A Review of Ixekizumab, an Anti-Interleukin-17A Monoclonal Antibody, for Moderate-to-Severe Plaque Psoriasis

Psoriasis is a multifactorial chronic skin disease that can have significant detrimental effects on patients' physical, mental, antibodypsychosocial wellbeing. Patients often suffer from a decreased quality of life along with numerous comorbidities. Recent advances in our understanding of the innate and adaptive immune systems have led to the identification of interleukin (IL)-17 as a key pro-inflammatory mediator in psoriasis. This knowledge has in turn led to the development of newer biologic agents that have been shown to be more effective than traditional therapies. In this article, we review phase 1-3 clinical trials of the anti-IL-17 monoclonal antibody, ixekizumab, for treatment of moderate-to-severe plaque psoriasis.

Pharmacokinetic Study of a Diclofenac Sodium Capsule Filled with Enteric-coated Pellets in Healthy Chinese Volunteers by Liquid Chromatography-electrospray Ionization-tandem Mass Spectrometry

The pharmacokinetic study of a diclofenac sodium capsule filled with enteric-coated pellets (abbreviated as CAPSULE) in healthy Chinese subjects was evaluated using liquid chromatography-electrospray ionization-tandem mass spectrometry with simple sample preparation. In a cross-over study, 12 healthy male volunteers were given 50 mg CAPSULE and diclofenac sodium enteric-coated tablet (abbreviated as TABLET, used as a control dosage form) at fasting. The Cmax, AUC0-t, and Tmax of CAPSULE were 1.01±0.52 μg/mL, 1.54±0.18 μg·h/mL, and 1.50±1.31 h, respectively. When compared with TABLET, the pharmacokinetic study showed that although this CAPSULE exhibited similar AUC (only 10% lower), it presented lower maximum plasma concentration, faster absorption and shorter time to reach maximum concentration. When compared with the previous study in Germany, obvious variations on Tmax were found in Chinese subjects taking CAPSULE, but not TABLET. The results indicated that individual difference should be paid attention when prescribing CAPSULE to Chinese patients.

Greater sensitivity of the cortical face processing system to perceptually-equated face detection

Face detection, the perceptual capacity to identify a visual stimulus as a face before probing deeper into specific attributes (such as its identity or emotion), is essential for social functioning. Despite the importance of this functional capacity, face detection and its underlying brain mechanisms are not well understood. This study evaluated the roles that the cortical face processing system, which is identified largely through studying other aspects of face perception, play in face detection. Specifically, we used functional magnetic resonance imaging (fMRI) to examine the activations of the fusifom face area (FFA), occipital face area (OFA) and superior temporal sulcus (STS) when face detection was isolated from other aspects of face perception and when face detection was perceptually-equated across individual human participants (n=20). During face detection, FFA and OFA were significantly activated, even for stimuli presented at perceptual-threshold levels, whereas STS was not. During tree detection, however, FFA and OFA were responsive only for highly salient (i.e., high contrast) stimuli. Moreover, activation of FFA during face detection predicted a significant portion of the perceptual performance levels that were determined psychophysically for each participant. This pattern of result indicates that FFA and OFA have a greater sensitivity to face detection signals and selectively support the initial process of face vs. non-face object perception.

The effects of bortezomib alone or in combination with 5-fluorouracil on proliferation and apoptosis of choriocarcinoma cells

PURPOSE

To investigate the effects of bortezomib alone and in combination with 5-fluorouracil (5-FU) on proliferation and apoptosis in the human choriocarcinoma cell line JEG-3.

MATERIALS AND METHODS

Cells were treated with bortezomib, 5-FU or with a combination. Proliferation and apoptosis were measured. NF-iB protein expression was examined using immunofluorescence.

RESULTS

Following treatment with ten nM bortezomib, rates of apoptosis were significantly higher than controls (p < 0.05) and NF-kB expression increased. 5-FU at 0.025 μg/ml or 0.25 μg/ml resulted in 60.1 ± 0.4% and 67.0 ± 0.2% growth inhibition, respectively, an increase compared to individual treatment (p < 0.05). Apoptosis in cells treated with bortezomib +5-FU was significantly higher than either treatment alone (p < 0.05). Inhibition of proliferation by the combination treatment was synergistic.

