Phase I, randomized, double-blind, placebo-controlled, single-dose escalation study of the recombinant factor VIIa variant BAY 86-6150 in hemophilia

BACKGROUND

BAY 86-6150 is a new human recombinant factor VIIa variant developed for high procoagulant activity and longer action in people with hemophilia with inhibitors.

OBJECTIVES

To investigate the safety, tolerability, pharmacodynamics, pharmacokinetics and immunogenicity of BAY 86-6150 in non-bleeding hemophilia subjects.

METHODS

The study included non-bleeding men (18-65 years of age) with moderate or severe hemophilia A or B with or without inhibitors. Sixteen subjects were randomized 3 : 1 to four cohorts of escalating doses of BAY 86-6150 (6.5, 20, 50 or 90 μg kg(-1) [n = 3 per cohort]) or placebo (n = 1 per cohort); an independent data-monitoring committee reviewed previous cohort data before the next dose escalation. Blood sampling was performed predose and postdose; subjects were monitored for 50 days postdose.

RESULTS

At the tested doses, BAY 86-6150 was not associated with clinically significant adverse events or dose-limiting toxicities. BAY 86-6150 pharmacokinetics exhibited a linear dose response, with a half-life of 5-7 h. Subjects demonstrated consistent, dose-dependent thrombin generation ex vivo in platelet-poor plasma (PPP) (mean peak effect, 26-237 nm thrombin from 6.5 to 90 μg kg(-1)). Peak thrombin levels over time paralleled BAY 86-6150, with thrombin kinetics appearing to be slightly shorter; thus, circulating BAY 86-6150 retained activity. There were corresponding decreases in activated partial thromboplastin and prothrombin times. No subject developed de novo anti-BAY 86-6150 neutralizing antibodies during the 50-day follow-up.

CONCLUSIONS

In this first-in-human, multicenter, randomized, double-blind, placebo-controlled, single-dose escalation study, BAY 86-6150 was tolerated at the highest dose (90 μg kg(-1)), with no safety concerns. Safety and efficacy will be further evaluated in phase II/III studies.

Association of vitamin D and antimicrobial peptide production during late-phase allergic responses in the lung

BACKGROUND

Vitamin D may play important roles in regulating immune responses and in defence against infectious diseases by effects on both innate and adaptive immune responses. Little is known regarding activation of vitamin D within airway tissues and its relationship to inflammation and antimicrobial responses.

OBJECTIVE

The objective of this study was to investigate the activation of vitamin D within the airways and to define relationships between vitamin D metabolites and measures of inflammatory and antimicrobial responses assessed by bronchoalveolar lavage (BAL) during late-phase responses following allergen challenge of allergic subjects.

METHODS

Segmental allergen challenge was performed with saline and allergen in 16 adult allergic subjects. BAL was performed in both saline and allergen-challenged sites 20-24 h. after challenge. Following extraction from BAL fluids, levels of 25-hydroxy-vitamin D (25(OH)D) and 1,25-dihydroxy-vitamin D (1,25(OH)(2)D) were assayed by specific radioimmunoassays. The cleavage product of cathelicidin, LL-37, was assayed by ELISA. Cellular constituents and albumin were measured.

RESULTS

Levels of vitamin D metabolites were increased in concentrated BAL fluids after allergen compared to saline challenge. Levels of 1,25(OH)(2)D increased from largely undetectable to 2.5 pm (median; range: 1-29.5; P = 0.005) while 25(OH)D increased from 3.2 (0.8-6.2) to 6.2 (1.5-184.9) nm (P = 0.0006). Levels of LL-37 increased from 2.1 (1.4-4.1) to 14.5 (2.2-106.7) ng/mL BAL (P = 0.0005). Levels of LL-37, 1,25(OH)(2)D, and 25(OH)D following allergen challenge were correlated with each other (P < 0.0001), cellular changes, and levels of albumin (P < 0.001).

CONCLUSIONS AND CLINICAL RELEVANCE

Levels of vitamin D metabolites, particularly 1,25(OH)(2)D, were low within the airways and increased after allergen challenge. The increases correlated with the magnitude of inflammation and increases in cathelicidin. Normalization to albumin suggested plasma exudation as a mechanism for the increases. The findings support a role for vitamin D in allergic and innate immune responses in the lung.

Two-color CO2/HeNe laser interferometer for C-2 experiment

A six-channel two-color interferometer has been developed for plasma electron density measurements in the C-2 field reversed configuration experiment. A CO(2) laser is utilized as the main probe beams, while copropagating visible HeNe laser beams are mainly sensitive to vibration. Density measurements in C-2 plasmas have shown that this is a reliable turn-key system. The maximum residual phase noise after vibration compensation is less than ±5°, corresponding to a line integral density of 3×10(18) m(-2). The time resolution for routine operation is 2 μs.

