Application of scientific criteria to food allergens of public health importance

Scientific criteria for identifying allergenic foods of public health importance (Björkstén, B., Crevel, R., Hischenhuber, C., Løvik, M., Samuels, F., Strobel, S., Taylor, S.L., Wal, J.-M., Ward, R., 2008. Criteria for identifying allergenic foods of public health importance. Regulatory Toxicology and Pharmacology 51(1), 42-52) have been further refined to incorporate an assessment of the strength of available scientific evidence (van Bilsen, J.H., Ronsmans, S., Crevel, R.W., Rona, R.J., Przyrembel, H., Penninks, A.H., Contor, L., Houben, G.F., 2011. Evaluation of scientific criteria for identifying allergenic food of public health importance. Regulatory Toxicology and Pharmacology 60, 281-289). A multi-disciplinary group was invited to critically test the refined approach. They independently evaluated selected publications on coconut, soy and/or peanut allergy, scored them using the newly developed level of evidence criteria, and debated proposed approaches for combining and utilising the scores to measure the overall impact of an allergen in public health impact assessments. The evaluation of selected publications using the modified criteria produced a relatively consistent result across the experts. These refined criteria were judged to be a way forward for the identification of allergenic foods of public health importance, and for prioritisation of allergen risk management and future data gathering. The debate to combine available evidence when assessing whether an allergenic food is of sufficient public health importance to warrant active management led to proposals on how to weight and combine evidence on allergen severity, potency and prevalence. The refined criteria facilitate a debate to find a meaningful sequence of steps to summarise the available information in relation to a food allergen.

An in vitro approach to the evaluation of repeat exposure in the prediction of toxicity

A strategy for the examination of repeat chronic exposure employed chemicals in the MEIC scheme. Repeat exposure to a non-cytotoxic concentration of certain chemicals leads to changes in sensitivity to a subsequent acute challenge. Six sequential exposures to 3T3-L1 cells, maintained in exponential growth, to ethylene glycol results in an enhanced resistance to cytotoxic damage from a subsequent challenge with 2-propanol. 2-propanol pre-exposure did not alter sensitivity to ethylene glycol. Ethanol or methanol pre-exposure reduces the apparent toxicity to a subsequent challenge with methanol or ethanol. Paracetamol or aspirin pretreatment reduces the toxic effects of paracetamol or aspirin. Hence, repeat exposure can result in a modulation of the cellular responses noted in vitro to cytotoxic concentrations of chemicals. This method demonstrates one approach to examining in vitro the relevance of chronic toxicity in vivo.

Immunoliposomes as targeted delivery vehicles for cancer therapeutics (Review)

Advances in liposome technology over the last decade has seen the development of stealth liposomes for drug delivery and cationic liposomes for gene delivery. Many of these liposome formulations are now in clinical trials for the treatment of a variety of malignancies. Whilst some clinical efficacy has been demonstrated, the goal of specific tumor targeting is yet to be attained. For this reason, antibodies have been attached to the surface of liposomes to produce immunoliposomes. These liposomes have shown preferential binding to specific tumor cells in animal models. The construction of the immunoliposome, and in particular the optimal method of antibody coupling to its surface is, however, yet to be determined. Despite these difficulties, immunoliposomes have demonstrated anti-tumor properties, both in vitro and in vivo, and show great promise as targeted delivery vehicles for the treatment of cancer.

Carbon monoxide from neighbouring restaurants: the need for an integrated multi-agency response

BACKGROUND

Carbon monoxide (CO) is a colourless, odourless toxic gas produced during incomplete combustion of carbon-based fuels. Most CO incidents reported to the UK Health Protection Agency (HPA) are due to faulty gas appliances, and legislation exists to ensure gas appliances are properly installed.

METHODS

We present three CO poisoning incidents of unusual origin reported to the HPA. In each, residents living above restaurants were poisoned after workers left charcoal smouldering overnight in specialist or traditional ovens whilst ventilation systems were turned off. This led to production of CO, which travelled through floorboards and built up to dangerous concentrations in the flats.

RESULTS

Working with local authorities, these incidents were investigated and resolved, and work was conducted to prevent further occurrences.

CONCLUSIONS

The novel nature of these CO incidents led to delays in recognition and subsequent remedial action. Although previously undescribed, it is likely that due to the number of residences built above restaurants and the rising popularity of traditional cooking methods, similar incidents may be occurring and could increase in frequency. Multi-agency response and reporting mechanisms could be strengthened. Awareness raising in professional groups and the public on the importance of correct ventilation of such appliances is vital.

Phase II study of single-agent bosutinib, a Src/Abl tyrosine kinase inhibitor, in patients with locally advanced or metastatic breast cancer pretreated with chemotherapy

BACKGROUND

This phase II study evaluated single-agent bosutinib in pretreated patients with locally advanced or metastatic breast cancer.

PATIENTS AND METHODS

Patients received oral bosutinib 400 mg/day. The primary end point was the progression-free survival (PFS) rate at 16 weeks. Secondary end points included objective response rate, clinical benefit rate, 2-year overall survival rate, safety, and changes in levels of bone resorption/formation biomarkers.

RESULTS

Seventy-three patients were enrolled and treated. Median time from diagnosis of metastatic disease to initiation of bosutinib treatment was 24.5 months. For the intent-to-treat population, the PFS rate at 16 weeks was 39.6%. Unexpectedly, all responding patients (n = 4) were hormone receptor positive. The clinical benefit rate was 27.4%. The 2-year overall survival rate was 26.4%. The main toxic effects were diarrhea (66%), nausea (55%), and vomiting (47%). Grade 3-4 laboratory aminotransferase elevations occurred in 14 (19%) patients. Myelosuppression was minimal. No consistent changes in the levels of bone resorption/formation biomarkers were seen.