CONCLUSION

Bortezomib alone or in combination with 5-FU inhibited JEG-3 cell proliferation and induced apoptosis by increasing NF-kB expression. Combination treatment exerted synergistic effects on growth inhibition.

Sciatic-femoral nerve block versus unilateral spinal anesthesia for outpatient knee arthroscopy: a meta-analysis

BACKGROUND

Because of the short hospital stay involved in outpatient knee arthroscopy, anesthesiologists should provide an effective and safe anesthesia scheme. Unilateral spinal anesthesia is a conventional choice for outpatient knee arthroscopy, and combined sciatic-femoral nerve block also permits successful results. This study aimed to compare sciatic-femoral nerve block with unilateral spinal anesthesia for outpatient knee arthroscopy.

METHODS

We screened randomized controlled trials (RCTs) that compared sciatic-femoral nerve block (SFB) with unilateral spinal anesthesia (USA) from EMBASE, MEDLINE and the Cochrane Library. Ten statistic parameters, such as time-to-readiness for discharge (TRD, minutes), time to first spontaneous urination (minutes), time to perform (PT, minutes), Visual Analogue Scale (VAS) for postoperative (24 hours) pain, patients' satisfaction, and total anesthesia time (TAT, minutes) were considered in this study. RevMan 5.2 and Stata 12.0 softwares were used for data analysis.

RESULT

There were 7 RCTs including 402 total patients which met our criteria. Compared with the USA group, in the SFB group TRD (mean difference [MD]=-38.8; 95% CI [-63.7, -14.0]; P=0.002) and time to first spontaneous urination (MD=-78.2; 95% CI [-92.7, -63.7]; P<0.00001) were shorter, TAT (MD=100.2; 95% CI [30.3, 170.1]; P=0.005) and PT (MD=4.0; 95% CI [2.4, 5.6]; P<0.00001; I2=97%) were longer in the SFB group. For the two groups, no statistically significant differences were observed in patients' satisfaction (MD=3.2; 95% CI [0.3, 31.8]; P=0.33).

CONCLUSION

SFB provided faster bladder function recovery and faster discharging from hospital, hence it could be a good alternative to USA for outpatient knee arthroscopy.

Optimal blood pressure levels in patients undergoing intravenous thrombolysis for AIS

AIM

We wished to define the most optimal blood pressure ranges in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis treatment.

METHODS

The study comprised 626 patients with AIS who underwent the treatment with recombinant tissue plasminogen activator. The patients were randomly assigned to receive either conservative blood pressure lowering regimen (N.=302, target systolic blood pressure of 151-185 mmHg) or intensive blood pressure lowering regimen (N.=324, target systolic blood pressure of 141-150 mm Hg). The outcomes were occurrence of intracranial hemorrhages and survival after 3 months post-treatment.

RESULTS

Patients who received intensive blood pressure lowering regimen showed significantly lower rates of intracranial hemorrhage and mortality. Also, these patients demonstrated a trend to better overall condition.

CONCLUSION

Intensive blood pressure lowering regimen warrants a safe and effective intravenous thrombolysis in patients with AIS, and the targeted systolic blood pressure levels should be within 141-150 mmHg.

Large-scale two-dimensional MoS₂ photodetectors by magnetron sputtering

We report on the demonstration of photodetectors based on large scale two-dimensional molybdenum disulfide (MoS2) transition metal dichalcogenides. Excellent film uniformity and precise control of the MoS2 thickness down to a monolayer (~0.75nm) were achieved by magnetron sputtering synthesis approach. In particular, the photodetectors integrated with five MoS2 monolayers exhibit a high photoresponsivity of 1.8 A/W, an external quantum efficiency exceeding 260%, and a photodetectivity of ~5 x 10(8) Jones for a wavelength of 850 nm, surpassing the performance of mechanically exfoliated based photodetectors.

