Predicting dosing advantages of factor VIIa variants with altered tissue factor-dependent and lipid-dependent activities

BACKGROUND

Recombinant factor VIIa (rFVIIa) is an FX-cleaving coagulation enzyme licensed for the treatment of bleeding episodes in hemophiliacs with inhibitory antibodies. Even though the optimal dosing and comparative dose efficacy of rFVIIa remain poorly understood, genetic or chemical modifications of rFVIIa have been proposed, with the goal of achieving faster and longer hemostatic action. No ongoing trial is currently comparing rFVIIa variants with each other.

OBJECTIVES AND METHODS

We used mathematical modeling to compare the pharmacokinetics, dose-response (pharmacodynamics) and dose-effect duration (pharmacokinetics/pharmacodynamics) of rFVIIa variants to predict their optimal doses. The pharmacodynamic (PD) model of FXa generation by FVIIa in complexes with tissue factor (TF) and procoagulant lipids (PLs) was validated against published ex vivo and in vitro thrombin generation (TG) experiments. To compare variants' safety profiles, the highest non-thrombogenic doses were estimated from the clinical evidence reported for the licensed rFVIIa product.

RESULTS

The PD model correctly described the biphasic TF-dependent and PL-dependent dose response observed in TG experiments in vitro. The pharmacokinetic/PD simulations agreed with published ex vivo TG data for rFVIIa and the BAY 86-6150 variant, and explained the similar efficacies of a single dose of 270 μg kg(-1) (as reported in the literature) and repeated doses of 90 μg kg(-1) of unmodified rFVIIa. The duration of the simulated hemostatic effect after a single optimal dose was prolonged for rFVIIa variants with increased TF affinity or extended half-lives, but not for those with modulated PL activity.

CONCLUSIONS

Some modifications of the rFVIIa molecule may not translate into a prolonged hemostatic effect.

Improving the anticancer activity of curcumin using nanocurcumin dispersion in water

Curcumin is a highly potent, nontoxic bioactive agent found in turmeric and is known to have significant anticancer properties against different types of cancer cells. The major disadvantage associated with the use of curcumin, however, is its low systemic bioavailability due to its poor aqueous solubility. The focus of the present study was to generate nanoparticles of curcumin with improved aqueous phase solubility, and to investigate their efficacy in treating cancer cells. Curcumin nanoparticles having particle size in the range 2-40 nm and aqueous solubility of up to a maximum of 3 mg/mL were prepared. Evaluation of anticancer properties of curcumin nanodispersion was carried out in 3 different cancer cell lines: lung (A549), liver (HepG2), and skin (A431). The results demonstrated that under aqueous conditions curcumin nanoparticles exhibited similar or a much stronger antiproliferative effect on the cancer cells compared to normal curcumin in DMSO. Our results lead way toward unharnessed potential of curcumin in the form of its nanoparticles as an adjuvant therapy for clinical application in treating various cancers.

All-trans-retinoic acid-induced pseudotumor cerebri in acute promyelocytic leukemia

All-trans-retinoic acid is an integral part in the treatment strategy of acute promyelocytic leukemia (APL). Here we describe a case of pseudotumor cerebri associated with all-trans-retinoic acid (ATRA) during the induction therapy in an adult with acute promyelocytic leukemia (APL).

All-trans-retinoic acid–induced pseudotumor cerebri in acute promyelocytic leukemia

All-trans-retinoic acid is an integral part in the treatment strategy of acute promyelocytic leukemia (APL). Here we describe a case of pseudotumor cerebri associated with all-trans-retinoic acid (ATRA) during the induction therapy in an adult with acute promyelocytic leukemia (APL).

Ascariasis in the Gall Bladder - A Rare Case

Settlement of adult form ascariasis parasite in the gall bladder is rare constituting 2.1 % of hepatobiliary ascariasis4. Radiologic imaging methods play an important role in the diagnosis of the parasite in the biliary tree. Computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic retrograde cholangiopancreatography (ERCP) are used in the diagnosis of hepatobiliary ascariasis. However, ultrasonography is still the first method and most preferred due to its ease of applicability and the fact that it is inexpensive and non-invasive. We report a rare case of Ascariasis lumbricoides present in gall bladder. DOI: http://dx.doi.org/10.3329/bjms.v13i3.17740 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.343-344

Superior vena cava obstruction (SVCO) in patients with advanced non small cell lung cancer (NSCLC)

INTRODUCTION

To report on prognostic and treatment factors influencing the response of SVCO and related survival outcomes in advanced non small cell lung cancer.

MATERIAL AND METHODS

From November 2008 through December 2011, 18 consecutively diagnosed NSCLC patients with SVCO were included in this study. The patient, tumor and treatment related factors were analyzed. Median overall survival (OS), Kaplan -Meier survival plots, T-test, Cox Proportional Hazards models were generated by multiple covariates (MVA) and analyzed on SPSS software (version 19.0; SPSS, Inc., Chicago, IL).

RESULTS

Thirteen patients (72%) had presented with SVCO before the pathological diagnosis of underlying lung malignancy, while 5 (28%) progressed to SVCO after initiating treatment with chemotherapy. Twelve (68%) patients achieved subjective relief from the obstruction at the completion of palliative radiation therapy. Treating oncologists preferred 4 Gy per fraction in 11 (62%), while the median biologically equivalent dose delivered was 28 Gy. Six (33%) patients received chemotherapy during the course of treatment. Median OS of the entire cohort was 3±1.85mths and 1-year survival rate of 7%. Univariate analysis confirmed that SVCO patients with good performance score (p=0.02), and partial response to chemotherapy (p= 0.001) have superior OS. However, Cox regression modeling for MVA demonstrated only good performance SVCO patients (p = 0.05) have a better OS.

