Enhanced Radiosensitivity of Esophagus Cancer through Loss of ADAR1 and Cell Apoptosis via NF-kB Signaling Pathway

PURPOSE/OBJECTIVE(S)

RNA editing is a common posttranslational mechanism for generating genomic diversity by modifying selected RNA sequences without altering the genome. A new understanding of cancer therapy can be enhanced by the discovery of ADAR1 in the control of signal transduction pathways. However, the study of the biological effects of ADAR1 in radioresistance of esophageal cancer is not very deep.

MATERIALS/METHODS

The TCGA data sets were used to explore the correlations between ADAR1 and prognosis in esophageal cancer. Two pairs of ADAR1 gene siRNA fragments (siADAR1-1 and siADAR1-2) were designed and transiently transfected into KYSE410 cells and KYSE410-RT cells. The expression of ADAR1 was detected by RT-PCR and WB. Colony formation assay was used to evaluate the radiosensitivity. Apoptosis was measured using a flow cytometric apoptosis assay. Furthermore, transcriptome sequencing was performed to elucidate the pathways regulated by ADAR1.

RESULTS

In this study, we found that ADAR1 is overexpressed in esophageal tumors and is associated with poor prognosis in bioinformatics analysis. Colony formation experiment showed that siRNA-mediated depletion of ADAR1 in KYSE410 cells could inhibit cell proliferation and reduce radiosensitivity significantly. Consistently results were showed in KYSE410-RT cells. Mechanism studies revealed loss of ADAR1 induced cell apoptosis and radiotherapy could enhance this process. Transcriptomic data indicated that ADAR1 could regulate apoptosis through the NF-kB pathway.

CONCLUSION

RNA editing was found to be involved in the regulation of radiosensitivity of esophageal cancer and loss of ADAR1 can cause cell apoptosis though NF-kB pathway. A better understanding of A-to-I RNA editing and its oncogenic mechanisms may facilitate the development of radiotherapy in esophageal cancer.

Magnetic resonance imaging detects white adipose tissue beiging in mice following PDE10A inhibitor treatment

Weight gain is a common harmful side effect of atypical antipsychotics used for schizophrenia treatment. Conversely, treatment with the novel phosphodiesterase-10A (PDE10A) inhibitor MK-8189 in clinical trials led to significant weight reduction, especially in patients with obesity. This study aimed to understand and describe the mechanism underlying this observation, which is essential to guide clinical decisions. We hypothesized that PDE10A inhibition causes beiging of white adipose tissue (WAT), leading to weight loss. Magnetic resonance imaging (MRI) methods were developed, validated, and applied in a diet-induced obesity mouse model treated with a PDE10A inhibitor THPP-6 or vehicle for measurement of fat content and vascularization of adipose tissue. Treated mice showed significantly lower fat fraction in white and brown adipose tissue, and increased perfusion and vascular density in WAT versus vehicle, confirming the hypothesis, and matching the effect of CL-316,243, a compound known to cause adipose tissue beiging. The in vivo findings were validated by qPCR revealing upregulation of Ucp1 and Pcg1-α genes, known markers of WAT beiging, and angiogenesis marker VegfA in the THPP-6 group. This work provides a detailed understanding of the mechanism of action of PDE10A inhibitor treatment on adipose tissue and body weight and will be valuable to guide both the use of MK-8189 in schizophrenia and the potential application of the target for weight loss indication.

Energetic Electron Precipitation Driven by Electromagnetic Ion Cyclotron Waves from ELFIN's Low Altitude Perspective

