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Objectives During 2020, the UK’s Department of Health and Social Care (DHSC) established the Moonshot programme to fund various diagnostic approaches for the detection of SARS-CoV-2, the pathogen behind the COVID-19 pandemic. Mass spectrometry was one of the technologies proposed to increase testing capacity. Methods Moonshot funded a multi-phase development programme, bringing together experts from academia, industry and the NHS to develop a state-of-the-art targeted protein assay utilising enrichment and liquid chromatography tandem mass spectrometry (LC-MS/MS) to capture and detect low levels of tryptic peptides derived from SARS-CoV-2 virus. The assay relies on detection of target peptides, ADETQALPQRK (ADE) and AYNVTQAFGR (AYN), derived from the nucleocapsid protein of SARS-CoV-2, measurement of which allowed the specific, sensitive, and robust detection of the virus from nasopharyngeal (NP) swabs. The diagnostic sensitivity and specificity of LC-MS/MS was compared with reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) via a prospective study. Results Analysis of NP swabs (n=361) with a median RT-qPCR quantification cycle (Cq) of 27 (range 16.7–39.1) demonstrated diagnostic sensitivity of 92.4% (87.4–95.5), specificity of 97.4% (94.0–98.9) and near total concordance with RT-qPCR (Cohen’s Kappa 0.90). Excluding Cq>32 samples, sensitivity was 97.9% (94.1–99.3), specificity 97.4% (94.0–98.9) and Cohen’s Kappa 0.95. Conclusions This unique collaboration between academia, industry and the NHS enabled development, translation, and validation of a SARS-CoV-2 method in NP swabs to be achieved in 5 months. This pilot provides a model and pipeline for future accelerated development and implementation of LC-MS/MS protein/peptide assays into the routine clinical laboratory.

The pandemic readiness toolbox needs to be extended, targeting different biomolecules, using orthogonal experimental set-ups. Here, we build on our Cov-MS effort using LC-MS, adding SISCAPA technology to enrich proteotypic peptides of the SARS-CoV-2 nucleocapsid (N) protein from trypsin-digested patient samples. The Cov

INTRODUCTIONThe pandemic readiness toolbox needs to be extended, providing diagnostic tools that target different biomolecules, using orthogonal experimental setups and fit-for-purpose specification of detection. Here we build on a previous Cov-MS effort that used liquid chromatography-mass spectrometry (LC-MS) and describe a method that allows accurate, high throughput measurement of SARS-CoV-2 nucleocapsid (N) protein.MATERIALS and METHODSWe used Stable Isotope Standards and Capture by Anti-Peptide Antibodies (SISCAPA) technology to enrich and quantify proteotypic peptides of the N protein from trypsin-digested samples from COVID-19 patients.RESULTSThe Cov2MS assay was shown to be compatible with a variety of sample matrices including nasopharyngeal swabs, saliva and blood plasma and increased the sensitivity into the attomole range, up to a 1000-fold increase compared to direct detection in matrix. In addition, a strong positive correlation was observed between the SISCAPA antigen assay and qPCR detection beyond a quantification cycle (Cq) of 30-31, the level where no live virus can be cultured from patients. The automatable “addition only” sample preparation, digestion protocol, peptide enrichment and subsequent reduced dependency upon LC allow analysis of up to 500 samples per day per MS instrument. Importantly, peptide enrichment allowed detection of N protein in a pooled sample containing a single PCR positive sample mixed with 31 PCR negative samples, without loss in sensitivity. MS can easily be multiplexed and we also propose target peptides for Influenza A and B virus detection.CONCLUSIONSThe Cov2MS assay described is agnostic with respect to the sample matrix or pooling strategy used for increasing throughput and can be easily multiplexed. Additionally, the assay eliminates interferences due to protein-protein interactions including those caused by anti-virus antibodies. The assay can be adapted to test for many different pathogens and could provide a tool enabling longitudinal epidemiological monitoring of large numbers of pathogens within a population, applied as an early warning system.

Objective To assess budget impact of the introduction of prolonged-release buprenorphine (PRB) for care of opioid use disorder (OUD) over 1 year in a defined population. Materials and Methods A healthcare perspective, decision-tree model analysis of the cost of OUD care for a standard population was prepared to compare two scenarios: treatment of a population under the existing standard of care, or with the addition of PRB. The model assessed OUD-related direct costs (medication, delivery, psychosocial treatment), other services costs (harm reduction, general healthcare, social and justice services) and the impact of behaviors such as engaging with treatment and electing to use additional opioids “on top” of treatment regimens, and “dropping out” from treatment. Results Standard population definition (persons offered OUD care services) is based on a typical administrative region in England with general population of 400,000 citizens, 1,777 high-risk opioid users requiring treatment and 909 patients initiating treatment in a year. The cost to provide OUD care for 1 year under the current scenario (70% treated with methadone, 30% sublingual buprenorphine) is £19.7M. In scenarios with increased PRB adoption/reduced sublingual buprenorphine or oral methadone use, the cost reduction ranges from £0.2M to 0.7M. Conclusion The assessment showed a reduction of overall costs after introduction of PRB.

