Phase 1b randomized trial and follow-up study in Uganda of the blood-stage malaria vaccine candidate BK-SE36

Background

Up to now a malaria vaccine remains elusive. The Plasmodium falciparum serine repeat antigen-5 formulated with aluminum hydroxyl gel (BK-SE36) is a blood-stage malaria vaccine candidate that has undergone phase 1a trial in malaria-naive Japanese adults. We have now assessed the safety and immunogenicity of BK-SE36 in a malaria endemic area in Northern Uganda.

Methods

We performed a two-stage, randomized, single-blinded, placebo-controlled phase 1b trial (Current Controlled trials ISRCTN71619711). A computer-generated sequence randomized healthy subjects for 2 subcutaneous injections at 21-day intervals in Stage1 (21–40 year-olds) to 1-mL BK-SE36 (BKSE1.0) (n = 36) or saline (n = 20) and in Stage2 (6–20 year-olds) to BKSE1.0 (n = 33), 0.5-mL BK-SE36 (BKSE0.5) (n = 33), or saline (n = 18). Subjects and laboratory personnel were blinded. Safety and antibody responses 21-days post-second vaccination (Day42) were assessed. Post-trial, to compare the risk of malaria episodes 130–365 days post-second vaccination, Stage2 subjects were age-matched to 50 control individuals.

Results

Nearly all subjects who received BK-SE36 had induration (Stage1, n = 33, 92%; Stage2, n = 63, 96%) as a local adverse event. No serious adverse event related to BK-SE36 was reported. Pre-existing anti-SE36 antibody titers negatively correlated with vaccination-induced antibody response. At Day42, change in antibody titers was significant for seronegative adults (1.95-fold higher than baseline [95% CI, 1.56–2.43], p = 0.004) and 6–10 year-olds (5.71-fold [95% CI, 2.38–13.72], p = 0.002) vaccinated with BKSE1.0. Immunogenicity response to BKSE0.5 was low and not significant (1.55-fold [95% CI, 1.24–1.94], p = 0.75). In the ancillary analysis, cumulative incidence of first malaria episodes with ≥5000 parasites/µL was 7 cases/33 subjects in BKSE1.0 and 10 cases/33 subjects in BKSE0.5 vs. 29 cases/66 subjects in the control group. Risk ratio for BKSE1.0 was 0.48 (95% CI, 0.24–0.98; p = 0.04).

Conclusion

BK-SE36 is safe and immunogenic. The promising potential of BK-SE36, observed in the follow-up study, warrants a double-blind phase 1/2b trial in children under 5 years.

Trial Registration

Controlled-Trials.com ISRCTN71619711 ISRCTN71619711

Gauze packing as damage control for uncontrollable haemorrhage in severe thoracic trauma

Introduction

The usefulness of thoracic damage control (DC) for trauma requiring a thoracotomy is not established. The aim of this study was to clarify the usefulness of thoracic packing as DC surgery.

Methods

This was a retrospective case series study of 12 patients with thoracic trauma suffering uncontrollable intrathoracic haemorrhage and shock who underwent intrathoracic packing. Our thoracic DC technique consisted of ligation and packing over the bleeding point or filling gauze in the bleeding spaces as well as packing for the thoracotomy wound. The success rates of intrathoracic haemostasis, changes in the circulation and the volume of discharge from the thoracic tubes were evaluated.

Results

Packing was undertaken for the thoracic wall in five patients, for the lung in four patients, for the vertebrae in two patients and for the descending thoracic aorta in one patient. Haemostasis was achieved successfully in seven cases. Of these, the volume of discharge from the thoracic tube exceeded 400ml/hr within three hours after packing in three patients, decreased to less than 200ml/hr within seven hours in six patients and decreased to 100ml/hr within eight hours in six patients. Systolic pressure could be maintained over 70mmHg by seven hours after packing.

Conclusions

Intrathoracic packing is useful for some patients, particularly in the space around the vertebrae, at the lung apex, and between the diaphragm and the thoracic wall. After packing, it is advisable to wait for three hours to see whether vital signs can be maintained and then to wait further to see if the discharge from the thoracic tube decreases to less than 200ml/hr within five hours.

Mixed red-complex bacterial infection in periodontitis

The red complex, which includes Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia (formerly Bacteroides forsythus), are recognized as the most important pathogens in adult periodontal disease. These bacteria are usually found together in periodontal pockets, suggesting that they may cause destruction of the periodontal tissue in a cooperative manner. This article discusses the interspecies pathogenic interactions within the red complex.