We review comprehensive observations of electromagnetic ion cyclotron (EMIC) wave-driven energetic electron precipitation using data collected by the energetic electron detector on the Electron Losses and Fields InvestigatioN (ELFIN) mission, two polar-orbiting low-altitude spinning CubeSats, measuring 50-5000 keV electrons with good pitch-angle and energy resolution. EMIC wave-driven precipitation exhibits a distinct signature in energy-spectrograms of the precipitating-to-trapped flux ratio: peaks at >0.5 MeV which are abrupt (bursty) (lasting ∼17 s, or Δ L ∼ 0.56 ) with significant substructure (occasionally down to sub-second timescale). We attribute the bursty nature of the precipitation to the spatial extent and structuredness of the wave field at the equator. Multiple ELFIN passes over the same MLT sector allow us to study the spatial and temporal evolution of the EMIC wave - electron interaction region. Case studies employing conjugate ground-based or equatorial observations of the EMIC waves reveal that the energy of moderate and strong precipitation at ELFIN approximately agrees with theoretical expectations for cyclotron resonant interactions in a cold plasma. Using multiple years of ELFIN data uniformly distributed in local time, we assemble a statistical database of ∼50 events of strong EMIC wave-driven precipitation. Most reside at L ∼ 5 - 7 at dusk, while a smaller subset exists at L ∼ 8 - 12 at post-midnight. The energies of the peak-precipitation ratio and of the half-peak precipitation ratio (our proxy for the minimum resonance energy) exhibit an L -shell dependence in good agreement with theoretical estimates based on prior statistical observations of EMIC wave power spectra. The precipitation ratio's spectral shape for the most intense events has an exponential falloff away from the peak (i.e., on either side of ∼ 1.45 MeV). It too agrees well with quasi-linear diffusion theory based on prior statistics of wave spectra. It should be noted though that this diffusive treatment likely includes effects from nonlinear resonant interactions (especially at high energies) and nonresonant effects from sharp wave packet edges (at low energies). Sub-MeV electron precipitation observed concurrently with strong EMIC wave-driven >1 MeV precipitation has a spectral shape that is consistent with efficient pitch-angle scattering down to ∼ 200-300 keV by much less intense higher frequency EMIC waves at dusk (where such waves are most frequent). At ∼100 keV, whistler-mode chorus may be implicated in concurrent precipitation. These results confirm the critical role of EMIC waves in driving relativistic electron losses. Nonlinear effects may abound and require further investigation.

[Advances in clinical characteristics of talaromycosis combined with other opportunistic infections]

Talaromycosis (TSM) is an opportunistic deep mycosis prevalent in southeast Asia and southern China, affecting HIV-positive, anti-interferon-gamma autoantibody-positive and other immunodeficiency hosts. These hosts are often co-infected with mycobacterium tuberculosis, non-tuberculosis mycobacteria, bacteria, fungi, viruses and other opportunistic infections. The clinical characteristics and the pathogenic spectrum of TSM with opportunistic infections vary with different immune states. The rates of misdiagnosis, missed diagnosis and mortality are high. This review summarized the clinical characteristics of TSM with opportunistic infections in order to improve the level of clinical diagnosis and treatment.

[Persistence follow-up of immune memory to hepatitis B vaccine among infants with non- and low-response to primary vaccination after revaccination with three doses]

This study followed up the immune memory after 3-dose revaccination among infants with non-and low-response following primary hepatitis B (HepB) vaccination. About 120 children without self-booster doses were finally included who had anti-HBs<10 mIU/ml (anti-HBs negative) at the time of follow-up, of whom 86 children completed blood sampling and anti-HBs testing. Before the challenge dose, all 86 children were negative for anti-HBs, and the GMC of anti-HBs was<10 mIU/ml. The seropositive conversion rate of anti-HBs was 100% and the GMC of anti-HBs was 886.11 (95%CI: 678.15-1 157.84) mIU/ml after the challenge dose. Compared with those with GMC<7 mIU/ml before the challenge dose, infants with GMC>7 mIU/ml had a higher anti-HBs level after the challenge dose. The β value (95%CI) was 0.82 (0.18-1.46) (P=0.012). Compared with those with GMC<1 000 mIU/ml at primary vaccination, infants with GMC≥1 000 mIU/ml had a higher anti-HBs level after the challenge dose. The β value (95%CI) was 0.78 (0.18-1.38)(P=0.012). The results showed a stronger immune memory was found at 9 years after revaccination among infants with non-and low-response to HepB.