Background Mindfulness-based stress reduction (MBSR) has demonstrated benefits for stress-related symptoms; however, for patients with burdensome treatment regimens, multiple co-morbidities and mobility impairment, time and travel requirements pose barriers to MBSR training. Purpose To describe the design, rationale and feasibility results of Journeys to Wellness, a clinical trial of mindfulness training delivered in a novel workshop and teleconference format. The trial aim is to reduce symptoms and improve quality of life in people waiting for a kidney transplant. Methods The standard 8-week MBSR program was reconfigured for delivery as two in-person workshops separated in time by six weekly teleconferences (tMBSR). A time and attention comparison condition (tSupport) was created using the workshop-telephone format. Feasibility results Kidney transplant candidates (N = 63) were randomly assigned to tMBSR or tSupport: 87% (n = 55) attended ≥ 1 class, and for these, attendance was high (6.6 ± 1.8 tMBSR and 7.0 ± 1.4 tSupport sessions). Fidelity monitoring found that all treatment elements were delivered as planned and few technical problems occurred. Patients in both groups reported high treatment satisfaction, but more tMBSR (83%) than tSupport (43%) participants expected their intervention to be quite a bit or extremely useful for managing their health. Symptoms and quality of life outcomes collected before (baseline, 8 weeks and 6 months) and after kidney transplantation (2, 6 and 12 months) will be analyzed for efficacy. Conclusions tMBSR is an accessible intervention that may be useful to people with a wide spectrum of health conditions. Clinicaltrials.gov: NCT01254214 .

Demographic and behavioral characteristics of students in four undergraduate online business courses were analyzed in order to build profiles of online demand, as well as to determine the market segment(s) being served. The analysis revealed student traits that demonstrate multiple market segments being served by these courses. A predictive model was prepared that incorporates key independent student variables that can forecast student demand for courses and degree programs online.

Thalassemia (THAL) patients have a genetic anemia causing incomplete erythropoiesis and iron overload, possibly leading to cardiomyopathy and diabetes. Plasma zinc (Zn) and Copper (Cu) deficiency are also observed in some patients with THAL, however, these effects are not as well characterized. It has been suggested that oxidative stress can be caused by increased labile plasma iron (LPI), and decreased serum Zn and Cu levels, however this is unproven. LPI can initiate peroxidation releasing malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE). Thus, we hypothesized that that a functional Zn or Cu deficiency can increase oxidative stress and that changes in the levels of key iron trafficking proteins, such as soluble transferrin receptor (sTfR) or hemopexin (HPX) would also affect oxidative stress. 39 subjects with informed consent were enrolled (29 patients with THAL and 10 healthy controls). LPI was measured using dihydrorhodamine 123. Both MDA and 4-HNE were measured using N-methyl-2-phenylindole. Iron trafficking proteins were measured by MRM mass spectrometry. Trace mineral levels were assessed by ICP spectroscopy. Plasma levels of the iron trafficking proteins, transferrin, HPX and haptoglobin (HAP) were all decreased in THAL patients (P

