 adipocytes treated for 20 h with the CLNA mixture. The mixture activated PPRE in cells with PPARα receptor over-expression, but not those with PPARγ over-expression. Decreased triacylglycerol was found in treated adipocytes. The lowest dose (10 µM) increased HSL expression and the highest dose (100 µM) increased ATGL gene expression. The other genes analyzed remained unchanged. The hypothesis of an anti-obesity action of the analyzed CLNA mixture, based on increased lipid mobilization in adipose tissue, can be proposed.