METTL14 modulates glycolysis to inhibit colorectal tumorigenesis in p53-wild-type cells

The frequency of p53 mutations in colorectal cancer (CRC) is approximately 40-50%. A variety of therapies are being developed to target tumors expressing mutant p53. However, potential therapeutic targets for CRC expressing wild-type p53 are rare. In this study, we show that METTL14 is transcriptionally activated by wild-type p53 and suppresses tumor growth only in p53-wild-type (p53-WT) CRC cells. METTL14 deletion promotes both AOM/DSS and AOM-induced CRC growth in mouse models with the intestinal epithelial cell-specific knockout of METTL14. Additionally, METTL14 restrains aerobic glycolysis in p53-WT CRC, by repressing SLC2A3 and PGAM1 expression via selectively promoting m⁶ A-YTHDF2-dependent pri-miR-6769b/pri-miR-499a processing. Biosynthetic mature miR-6769b-3p and miR-499a-3p decrease SLC2A3 and PGAM1 levels, respectively, and suppress malignant phenotypes. Clinically, METTL14 only acts as a beneficial prognosis factor for the overall survival of p53-WT CRC patients. These results uncover a new mechanism for METTL14 inactivation in tumors and, most importantly, reveal that the activation of METTL14 is a critical mechanism for p53-dependent cancer growth inhibition, which could be targeted for therapy in p53-WT CRC.

Temperature Effects on the Crystalline Structure of iPP Containing Different Solvent-Treated TMB-5 Nucleating Agents

TMB-5 nucleating agent (NA) treated by different solvents were used as the β-NA of iPP. The effects of temperature on the crystalline structure of different iPP/TMB-5, as well as the crystallization and melting behaviors were investigated. It was found that strong polar solvent treated TMB-5 (TMB-5_DMSO and TMB-5_DMF) could induce more β-crystal at high T_c = 140 °C than the other TMB-5 NAs, while the β-crystal inducing efficiency of untreated TMB-5 (TMB-5_UT) and non-polar solvent treated TMB-5 (TMB-5_LP) is seriously reduced at high T_c = 140 °C. TMB-5_DMSO can induce a high and stable content of β-crystal with K_β = 83-94% within T_c = 90-140 °C, and TMB-5_ODCB can induce a high content of β-crystal with K_β > 91.3% within T_c = 90-130 °C. TMB-5_DMF is the most temperature-sensitive one, but can induce a high fraction of β-crystal with K_β > 92% both at low T_c = 90 °C and high T_c = 140 °C. High temperature pre-crystallization at T_pc = 150 °C tremendously reduces the β-crystal inducing efficiency of all TMB-5 NAs. TMB-5_UT and TMB-5_LP exhibit higher nucleating efficiency than TMB-5_DMSO, TMB-5_DMF and TMB-5_ODCB. During the non-isothermal crystallization process, TMB-5_UT induced β-crystal possesses higher structural perfection and stability, while TMB-5_LP is more likely to induce α-crystal with considerable quantity and stability. The structural perfection and stability of TMB-5 induced β-crystal can be enhanced with appropriate increasing of T_c.

Effects of plant age on antioxidant activity and endogenous hormones in Alpine Elymus sibiricus of the Tibetan Plateau