CONCLUSIONS

Bosutinib showed promising efficacy in prolonging time to progression in chemotherapy-pretreated patients with locally advanced or metastatic breast cancer. Bosutinib was generally well tolerated, with a safety profile different from that of the Src/Abl tyrosine kinase inhibitor dasatinib in a similar patient population.

Can we define a tolerable level of risk in food allergy? Report from a EuroPrevall/UK Food Standards Agency workshop

BACKGROUND

There is an emerging consensus that, as with other risks in society, zero risk for food-allergic people is not a realistic or attainable option. Food allergy challenge data and new risk assessment methods offer the opportunity to develop quantitative limits for unintended allergenic ingredients which can be used in risk-based approaches. However, a prerequisite to their application is defining a tolerable level of risk. This requires a value judgement and is ultimately a 'societal' decision that has to involve all relevant stakeholders.

OBJECTIVE

The aim of the workshop was to bring together key representatives from the stakeholders (regulators, food industry, clinical researchers and patients), and for the first time ever discuss the definition of a tolerable level of risk with regard to allergic reactions to food.

RESULTS

The discussions revealed a consensus that zero risk was not a realistic option and that it is essential to address the current lack of agreed action levels for cross-contamination with allergens if food allergen management practice is to be improved. The discussions also indicated that it was difficult to define and quantify a tolerable level of risk, although both the clinical and the industry groups tried to do so. A consensus emerged that doing nothing was not a viable option, and there was a strong desire to take action to improve the current situation.

CONCLUSIONS AND CLINICAL RELEVANCE

Two concrete actions were suggested: (1) Action levels should be derived from the data currently available. Different scenarios should be examined and further developed in an iterative process. On the basis of this work, a tolerable level of risk should be proposed. (2) 'One-dose' clinical trial with a low challenge dose should be performed in multiple centres to provide additional information about the general applicability of dose-distribution models and help validate the threshold levels derived.

Reprinted article "Factors associated with early failure of arteriovenous fistulae for haemodialysis access"

The radiocephalic arteriovenous fistula remains the method of choice for haemodialysis access. In order to assess their suitability for fistula formation, the radial arteries and cephalic veins were examined preoperatively by ultrasound colour flow scanner in conjunction with a pulse-generated run-off system. Intraoperative blood flow was measured after construction of the fistulae. Post-operative follow-up was performed at various intervals to monitor the development of the fistulae. Radial artery and cephalic vein diameter less than 1.6 mm was associated with early fistula failure. The intraoperative fistula blood flow did not correlate with the outcome of the operation probably due to vessel spasm from manipulation. However, blood flow velocities measured non-invasively 1 day after the operation were significantly lower in fistulae that failed early compared with those that were adequate for haemodialysis. Most of the increase in fistula diameter and blood flow occur within the first 2 weeks of surgery.

Effect of tamoxifen or anastrozole on steroid sulfatase activity and serum androgen concentrations in postmenopausal women with breast cancer

BACKGROUND

In postmenopausal women estrogens can be formed by the aromatase pathway, which gives rise to estrone, and the steroid sulfatase (STS) route which can result in the formation of estrogens and androstenediol, a steroid with potent estrogenic properties. Aromatase inhibitors, such as anastrozole, are now in clinical use whereas STS inhibitors, such as STX64, are still undergoing clinical evaluation. STX64 was recently shown to block STS activity and reduce serum androstenediol concentrations in postmenopausal women with breast cancer. In contrast, little is known about the effects of aromatase inhibitors or anti-estrogens on STS activity or serum androgen levels.

PATIENTS AND METHODS

Study 1: Blood was collected from ten postmenopausal women with breast cancer before and after two-week treatment with anastrozole and serum concentrations of androstenediol and other androgens and estrogens were assessed. Study 2: Blood samples were collected from 15 breast cancer patients before and after four-week treatment with anastrozole and 10 patients before and after four-week treatment with tamoxifen. Blood was used to assess STS activity in peripheral blood lymphocytes (PBLs) and serum dehydroepiandrosterone sulfate and dehydroepiandrosterone levels.

RESULTS

Neither anastrozole nor tamoxifen had any significant effect on STS activity as measured in PBLs. Anastrozole did not affect serum androstenediol concentrations.

CONCLUSION

Anastrozole and tamoxifen did not inhibit STS activity and serum androstenediol concentrations were not reduced by aromatase inhibition. As androstenediol has estrogenic properties, it is possible that the combination of an aromatase inhibitor and STS inhibitor may give a therapeutic advantage over the use of either agent alone.

Higher-order Laguerre-Gauss mode generation and interferometry for gravitational wave detectors

We report on the first experimental demonstration of higher-order Laguerre-Gauss (LG(p)(ℓ)) mode generation and interferometry using a method scalable to the requirements of gravitational wave (GW) detection. GW detectors which use higher-order LG(p)(ℓ) modes will be less susceptible to mirror thermal noise, which is expected to limit the sensitivity of all currently planned terrestrial detectors. We used a diffractive optic and a mode-cleaner cavity to convert a fundamental LG(0)(0) Gaussian beam into an LG(3)(3) mode with a purity of 98%. The ratio between the power of the LG(0)(0) mode of our laser and the power of the LG(3)(3) transmitted by the cavity was 36%. By measuring the transmission of our setup using the LG(0)(0), we inferred that the conversion efficiency specific to the LG(3)(3) mode was 49%. We illuminated a Michelson interferometer with the LG(3)(3) beam and achieved a visibility of 97%.