Effects of p-chlorophenoxyisobutyric acid, arabinogalactan, and activated charcoal on microspore embryogenesis in kale

To improve embryogenesis in microspore cultures of kale (Brassica oleracea L. var. acephala DC.), 6-benzylaminopurine (6-BA), naphthaleneacetic acid (NAA), arabinogalactan (AG), p-chlorophenoxyisobutyric acid (PCIB), and activated charcoal (AC) were added to the medium using four varieties of kale. The results showed that the addition of AG (0.1-0.2 g/L), AC (0.1-0.2 g/L) or a combination of 6-BA (0.1-0.2 mg/L) and NAA (0.1-0.2 mg/L) promoted embryo-genesis. Adding 40 μM PCIB or a combination of 40 μM PCIB and 0.2 g/L AC to NLN-13 medium at pH 5.8 effectively enhanced embryogenesis. Treatment with a combination of 40 μM PCIB and 10 mg/L AG gave the highest rate of embryonic induction, especially in genotype "Y007," which showed a twelve-fold increase in yield.

Serum immunoglobulin E level and its impact on the pregnancy outcome associated with fetal growth restriction: a prospective cohort study

We evaluated the relationship between total serum immunoglobulin E (IgE) levels and pregnancy outcome in a prospective cohort study focusing on fetal growth restriction (FGR). Sixty women with FGR and twenty with normal singleton pregnancy were enrolled during their third trimester. Infants were followed up for 6 months. Blood samples were obtained from pregnant women during the third trimester; cord blood samples were also taken. Six months after birth, blood samples were obtained from infants. Demographic and baseline characteristics were compared between groups. Birth weight, length and head circumference of neonates in the FGR group were lower than those in the control group. Total serum IgE level was significantly increased in third-trimester pregnant women with FGR compared with normal group (P < 0.05). However, this trend was not observed in the cord blood at birth or peripheral blood of 6-month-old infants. The prevalence of atopic eczema between the 2 groups was similar. Linear regression analysis revealed that the IgE level in the third trimester was negatively correlated with birth weight (P < 0.05). Higher serum IgE level in the cord blood was significantly associated with an increased risk of being small for gestational age (P < 0.05). In conclusion, IgE levels in the third trimester of pregnancy and cord blood are strongly related to birth outcomes of FGR.

Orthotopic models of pediatric brain tumors in zebrafish

High-throughput screens (HTS) of compound toxicity against cancer cells can identify thousands of potential new drug-leads. But only limited numbers of these compounds can progress to expensive and labor-intensive efficacy studies in mice, creating a 'bottle neck' in the drug development pipeline. Approaches that triage drug-leads for further study are greatly needed. Here we provide an intermediary platform between HTS and mice by adapting mouse models of pediatric brain tumors to grow as orthotopic xenografts in the brains of zebrafish. Freshly isolated mouse ependymoma, glioma and choroid plexus carcinoma cells expressing red fluorescence protein were conditioned to grow at 34 °C. Conditioned tumor cells were then transplanted orthotopically into the brains of zebrafish acclimatized to ambient temperatures of 34 °C. Live in vivo fluorescence imaging identified robust, quantifiable and reproducible brain tumor growth as well as spinal metastasis in zebrafish. All tumor xenografts in zebrafish retained the histological characteristics of the corresponding parent mouse tumor and efficiently recruited fish endothelial cells to form a tumor vasculature. Finally, by treating zebrafish harboring ERBB2-driven gliomas with an appropriate cytotoxic chemotherapy (5-fluorouracil) or tyrosine kinase inhibitor (erlotinib), we show that these models can effectively assess drug efficacy. Our data demonstrate, for the first time, that mouse brain tumors can grow orthotopically in fish and serve as a platform to study drug efficacy. As large cohorts of brain tumor-bearing zebrafish can be generated rapidly and inexpensively, these models may serve as a powerful tool to triage drug-leads from HTS for formal efficacy testing in mice.

Acarbose monotherapy and weight loss in Eastern and Western populations with hyperglycaemia: an ethnicity-specific meta-analysis

OBJECTIVE

To demonstrate if weight loss achieved with acarbose in individuals with hyperglycaemia differs between Eastern and Western populations.