Elymus sibiricus L. is a perennial forage species that has potential to serve as a forage source in livestock grazing systems. However, E. sibiricus has been shown to have a rapid and substantial reduction of aboveground biomass and seed yield after 3 or 4 years and an accelerated aging process. To determine possible aging mechanisms, we planted E. sibiricus seeds in triplicate blocks in 2012, 2015, and 2016, respectively, and harvested samples of leaves and roots at the jointing and heading stages in 2018 and 2019 to determine oxidative indices and endogenous hormones. The fresh aboveground biomass of 4- and 5-year old plants declined by 34.2% and 52.4% respectively compared with 3-year old plants, and the seed yield declined by 12.7% and 34.1%, respectively. The water content in leaves was 51.7%, 43.3%, and 35.6%, and net photosynthesis was 7.73, 6.35, and 2.08 µmol/m²·s in 3-, 4-, and 5-year old plants, respectively. The superoxide anion radical generation rate in leaves and roots did not show any aging pattern. There was a non-significant increase in malondialdehyde concentration with plant age, particularly in leaves and roots at the heading stage in 2019. The superoxide dismutase activity showed a declining trend with age of plant roots at the jointing stage in both 2018 and 2019. The peroxidase activity declined with plant age in both leaves and roots, for example, and the catalase activity in roots 4- and 7-year old plants declined by 13.8% and 0.85%, respectively, compared to 3-year old plants at the heading stage in 2018. Therefore, the reduced capacity of the antioxidant system may lead to oxidative stress during plant aging process. Overall, the concentrations of plant hormones, auxin (IAA), gibberellin (GA), zeatin (ZT), and abscisic acid (ABA) were significantly lower in roots than in leaves. The IAA concentration in leaves and roots exhibited different patterns with plant age. The ZT concentrations in leaves of 3-year old plants was 2.39- and 2.62-fold of those in 4- and 7-year old plants, respectively at the jointing stage, and in roots, the concentration declined with plant age. The changes in the GA concentration with plant age varied between the physiological stages and between years. The ABA concentrations appeared to increase with plant age, particularly in leaves. In conclusion, the aging process of E. sibiricus was apparently associated with an increase in oxidative stress, a decrease of ZT and an increase of ABA, particularly in roots. These findings highlight the effects of plant age on the antioxidant and endogenous hormone activity of E. sibiricus. However, these plant age-related trends showed variations between plant physiological stages and between harvest years that needs to be researched in the future to develop strategies to manage this forage species.

Numerical Simulation Study on Flow and Heat Transfer of the Tungsten Crucible CVD Reactor

In order to investigate the optimization of the performance and structure of a tungsten crucible CVD reactor, the CFD simulation method was used in this paper to simulate the internal flow of the tungsten crucible CVD reactor. The velocity distribution and temperature distribution in the reactor were obtained. The simulation results show that the axial and radial heat convection will occur between the susceptor and the outer wall surface, but the axial heat convection is more intense. Moreover, it was found that the temperature distribution in the CVD reactor was more uniform and reasonable when the upper gas inlet was applied, which was beneficial to the reduction and deposition processes of tungsten. The molar ratio of H₂ to WF₆ has a great influence on the deposition rate of tungsten, and excess H₂ is not conducive to the deposition of tungsten. Thermal radiation has a great influence on the temperature distribution of CVD reactors. It cannot be neglected.

Anti-tumor effects of P-LPK-CPT, a peptide-camptothecin conjugate, in colorectal cancer

To explore highly selective targeting molecules of colorectal cancer (CRC) is a challenge. We previously identified a twelve-amino acid peptide (LPKTVSSDMSLN, namely P-LPK) by phage display technique which may specifically binds to CRC cells. Here we show that P-LPK selectively bind to a panel of human CRC cell lines and CRC tissues. In vivo, Gallium-68 (⁶⁸Ga) labeled P-LPK exhibits selective accumulation at tumor sites. Then, we designed a peptide-conjugated drug comprising P-LPK and camptothecin (CPT) (namely P-LPK-CPT), and found P-LPK-CPT significantly inhibits tumor growth with fewer side effects in vitro and in vivo. Furthermore, through co-immunoprecipitation and molecular docking experiment, the glutamine transporter solute carrier 1 family member 5 (SLC1A5) was identified as the possible target of P-LPK. The binding ability of P-LPK and SLC1A5 is verified by surface plasmon resonance and immunofluorescence. Taken together, P-LPK-CPT is highly effective for CRC and deserves further development as a promising anti-tumor therapeutic for CRC, especially SLC1A5-high expression type.

A peptide that specifically targets amino acid transporter SLC1A5 in colorectal cancer cells is identified and conjugated with camptothecin to show selective cytotoxicity to colorectal cancer cells in preclinical models.

To what extent do social support and mastery mediate the association between childhood maltreatment and depression? A sequential causal mediation analysis

AIMS

This study aimed to examine the independent roles of various childhood maltreatment (CM) subtypes in the development of depression; quantify the joint mediation effect of social support and mastery in the association between subtypes of CM and depression and examine the additional contribution of mastery beyond the effect that is operating through social support to this relationship.