Gauze packing as damage control for uncontrollable haemorrhage in severe thoracic trauma

Introduction

The usefulness of thoracic damage control (DC) for trauma requiring a thoracotomy is not established. The aim of this study was to clarify the usefulness of thoracic packing as DC surgery.

Methods

This was a retrospective case series study of 12 patients with thoracic trauma suffering uncontrollable intrathoracic haemorrhage and shock who underwent intrathoracic packing. Our thoracic DC technique consisted of ligation and packing over the bleeding point or filling gauze in the bleeding spaces as well as packing for the thoracotomy wound. The success rates of intrathoracic haemostasis, changes in the circulation and the volume of discharge from the thoracic tubes were evaluated.

Results

Packing was undertaken for the thoracic wall in five patients, for the lung in four patients, for the vertebrae in two patients and for the descending thoracic aorta in one patient. Haemostasis was achieved successfully in seven cases. Of these, the volume of discharge from the thoracic tube exceeded 400ml/hr within three hours after packing in three patients, decreased to less than 200ml/hr within seven hours in six patients and decreased to 100ml/hr within eight hours in six patients. Systolic pressure could be maintained over 70mmHg by seven hours after packing.

Conclusions

Intrathoracic packing is useful for some patients, particularly in the space around the vertebrae, at the lung apex, and between the diaphragm and the thoracic wall. After packing, it is advisable to wait for three hours to see whether vital signs can be maintained and then to wait further to see if the discharge from the thoracic tube decreases to less than 200ml/hr within five hours.

A randomized, controlled trial of narrow-band imaging vs high-definition white light for adenoma detection in patients at high risk of adenomas

AIM

The study aimed to investigate whether narrow-band imaging (NBI) can enhance adenoma detection in patients at high risk for adenomas compared with high-definition white-light endoscopy (WLE). High risk was defined as three or more adenomas at last colonoscopy, history of colorectal cancer and positive faecal occult blood test.

METHOD

Two hundred and fourteen patients were randomized 1:1 to examination with NBI or WLE. The primary outcome measure was the proportion of patients with at least one adenoma detected. Secondary outcomes included total adenomas and polyps, flat adenomas, nonadenomatous polyps, advanced adenomas and patients with three or five or more adenomas. A post hoc analysis to examine the effect of endoscopist and bowel preparation was performed.

RESULTS

There was no significant difference in the proportion of patients with at least one adenoma: NBI 73%vs WLE 66%, odds ratio 1.40 (95% CI 0.78-2.52), P = 0.26. There was no significant difference for any secondary outcome measure except for the number of flat adenomas which was significantly greater with NBI [comparison ratio 2.66 (95% CI 1.52-4.63), P = 0.001]. Post hoc analysis indicated that one of three endoscopists performed significantly better for adenoma detection with NBI than WLE [comparison ratio 1.92 (95% CI 1.07-3.44), P = 0.03]. Good bowel preparation was associated with significantly improved adenoma detection with NBI [comparison ratio 1.55 (95% CI 1.01-2.22), P = 0.04] but not with fair preparation.

CONCLUSION

Overall NBI did not improve detection compared with WLE in a group of patients at high risk for colorectal adenomas, but specific subgroups might benefit.

Efficacy of porcine placental extract on shoulder stiffness in climacteric women

OBJECTIVES

Some of the most common climacteric symptoms are somatic symptoms, such as muscle and joint pain, which cause limitations in performing daily tasks. This study aimed to assess whether oral porcine placental extract (PPE) affects patients with shoulder stiffness, one of the most common types of muscle-tendon stiffness, in climacteric women and postmenopausal women with hormone therapy (HT).

METHODS

Sixty-six climacteric women (33 each in the control and study groups) with shoulder stiffness and 54 postmenopausal women (27 each in the control and study groups) with HT-resistant shoulder stiffness were enrolled into this open-label, randomized, controlled study. The control subjects received Toki-shakuyaku-san (TJ23; 7.5 g/day, daily per os), an oral herbal remedy used to alleviate climacteric symptoms, and study subjects received PPE orally for 24 weeks in climacteric women and for 12 weeks in postmenopausal women with HT. Changes in the degree of shoulder stiffness were evaluated by the Visual Analog Scale (VAS).

RESULTS

Treatment with PPE was significantly effective in reducing the VAS score for shoulder stiffness during the study period compared with the control group in both climacteric and postmenopausal women with HT. The VAS score at the end of treatment was significantly reduced (p < 0.01 vs. baseline) by 76.4% for climacteric women and 64.8% for postmenopausal women with HT compared with baseline.

