Modeling absolute lymphocyte counts after treatment of chronic lymphocytic leukemia with ibrutinib

The objective in this study was to characterize the pattern of the treatment-related lymphocytosis curve in chronic lymphocytic leukemia (CLL) patients treated with ibrutinib, and assess the relationship between the baseline factors and absolute lymphocyte counts (ALC). The PCYC-1102-CA study was a five-arm phase Ib/II open-label, nonrandomized, multicenter study in CLL/SLL. The arms and accruals were 420 and 840 mg/day treatment-naive elderly CLL/SLL (N = 27 and N = 4, respectively), 420 and 840 mg/day relapsed/refractory CLL/SLL (N = 27 and N = 34, respectively), and 420 mg/day high-risk CLL/SLL (N = 24). The results were generated through statistical modeling using data from a clinical trial (PCYC-1102) in five cohorts of treatment-naïve or relapsed/refractory CLL patients treated at 420 and 840 mg daily of ibrutinib. In cases in which the initial increase in ALC doubles by day 28, it takes patients longer to reach their maximum ALC when compared with those with a lower rate of increase. Our models show that all of the cohorts exhibited the same pattern of treatment-related lymphocytosis from ibrutinib, and there are no significant differences between cohorts, including no detectable dose effect. The ALC of the majority of patients return to baseline ALC values by the end of cycle 5.

Bruton tyrosine kinase inhibitor ibrutinib (PCI-32765) has significant activity in patients with relapsed/refractory B-cell malignancies

PURPOSE

Survival and progression of mature B-cell malignancies depend on signals from the B-cell antigen receptor, and Bruton tyrosine kinase (BTK) is a critical signaling kinase in this pathway. We evaluated ibrutinib (PCI-32765), a small-molecule irreversible inhibitor of BTK, in patients with B-cell malignancies.

PATIENTS AND METHODS

Patients with relapsed or refractory B-cell lymphoma and chronic lymphocytic leukemia received escalating oral doses of ibrutinib. Two schedules were evaluated: one, 28 days on, 7 days off; and two, once-daily continuous dosing. Occupancy of BTK by ibrutinib in peripheral blood was monitored using a fluorescent affinity probe. Dose escalation proceeded until either the maximum-tolerated dose (MTD) was achieved or, in the absence of MTD, until three dose levels above full BTK occupancy by ibrutinib. Response was evaluated every two cycles.

RESULTS

Fifty-six patients with a variety of B-cell malignancies were treated over seven cohorts. Most adverse events were grade 1 and 2 in severity and self-limited. Dose-limiting events were not observed, even with prolonged dosing. Full occupancy of the BTK active site occurred at 2.5 mg/kg per day, and dose escalation continued to 12.5 mg/kg per day without reaching MTD. Pharmacokinetic data indicated rapid absorption and elimination, yet BTK occupancy was maintained for at least 24 hours, consistent with the irreversible mechanism. Objective response rate in 50 evaluable patients was 60%, including complete response of 16%. Median progression-free survival in all patients was 13.6 months.

CONCLUSION

Ibrutinib, a novel BTK-targeting inhibitor, is well tolerated, with substantial activity across B-cell histologies.

QT Dispersion Measured by Automatic Computerized 12-Lead Electrocardiography Contributes Significantly to Detection of Left Ventricular Hypertrophy in Japanese Patients

This study assessed the diagnostic value of QT dispersion for left ventricular hypertrophy (LVH) as determined by echocardiography. The QT and QRS interval parameters were determined automatically using computerized 12-lead electrocardiography in 153 Japanese outpatients. Corrected QT dispersion (QTcD) and maximal QRS duration (MaxQRS) were significantly correlated with left ventricular mass index. The sum of QTcD and MaxQRS showed the highest correlation with left ventricular mass index among QT and QRS interval parameters and their combinations. The cut-off points for LVH discrimination in this study were different to those reported in Western, mainly Caucasian, populations, suggesting the need for ethnicity-specific LVH detection criteria. A scoring system derived from multiple logistic regression analysis, employing a combination of QTcD, QRS time–voltage product and ST-T change, showed a specificity of 86.3%. It was concluded that QTcD, in addition to QRS time–voltage product and ST-T change, improved the detection of LVH.