METHODS

Data analysed were from the Zone d'Épidémiologie Psychiatrique du Sud-Ouest de Montréal, an ongoing longitudinal population-based study. In total, 1351 participants with complete information on the studied variables were included. The propensity score matching and inverse-probability weighted regression adjustment estimation methods were used to minimise the potential confounding in the relationship between CM and major depression. We then used inverse odds ratio-weighted estimation to estimate the direct effects of maltreatment and indirect effects of social support and mastery.

RESULTS

We found that exposures to all maltreatment subtypes increased the risk of subsequent depression. The joint mediating effect of social support and mastery explained 37.63-46.97% of the association between different maltreatment subtypes and depression. The contribution of these two mediators differed by maltreatment subtypes, with social support being the major contributor to the mediating effect.

CONCLUSIONS

The findings of the study not only provide scientific evidence on the importance of psychosocial attributes in the development of major depression but also suggest that prevention and invention strategies should focus on these psychosocial attributes to effectively break the vicious cycle of CM on major depression.

Self-assembled peptide-paclitaxel nanoparticles for enhancing therapeutic efficacy in colorectal cancer

Chemotherapy is one of the main treatments for colorectal cancer, but systemic toxicity severely limits its clinical use. Packaging hydrophobic chemotherapeutic drugs in targeted nanoparticles greatly improve their efficacy and reduce side effects. We previously identified a novel colorectal cancer specific binding peptide P-LPK (LPKTVSSDMSLN) from phage display peptide library. Here we designed a self-assembled paclitaxel (PTX)-loaded nanoparticle (LPK-PTX NPs). LPK-PTX NPs displayed a superior intracellular internalization and improved tumor cytotoxicity in vitro. Cy5.5-labeled LPK-PTX NPs showed much higher tumor accumulation in colorectal cancer-bearing mice. Furthermore, LPK-PTX NPs exhibit enhanced antitumor activity and decreased systemic toxicity in colorectal cancer patient-derived xenografts (PDX) model. The excellent in vitro and in vivo antitumor efficacy proves the improved targeting drug delivery, suggesting that peptide P-LPK has potential to provide a novel approach for enhanced drug delivery with negligible systemic toxicity.

Transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts: A retrospective study

Background:

We aimed to investigate the clinical efficacy and safety of transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts.

Materials and Methods:

Between October 2017 and April 2021, the clinical data of 65 patients with parapelvic renal cysts were evaluated retrospectively. Thirty-one patients with parapelvic cysts (Group 1) underwent a transurethral flexible ureteroscopic incision and drainage with a holmium laser, whereas the other 34 patients (Group 2) underwent retroperitoneal laparoscopic unroofing. The patients' clinical features were documented. The surgery time, intraoperative blood loss, hospitalization time, complications and cyst size were recorded and statistically assessed one year following the procedure.

Results:

All of the patients were successfully treated with flexible ureteroscopic incision and drainage or retroperitoneal laparoscopic unroofing. In terms of clinical parameters, such as age, gender, BMI, location, cyst size, and Bosniak classification of renal cysts, no statistically significant difference was detected between Groups 1 and 2. Compared to the control group (Group 2), Group 1 demonstrated a shorter surgery duration, less intraoperative blood loss, and a shorter hospital stay (p < 0.001). However, no significant differences in complications and cyst size were observed between the two groups one year after the surgery (p > 0.05).

Conclusions:

Transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts has obvious advantages over traditional surgery, and is worthy of advancement and application, but its long-term effect needs further follow-up studies.

3 liters of polyethylene glycol vs. standard bowel preparation have equal efficacy in a Chinese population: a randomized, controlled trial

BACKGROUND

The European Society of Gastrointestinal Endoscopy recommends 4L Polyethylene Glycol (PEG) as the standard regimen for bowel preparation (BP). The current study compared 3L and 4L PEG with regard to their effectiveness, tolerability, and safety among Chinese patients to identify the best bowel cleansing method for this population.

METHODS

The study employed a prospective, observer-blinded, randomized and controlled design in a high-volume endoscopic center. Consecutive patients undergoing colonoscopy were randomly assigned (1:1) to the 3L-PEG or 4L-PEG group. The quality of bowel cleansing, procedure time, adenoma detection rate (ADR), patient tolerance, and adverse events were compared.