METHODS

Databases and reference lists of clinical trials on acarbose were searched. Eligible studies were randomised controlled trials of acarbose monotherapy in populations with hyperglycaemia of more than 12-week duration that provided data on body weight (BW) or body mass index (BMI).

RESULTS

A total of 34 trials (6082 participants) were included. The effect of acarbose on BW was superior to that of placebo [weighted mean difference (WMD) = -0.52, 95% confidence interval (CI) -0.78 to -0.25], nateglinide (WMD = -1.33, 95% CI -1.51 to -0.75) and metformin (WMD = -0.67, 95% CI -1.14 to -0.20). Compared with placebo, there was a significantly greater weight loss of 0.92 kg (p < 0.05, I(2)  = 88.8%) with acarbose in Eastern populations (WMD = -1.20, 95% CI -1.51 to -0.75) than that in Western populations (WMD = -0.28, 95% CI -0.59 to 0.03). Across all studies, the acarbose group achieved a significantly larger absolute weight loss of (change from baseline) 1.35 kg (p < 0.05, I(2)  = 94.3%) in Eastern populations (WMD = -2.26, 95% CI -2.70 to -1.81) than in Western populations (WMD = -0.91, 95% CI -1.36 to -0.47). Nevertheless, the possible risk of bias in Eastern studies may influence the results.

CONCLUSION

The effect of acarbose on weight loss seems to be more pronounced in Eastern than in Western populations with hyperglycaemia, and is superior to that of placebo, nateglinide and metformin across both ethnicities.

Gene signatures of drug resistance predict patient survival in colorectal cancer

Different combinations of 5-fluorouracil (5-FU), oxaliplatin, irinotecan and other newly developed agents have been used to treat colorectal cancer. Despite the advent of new treatment regimens, the 5-year survival rate for metastatic colorectal cancer remains low (~10%). Knowing the drug sensitivity of a given tumor for a particular agent could significantly impact decision making and treatment planning. Biomarkers are proven to be successful in characterizing patients into different response groups. Using survival prediction analysis, we have identified three independent gene signatures, which are associated with sensitivity of colorectal cancer cells to 5-FU, oxaliplatin or irinotecan. On the basis of the three gene signatures, three score systems were developed to stratify patients from sensitive to resistance. These score systems exhibited robustness in stratify patients in two independent clinical studies. Patients with high scores in all three drugs exhibited the lowest survival.

The MTMR9 rs2293855 polymorphism is associated with glucose tolerance, insulin secretion, insulin sensitivity and increased risk of prediabetes

BACKGROUND

Polymorphism of rs2293855 in gene MTMR9 has been associated with obesity and metabolic syndrome. We aim to study the association of rs2293855 with type 2 diabetes mellitus (T2DM) intermediate phenotypes in a Han Chinese population.

METHODS

The polymorphism was genotyped in 838 Han Chinese individuals using Matrix-Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS); all participants underwent a 75 g oral glucose tolerance test (OGTT); associations between the polymorphism and glucose tolerance, indices of insulin secretion and indices of insulin sensitivity were analyzed.

RESULTS

The frequency of genotypes and alleles differed significantly between normal glucose tolerance and prediabetes (P=0.043 and P=0.009, respectively). The GG homozygous presented higher fasting plasma glucose (P=0.009), higher 2-hour plasma glucose (P=0.024) and higher glucose area under the curve (AUC, P=0.01). Moreover, the G allele of rs2293855 was associated with glucose intolerance (fasting glucose, P=0.012; glucose AUC, P=0.006; 2-h glucose, P=0.024); it is also associated with decreased indices of insulin sensitivity (fasting insulin, P=0.043; insulin sensitivity index composite, P=0.009; homeostasis model assessment of insulin resistance, HOMA-IR, P=0.008) and decreased indices of insulin secretion (HOMA of beta cell function, HOMA-B, P=0.028; insulinogenic index, P=0.003). In addition, the minor allele G was also associated with increased risk of prediabetes (OR=1.463, 95%CI: 1.066-2.009, P=0.018).