Chronomics of heart rate variability on earth and in space

Chronomes are time structures consisting of multifrequency rhythms, elements of chaos, and trends in chaotic and rhythmic endpoints. Chronomics maps the dynamics of organisms' broad interactions with the environment near and far, rather than merely the daily routines. We introduced the chronomics of heart rate variability (HRV), characterized by a broad time structure, that includes the prominent circadians and also ultradian (notably about 8h and about 12h) and infradian (notably about-weekly, about-yearly, and about 10-yearly) changes, in addition to undergoing trends with aging. Alterations in these HRV chronomes are known to predict the presence of disease in the near future. Thus, for the health and safety of astronauts, HRV chronomes should be assessed before, during and after the mission in the International Space Station to check for any alteration. Future work should focus on how phenomena in the cosmos, including helio- and geomagnetics, can affect physiological chronomes, those of the HRV in particular.

Clinical predictors of glycosylated hemoglobin response to thiazolidinedione therapy

BACKGROUND

The aim of this investigation was to assess clinical predictors of the glycosylated hemoglobin (HbA1C) response after the addition of a thiazolidinedione (TZD) to a biguanide, a sulfonylurea, or both in subjects with type 2 diabetes.

METHODS

Chart review (n = 68 physicians) was used to identify consecutive subjects started on a TZD. Qualifying subjects had been treated with pioglitazone (> or = 4 mg/day) or rosiglitazone (> or = 30 mg/day) for > or = 12 weeks. Clinical characteristics and HbA1C responses were assessed for the purpose of creating an initial predictive response model (Study 1). A separate sample from a managed care database was used to independently validate the model (Study 2).

RESULTS

Data were collected from 4085 subjects (1365 in Study 1; 2720 in Study 2). In Study 1, baseline HbA1C was 8.2 +/- 0.1%. Forty-five percent (611 of 1365) and 55% (754 of 1365) were prescribed pioglitazone and rosiglitazone, respectively. In multivariate regression, baseline HbA1C (beta = -0.693%), age (beta = -0.006%), and use of multiple agents at baseline (referent = single agent, beta = 0.189%) were significant (P < 0.05) predictors, explaining 49% of the variance in HbA1C response in Study 1 and 44% of the variance in HbA1C response in the Study 2 sample. The model showed no material evidence of bias across the range of baseline HbA1C values.

CONCLUSIONS

These results suggest that readily available clinical information, particularly baseline HbA1C, explains a substantial proportion of the variance in the response to TZD therapy.

Perspectives on development of a combination pharmacogenomic diagnostic and drug product

This perspective outlines the challenges to joint development of a predictive genetic diagnostic with a drug to enhance the efficacy or safety of therapy with the targeted drug. Joint development requires a discovery approach to identify the genetic marker(s), followed by a replication or validation process confirming the clinical utility of the genetic marker(s) in predicting response to the targeted drug. The promise of overcoming these hurdles is that combined use of the genetic diagnostic linked to the drug provides additional scientific information to assist the clinician in their choice of therapeutic interventions on a patient-by-patient basis.