Development of a nine spatial point, multipulse Thomson scattering diagnostic

A Thomson scattering diagnostic has been developed for the C-2 field-reversed configuration device. Based on a multipulse ruby laser, the system measures the electron temperature at nine spatial points. These points are chosen from 22 selectable positions covering r≈1-41 cm. Twin collection lenses couple the scattered photons to nine optical fiber pairs. Extra fiber lengths delay the signals from different spatial points relative to each other, allowing up to three points to be analyzed by a single polychromator. The polychromator, using compact photomultipliers as detectors, has six spectral channels covering the range of 685-725 nm and is able to estimate electron temperatures of ≈10-200 eV. The photomultiplier output signals are recorded by digital storage oscilloscopes integrated with the main MDSplus database, with temperature and error estimates generated automatically at the conclusion of each plasma discharge.

Doppler spectroscopy and D-alpha emission diagnostics for the C-2 FRC plasma

Two Doppler spectroscopy diagnostics with complementary capabilities are developed to measure the ion temperatures and velocities of FRC plasmas in the C-2 device. First, the multichord ion doppler diagnostic can simultaneously measure 15 chords of the plasma using an image intensified camera. Second, a single-chord fast-response ion Doppler diagnostic provides much higher faster time response by using a 16-channel photo-multiplier tube array. To study the neutral density of deuterium under different wall and plasma conditions, a highly sensitive eight-channel D-alpha diagnostic has been developed and calibrated for absolute radiance measurements. These spectroscopic diagnostics capabilities, combined with other plasma diagnostics, are helping to understand and improve the field reversed configuration plasmas in the C-2 device.

Weight change and cancer risk in a cohort of more than 65,000 adults in Austria

BACKGROUND

To investigate relations between weight loss or weight gain and the incidence of cancer.

PATIENTS AND METHODS

Weight change was assessed in a population-based cohort of >65 000 Austrian adults (28 711 men and 36 938 women) for a period of 7 years, after which participants were followed for incident cancers over 8 years on average. Incident cancers (other than nonmelanoma skin cancers) were ascertained by a population-based cancer registry (n = 3128). Cox proportional hazards models were used to estimate hazard rate ratios (HRs) stratified by age and adjusted for smoking, occupational group, blood glucose and body mass index at baseline.

RESULTS

In both men and women, neither weight loss nor weight gain was clearly associated with the incidence of all cancers combined. Weight loss (>0.10 kg/m(2)/year) was inversely associated with colon cancer in men [HR 0.50; 95% confidence interval (CI) 0.29-0.87], while high weight gain (> or =0.50 kg/m(2)/year) was inversely associated with prostate cancer (HR 0.43; 95% CI 0.24-0.76). Among women, high weight gain was positively associated with ovarian cancer (HR 2.48; 95% CI 1.05-5.85).

CONCLUSION

These findings indicate that recent weight change may influence the incidence of several types of cancer.

Low-grade abdominopelvic sarcoma with myofibroblastic features (low-grade myofibroblastic sarcoma): clinicopathological, immunohistochemical, molecular genetic and ultrastructural study of two cases with literature review

AIMS

Low-grade myofibroblastic sarcoma (LGMS) represents a rare soft tissue neoplasm with a predilection for the head and neck. Intra-abdominal LGMS are rare with only four unequivocal examples reported so far. Two further cases in females in their 60s and 70s are analysed here.

METHODS

Immunohistochemical stains were applied on fresh-cut sections using the avidin-biotin complex method and the following antibodies: vimentin, alpha-SMA, desmin, h-caldesmon, S-100, CD117, CD34, fibronectin, HMB45, Pan-keratin, Ki-67, beta-catenin, MDM2, PDGFRalpha, PDGFRbeta and ALK-1. Genomic DNA was isolated from microdissected formalin-fixed paraffin-embedded tumour tissue and examined for KIT and PDGFRA mutations by PCR and direct sequencing of KIT and PDGFRA. Ultrastructural studies were also performed.

RESULTS

The tumours arose in the mesentery and the pelvic peritoneum. Both revealed features intermediate between conventional fibrosarcoma and leiomyosarcoma with fascicles of spindled, stellated or plump cells possessing fusiform indented vesicular nuclei and pale eosinophilic cytoplasm. Mitotic activity ranged from 1 to 15 per 10 HPFs. The tumour cells strongly expressed vimentin, variably alpha-smooth muscle actin and fibronectin, but were negative for CD117, S-100, desmin, h-caldesmon, beta-catenin, ALK-1, MDM2, PDGFRalpha and PDGFRbeta. One tumour showed a weak expression of CD34. Molecular analysis revealed a wild-type KIT, exons 9, 11 and 13, and PDGFRA, exons 12 and 18. The patients developed multiple peritoneal recurrences at 5, 13 and 25 months, and 10, 19, 25 and 32 months, and were alive at 25 and 32 months, respectively. Distant metastases were not detected.

CONCLUSION

Abdominopelvic LGMS follows a more aggressive clinical course characterised by a higher propensity for local recurrence, contrasting their more superficially located counterparts. LGMS may mimic a variety of benign and low-grade malignant neoplasms and might be under-recognised.