CONCLUSIONS

Polymorphism of rs2293855 in MTMR9 is associated with measures of glucose tolerance, indices of insulin secretion and indices of insulin sensitivity. We also suggest that allele G is likely to increase the risk of prediabetes by influencing both insulin secretion and insulin sensitivity.

Huwe1 as a therapeutic target for neural injury

The ubiquitin-proteasome system (UPS) regulates many cellular processes, including protein stability, cell cycle control, DNA repair, transcription, signal transduction, and protein trafficking. In fact, UPS plays a key role in various stress conditions such as ischemia, glutamate toxicity, Alzheimer's disease, and Parkinson's disease. Huwe1, a homologous to E6-AP carboxy terminus (HECT) domain ubiquitin ligase, is now being regarded as a vital protein involved in neural stem cell differentiation, adult neurogenesis, and the DNA damage response pathway. In response to DNA damage, Huwe1 may have a dual function in arresting DNA replication and in ending checkpoint signaling. The proliferation and differentiation of neural stem cells regulated by Huwe1-mediated Notch signaling could also play an important role in neural protection following neural injury. Considering Huwe1 is required for neural precursor survival and the regulation of the DNA damage response pathway, there is growing evidence and considerable hope that Huwe1 might be a therapeutic target for neural injury.

Systematic review and meta-analysis of robotic surgery compared with conventional laparoscopic and open resections for gastric carcinoma

BACKGROUND

Robot-assisted gastrectomy (RAG) has been developed in the hope of improving surgical quality and overcoming the limitations of conventional laparoscopically assisted gastrectomy (LAG) and open gastrectomy (OG) for gastric cancer. The aim of this study was to determine the extent of evidence in support of these ideals.

METHODS

A systematic review of the three operation types (RAG, LAG and OG) was carried out to evaluate short-term outcomes including duration of operation, retrieved lymph nodes, estimated blood loss, resection margin status, technical postoperative complications and hospital stay.

RESULTS

Nine non-randomized observational clinical studies involving 7200 patients satisfied the eligibility criteria. RAG was associated with longer operating times than LAG and OG (weighted mean difference 61.99 and 65.73 min respectively; P ≤ 0.001). The number of retrieved lymph nodes and the resection margin length in RAG were comparable with those of LAG and OG. Estimated blood loss as significantly less in RAG than in OG (P = 0.002), but not LAG. Mean hospital stay for RAG was similar to that for LAG (P = 0.14). In contrast, hospital stay was significantly shorter, by a mean of 2.18 days, for RAG compared with OG (P < 0.001). Postoperative complications were similar for all three operative approaches.

CONCLUSION

Short-term oncological outcomes of RAG were comparable with those of the other approaches. LAG was a shorter procedure and less expensive than RAG. Future studies involving RAG should focus on minimizing duration of operation and reducing cost.

Immune tolerance of skin allograft transplantation induced by immature dendritic cells of a third party carrying donor antigens in mice

BACKGROUND

Dendritic cells (DCs) are the most powerful antigen-presenting cells in the body. Immature DCs (imDCs) can induce transplantation tolerance. In this study, using a mouse model of skin transplantation. We explored the antigen uptake by imDCs, changes in phenotype and function after antigen loading, as well as survival of skin grafts.

METHODS

Mononuclear cells from C57BL/6 mice mixed with a tritiated leucine ([(3)H]Leu) antigen supernate were incubated with Kunming mice imDC and mature DCs. We recorded the expressions of surface molecules that were detected using flow cytometry, mixed lymphocyte reactions, mean survival times, and postoperative morphological changes in skin grafts.

RESULTS

After the addition of allogeneic antigen supernate, the counts per minute of imDCs were significantly higher than those of mature DCs. The expression rates of I(A)/I(E) and CD80 significantly increased on the cell surface of imDCs. The counts per minute of imDCs in mixed lymphocyte reactions in the presence of allogeneic antigens was significantly higher than those of controls. Comparing mean survival times with controls, skin grafts were significantly longer in the imDCs groups from donors or from a third party carrying donor antigens.