Targeting internal ribosome entry site (IRES)-mediated translation to block hepatitis C and other RNA viruses

A number of RNA-containing viruses such as hepatitis C (HCV) and poliovirus (PV) that infect human beings and cause serious diseases use a common mechanism for synthesis of viral proteins, termed internal ribosome entry site (IRES)-mediated translation. This mode of translation initiation involves entry of 40S ribosome internally to the 5' untranslated region (UTR) of viral RNA. Cap-dependent translation of cellular mRNAs, on the other hand, requires recognition of mRNA 5' cap by the translation machinery. In this review, we discuss two inhibitors that specifically inhibit viral IRES-mediated translation without interfering with cellular cap-dependent translation. We present evidence, which suggest that one of these inhibitors, a small RNA (called IRNA) originally isolated from the yeast Saccharomyces cerevisiae, inhibits viral IRES-mediated translation by sequestering both noncanonical transacting factors and canonical initiation factors required for IRES-mediated translation. The other inhibitor, a small peptide from the lupus autoantigen La (called LAP), appears to block binding of cellular transacting factors to viral IRES elements. These results suggest that it might be possible to target viral IRES-mediated translation for future development of therapeutic agents effective against a number of RNA viruses including HCV that exclusively use cap-independent translation for synthesis of viral proteins.

Space environment, electromagnetic fields, and circadian rhythm

Human space activity began in 1961. About 400 persons have gone to space since then, and about 70 of them have stayed more than 1 month. Circadian rhythm and sleep in space have been investigated several times, though the effect of longer stays in space has not been adequately clarified. Electromagnetic fields are different in the space environment, especially in deeper space missions, such as the Moon or Mars, but their effects on human health have rarely been studied. In this article, we summarize the current status of the International Space Station project, study circadian rhythm and sleep in space, investigate electromagnetic fields, and state the necessity for investigating this research field.

Cell body size and succinate dehydrogenase activity of spinal motoneurons innervating the soleus muscle in mice, rats, and cats

The cell body sizes and succinate dehydrogenase (SDH) activities of motoneurons in the retrodorsolateral region of the ventral horn in the spinal cord innervating the soleus muscle in mice, rats, and cats were compared using quantitative enzyme histochemistry. There was an inverse relationship between cell body size and SDH activity of motoneurons in the three species. The mean cell body sizes of both gamma and alpha motoneuron pools were in the rank order of mice < rats < cats, while the mean SDH activities of both gamma and alpha motoneuron pools were in the rank order of mice > rats > cats. It is concluded that smaller motoneurons innervating the soleus muscle have higher SDH activities than larger motoneurons, irrespective of the species, and that motoneuron pools innervating the soleus muscle in smaller animals have smaller mean cell body sizes and higher mean SDH activities than those in larger animals.

[Evaluation of postoperative pain relief by infiltration of bupivacaine or epidural block after laparoscopic cholecystectomy]

We compared the analgesic effect of bupivacaine infiltration into surgical wounds with that of epidural block after laparoscopic cholecystectomy (LC). Forty-five patients (ASA physical status I-II) for LC were randomized into three groups (n = 15 in each group). Patients received only general anesthesia (Group C), received infiltration of 0.5% bupivacaine into the surgical wound before surgery combined with general anesthesia (Group L), or received epidural anesthesia combined with general anesthesia (Group E). Postoperative pain was assessed using visual analogue scale (scale: 0-10) at 1, 2, 6 and 12 hours after the operation, the need for additional supplemental analgesics, and the cost of anesthesia. Visual analogue scale in Group C at 1, 2, or 6 hours was significantly greater than that of Group L and E. The number of patients who needed supplemental analgesics was 9 in Group C, 5 in Group L, and 2 in Group E. The cost of pharmaceutical and anesthetic practice of Group E was more expensive than Group L and C. In conclusion, infiltration of bupivacaine combined with general anesthesia is an effective and economical method of postoperative pain relief.

Assessment of the otolith-autonomic response using spectral analysis of the R-R interval and blood pressure

The effects of otolith stimulation on systolic blood pressure (SBP) and R-R interval fluctuations were investigated in 12 healthy subjects and 5 patients with loss of labyrinthine function. The vestibular otolith organs were stimulated by centrifugal forces, the constant rotation of a chair fixed outside of the rotation axis on the horizontal plane. The chair was fixed along the direction of centrifugal force (eccentric rotation [ECR]) or along the tangent line (eccentric lateral rotation [ECLR]). The ECR stimulates both the utricular and saccular maculae, whereas the ECLR stimulates only the utricular maculae. Spectral analysis showed that in the healthy subjects, low-frequency SBP increased significantly during ECR but not during ECLR. There was no significant increase in low-frequency SBP in patients with labyrinthine loss. In the R-R interval analysis, however, the low- and high-frequency components did not change significantly in the healthy subjects during ECR. Our findings indicate that stimulation of the otolith maculae, especially the saccular organs, predominantly produces augmentation of the alpha-sympathetic activities rather than cardiac sympathovagal outflow to the heart.