CONCLUSIONS

PPE is useful as an oral supplement for shoulder stiffness in climacteric women without HT or in postmenopausal women with HT-resistant, long-term shoulder stiffness.

Il2rg gene-targeted severe combined immunodeficiency pigs

A porcine model of severe combined immunodeficiency (SCID) promises to facilitate human cancer studies, the humanization of tissue for xenotransplantation, and the evaluation of stem cells for clinical therapy, but SCID pigs have not been described. We report here the generation and preliminary evaluation of a porcine SCID model. Fibroblasts containing a targeted disruption of the X-linked interleukin-2 receptor gamma chain gene, Il2rg, were used as donors to generate cloned pigs by serial nuclear transfer. Germline transmission of the Il2rg deletion produced healthy Il2rg(+/-) females, while Il2rg(-/Y) males were athymic and exhibited markedly impaired immunoglobulin and T and NK cell production, robustly recapitulating human SCID. Following allogeneic bone marrow transplantation, donor cells stably integrated in Il2rg(-/Y) heterozygotes and reconstituted the Il2rg(-/Y) lymphoid lineage. The SCID pigs described here represent a step toward the comprehensive evaluation of preclinical cellular regenerative strategies.

Mass spectrometric analysis of phosphoserine residues conserved in the catalytic domain of membrane-bound guanylyl cyclase from the sea urchin spermatozoa

We have developed a large-scale purification method of the phosphorylated form (131 kDa) of membrane-bound guanylyl cyclase (mGC) from Hemicentrotus pulcherrimus spermatozoa. The purified mGC contained 26.0 +/- 1.3 moles of phosphate/mol enzyme (mean +/- S.D., n = 6). Phosphorylated peptides were isolated from the trypsin digest of the carboxymethylated H. pulcherrimus sperm mGC by affinity chromatography on a Chelating Sepharose Fast Flow column, and the peptides were then subjected to mass spectrometric analysis and determination of phosphoserines, after the conversion of phosphoserines to Sethylcysteines by amino acid analysis. Based on the observed mass number and the content of phosphoserine, serine residues at positions 561, 565, 652, 722, 740, 755, 894, 897, 914, 918, 927, 930, 951, and 985, in addition to two residues among those at positions 666, 670, and 671, were shown to be phosphorylated. They are all located in the intracellular region (kinase-like and catalytic domains). Notably, serine residues at positions 894, 918, 927, and 930, that are conserved in the sequence of mammalian mGCs and medaka fish-eye-specific mGCs, are phosphorylated in the sea urchin sperm mGC.

Comparison of human versus Syrian hamster cells in culture for induction of mitotic inhibition, binucleation and multinucleation, following treatment with four aneuploidogens

The responses of human and rodent cells in vitro to aneuploidy-inducing chemicals were compared. Normal human fibroblasts and Syrian hamster embryo fibroblasts were treated with four aneuploidogens; Colcemid, vincristine, and the oestrogens diethylstilboestrol and oestra-1,3,5(10)-triene-3,17beta-diol (17beta-oestradiol). All compounds at a critical dose inhibited cell growth of both cell types. The concentrations of the two oestrogens required to inhibit growth of human and hamster cells were similar, whereas for the two mitotic inhibitors Colcemid and vincristine, the concentrations required for growth-inhibitory effects were lower for human cells than for hamster cells. The growth inhibition was reversible for all treatments except Colcemid. Doses that inhibited cell growth also resulted in large numbers of mitotic cells appearing in a time-dependent manner, indicating that both cell types were arrested in mitosis by all four compounds. The time required for maximum increases in the mitotic indices was greater for human cells, which is consistent with the longer cell cycle of these cells in culture. Few binucleated cells of either type were induced by any treatment except 17beta-oestradiol, which induced a high level of binucleated hamster cells, but not human cells. With time, the mitotic index of all treated cells decreased. For hamster cells, this was always accompanied by a large increase in multinucleated cells. The percentage of multinucleated hamster cells reached 50-60% in the Colcemid- and vincristine-treated cultures and 30-35% in the oestrogen-treated cultures. In contrast, the level of multinucleated human cells was significantly lower for all treatments. Colcemid and vincristine treatments induced 20-25% multinucleated human cells, and the oestrogens induced <5% multinucleated human cells. This latter finding appears to be the most significant difference between the two cell types. These results indicate that human cells respond differently from rodent cells to agents that induce mitotic arrest. This may help in understanding the decreased induction of aneuploidy in human cells by these compounds.