CONCLUSIONS

ImDCs display a strong antigen uptake, gradually maturing in terms of phenotype and function after loading. Complementary application of cytotoxic T-lymphocyte-associated antigen 4 immunoglobulin blocks the immune response of imDCs. Both imDCs from the third party carrying donor antigens and those from the donor strain can establish antigen-specific immune tolerance to allogeneic skin grafts.

β-Catenin and AKT are promising targets for combination therapy in acute myeloid leukemia

In this study, we confirmed that combining HHT with ACR can result in synergistic cytotoxicity to AML cells in vitro and in vivo. Combining HHT and ACR simultaneously inhibited PI3K/AKT and WNT/β-catenin signaling in AML cells. Significant increases in growth inhibition and apoptosis were induced by an AKT inhibitor when the WNT3A gene of THP-1 cells was silenced. HHT+ACR could synergistically induce the apoptosis of CD34(+)/CD38(-) primary AML cells. These results highlight β-catenin and AKT are promising targets for combination therapy for AML.

Abstract 2460: Discovery of potent androgen receptor antagonists for treating CRPC and AR+ breast cancer

Androgen Receptor (AR) antagonists have been used in clinic to treat prostate cancer. One example is bicalutamide (Casodex®), which is used along with castration to treat advanced prostate cancer. Unfortunately, the patients developed resistance to bicalutamide (alone or in combination therapy) after only 0.5-2 years of treatment, resulting in castration-resistant prostate cancer (CRPC). Elevated AR expression in tumor cells correlates with a change in the functional activity of bicalutamide from antagonist to agonist, suggesting that prostate tumors may adapt to survive on any residual agonism. MDV3100, a more potent AR antagonist (∼5x vs bicalutamide) without residual agonism, has demonstrated excellent efficacy in CRPC patients and has been approved by FDA for treating CRPC in clinic. Recently, AR antagonists demonstrated anti-tumor activities in preclinical AR+ breast cancer models. Approximately 75% of invasive breast cancers were founded to be AR+.

Although MDV3100 is generally well-tolerated, there is a need to eliminate the clinically observed CNS adverse side effects (∼1% incidences of seizure). Suzhou Kintor launched a research effort looking for more potent full AR antagonists with reduced CNS drug distribution.

Lead series was rapidly generated by computer-aided drug design. Designed molecules based on clinically proven thiohydantoin core were docked into AR LBD binding site and filtered with criteria of binding and ability to induce antagonism conformation. Initial optimization mainly focused on improving AR antagonism potency. Additional substitutions were introduced in the left hand side to increase binding affinity to AR whereas more extended fragment was used in the AR helix 12 region to prevent AR to adopt agonism conformation hence ensure full antagonism (which may help overcome resistance arise from residual AR agonism). Further optimization for ADME properties with focus to reduce CNS drug exposure led to discovery of several candidate compounds, after overcoming the challenge of increase polarity while maintaining/improving AR antagonism potency. GT0918 and GT0903 emerged as two of top candidates for further preclinical clinical development. Both compounds have excellent affinity with AR (4-10x tighter than MDV3100), as well as potent AR antagonism (2-5x more potent than MDV3100). They also demonstrated good anti-tumor efficacy in both hormone sensitive and CRPC animal models. In addition, both candidate compounds demonstrated anti-proliferation effects in AR positive breast cancer cell lines (MCF-7 and MDA-MB-453). With higher polar surface area (PSA), GT0918 demonstrated low CNS drug distribution and no seizure was observed in animal toxicity studies (up to 1g/kg, rat/dog). With improved ADME profile (better solubility and predicted to have less drug accumulation in patients), GT0918 is being developed for Phase I trial start.

Citation Format: Youzhi Tong, Chunyun Chen, Juan Wu, Huihui Zhang, Xiaojun Wu, Yanmei Duan, Wei Gao, Xiaoxia Niu, Linglan Ma, Chuangxing Guo. Discovery of potent androgen receptor antagonists for treating CRPC and AR+ breast cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2460. doi:10.1158/1538-7445.AM2013-2460