CONCLUSION

RT effectively relieves SVCO but overall poor survival associated in our clinical scenario needs to be improved with multimodality approach. Adjuvant chemotherapy is to be considered after initial radiation therapy in good performance patients.

KEYWORDS

superior vena cava obstruction (SVCO), radiation therapy, chemotherapy, non small cell lung cancer (NSCLC), BED (biologically equivalent dose).

Hair: an unusual foreign body in airways presenting with haemoptysis in an adult patient

Haemoptysis is defined as expectoration of blood originating from the lungs or tracheo-bronchial tree. It is attributed to various causes like tuberculosis, bronchiectasis, lung cancer, mycetoma, foreign bodies etc. Various types of foreign bodies have been reported in the literature. We report the case of an adult female patient who presented with an episode of haemoptysis (150 mL) in whom flexible fibreoptic bronchoscopy revealed a single long hair at the carina going to left main bronchus. Following successful removal of this hair there were no further episodes of haemoptysis and the patient manifested clinical and radiological improvement.

Application of small-angle neutron scattering to the study of forces between magnetically chained monodisperse ferrofluid emulsion droplets

The optical magnetic chaining technique (MCT) developed by Leal-Calderon, Stora, Mondain-Monval, Poulin & Bibette [Phys. Rev. Lett.(1994),72, 2959–2962] allows precise measurements of force profiles between droplets in monodisperse ferrofluid emulsions. However, the method lacks anin situdetermination of droplet size and, therefore, requires a combination of separately acquired measurements of droplet chain periodicityversusan applied magnetic field from optical Bragg scattering and droplet diameter inferred from dynamic light scattering (DLS) to recover surface force–distance profiles between the colloidal particles. Compound refractive lens (CRL) focused small-angle neutron scattering (SANS) MCT should result in more consistent measurements of droplet size (form factor measurements in the absence of field) and droplet chaining period (from structure factor peaks when the magnetic field is applied), and, with access to shorter length scales, extend force measurements to closer approaches than possible by optical measurements. This article reports on CRL-SANS measurements of monodisperse ferrofluid emulsion droplets aligned in straight chains by an applied field perpendicular to the incident beam direction. Analysis of the scattering from the closely spaced droplets required algorithms that carefully treated resolution and its effect on mean scattering vector magnitudes in order to determine droplet size and chain periods to sufficient accuracy. At lower applied fields, scattering patterns indicate structural correlations transverse to the magnetic field direction owing to the formation of intermediate structures in early chain growth.

Prevalence of hand disorders in type 2 diabetes mellitus and its correlation with microvascular complications

Background:

Physicians have long recognized the association between diabetes mellitus and several pathologic conditions of the hand. The most commonly recognized maladies are limited joint mobility (LJM), Dupuytren's disease (DD), trigger finger (TF), and carpal tunnel syndrome (CTS). Incidence of these hand disorders has increased in the setting of diabetes. Collectively, these are described as diabetic hand syndrome.

Aim:

The aims were to find out the prevalence of hand disorders in diabetic patients, and to study the relation of these hand disorders with microvascular complications.

Subjects and Methods:

This is an observational cross-sectional case-control study done over a period of 1 year Patients of type 2 DM, of age < 65 years, who visited Gandhi Memorial Hospital, Lucknow were enrolled and were described as cases. Age- and sex-matched nondiabetic individuals were taken in the control group. The data were analyzed using software SPSS. SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc. Means and standard deviations were computed; the Student t-test and Chi-square (χ²) test were used as appropriate.

Results:

A total of 400 subjects were studied, 200 each in the case and control groups. Of total 200 diabetic patients, 30% (60/200) patients had neuropathy, 37.5% (75/200) had nephropathy, and 44.5% (89/200) patients had retinopathy. In the study population, 67% patients were having one or more hand disorders, in which LJM was found in 40.5% (81/200) patients, DD was found in 19% (38/200) patients, TF in 16.5% (33/200), and CTS in 14% (28/200) patients.

Conclusions:

This study shows a high prevalence of hand disorders in diabetic patients and also correlates with the duration of type 2 DM, LJM being the most common hand disorder and more common in patients who have microvascular complications.

PANNOTATOR: an automated tool for annotation of pan-genomes

Due to next-generation sequence technologies, sequencing of bacterial genomes is no longer one of the main bottlenecks in bacterial research and the number of new genomes deposited in public databases continues to increase at an accelerating rate. Among these new genomes, several belong to the same species and were generated for pan-genomic studies. A pan-genomic study allows investigation of strain phenotypic differences based on genotypic differences. Along with a need for good assembly quality, it is also fundamental to guarantee good functional genome annotation of the different strains. In order to ensure quality and standards for functional genome annotation among different strains, we developed and made available PANNOTATOR (http://bnet.egr.vcu.edu/iioab/agenote.php), a web-based automated pipeline for the annotation of closely related and well-suited genomes for pan-genome studies, aiming at reducing the manual work to generate reports and corrections of various genome strains. PANNOTATOR achieved 98 and 76% of correctness for gene name and function, respectively, as result of an annotation transfer, with a similarity cut-off of 70%, compared with a gold standard annotation for the same species. These results surpassed the RAST and BASys softwares by 41 and 21% and 66 and 17% for gene name and function annotation, respectively, when there were reliable genome annotations of closely related species. PANNOTATOR provides fast and reliable pan-genome annotation; thereby allowing us to maintain the research focus on the main genotype differences between strains.