Growth regulation mechanisms in higher plants under microgravity conditions - changes in cell wall metabolism

During Space Shuttle STS-95 mission, we cultivated seedlings of rice (Oryza sativa L. cv. Koshihikari and cv. Tan-ginbozu) and Arabidopsis (Arabidopsis thaliana L. cv. Columbia and cv. etr1-1) for 68.5, 91.5, and 136 hr on board, and then analyzed changes in the nature of their cell walls, growth, and morphogenesis under microgravity conditions. In space, elongation growth of both rice coleoptiles and Arabidopsis hypocotyls was stimulated. Also, the increase in the cell wall extensibility, especially that in the irreversible extensibility, was observed for such materials. The analyses of the amounts, the structure, and the physicochemical properties of the cell wall constituents indicated that the decreases in levels and molecular masses of cell wall polysaccharides were induced under microgravity conditions, which appeared to contribute to the increase in the wall extensibility. The activity of certain wall enzymes responsible for the metabolic turnover of the wall polysaccharides was increased in space. By the space flight, we also confirmed the occurrence of automorphogenesis of both seedlings under microgravity conditions; rice coleoptiles showed an adaxial bending, whereas Arabidopsis hypocotyls elongated in random directions. Furthermore, it was shown that spontaneous curvatures of rice coleoptiles in space were brought about uneven modifications of cell wall properties between the convex and the concave sides.

STS-95 space experiment for plant growth and development, and auxin polar transport

The principal objective of the space experiment, BRIC-AUX on STS-95, was the integrated analysis of the growth and development of etiolated pea and maize seedlings in space, and the effect of microgravity conditions in space on auxin polar transport in the segments. Microgravity conditions in space strongly affected the growth and development of etiolated pea and maize seedlings. Etiolated pea and maize seedlings were leaned and curved during space flight, respectively. Finally the growth inhibition of these seedlings was also observed. Roots of some pea seedlings grew toward the aerial space of Plant Growth Chamber. Extensibilities of cell walls of the third internode of etiolated pea epicotyls and the top region of etiolated maize coleoptiles which were germinated and grown under microgravity conditions in space were significantly low. Activities of auxin polar transport in the second internode segments of etiolated pea seedlings and coleoptile segments of etiolated maize seedlings were significantly inhibited and extremely promoted, respectively, under microgravity conditions in space. These results strongly suggest that auxin polar transport as well as the growth and development of plants is controlled under gravity on the earth.

[A case of advanced esophageal carcinoma successfully treated with chemoradiation therapy with low-dose cisplatin and 5-fluorouracil]

We have experienced a case of advanced esophageal carcinoma successfully treated with chemoradiation therapy together with low-dose cisplatin and 5-fluorouracil, having only minor toxicity. A 55-year-old man was admitted to our hospital because of dysphagia. Cervical esophageal carcinoma was found to have invaded the larynx through endoscopy, and invasion to thyroid gland and trachea was suspected from a cervical CT. We diagnosed the condition as advanced esophageal carcinoma (A2N(-)M0Pl0 Stage III). We then treated the patient by chemoradiation therapy. After the treatment, the carcinoma could not be detected by CT and endoscopy, and endoscopic biopsy revealed there were no active carcinoma cells. The side effects of the therapy were very mild, therefore the patient could be discharged after a short time. No evidence of a tumor relapse was found 5 months after the therapy. We treated 4 patients with esophageal carcinoma using the same regimen, and the results of the therapy were 2 CR, 1 PR, and 1 PD, with an overall response rate of 75%.