RESULTS

A total of 330 patients were included in the study. After exclusions, 160 cases in the 3L-PEG group and 158 cases in the 4L-PEG group were included in the final analysis. The quality of bowel cleansing (Boston Bowel Preparation Scale) for both the whole intestine and each segment had no significant differences between the groups (P > 0.05). No significant differences were found with regard to procedure time or ADR. The incidences of adverse events such as nausea (P = 0.001), vomiting (P = 0.002), and bloating (P < 0.001) were lower in the 3L-PEG group. Moreover, there was a higher rate of satisfaction in the 3L-PEG group than in the 4L-PEG group (P = 0.009).

CONCLUSIONS

3L-PEG bowel cleansing represents an optimal alternative to a 4L-PEG preparation, showing similar efficacy and superior levels of satisfaction, acceptability, and safety among users. We recommend 3L PEG as a routine regimen in the clinical setting for Chinese patients. (ClinicalTrials.gov registration number: NCT03356015, registered in 29 November, 2017, https://www.

CLINICALTRIALS

gov/ct2/show/NCT03356015).

[Anti-HBs persistence after primary vaccination with three doses of 5 μg recombinant hepatitis B vaccine among normal and high-responder infants: 10-year of follow-up]

Objective: Assess the 10-year Immune persistence and the predictors after primary vaccination hepatitis B vaccine (HepB) among normal and high-responder infants. Methods: A total of 1 838 Infants of 7-12 months old located in Jinan, Weifang, Yantai and Weihai of Shandong Province who were induced normal or high antibody response (anti-HBs titer ≥ 100 mIU/ml) after primary vaccination (three dose with 0-1-6 procedure) with 5 μg recombinant HepB among newborns were included in the study, in 2009. 3 ml of venous blood samples were collected at baseline survey (T₀) and antibodies against hepatitis B surface antigen (anti-HBs), antibody against hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg) were detected using chemiluminescence microparticle immunoassay (CMIA) method. A self-designed questionnaire was used to collect information including the infant's age, sex, birth weight, premature birth, birth number, delivery location and mother's HBV infection status. In 2014 (followed up for 5 years) and in 2019 (followed up for 10 years) (T₁), 2 ml of venous blood samples were collected. Anti HBS and anti HBC were detected by CMIA method. Those with anti HBS<10 mIU/ml were detected by CMIA method. Multivariate unconditional logistic and linear regression models were used to analyze the influencing factors of anti-HBs positive rate and geometric mean concentration (GMC) at T₁. Results: After 10 years follow-up, 73.94% of the subjects (1 359/1 835) finished the follow-up. 51.15% of the subjects, a total of 625 were boys. The positive rate of anti-HBs was 100% at T₀ and decreased to 53.44% (95%CI: 50.59%-56.26%) at T₁. The average annual decline rate of anti-HBs positive rate from T₀ to T₁ was 6.07%. The GMC of anti-HBs decreased from 607.89 (95%CI: 579.01-642.62) mIU/ml to 16.44 (95%CI: 15.06-18.00) mIU/ml. The average annual decline rate of anti-HBs GMC in 10-year follow-up was 30.30%. Multivariate logistic analysis showed that the positive rate of anti-HBs at T₁ was lower in those who did not vaccinate the first dose in time (OR=0.25, 95%CI:0.07-0.71). Compared with those with GMC<1 000 mIU/ml at T₀, those with GMC ≥ 1 000 mIU/ml had a higher positive rate of anti-HBs at T₁ (OR=2.29, 95%CI:1.76-2.97). Multivariate regression analysis showed that the GMC of anti-HBs at T₁ was lower in those who did not vaccinate the first dose in time (β=-0.50, 95%CI:-1.24-0.24). Compared with those with GMC<1 000 mIU/ml at T₀, those with GMC ≥ 1 000 mIU/ml had a higher GMC of anti-HBs at T₁ (β=0.81, 95%CI: 0.62-1.05). Conclusion: Anti-HBs GMC decreased in 10 years after primary vaccination of 5 μg recombinant hepatitis B vaccine among normal and high-responders. The anti-HBs persistence was mainly associated with whether the first dose was vaccinated in time and the level of anti-HBs at the end of primary vaccination.