The analysis of the innate pathways of 5-fluorouracil phosphorylation in human gastrointestinal cancer cell lines in vitro and in vivo

Possible pathways of the phosphorylation of 5-fluorouracil (FUra) were investigated in vitro and in vivo, using certain xenografts, of human gastric and colorectal cancer cell lines. The oxonic acid (Oxo), an inhibitor of orotate phosphoribosyltransferase (OPRTase) that catalyzes the direct production of 5-fluorouridine 5'-monophosphate from FUra (the first pathway) and 2, 6-dihydroxypyridine (DP), an inhibitor of uridine phosphorylase (UPase), the enzyme converting FUra to 5-fluorouridine (the second pathway), were employed to estimate a contribution of these two metabolic pathways in the anabolism of FUra. Ten out of 13 cancer cell lines tested were found to utilize the first route for the phosphorylation of FUra, as revealed by marked inhibition of the phosphorylation of FUra by Oxo in 4 of 5 and in 6 of 8 gastric and colorectal cancer cell lines, respectively. The phosphorylation of FUra in the xenografts of human AZ521 gastric adenocarcinoma and SNU-C2A colorectal carcinoma was also regulated by Oxo, the production of 5-fluoro-nucleotides after i.v. injection of FUra with the Oxo significantly decreased from 0.587 to 0.311 nmol/g and from 1.75 to 0.40 nmol/g in respective xenografts, suggesting that the nature of an anabolic pathway of FUra in the tumor cells in vitro reflects the metabolic pattern found in the in vivo conditions. Moreover, the intracellular concentrations of phosphoribosylpyrophosphate (PPRibP) in DLD-1 and SNU-C(2)A cells were much higher than those found in HCT-15 and MKN-28 cells, leading to the findings that FUra was phosphorylated by OPRTase in the former and by UPase and uridine kinase in the latter cells. These results also may suggest that the intracellular levels of PPRibP in the tumor cells are importantly related to the selection of a proper metabolic pathway of FUra by the cell.

Cytotoxicity and chromosome aberrations in normal human oral keratinocytes induced by chemical carcinogens: Comparison of inter-individual variations

Normal human keratinocytes from the oral cavity were cultured in vitro in serum-free medium. Cultures from different individuals were established, and the responses of the cells to different chemicals were compared. The cells, grown at clonal densities, were treated separately with an alkylating agent (N-methyl-N'-nitro-N-nitrosoguanidine; MNNG), two arsenical salts (sodium arsenate or sodium arsenite), sodium fluoride or two polyaromatic hydrocarbons (benzo[a]pyrene or 7,12-dimethylbenz[a]-anthracene). There were no significant differences in the colony-forming efficiencies (22.8 +/- 4.2%) of control (untreated) cells from five different individuals. At selected doses, each of the chemicals reduced the colony-forming efficiencies of the treated cells. The cytotoxicity of most of the chemicals did not differ significantly among cells derived from different individuals, with the exception of sodium arsenate at two doses and sodium fluoride at the highest dose tested. Induction of chromosome aberrations by MNNG, sodium arsenite, sodium arsenate and sodium flouride was analysed with cells derived from up to nine individuals. There was little difference in the inducibilities of chromosome aberrations among cultured keratinocytes from different donors. Treatment of cells from nine donors with one dose of sodium fluoride revealed a statistically significant inter-individual variation. These findings provide a model system to study the effects of carcinogens on the target cells for oral cancers. The results can be compared with findings for cells from other epithelial tissues, since the culture conditions support the growth of keratinocytes regardless of origin. Little inter-individual variation was observed in the response of oral keratinocytes to the chemicals examined.

Ratings of perceived exertion in adults with chronically physical challenges

AIM

The purposes of this study were to investigate: the relationship between ratings perceived exertion (RPE) and percentage of maximal oxygen uptake (%VO2max) during submaximal exercise; the influence of daily physical activities on RPE; and the influence of aerobic fitness on RPE.

METHODS

The participants were thirty-eight adults with chronically physical challenges. Submaximal exercise testing was conducted to estimate VO2max. The participants themselves declared their perceived exertion just before the end of the exercise testing by indicating the Borg's 6-20 RPE scale. Measurement of continuous heart rates was employed for measurement of the intensity of daily physical activities. The relationship between %VO2max and RPE was analyzed.