Histochemical responses of human soleus muscle fibers to long-term bedrest with or without countermeasures

Effects of 2- or 4-month bedrest in -6 degrees head-down tilt position with or without countermeasures on the histochemical properties of fiber phenotype and cross-sectional area (CSA) were studied in human soleus. The CSAs in slow fibers decreased approximately 32% during 4-month bedrest. This reduction was normalized after 1-month recovery. Although the reduction of percent slow fibers was not significant statistically, the percent intermediate fibers was significantly elevated 4 months after bedrest. Such shift in fiber type was not normalized following 1-month recovery. Effects of wearing an anti-g Penguin suit which has a modest, but continuous resistance at the knee and ankle (Penguin-1) or with knee resistance without loading on the ankle (Penguin-2) for 10 consecutive hours daily were also investigated during approximately 2 months of bedrest. The subjects performed knee extension and flexion for the last 15 min of each hour while in a supine position in bed. Bedrest-induced fiber atrophy was prevented in the Penguin-1 group but not the Penguin-2 group. Transformation of fiber type was not prevented in either Penguin suit group. It is suggested that long-term bedrest causes an atrophy and a shift of fiber phenotype toward fast-twitch type in human soleus. Data also indicated that loading on the muscle is an effective countermeasure for prevention of fiber atrophy but not fiber-type transformation.

Cervical adenocarcinoma, a novel combination chemotherapy with mitomycin C, etoposide, and cisplatin for advanced or recurrent disease

We review the cases of 31 patients with stage IVb or recurrent cervical adenocarcinoma who were treated with combination chemotherapy utilizing mitomycin C, etoposide, and cisplatin (MEP). The total response rate was 16.1% (95% confidence intervals (CIs), 5. 5 to 33.7%) with 4 patients having a complete response (CR) and 1 having a partial response. In patients with no prior chemotherapy, the response rate was 26.7% (95% CIs, 7.8 to 55.1%) with 2 of these CR patients surviving over 3 years, 1 a disease-free survival. A marked response was found in distant recurrent lesions. The major toxicity was myelosuppression. Forty-five percent of patients had leukocytopenia above grade 3; thrombocytopenia and anemia were not common. In patients with cervical adenocarcinoma and no prior chemotherapy, there was a moderate response to MEP therapy.

Cholinergic and glutamatergic transmission in medial vestibular nucleus neurons responding to lateral roll tilt in rats

The responses of the medial vestibular nucleus (MVN) neurons to lateral tilt and the neurotransmitters mediating otolith information to MVN neurons were investigated using rats. A computer-operated goniometer was tilted 20 degrees clockwise and counterclockwise at an angular speed of 5 degrees /s and paused in the inclined positions for 10 s to record neuronal responses in the static phase. The 185 MVN neurons recorded were classified into eight types according to their responses to tilt (alpha, beta, gamma, delta, epsilon, zeta, eta and theta). A majority showed increased firing in response to ipsilateral tilting and decreased firing in response to contralateral tilting (alpha type: 31.4%) or exhibited the reverse pattern (beta type: 36.8%). Further, other groups of neurons increased (gamma type) or decreased (delta type) firing rates to either side tilting and increased (epsilon and zeta type) or decreased (eta and theta type) firing only on one side. Atropine or L-glutamic acid diethyl ester hydrochloride (GDEE) applied microiontophoretically antagonized tilt-induced firing of alpha type neurons in 58.8% or 60.0%, respectively, and of beta type neurons in 66.7% or 58.3%, respectively. When the effects of atropine and GDEE were examined in the same neurons, antagonizing effects of both drugs on tilt-induced firing were obtained in 28.6% and 40.0% of alpha and beta type neurons, respectively. These results suggest that both acetylcholine and glutamate act as neurotransmitters in the transmission of otolith information to most MVN neurons.