The efficacy and safety of different doses of calcitriol combined with neutral phosphate in X-linked hypophosphatemia: a prospective study

The present study was the first prospective cohort evaluated the efficacy and safety of different doses of calcitriol in XLH children. The results suggested that a dose of 40 ng/kg/day calcitriol, compared with 20 ng/kg/day, was more effective in relieving the rickets, with similar safety outcomes. Further investigations were expected to set more dose groups.

INTRODUCTION

Dose recommended for calcitriol in X-linked hypophosphatemia (XLH) varies in different studies. Therefore, we aimed to compare the efficacy as well as the safety of 20 ng/kg/d and 40 ng/kg/d calcitriol in Chinese XLH pediatrics population.

METHODS

A 2-year, randomized, open-label, prospective study recruited 68 XLH children, which were randomized to receive either 40 ng/kg/day or 20 ng/kg/day calcitriol. Efficacy endpoints were the total Thacher ricket severity score (RSS) change from baseline to month 12 and 24, the difference in serum TALP level, fasting serum phosphate level, body height Z-score, and frequency of dental abscess. Safety assessments were done using renal ultrasound nephrocalcinosis grades (0-4), fasting serum and 24 h urine calcium level, and the occurrence of hyperparathyroidism.

RESULTS

The decrease in the total RSS from baseline was more significant in the high-dose group at 12 (difference 0.87, p = 0.049) and 24 month (difference 1.23, p = 0.011). The serum TALP level was significantly lower in the high-dose group at 6 months. Pi level, height Z-score change, frequency of dental abscess and ratio of de novo nephrocalcinosis were comparable. A lower incidence of secondary hyperparathyroidism was seen in the high-dose group (p < 0.0001).

CONCLUSION

For the first time in this prospective cohort, 40 ng/kg/d calcitriol was shown to be the more effective therapy in XLH children than the 20 ng/kg/d. Moreover, 40 ng/kg/d calcitriol was not associated with increasing adverse events.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT 03,820,518.

POS1016 RELATIONSHIPS BETWEEN DISEASE DURATION AND RADIOGRAPHIC PROGRESSION AMONG PATIENTS WITH PSORIATIC ARTHRITIS TREATED WITH SECUKINUMAB IN FUTURE 5

Background

For patients with psoriatic arthritis (PsA), delays in diagnosis and treatment can lead to permanent radiographic damage, even early in the course of disease.1 In the phase 3 FUTURE 5 study (NCT02404350), treatment with secukinumab (SEC) was shown to inhibit progression of structural damage through Week 104 in patients with PsA.2 However, the effect of disease duration on inhibition of radiographic progression by SEC has not been characterized.

Objectives

This post hoc analysis explored relationships between time since diagnosis (TSD) of ≤1 year vs >1 year and radiographic progression among patients with PsA receiving SEC over 2 years in FUTURE 5.

Methods

Patient data from FUTURE 5 were stratified by TSD ≤1 year vs >1 year and analyzed by treatment arm. Through Week 24, patients received SEC 300 or 150 mg with subcutaneous loading dose (LD), SEC 150 mg without LD, or placebo (PBO) (period 1). After Week 24, patients receiving PBO were switched to SEC 300 or 150 mg (period 2), and a protocol amendment allowed those with suboptimal clinical response to SEC 150 mg to escalate to SEC 300 mg after Week 52 per investigator judgment.2 The proportion of patients with no radiographic progression, defined as change from baseline in van der Heijde total modified Sharp score ≤0.0, was analyzed at Weeks 24, 52, and 104. Mean total Sharp score was evaluated at baseline, and mean change from baseline was determined at Weeks 24, 52, and 104.