Introduction:Patients with transfusion dependent thalassemia (TDT) have a genetic anemia that causes incomplete erythropoiesis and iron overload. Plasma zinc deficiency is also seen in roughly 25% of patients with TDT. Iron overload is thought to be related to a number of secondary complications in TDT including cardiomyopathy and diabetes. However, in TDT the effects of altered Zn status are not as well characterized and the effects of low copper (Cu) are even less well known. One possible cause of these complications is oxidative damage to tissues. This oxidative stress can be caused by labile plasma iron (LPI), a component of the non-transferrin bound iron pool, which is often seen in individuals suffering from iron overload. LPI is both redox-active and chelatable and is the likely culprit distributing iron to extra-hepatic tissues. Through reactive Fenton chemistry, LPI, can also cause lipid peroxidation releasing malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE), which are damage-associated molecular patterns and markers of oxidative tissue damage that activate the immune system to induce inflammation. Incomplete erythropoiesis as well as transfusional iron overload are responsible for an increase in the amount of poorly handled, redox active LPI in TDT. Thus, we hypothesized that changes in the levels of key iron trafficking proteins (such as soluble transferrin receptor (sTfR) or hemopexin) would affect oxidative stress levels in TDT. We also hypothesized that metal dyshomeostasis, such as a functional Zn or Cu deficiency would affect oxidative stress. Aims: The purpose of this pilot project is to 1) Determine the state of circulating levels of oxidative stress markers and iron trafficking proteins in TDT patients and 2) Explore the relationship between the markers and proteins measured in (1)and the Zn and Cu status of TDT patients. Methods:39 subjects with informed consent were enrolled (29 patients with TDT and 10 controls). Liver iron concentration (LIC) was measured by a superconducting quantum interference device (SQUID™). LPI was measured using dihydrorhodamine 123. Both MDA and MDA + 4-HNE were measured using N-methyl-2-phenylindole. The iron trafficking proteins sTfR, transferrin, haptoglobin and hemopexin were measured by immunoassay isolation followed by multiplex multiple reaction monitoring mass spectrometry. Zn and Cu were assessed by inductively coupled plasma atomic emission spectroscopy. Fructosamine was measured by quantitative spectrophotometry. Results: Patients with TDT had elevated LIC levels of 2681 ± 2424 ug iron/g wet weight. Plasma levels of the iron trafficking proteins, transferrin, hemopexin and haptoglobin were all decreased in TDT patients (P Conclusion: Metal dyshomeostasis involving Zn and Cu may be important contributors to oxidative stress and iron injury in TDT. We confirm previous findings in TDT of elevated levels of LPI as well as the oxidative stress markers MDA and 4-HNE. We expand previous findings of reduced transferrin levels in TDT to show a similar reduction in both haptoglobin and hemopexin. StfR levels were elevated in TDT patients, possibly due to a strong erythropoietic drive. Both reduced haptoglobin and hemopexin as well as decreased Zn and Cu levels and increased Zn excretion appear to be present in TDT. These preliminary findings suggest that low levels of Zn, Cu, haptoglobin and hemopexin may be related to increased oxidative stress and LPI in TDT, which could be important contributors to secondary complications of TDT. Disclosures Walter: Apopharma: Research Funding.

The aim of this investigation is to understand the factors influencing uptake of persistent organochlorine pesticides into a freshwater mussel (Sphaerium corneum). Previous work has shown that although a substantial proportion of dieldrin is bound to particulates in the river system, uptake is from the dieldrin in solution. This suggests partitioning of the hydrophobic xenobiotics into membranes as the major route of entry. Membrane composition was established using lipid fractionation into neutral lipids and phospholipids followed by derivatisation to fatty acid methyl esters and estimation using GC/FID. Membrane composition varied with acclimation temperature over the range 5–20°C. Dieldrin concentrations in the mussel at equilibrium with 2000 ng dieldrin/litre water burden were studied at one temperature under laboratory conditions using animals acclimated to different temperatures. Any differences may be explicable in terms of effects of membrane composition on partitioning or other physiological adaptations. To establish which of these factors is most significant a membrane fragment partition system has been analysed in vitro. Preliminary results indicate that although water/lipid partitioning may be important in entry (and exit) of non-polar xenobiotics, significant differences could not be found using current methods. The role of membrane composition and therefore temperature history of the organism may still be significant. The implications of this for attempted correlations between bioaccumulation factors and simple octanol/water partition coefficients are discussed.

Disposable microimmunoadsorbent columns containing Staphylococcus Protein A and monoclonal antibodies were used to bind antigenic proteins from a mixture. Eluates from these columns were directly analyzed by electrophoresis on two-dimensional (2-D) gels. In this way, biochemical and biophysical information on the bound antigen and on the specific antibody can be obtained simultaneously. The microimmunoadsorbents are easy to handle and in conjunction with multiple 2-D gel systems provide a means for screening large numbers of myeloma hybrids for specificity to antigens in complex mixtures.

Hybrid cells were prepared by fusin an immunoglobulin-secreting mouse myeloma lin e (B cell) with an allogenic T-cell lymphoma which expresses the surface antigen Thy 1. The resulting hybrids expressed H2 antigens of both parental cells and secreted the immunoblobulin of the myeloma parent but did not express the Thy 1 antigen of the lymphoma parent. Twenty-one hybrids were formed from fusion of the same myeloma line with TNP-SRBC-primed spleen cells. Most of the hybrid lines exhibited characteristics expected for the fusion of the myeloma to B lymphocytes. No hybrids between the myeloma line and spleen T cells were identified as none of the hybrids expressed the T-cell-specific antigen Thy 1. We discuss possible reasons for failure to produce hybrids with T-cell characteristics in these types of fusion.

Lymph node cells from guinea pigs immunized to oxidized ferredoxin (O-Fd) were treated in an antigen suicide procedure designed to inactivate lymphocytes binding the haptenic peptide determinants of the ferredoxin molecule. O-Fd-induced DNA synthesis and cells binding either determinant were examined both before and after allowing suicide. The proliferative response to O-Fd and the number of determinant-binding cells were specifically and markedly decreased after antigen suicide. School, Hills Road, Cambridge CB2 2QH, England.