RESULTS

There was a significant correlation between %VO2max and RPE only in the active men who did daily aerobic physical activities with intensity of 30%HRR and more (N.=9, r=0.74, P=0.02). In the good fitness groups of both women and men, the actual %VO2max in 11 out of 12 participants was lower than the reference value of %VO2max of the RPE while the opposite trend was found in poor aerobic fitness group.

CONCLUSION

Our results recommend that RPE should be used together with objective physiological variables such as HR for assessment of exercise intensity in people with chronically physical challenges, especially who are low in aerobic fitness or who are inactive.

A possible mechanism for Inv22-related F8 large deletions in severe hemophilia A patients with high responding factor VIII inhibitors

BACKGROUND

Intron 22 inversion (Inv22) of the coagulation factor (F)VIII gene (F8) is a frequent cause of severe hemophilia A. In addition to Inv22, a variety of F8 mutations (1492 unique mutations) causing hemophilia A have been reported, of which 171 involve deletions of over 50 bp (HAMSTeRs database; http://hadb.org.uk/). However, only 10% of these large deletions have been fully characterized at the nucleotide level.

PATIENTS AND METHODS

We investigated gene abnormalities in three unrelated severe hemophilia A patients with high titer FVIII inhibitors. They had previously been shown to carry large deletions of the F8, but the precise gene abnormalities remain to be elucidated.

RESULTS

Inverse shifting-PCR (IS-PCR) Inv22 diagnostic tests revealed that these patients carried either type I or II Inv22. However, they showed a wild-type (WT) pattern in the IS-PCR Inv22 complementary tests. We further analyzed their X chromosomes to account for the puzzling results, and found that they had different centromeric breakpoints in the Inv22 X chromosomes, adjacent to the palindromic regions containing int22h-2 or -3, and their spacer region, respectively. The connections appeared to be shifted towards the telomere of the WT F8 Xq28, resulting in a new telomere with an additional intact int22h copy.

CONCLUSIONS

These gene rearrangements might result from double-strand breaks in the most distal regions of the long arms of the Inv22 X chromosomes, followed by DNA restorations using the WT F8 Xq28 by non-homologous end joining or break-induced replication; thus leading to large F8 deletions in severe hemophilia A patients.

Efficacy of porcine placental extract on climacteric symptoms in peri- and postmenopausal women

OBJECTIVES

Injections of human placental extract have long been used to treat menopausal symptoms. Recently, porcine placental extract (PPE), an oral supplement, has been developed for this purpose. The aim of this study was to assess whether PPE has an impact on climacteric symptoms in perimenopausal and postmenopausal women.

METHODS

Seventy-six women with climacteric symptoms were enrolled into this open-label, randomized, controlled study. The control group (n = 38) underwent 24 weeks of open treatment with Toki-shakuyaku-san (TJ23), an oral herbal remedy used to alleviate climacteric symptoms. The PPE group (n = 38) received three capsules of PPE/day orally for the initial 12 weeks and six capsules/day for the next 12 weeks. Climacteric symptoms were evaluated in both groups using the Simplified Menopausal Index (SMI) score, Zung's Self-Rating Depression Scale (ZSDS) and the Spielberger State-Trait Anxiety Inventory (STAI) before commencing treatment, after 12 weeks of treatment and on completion of treatment.

RESULTS

Treatment with PPE was significantly (p < 0.01) more effective in reducing the SMI, ZSDS and STAI measures at 12 and 24 weeks than TJ23 treatment alone. Treatment with PPE was also significantly effective (p < 0.01) in reducing the subscale scores of the SMI for items such as hot flushes, insomnia, irritability, depression, fatigue and joint pain. PPE treatment had no significant adverse effects.

CONCLUSION

Oral PPE treatment is another possible option for treating perimenopausal and postmenopausal women with climacteric symptoms.

Development of multi-channel Doppler spectroscopic measurement system using 8 × 8 multianode photomultiplier tube assembly

Using an 8 × 8 channel photomultiplier tube assembly and a single Czerny-Turner monochromator, we have developed a novel Doppler spectroscopic system which can measure the time evolutions of spectral distribution of plasma emission from eight different lines of sight simultaneously. An optical lens system is employed to couple the output of the monochromator with the detector assembly, resulting in small cross-talks less than 5% in spatial distribution together with large magnification of up to 50 in wavelength direction. The suggested system yields cost-effective polychromatic measurements of eight spatial channels with uniform optical and electrical characteristics.