Results

Of 996 patients with PsA included here, 217 (21.8%) had a TSD ≤1 year and 779 (78.2%) had a TSD >1 year. At baseline, patients with TSD >1 year had greater radiographic damage than patients with TSD ≤1 year as determined by mean total Sharp score (Table 1). As early as Week 24, patients receiving SEC had less radiographic progression than those receiving PBO, regardless of TSD. From Week 24 to Week 104, radiographic progression remained low among all patients receiving SEC, with a trend of least progression among patients randomized to SEC 300 mg at baseline. Regardless of treatment, patients with TSD >1 year had numerically greater radiographic progression than those patients with TSD ≤1 year. Overall, the proportion of patients receiving SEC who did not have any radiographic progression was higher than that of placebo at Week 24 irrespective of TSD, with a trend towards a higher number of non-progressors among those treated with SEC 300 mg (Figure). Patients randomized to SEC 300 mg were the least likely to experience radiographic progression through 52 weeks.

Table 1.

Baseline Total Sharp Score and Change From Baseline at Weeks 24, 52, and 104 by TSD

Total Sharp scoreTSD ≤1 yearTSD >1 yearPeriod 1SEC 300 mg n = 54SEC 150 mg n = 46SEC 150 mg NL n = 43PBO n = 74SEC 300 mg n = 168SEC 150 mg n = 174SEC 150 mg NL n = 179PBO n = 258Baseline, mean (SD)8.02 (20.77)8.82 (12.06)12.74 (33.67)8.84 (20.42)14.37 (24.17)14.67 (28.01)15.56 (37.52)17.34 (41.21)Week 24 change from baseline, mean (SD)0.05 (0.72)−0.08 (1.40)−0.61 (5.25)0.76 (2.05)0.09 (1.37)0.23 (1.24)0.03 (2.05)0.42 (1.56)Period 2SEC 300 mg* n = 54SEC 150 mg†n = 46SEC 150 mg NL†n = 43PBO ‒ 300 mg n = 40PBO ‒ 150 mg†n = 30SEC 300 mg* n = 168SEC 150 mg†n = 174SEC 150 mg NL†n = 179PBO ‒ 300 mg n = 113PBO ‒ 150 mg†n = 123Week 52 change from baseline, mean (SD)0.05 (0.48)−0.03 (1.22)0.35 (2.25)0.22 (0.70)0.18 (0.75)−0.07 (1.16)0.26 (1.96)0.26 (1.05)0.16 (0.94)0.40 (2.00)Week 104 change from baseline, mean (SD)0.06 (0.63)0.11 (0.99)0.20 (2.71)0.11 (0.68)−0.07 (0.50)0.11 (2.00)0.62 (2.94)0.46 (2.08)0.12 (0.90)0.81 (2.66)

NL, no loading dose; PBO, placebo; SEC, secukinumab; TSD, time since diagnosis.

* One outlier in the 300-mg dose group was excluded.

† Includes patients who received dose escalation to SEC 300 mg after Week 52.

Conclusion

SEC resulted in low rates of radiographic progression through 2 years of treatment among patients in FUTURE 5, regardless of time since PsA diagnosis.

References

[1]Haroon M, et al. Ann Rheum Dis. 2015;74:1045-50.

[2]Mease P, et al. RMD Open. 2021;7:e001600.

Acknowledgements

This study was funded by Novartis Pharmaceuticals Corporation. Medical writing support was provided by Richard Karpowicz, PhD, CMPP, of Health Interactions, Inc, and was funded by Novartis Pharmaceuticals Corporation. This abstract was developed in accordance with Good Publication Practice (GPP3) guidelines. Authors had full control of the content and made the final decision on all aspects of this publication.

Disclosure of Interests

Christopher T. Ritchlin Consultant of: AbbVie, Amgen, Eli Lilly, Janssen, Pfizer, Novartis, Gilead, and UCB, Ana-Maria Orbai Consultant of: Bristol Myers Squibb, Janssen, Lilly, Novartis, Pfizer, and UCB, Grant/research support from: to Johns Hopkins University from AbbVie, Amgen, Celgene, Horizon, Janssen, Lilly, and Novartis, Bhumik Parikh Employee of: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, Corine Gaillez Employee of: Novartis Pharma AG, Basel, Switzerland, Xiangyi Meng Employee of: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, Philip J Mease Speakers bureau: AbbVie, Amgen, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, and UCB